Patients In ICU Setting Research Articles

Reliability and validity of the Chinese version of the functional status score for the ICU (FSS-ICU) after translation and cross-cultural adaptation

Purpose The Functional Status Score for the Intensive Care Unit (FSS-ICU) is designed to assess the physical functional status of patients in ICU settings. This study aimed to translate and culturally adapt the FSS-ICU for the Chinese context and to evaluate its reliability and validity. Methods Following Beaton’s translation model, the original FSS-ICU was subjected to forward translation, back-translation, and synthesis. After cultural adaptation and preliminary testing, the Chinese version of the FSS-ICU was established, and then two rehabilitation therapists assessed the functional status of 51 ICU patients using this scale, evaluating its reliability and validity. Results The Chinese version of the FSS-ICU exhibits excellent internal consistency with a Cronbach’s alpha coefficient of 0.934. The inter-rater and intra-rater correlation coefficients are 0.995 and 0.997, respectively. Both item-level and scale-level content validity indices are 1.00. The FSS-ICU demonstrates good convergent validity with other physical function assessment tools (Medical Research Council Sum-Score, grip strength, the Intensive Care Unit Mobility Scale), with |rs| values all above 0.5, and satisfactory discriminant validity with non-physical function assessment indicators (body mass index, blood glucose), with |rs| values all below 0.2. Additionally, it demonstrated no ceiling or floor effects. Conclusion The Chinese FSS-ICU, demonstrating strong reliability and validity, can serve as an effective assessment tool for physical function in ICU patients.

Effect of Ivabradine in Controlling Heart Rate in Patients with Sepsis and Septic Shock: Randomized Control Trails

Background: Ivabradine is a selective inhibitor of (If) channels in the sinoatrial node and a pure bradycardic agent with no deleterious effect on other aspects of cardiac function nor on blood pressure. This study was conducted to evaluate the effect of Ivabradine on controlling tachycardia in sepsis patients as compared to placebo. Methods: A total of 100 patients admitted to the Medical Intensive Care Unit (MICU) were recruited in this randomized controlled trial. A total of 50 patients were randomly allocated to either Group A (the Ivabradine group) or Group B (the control group). Heart rate (HR) was recorded for all patients at baseline, 12, 24, 48, 72, 96, and 120 hours. Mean arterial pressure (MAP), ejection fraction (EF), and change in Norepinephrine (NE) dosage were recorded at baseline and post-intervention (120 hours). A mortality rate was recorded for both groups. Results: The patients had a mean age of 32.49 + 16.22 years. There were 56 males and 44 females in the study. Epilepsy (n = 12, 12%) and tetanus (n = 11, 11%) were the most common primary diagnosis. Ventilator Associated Pneumonia (n = 60) was found to be the most common infection. Patients in Group A (23.2 + 11.02 beats per minute) had a significantly greater heart rate reduction at 120 hours in mean heart rate as compared to Group B patients (8.92 + 30.46 beats per minute, p = 0.002). The increase in mean MAP for Group A (1.68 + 2.44 mm Hg) was also significantly greater than that for Group B (0.54 + 2.46 mm Hg, p = 0.022). There was no difference in the mean change in NE dosage between Groups A (0.63 + 0.25 units/minute) and B (-0.34 + 0.36 units/minute, p = 0.106). A significantly greater increase in EF was found for Group A (1.16 + 1.5%), in comparison to Group B (0.30 + 1.69 %, p = 0.009). There were 22 (44%) deaths reported in Group A as compared to 24 (48%, p = 0.688) in Group B. Conclusion:Ivabradine has a significantly greater effect on controlling heart rate as compared to placebo in sepsis patients. The use of Ivabradine should be included in clinical guidelines for managing sepsis patients in ICU settings. Doi: 10.28991/SciMedJ-2023-05-01-04 Full Text: PDF

Patient and public involvement in contemporary large intensive care trials: A meta-epidemiological study.

