Polyvalent Intensive Care Unit Research Articles

Towards an Individualized Care Pathway for the Elderly Intensive Care Patients: Retrospective Analysis of Factors Associated with Mortality in 684 Cases

As the population ages, the number of elderly patients admitted to the ICU continues to rise. The physiological changes associated with ageing represent a challenge for the management of this often-fragile population at high cognitive risk. An epidemiologic and evolution profile in our Moroccan context is necessary to improve survival and its quality in post-intensive care in our elders. This is a retrospective analytic study including all patients over 65 years of age admitted to the A4 polyvalent intensive care unit of the Hassan II University Hospital in Fez, from January 2017 to December 2021, excluding patients initially admitted for COVID-19 infection. The epidemiology, stay, management and outcome data were collected and analyzed.

Characterization of Pulmonary Bacteriobiota in Critically Ill Patients in Southern Peru through Next-Generation Sequencing Technology.

Sequence variation in the 16S gene is widely used to characterize diverse microbial communities. This was the first pilot study carried out in our region where the pulmonary microbiota of critically ill patients was investigated and analyzed, with the aim of finding a specific profile for these patients that can be used as a diagnostic marker. An study of critical patients mechanically ventilated for non-respiratory indications, in a polyvalent intensive care unit, was carried out; samplee were extracted by endotracheal aspiration and subsequently the microbiota was characterized through Next-Generation Sequencing Technology (NGS). The predominant phyla among the critically ill patients were Proteobacteria, Firmicutes and Bacteroidata. In the surviving patients group, the predominant phyla were Proteobacteria, Bacteroidata and Firmicutes, in the group of deceased patients thy were Firmicutes, Proteobacteria, and Bacteroidata. We found a decrease in commensal bacteria in deceased patients and a progressive increase in in-hospital germs.

Dependency-related skin lesions in the prone critical patient. Incidence study

ObjectiveTo determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors. MethodFollow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL: (pressure ulcers [PU], moisture-associated skin damage [MASD] and friction injuries [FI]), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: chi-square test, t-test or Mann–Whitney U test. Multivariate analysis: logistic regression. ResultsForty nine patients were included and 170PP were performed.Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95%CI: 31.6–58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III).The median age of the lesion group (LG) was 66.5 [61.8−71.3] vs. 64 [43−71] years old in the non-lesion group (NLG), p=0.04. Eighty percent of the LG had PVD vs. 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 [56.1−149.4] vs. 38.2 [18.8−57] of the NIG, p<0.001. Multivariate analysis selected total PP hours (OR=1.03; 95%CI:1.01–1.05) and PVD (OR=8.9; 95%CI:1.3–58.9) as predisposing factors for developing DRSL. ConclusionsThere is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity.The accumulated hours in probe position and peripheral vascular disease favor their development.

Lesiones cutáneas relacionadas con la dependencia en el paciente crítico pronado. Estudio de incidencia

ObjectiveTo determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors. MethodFollow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL:(pressure ulcers (PU), moisture-associated skin damage (MASD) and friction injuries (FI)), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: Chi-square test, t-test or Mann-Whitney U test. Multivariate analysis: logistic regression. ResultsForty nine patients were included and 170 PP were performed. Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95% CI: 31.6-58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III). The median age of the lesion group (LG) was 66.5 (61.8-71.3) vs 64 (43-71) years old in the non-lesion group (NLG), P=.04. Eighty percent of the LG had PVD vs 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 (56.1-149.4) vs 38.2 (18.8-57) of the NIG, P<.001. Multivariate analysis selected total PP hours (OR: 1.03; 95% CI: 1.01-1.05) and PVD (OR: 8.9; 95% CI: 1.3-58.9) as predisposing factors for developing DRSL. ConclusionsThere is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity. The accumulated hours in probe position and peripheral vascular disease favor their development.