Patient and public involvement in randomised clinical trials has received increased focus, including in intensive care trials, but the frequency, method and extent is unknown. This meta-epidemiological study investigated patient and public involvement in contemporary, large ICU trials. We systematically searched PubMed for large (≥225 randomised patients), contemporary trials (published between 1 January 2019 and 31 January 2022) assessing interventions in adult patients in ICU settings. Abstracts and full-text articles were assessed independently and in duplicate. Data were extracted using a pre-defined, pilot-tested data extraction form with details on trials, patient and public involvement including categories and numbers of individuals involved, methods of involvement, and trial stage(s) with involvement. Trials authors were contacted as necessary. We included 100 trials, with 18 using patient and public involvement; these were larger and conducted in more centres than trials without patient and public involvement. Among trials with patient and public involvement, patients (in 14/18 trials), clinicians (13 trials), and family members (12 trials) were primarily involved, mainly in the development of research design (15 trials) and development of research focus (13 trials) stages and mostly by discussion (12 trials) and solo interviews (10 trials). A median of 65 individuals (range 1-6894) were involved. We found patient and public involvement in a fifth of large, contemporary ICU trials. Primarily patients, families, and clinicians were included, particularly in the trial planning stages and mostly through interviews and discussions. Increased patient and public involvement in ICU trials is warranted.

510 5-Year Retrospective Analysis of a Vented Early Mobility Algorithm in the Burn ICU

IntroductionThe practice of early mobilization on mechanically ventilated patients in ICU settings has received significant attention within recent literature, however limited research to date has focused specifically on the burn population. The purpose of this single center retrospective analysis was to review the use of a burn critical care mobility algorithm, to determine the safety and feasibility of early mobility programs in the burn population, expose limitations preventing mobility progression at our facility, and discuss unique challenges to early mobility with burn patients.MethodsA retrospective review was completed for all intubated burn center admissions between January 2015 to December 2019. Burn Therapy notes were then reviewed for all intubated patients from initial evaluation until each patient was either extubated or underwent a tracheostomy. Data was collected using the stages of the mobility algorithm.ResultsIn the 5 years following initial implementation, the vented mobility algorithm was utilized on 127 patients with an average TBSA of 22.8%. Of these patients, 25 were transitioned to comfort care measures due to the extent of their burn injuries but were included in the review. The average intubated days were 8.05 days and the average length of stay was 26 days. No adverse events occurred during treatment with the algorithm. Stage 1: PROM/AROM was completed with 100% of patients (n=127). Chair mode of bed, stage 2a, was utilized in 39.4%(n=50) of patients, while 15.8% (n=20) of patients were dependently transferred to the cardiac chair in stage 2b. Stage 3 (sitting on the edge-of-bed) was completed with 25% (n=32) of patients, with only 11% (n=14) progressing to stage 5 (standing), and 3.9% (n=5) actively transferring to a chair. In 5 years, only 4.7% (n=6) reached stage 6 (ambulation). The most common treatment limitations were medical complications (33%) including: unstable medical status, agitation, sedation, cultured epithelial autograft placement, and orthopedic restrictions. Line placement, including femoral and pedal catheters , was also found to be a barrier to the use of our algorithm in 21% of held patient treatments.ConclusionsRetrospective analysis demonstrates that early mobilization during mechanical ventilation is safe and feasible with in the burn population despite challenges including airway stability, sedation, and line limitations. Dedicated burn therapy staff and team coordination is required to optimize management during the critical care stage of recovery and improve outcomes for survivors.

Safety of Percutaneous vs Open Tracheostomy on Intubated Patients in ICU Setting: Which One is Better?

To study the safety of percutaneous vs open tracheostomy approaches on patients requiring long term ventilation in ICU setting. It is a prospective study done over a period of 2years on 105 patients requiring long term ventilation in ICU set up in a tertiary care hospital. Patients were subjected to either open approach or percutaneous tracheostomy bedside in ICU itself. Then patients were followed during their hospital stay to look for any tracheostomy related complications. Data regarding age, gender, indications of long term ventilation and complications were compiled and analysis was done. It was found that most of the patients were of male gender (88.6%) in the age group of 50-59years of age. The most common cause for tracheostomy was head injury secondary to road traffic accident, seen in 79 out of 105 cases. On comparing complications rate, there was no statistically significant difference in both the groups. However rate of peristomal infection is more with open approach group (P < 0.05). Percutaneous tracheostomy can be performed safely in ICU as a bedside procedure. There is significant reduction in peristomal infection with percutaneous tracheostomy and there is no significant difference in other complications between the two groups. Thus percutaneous tracheostomy is as safe as an open approach tracheostomy in properly selected cases.

Comparative efficacies of nebulized budesonide and systemic corticosteroids in the treatment of exacerbations of chronic obstructive pulmonary disease: A systematic review and meta-analysis.

Corticosteroids are recommended by almost all international guidelines for the management of exacerbations of chronic obstructive pulmonary disease (COPD). Nevertheless, due to their side effects, there are still concerns regarding the use of systemic corticosteroids (SCs). The Global Initiative for Chronic Obstructive Lung Disease guideline states nebulized budesonide (NB) may be a suitable alternative to SCs for treating COPD exacerbations. We conducted this study to systematically compare the efficacies of NB and SCs by using a meta-analysis. PubMed, EMBASE and Cochrane Library databases were searched from database inception to 10 October 2019. Our main end points were change in pulmonary function and blood gas analysis. Secondary end points were numbers of exacerbations and hyperglycaemia. Of 645 identified studies, 6 were eligible and were included in our analysis (N=867 participants). Compared with SCs, NB was non-inferior on the change in FEV1 %predicted at 24hours, 48-72hours and 5-7days; FEV1 at 5-7days; FEV1 /FVC at 7days. For blood gas analysis, our meta-analysis indicated that PaO2 , PaCO2 at 24hours, 48-72hours and 7-10days and SaO2 at 24hours and 7-10days showed a non-significant difference in both groups, whereas the SaO2 was significant higher in NB group at 48-72hours after treatment. Hyperglycaemia was less frequent with NB (odds ratio, 0.1; 95% CI, 0.01-0.85; P=.04). Based on our meta-analysis, NB was not inferior to SCs when used in the treatment of COPD exacerbations. However, additional well-designed prospective studies are needed to identify the optimal dose of nebulized budesonide and the effects of nebulized budesonide in outpatients, or patients in ICU settings.

Relation between central venous pressure values and outcome in critically ill patients

Background Central venous pressure (CVP) was the most commonly used parameter to guide fluid responsiveness. However, recent studies showed that there is no correlation between CVP and circulating blood volume, and CVP more than 8 mmHg is independently associated with a higher mortality and increased risk of acute kidney injury in patients with sepsis and heart failure. Objective The aim of this study was to assess the effect of CVP over 7 days after ICU admission on clinical prognosis and mortality. Patients and methods The study was conducted on 218 patients in whom hemodynamic monitoring was required, and CVP was measured from the first day of ICU admission. Three values of CVP were selected to be measured (the values once inserted, the peak values, and the mean values of CVP) throughout the monitoring process over 7 days of ICU admission. Acute Physiology and Chronic Health Evaluation II score was calculated on admission, and Sequential Organ Failure Assessment (SOFA) score was calculated every other day. Length of ICU stay, mechanical ventilation days, and mortality at days 7 and 28 were recorded. Results Although the initial CVP values were only correlated with mean of SOFA scores, mean and peak CVP values were correlated with Acute Physiology and Chronic Health Evaluation II score, mean SOFA score, mechanical ventilation days, and mortality. Only peak CVP showed correlation with mean creatinine, and only mean CVP values were correlated with length of ICU stay. According to mean CVP values, patients were classified as low CVP ( 12 mmHg). The elevated mean CVP group was associated with increased 28-day mortality, and regarding further investigations such as renal function, duration of mechanical ventilation, and laboratory results related to organ dysfunction, it also demonstrated that higher mean CVP group was associated with poor ICU outcome for patients in ICU settings. Conclusion The study showed that for patients in ICU settings, elevated mean CVP load was associated with poor clinical outcome and prolonged treatment in ICU. Level and duration of elevated mean CVP should be evaluated, and more effort should be made to establish the cause and appropriate treatment for elevated mean CVP.

Study of tracheal cuff pressure variation in adult tracheostomized patients in the intensive care unit

Background: Tracheostomy tube cuff pressure requires to be maintained within the acceptable range in ICU patients to prevent complications like tracheal stenosis, aspiration pneumonia etc. However tracheal cuff pressure monitoring is still not being strictly followed in many medical centres. Aim: To evaluate variation in Tracheal Cuff pressure over 24 hours once inflated to recommended pressure in adult tracheotomised patients. Setting and Design: Prospective observational study. Methods and Material: This study was carried out on 82 tracheostomised adult patients in ICU of a tertiary care hospital. Tracheal cuff pressure was monitored by Manometer every six hourly over 24 hours for 4 days. Statistical Analysis Used: Student's t- test. Result: Tracheal cuff pressure showed significant variation in tracheal cuff pressure within 24 hours period of daily monitoring with all cases showing fall in cuff pressure below the acceptable range. Conclusion: Regular Manometric monitoring of tracheal cuff pressure is recommended in Tracheotomised patients in ICU setting to avoid associated complications.