Uso de la realidad virtual inmersiva como método de relajación en el entorno de una unidad de cuidados intensivos

IntroductionThe usage of immersive virtual reality (iVR) in the context of an intensive care unit (ICU) is scarce. Our objective was to assess the feasibility of the usage of iVR in critical patients with or without mechanical ventilation (MV) and to determine the anxiety degree before and after each session. MethodsAnalytical, descriptive, prospective, and cross-sectional research. Pilot test with 20 patients from a polyvalent ICU of a tertiary hospital. Adult patients were included, either connected or not to MV, watchful and calmed (RASS −1/+1) and without delirium (negative CAM-ICU).Oculus Go (Facebook Technologies, LLC) iVR glasses were the model used. The relaxation strategy consisted in the visualization of an experience of 15minutes with scenes related to nature and fantasy, relaxing music with a plot. The sessions were individual, with the patient monitored in a fowler position or seated. The anxiety degree before and after each session was evaluated following a reduced version of the Spanish “Cuestionario de Ansiedad Estado-Rasgo (STAI-e)” and they were analysed using T samples coupled (statistical significance when p-value was <.05). ResultsIncorporation of 20 patients with an average age of 63.9 years old (60% men). A total of 34 sessions of iVR were conducted. The 32% patients mechanically ventilated, 32% high-flow oxygen therapy, 36% other breathing supports. 80% of the sessions were completed without serious side effects. A significant decrease in the anxiety degree was observed after each iVR session: first session mean change −2.68 (SD=2.75), P=.000; second session mean change −1.86 (SD=1.57), P=.021; third session mean change −1.67 (SD=1.63), P=.054. ConclusionThe usage of iVR in the context of an ICU is feasible, even with patients mechanically ventilated. iVR reduces the anxiety degree in the critic patient, which suggests that “digital therapies” can be effective to improve the emotional state during their stay in the ICU.

Usage of immersive virtual reality as a relaxation method in an intensive care unit

IntroductionThe usage of immersive virtual reality (iVR) in the context of an intensive care unit (ICU) is scarce. Our objective was to assess the feasibility of the usage of iVR in critical patients with or without mechanical ventilation (MV) and to determine the anxiety degree before and after each session. MethodsAnalytical, descriptive, prospective, and cross-sectional research. Pilot test with 20 patients from a polyvalent ICU of a tertiary hospital. Adult patients were included, either connected or not to MV, watchful and calmed (RASS −1/+1) and without delirium (negative CAM-ICU).Oculus Go (Facebook Technologies, LLC) iVR glasses were the model used. The relaxation strategy consisted in the visualization of an experience of 15 min with scenes related to nature and fantasy, relaxing music with a plot. The sessions were individual, with the patient monitored in a fowler position or seated. The anxiety degree before and after each session was evaluated following a reduced version of the Spanish “Cuestionario de Ansiedad Estado-Rasgo (STAI-e)” and they were analysed using T samples coupled (statistical significance when p-value was <0.05). ResultsIncorporation of 20 patients with an average age of 63.9 years old (60% men). A total of 34 sessions of iVR were conducted. 32% patients mechanically ventilated, 32% high-flow oxygen therapy, 36% other breathing supports. 80% of the sessions were completed without serious side effects. A significant decrease in the anxiety degree was observed after each iVR session: first session mean change −2.68 (SD = 2.75), p = 0.000; second session mean change −1.86 (SD = 1.57), p = 0.021; third session mean change −1.67 (SD = 1.63), p = 0.054. ConclusionThe usage of iVR in the context of an ICU is feasible, even with patients mechanically ventilated. iVR reduces the anxiety degree in the critic patient, which suggests that “digital therapies” can be effective to improve the emotional state during their stay in the ICU.

The role of vitamin d in patients with severe sars cov2 pneumonia admitted to a polyvalent intensive care unit. Prospective study on clinical and laboratory evolution and prognosis

The role of vitamin d in patients with severe sars cov2 pneumonia admitted to a polyvalent intensive care unit. Prospective study on clinical and laboratory evolution and prognosis

Deep Vein Thrombosis in Critically Ill Patients in Polyvalent Intensive Care Units: Does a Combination between Pharmacological Prophylaxis and Intermittent Pneumatic Compression Reduce Incidence?

Deep Vein Thrombosis in Critically Ill Patients in Polyvalent Intensive Care Units: Does a Combination between Pharmacological Prophylaxis and Intermittent Pneumatic Compression Reduce Incidence?

Secondary use of data extracted from a clinical information system to assess the adherence of tidal volume and its impact on outcomes

ObjectivesTo extract data from clinical information systems to automatically calculate high-resolution quality indicators to assess adherence to recommendations for low tidal volume. DesignWe devised two indicators: the percentage of time under mechanical ventilation with excessive tidal volume (>8mL/kg predicted body weight) and the percentage of patients who received appropriate tidal volume (≤8mL/kg PBW) at least 80% of the time under mechanical ventilation. We developed an algorithm to automatically calculate these indicators from clinical information system data and analyzed associations between them and patients’ characteristics and outcomes. SettingsThis study has been carried out in our 30-bed polyvalent intensive care unit between January 1, 2014 and November 30, 2019. PatientsAll patients admitted to intensive care unit ventilated >72h were included. InterventionUse data collected automatically from the clinical information systems to assess adherence to tidal volume recommendations and its outcomes. Main variables of interestMechanical ventilation days, ICU length of stay and mortality. ResultsOf all admitted patients, 340 met the inclusion criteria. Median percentage of time under mechanical ventilation with excessive tidal volume was 70% (23%–93%); only 22.3% of patients received appropriate tidal volume at least 80% of the time. Receiving appropriate tidal volume was associated with shorter duration of mechanical ventilation and intensive care unit stay. Patients receiving appropriate tidal volume were mostly male, younger, taller, and less severely ill. Adjusted intensive care unit mortality did not differ according to percentage of time with excessive tidal volume or to receiving appropriate tidal volume at least 80% of the time. ConclusionsAutomatic calculation of process-of-care indicators from clinical information systems high-resolution data can provide an accurate and continuous measure of adherence to recommendations. Adherence to tidal volume recommendations was associated with shorter duration of mechanical ventilation and intensive care unit stay.

Perception of Patient Safety at The End of the 3rd Wave of COVID-19 (2021) and in 2014 in A Spanish Polyvalent ICU

Introduction: Healthcare has brought undeniable benefits, but each interaction with the health system can lead to inconveniences. The Intensive Care Unit (ICU) work environment is highly technical; security concerns may be especially relevant in this location. A fundamental issue of the development of safety tasks in health institutions is the assessment of the patient safety climate. Objective: To assess the security climate perceived by the workers of our unit in 2014 and 2021 to articulate continuous improvement measures to improve the areas with poor evaluation. Results: In 2021, employees worked in the ICU for less time (5.48 +/- 6.7 vs. 12.09 +/- 7.52 vs. years), and their safety perception score was somewhat better (8.06 + / - 1.16 vs. 7.69 +/- 1.43) than in 2014. Almost no worker declared any adverse event. The scores of the 12 dimensions were generally similar in the two periods, with a significant decrease in the positive responses of the dimension “Nonpunitive response to error” and a significant increase in “Teamwork within units” in the 2021 survey compared to 2014. In both surveys, the dimensions “Staffing” and “Management support for patient safety” account for more than 40% of the negative responses, so the efforts to improve the security climate must be directed in these two dimensions. The incorporation of a high percentage of young personnel and the slow consolidation of the safety culture values may explain these results. Conclusions: The declaration of adverse events in the ICU is very scarce. The perception of teamwork within the ICU is very good. Quality improvement actions should target “Staffing” and “Management support for patient security”.