Choosing Wisely in Critical Care: Results of a National Survey From the Critical Care Societies Collaborative.

Over-utilization of tests, treatments, and procedures is common for hospitalized patients in ICU settings. American Board of Internal Medicine Foundation's Choosing Wisely campaign tasked professional societies to identify sources of overuse in specialty care practice. The purpose of this study was to assess how critical care clinicians were implementing the Critical Care Societies Collaborative Choosing Wisely recommendations in clinical practice. Descriptive survey methodology with use of Research Electronic Data Capture (https://projectredcap.org/) sent via email newsletter blast or to individual emails of the 150,000 total members of the organizations. National survey. ICU physicians, nurses, advanced practice providers including nurse practitioners and physician assistants, and pharmacist members of four national critical care societies in the United States. None. A six-question survey assessed what Choosing Wisely recommendations had been implemented in ICU settings and if the impact was assessed. A total of 2,520 responses were received from clinicians: nurses (61%; n = 1538), physicians (25.9%; n = 647), advanced practice providers (10.5%; n = 263), and pharmacists (2.1%; n = 52), reflecting a 1.6% response rate of the total membership of 150,000 clinicians. Overall, 1,273 respondents (50.6%) reported they were familiar with the Choosing Wisely campaign. Respondents reported that Choosing Wisely recommendations had been integrated in a number of ways including being implemented in clinical care (n = 817; 72.9%), through development of a specific clinical protocol or institutional guideline (n = 736; 65.7%), through development of electronic medical record orders (n = 626; 55.8%), or with integration of longitudinal tracking using an electronic dashboard (n = 213; 19.0%). Some respondents identified that a specific quality improvement initiative was developed related to the Choosing Wisely recommendations (n = 468; 41.7%), or that a research initiative had been conducted (n = 156; 13.9%). The results provide information on the application of the Choosing Wisely recommendations to clinical practice from a small sample of critical care clinicians. However, as only half of the respondents report implementation, additional strategies are needed to promote the Choosing Wisely recommendations to make impactful change to improve care in ICU settings.

Tako-tsubo cardiomyopathy in critically ill patients in ICU setting

Tako-tsubo cardiomyopathy in critically ill patients in ICU setting

Secondary Analysis on Ventilator-Associated Pneumonia and Pressure Injury

Ventilator-associated pneumonia (VAP) is a lung infection that develops in patients receiving mechanical ventilation. VAP contributes to about 50% of hospital-acquired pneumonia in ICU settings. One of the recommendation of the Institute of for Healthcare Improvement ventilator bundle is HOB elevation. HOB elevation affects shearing forces and makes higher risk for pressure injury development. Pressure injury (PI) is localized damage to the skin over a bony prominence. PI prevention guidelines recommend that HOB positioning should be lower to reduce risk for PI development which contradicts VAP prevention guidelines for the HOB between 30 and 45 degrees for ICU patients. This presents a care dilemma and tension. The purpose of this study was to perform a secondary data analysis using cumulative electronic health record data in order to determine the association of HOB elevation with VAP and PI in ICU patients. A secondary data analysis was conducted to determine whether HOB elevation is associated with VAP and PI. HOB elevation was not likely to be associated with VAP prevention whereas it was likely to be related to PI development. This is somewhat contrary to popular data and publications. Prospective cohort study is desired to inform us in an evidence-based fashion what actually is optimal HOB elevation for ventilated patients in ICU settings.