Low-dose corticosteroid therapy for cardiogenic shock in adults (COCCA): study protocol for a randomized controlled trial

BackgroundCardiogenic shock (CS) is a life-threatening condition characterized by circulatory insufficiency caused by an acute dysfunction of the heart pump. The pathophysiological approach to CS has recently been enriched by the tissue consequences of low flow, including inflammation, endothelial dysfunction, and alteration of the hypothalamic-pituitary-adrenal axis. The aim of the present trial is to evaluate the impact of early low-dose corticosteroid therapy on shock reversal in adults with CS.Method/designThis is a multicentered randomized, double-blind, placebo-controlled trial with two parallel arms in adult patients with CS recruited from medical, cardiac, and polyvalent intensive care units (ICU) in France. Patients will be randomly allocated into the treatment or control group (1:1 ratio), and we will recruit 380 patients (190 per group). For the treatment group, hydrocortisone (50 mg intravenous bolus every 6 h) and fludrocortisone (50 μg once a day enterally) will be administered for 7 days or until discharge from the ICU. The primary endpoint is catecholamine-free days at day 7. Secondary endpoints include morbidity and all-cause mortality at 28 and 90 days post-randomization. Pre-defined subgroups analyses are planned, including: postcardiotomy, myocardial infarction, etomidate use, vasopressor use, and adrenal profiles according the short corticotropin stimulation test. Each patient will be followed for 90 days. All analyses will be conducted on an intention-to-treat basis.DiscussionThis trial will provide valuable evidence about the effectiveness of low dose of corticosteroid therapy for CS. If effective, this therapy might improve outcome and become a therapeutic adjunct for patients with CS.Trial registrationClinicalTrials.gov, NCT03773822. Registered on 12 December 2018

Impacto de un programa de vigilancia activa y medidas de control de infecciones sobre la incidencia de bacilos gram negativos resistentes a carbapenems en una unidad de cuidados intensivos

Hospital-acquired infections caused by carbapenem-resistant Gram-negative bacteria (CRGNB) have been increasingly reported worldwide and are associated with high rates of mortality especially in intensive care units(ICUs). Early identification through rectal surveillance cultures and implementation of infection control measures(ICM) including contact precautions, staff education on cleaning and hand hygiene may reduce the spread of these microorganisms. The aim of this work was to assess the impact of enhanced ICM on CRGNB colonization and to describe the molecular epidemiology of these bacteria in a polyvalent ICU in a tertiary level hospital.A prospective study including audits and active surveillance culture program, with molecular characterization, was conducted before and after the implementation of prevention programs and infection control measures. Microbiological screening was performed in chromogenic media; PCR targeting β-lactamases genes (blaKPC, blaNDM, blaVIM and blaOXA-48, blaSHV and blaCTX-M), molecular typing by PFGE; and MLST in K. pneumoniae were performed. CRGNB colonization was reduced from 16.92% to 9.67% upon implementing the infection control measures. In K. pneumoniae the most frequent carbapenemase type was KPC-2 associated with SHV-2 and CTX-M-15, and was disseminated in various STs (ST17, ST13, ST2256, ST353); there was no persistence of particular clones and virulence factors showed no association with hypervirulence. IMP-1 carbapenemase predominated in A. baumannii and the PFGE analysis individualized 3 clusters, assuming that the dissemination in the ICU was clonal. The early detection of patients colonized with CRBGN by using epidemiological surveillance cultures and the implementation of prophylactic measures are key to reducing the incidence of these microorganisms.

The Reality of Critical Cancer Patients in a Polyvalent Intensive Care Unit.

Background and objectiveWith the increasing incidence of cancer and the rise in the survival rates of cancer patients, more and more oncological candidates are being considered for admission to intensive care units (ICU). Several studies have demonstrated no difference in the outcomes of cancer patients compared to non-cancer patients. Our study aimed to describe and analyze the outcomes related to cancer patients in a polyvalent ICU.MethodsWe conducted a retrospective study of consecutive oncological patients admitted to a polyvalent ICU (2013-2017). Cox model and receiver operating characteristic (ROC) curve analysis were performed to analyze the results.ResultsA total of 236 patients were included in the study; the mean age of the patients was 53.5 ± 15.3 years, and 65% of them were male. The main cancer types were those related to the central nervous system (CNS; 31%), as well as gastrointestinal (18%), genitourinary (17%), and hematological (15%). Curative/diagnostic surgeries (49%) and sepsis/septic shock (17%) were the main reasons for admission. The Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scores in hematological patients vs. solid tumors were as follows: 30 vs. 20 and 63 vs. 38, respectively (p<0.005). Vasopressors, invasive mechanical ventilation (IMV), and renal replacement therapy (RRT) were used more widely in hematological patients compared to solid-tumor patients. Length of stay was longer in hematological patients vs. solid-tumor patients (12.8 vs. 7 days, p=0.002). The median overall survival in hematological patients was one month and that in solid-tumor patients was 5.8 months (p<0.005). The survival rate at six months was better than described in the existing literature (48 vs. 32.4%).ConclusionBoth SAPS II and APACHE II scores were reasonably accurate in predicting mortality, demonstrating their value in cancer patients.

Benefits of an education program and a clinical algorithm in mixed nutritional support to improve nutrition for the critically ill patient: a before-and-after study

Introduction: optimal nutrition in the critically ill patient is a key aspect for recovery. Objectives: to promote training in and knowledge of mixed nutrition support (MNS) by means of a clinical algorithm among intensivists for improving the nutritional status of critically ill patients. Methods: a before-and-after study with the participation of 19 polyvalent intensive care units (ICUs) in 10 autonomous communities. Five members of the scientific committee trained the trainers by means of oral presentations and a clinical algorithm on MNS. Then, trainers were responsible for explaining the algorithm to local intensivists in their ICUs. The 30-item study questionnaire was completed before and after the intervention by 179 and 105 intensivists, respectively. Results: a clear improvement of knowledge was found in six (20 %) specific MNS-related questions. In 11 items (36.6 %), adequate knowledge on different aspects of nutritional support that were already present before the intervention were maintained, and in five items (16.7 %) an improvement in the rate of correct responses was recorded. There were no improvements in correct responses for four items (13.3 %), and for four (13.3 %) additional items the percentage of correct responses decreased. Conclusions: the use of the MNS algorithm has achieved a solid consolidation of the main concepts of MNS. Some aspects regarding how to manage the malnourished patient, how to identify them and what type of nutrition to guide from the beginning of admission to the ICU, nutritional contributions in special situations, and the monitoring of possible complications such as refeeding are areas for which further training strategies are needed.

Automatic generation of minimum dataset and quality indicators from data collected routinely by the clinical information system in an intensive care unit

BackgroundQuality indicators (QIs) are being increasingly used in medicine to compare and improve the quality of care delivered. The feasibility of data collection is an important prerequisite for QIs. Information technology can improve efforts to measure processes and outcomes. In intensive care units (ICU), QIs can be automatically measured by exploiting data from clinical information systems (CIS). ObjectiveTo describe the development and application of a tool to automatically generate a minimum dataset (MDS) and a set of ICU quality metrics from CIS data. MethodsWe used the definitions for MDS and QIs proposed by the Spanish Society of Critical Care Medicine and Coronary Units. Our tool uses an extraction, transform, and load process implemented with Python to extract data stored in various tables in the CIS database and create a new associative database. This new database is uploaded to Qlik Sense, which constructs the MDS and calculates the QIs by applying the required metrics. The tool was tested using data from patients attended in a 30-bed polyvalent ICU during a six-year period. ResultsWe describe the definitions and metrics, and we report the MDS and QI measurements obtained through the analysis of 4546 admissions. The results show that our ICU’s performance on the QIs analyzed meets the standards proposed by our national scientific society. ConclusionsThis is the first step toward using a tool to automatically obtain a set of actionable QIs to monitor and improve the quality of care in ICUs, eliminating the need for professionals to enter data manually, thus saving time and ensuring data quality.