Identification of the risk factors and microbes responsible for inducing central line blood stream infection at a ministry of health hospital in Egypt

Aim of the study: To identify the risk factors and microbes responsible for inducing central line blood stream infection and study the antibiotic sensitivity patterns of the isolated organisms in critically ill patients in ICU setting. Design setting and participants: A descriptive exploratory design was used utilizing non probability convenient sample consisting of 120 adult patients who underwent insertion of central venous catheter in the Intensive Care Units at one of a Ministry of Health Hospital in Egypt between September 2016 and September 2017. Methods: Patients' demographic data, clinical characteristics, blood culture, antibiotic sensitivity test and catheterrelated data were utilized in data collection from patients, records and microbiology laboratory. Results: Out of 120 central line catheters sent for culture from patients during and seven days after insertion revealed no growth during insertion and 10.83% were colonized after insertion. Of the 13 catheter infections cases, it revealed that 10(76.9%) were Staphylococcus epidermis and 3 (23.07%) were Staphylococcus aureus. In addition, most infected patients were overweight and obese, diabetic, had sub-clavian route, and their length of hospital stayed more than 7 day. Conclusions and recommendations: Conclusions and recommendations: Central line venous catheter related factors are the contributing factors for inducing infection of cases with Staphylococcus epidermis in the present study. Moreover, replication of the study and further researches are recommended on a larger probability sample to validate findings.

Effect of transcutaneous electroacupuncture at Neiguan (PC 6) on refractory vomiting in patients in intensive care unit

ObjectiveTo observe the effect of transcutaneous electroacupuncture (TEA) at Neiguan (PC 6) on refractory vomiting in critically ill patients in intensive care (ICU) setting. MethodsTen patients admitted in ICU and presenting vomiting refractory to one or more antiemetic drugs were prospectively included in the study. TEA was applied at acupoint of Neiguan (PC 6) during 30 min with a neuromuscular transmission monitor (single-twitch stimulation with 1 Hz at a constant current of 10 mA). Nausea and Vomiting were evaluated at the following intervals: immediately after 30 min of TEA at Neiguan (PC 6), 30 min-6h and 6–24 h. The presence of nausea and/or vomiting throughout the observational period was defined as the primary end point. ResultsThe presence of nausea or vomiting throughout the observational period was 10% at the end of TEA, 40% between 30 min and 6 h, and 50% between 30 min and 24 h (P < 0.001, P = 0.01 and P = 0.03 vs pre-TEA, respectively). There were no complications or side effects related to TEA. ConclusionTEA at Neiguan (PC 6) seems effective in reducing refractory vomiting in the patients in ICU setting, even if larger trials are needed to define optimal modalities.

Frequency of TGF- β and IFN- γ genotype as risk factors for acute kidney injury and death in intensive care unit patients.

Genetic variations in TGF-β and IFN-γ may interfere with proinflammatory cytokine production and, consequently, may be involved with inflammatory diseases, as acute kidney injury (AKI). We considered that genetic polymorphisms of these cytokines may have a crucial role in the outcome of critically ill patients. To investigate whether the genetic polymorphisms of rs1800470 (codon 10 T/C), rs1800471 (codon 25 C/G) from the TGF-β, and rs2430561 (+874 T/A) from IFN-γ may be a risk factor for ICU patients to the development of AKI and/or death. In a prospective nested case-control study, were included 139 ICU patients who developed AKI, 164 ICU patients without AKI, and 244 healthy individuals. We observed a higher frequency to T/A genotype for IFN-γ (intermediate producer phenotype) and higher frequency of TT GG and TC GG genotype (high producer) for TGF-β polymorphism in overall population. However, these polymorphisms have not been shown as a predictor of risk for AKI and death. We found an increased prevalence of high and intermediate producer phenotypes from TGF-β and IFN-γ, respectively, in patients in ICU setting. However, the studied genetic polymorphism of the TGF-β and IFN-γ was not associated as a risk factor for AKI or death in our population.

A computer system for continuous long-term recording, processing, and analysis of physiological data of brain injured patients in ICU settings

The objective of this project was to assemble and test a computer-based system for continuous long-term physiological data acquisition. The system would be used to study short-term (heart rate variability) and long-term (circadian rhythms) dynamics of physiological parameters in severely brain injured patients in ICU settings. A system has been built using open-source software and the Linux operating system as the platform. The system consists of three main parts: data acquisition, processing and analysis. The system was tested in ICU and experimental settings for long periods of time (up to 10 days of non-stop recording). The system appeared to function properly and accurately. Samples of the data according to the stages of acquisition-analysis process are presented in the paper. Avenues for the system use and development are discussed.