Lymphopenia in critically ill COVID‐19 patients: A predictor factor of severity and mortality

International Journal of Laboratory HematologyVolume 43, Issue 1 p. e38-e40 LETTER TO THE EDITOR Lymphopenia in critically ill COVID-19 patients: A predictor factor of severity and mortality Amra Ziadi, Amra Ziadi Polyvalent Intensive Care Unit, Arrazi Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorAbdelhamid Hachimi, Corresponding Author Abdelhamid Hachimi ab.hachimi@uca.ma orcid.org/0000-0002-7170-9397 Medical Intensive Care Unit, Arrazi Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, Morocco Correspondence Abdelhamid Hachimi, Medical ICU, Mohammed VIth Teaching Center of Marrakech, Ibn Sina 31 Avenue, Amerchich, 40080 Marrakech, Morocco. Email: ab.hachimi@uca.maSearch for more papers by this authorBrahim Admou, Brahim Admou Laboratory of Immunology, Center of Clinical Research, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorRaja Hazime, Raja Hazime Laboratory of Immunology, Center of Clinical Research, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorImane Brahim, Imane Brahim Laboratory of Immunology, Center of Clinical Research, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorFouzia Douirek, Fouzia Douirek Polyvalent Intensive Care Unit, Arrazi Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorYoussef Zarrouki, Youssef Zarrouki Polyvalent Intensive Care Unit, Arrazi Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorAhmed R. El Adib, Ahmed R. El Adib Polyvalent Intensive Care Unit, Child and mother Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorSaid Younous, Said Younous Polyvalent Intensive Care Unit, Child and mother Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorAbdenasser M. Samkaoui, Abdenasser M. Samkaoui Polyvalent Intensive Care Unit, Arrazi Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this author Amra Ziadi, Amra Ziadi Polyvalent Intensive Care Unit, Arrazi Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorAbdelhamid Hachimi, Corresponding Author Abdelhamid Hachimi ab.hachimi@uca.ma orcid.org/0000-0002-7170-9397 Medical Intensive Care Unit, Arrazi Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, Morocco Correspondence Abdelhamid Hachimi, Medical ICU, Mohammed VIth Teaching Center of Marrakech, Ibn Sina 31 Avenue, Amerchich, 40080 Marrakech, Morocco. Email: ab.hachimi@uca.maSearch for more papers by this authorBrahim Admou, Brahim Admou Laboratory of Immunology, Center of Clinical Research, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorRaja Hazime, Raja Hazime Laboratory of Immunology, Center of Clinical Research, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorImane Brahim, Imane Brahim Laboratory of Immunology, Center of Clinical Research, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorFouzia Douirek, Fouzia Douirek Polyvalent Intensive Care Unit, Arrazi Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorYoussef Zarrouki, Youssef Zarrouki Polyvalent Intensive Care Unit, Arrazi Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorAhmed R. El Adib, Ahmed R. El Adib Polyvalent Intensive Care Unit, Child and mother Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorSaid Younous, Said Younous Polyvalent Intensive Care Unit, Child and mother Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this authorAbdenasser M. Samkaoui, Abdenasser M. Samkaoui Polyvalent Intensive Care Unit, Arrazi Hospital, Mohammed VIth Teaching Center, Cadi Ayyad University, Marrakech, MoroccoSearch for more papers by this author First published: 30 September 2020 https://doi.org/10.1111/ijlh.13351Citations: 15 Amra Ziadi, Abdelhamid Hachimi, Brahim Admou, and Abdenasser M. Samkaoui contributed equally to this study. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume43, Issue1February 2021Pages e38-e40 RelatedInformation

Validity of a clinical scale in predicting the failure of non-invasive ventilation in hypoxemic patients.

The HACOR scale is a clinical score that can predict early failure of NIV in hypoxemic acute respiratory failure (ARF) The aim of this study is to analyze the validity of the HACOR scale. A retrospective study of a cohort of over 2749 episodes on 2711 consecutive patients requiring NIV for hypoxemic ARF in a polyvalent intensive care unit. The scale was measured before starting NIV and at 1, 6, 12, 24 and 48h after the initiation of NIV. NIV failure occurred in 963 patients (35%). The value of the HACOR scale before NIV did not differ between success and failure. However, at 1, 6, 12, 24 and 48h of NIV, the scale values clearly differed between the two groups. The HACOR scale at NIV initiation accurately predicts NIV failure in the first hour, with an optimal cut-off value of 8 points. The AUC for predicting NIV failure with HACOR at 1h is greater than 0.9 in patients with pneumonia and adult respiratory distress syndrome (ARDS). The HACOR scale measured at 1h after NIV initiation accurately predicts NIV failure, especially in pneumonia and ARDS.

P0582MAGNESIUM TREATMENT IN PREECLAMPSIA SHOULD BE TARGETED TO SERIC LEVELS TO AVOID TOXICITY

Abstract Background and Aims Preeclampsia is potentially serious complication of pregnacy and frequently requires admission in ICU. Management of this condition involves treatment with magnesium sulfate to prevent progression to eclampsia or even more adverse outcomes such as maternal or fetal death. However the exact dose of magnesium needed is still to be determined and few studies have analyzed the impact of this therapheutic intervention in women admitted in intensive care units, in terms of outcomes and adverse effects. Herein, we present a series of patients diagnosed with preeclampsia, including its most severe presentations with eclampsia or HELLP syndrome, admitted in an intensive care unit. Method Demographic, clinical and laboratorial data of women admitted between January-2016 and December-2018 to the Polyvalent Intensive Care Unit (ICU) of Hospital Fernando Fonseca, a tertiary Hospital in Portugal, with the diagnosis of preeclampsia, were retrospectively collected. Diagnosis of preeclampsia, HELLP syndrome and eclampsia were performed according to the ISSHP criteria (2004). Acute Kidney Injury (AKI) was defined according to the KDIGO criteria. The study was approved by the Ethical Committee of the institution. Results 42 patients were included, 52.3% (n=22) diagnosed as non-severe preeclampsia; 31% (n=13) as HELLP syndrome and 16.7% (n=7) as eclampsia. Mean age at presentation was 29.6±6.6 years old, with 52,4% (n=22) caucasian and 47.6% (n=20) black. Most patients were admitted in ICU in post-partum period, after cesarian delivery in 95.2% (n=40). Seven patients (16.7%) had a previous diagnosis of hypertension; 11.9% (n=5) were obese; none has previous chronic kidney disease. At presentation, most patients diagnosed with preeclampsia had three diagnostic criteria (28.6%, n=12), including hypertension. Renal dysfunction was found in 80.9% (n=34) of patients, with proteinuria &amp;gt;200mg/dL in 69% (n=29) and AKI in 19% (n=8). Mean Hb of 11.1±2.1g/dL, with median platelet count of 126000/uL (IQR 72000-201500) and median LDH of 388mg/dL (IQR 240-773). Pre-partum magnesium sulfate treatment was initiated in 78.6% (n=33) of patients, but only 2.4% (n=1) had previous magnesemia levels determination. During the stay in ICU, daily levels of seric magnesium levels were obtained, with the highest median values found at day one after admission. Adverse events related to hypermagnesemia (bradipnea) occurred in 50% (n=21) of patients. In six patients (14.3%), treatment was stopped because of high levels of magnesemia or adverse events. 14.3% (n=6) progressed to eclampsia and fetal death occured also in 14.3% (n=6). Maternal deaths did not occur. By logistic binary regression we found out that weight was an independent risk factor for the development of the composite outcome of eclampsia or fetal death, when adjusted to age, race, AKI, hemoglobin, platelet count, ALT, LDH, serum albumin and proteinuria. (p=0.04). However, when Magnesium was included in the analysis, all variables lost significance. An association between SOFA and SAPS scores and the occurrence of the composite outcome has been found (p= 0.03 and p=0.019, respectively). Conclusion Most patients with preeclampsia received treatment with magnesium sulfate without previous measurement of serum levels. Bradipnea occurred in 50% of cases and treatment had to be stooped in almost 15%. Nevertheless, magnesium levels were not independently associated with the composite outcome of fetal death or eclampsia. Future studies should evaluate if a dose adjusted to a specific target of magnesium seric level could be associated with less adverse effects while still reducing the risk associated with preeclampsia.

Predicting of enteral nutrition intolerance in critically ill patients

Even in minimal morphological changes in the gut of critically ill patients, its ability to absorb nutrients, drugs and, in particular, acetaminophen is reduced. The search for a simple and accessible clinical method that allows to assess the possibility of enteral nutrition is rather actual. Objectives. To assess the prognostic value of the acetaminophen enteral absorption test in critically ill patients. Materials and methods. A single-center, prospective study was performed in 52 patients of the polyvalent intensive care unit (ICU). 0.5 g of paracetamol was injected into the nasogastric tube. After 10, 15, 20, 30, 40, 50 and 90 minutes 5 ml of venous blood was taken to determine the concentration of acetaminophen in it. On the next day the volume of administered and excreted via a nasogastric tube was recorded. Healthy volunteers (n = 12) were included in group 1. The second group (n = 15) — a positive balance by the nasogastric tube, the third group (n = 15) — the balance is negative up to 500 ml per day, the fourth — negative up to 1 liter per day, the fifth group — negative &gt; 1 liter per day. To identify the predictive value and cutoff values of the test, the data were analyzed using the logistic regression method, and then the ROC analysis. The authors received permission from the local ethics committee. Results. The most informative time interval for determining the concentration of paracetamol in the blood after its administration into the stomach is the interval from 15 to 30 minutes. A strong correlation (r = 0.846 [p &lt; 0.001]) was found out between the results of the paracetamol test and the daily balance by the nasogastric tube. ROC analysis showed that the sensitivity of this test exceeds 86 %, and the specificity was about 75 %. If the concentration of paracetamol in the blood is &gt; 6.17 μg/ml successful total enteral nutrition is highly possible. The values of this indicator in the range from 2.47 μg/ml to 6.17 μg/ml can serve as the basis for the implementation of the method of partial enteral nutrition. We believe that at levels &lt; 2.47 mcg/ml, a “minimal enteral nutrition” attempt can be made. Conclusion. The paracetamol absorption test in critically ill patients can be considered as an independent predictor of the feasibility of enteral zone feeding. Predicting enteral feeding intolerance using the paracetamol absorption test in critically ill patients can significantly improve the efficacy and safety of tube feeding method.

Root causes and outcomes of postoperative pulmonary complications after abdominal surgery: a retrospective observational cohort study

BackgroundPostoperative pulmonary complications (PPCs) contribute significantly to overall postoperative morbidity and mortality. In abdominal surgery, PPCs remain frequent. The study aimed to analyze the profile and outcomes of PPCs in patients submitted to abdominal surgery and admitted in a Portuguese polyvalent intensive care unit.MethodsFrom January to December 2017 in the polyvalent intensive care unit of Hospital Garcia de Orta, Almada, Portugal, we conducted a retrospective, observational study of inpatients submitted to urgent or elective abdominal surgery who had severe PPCs. We evaluated the perioperative risk factors and associated mortality. Logistic regression was performed to find which perioperative risk factors were most important in the occurrence of PPCs.ResultsSixty patients (75% male) with a median age of 64.5 [47–81] years who were submitted to urgent or elective abdominal surgery were included in the analysis. Thirty-six patients (60%) developed PPCs within 48 h and twenty-four developed PPCs after 48 h. Pneumonia was the most frequent PPC in this sample. In this cohort, 48 patients developed acute respiratory failure and needed mechanical ventilation. In the emergency setting, peritonitis had the highest rate of PPCs. Electively operated patients who developed PPCs were mostly carriers of digestive malignancies. Thirty-day mortality was 21.7%. The risk of PPCs development in the first 48 h was related to the need for neuromuscular blocking drugs several times during surgery and preoperative abnormal arterial blood gases. Median abdominal surgical incision, long surgery duration, and high body mass index were associated with PPCs that occurred more than 48 h after surgery. The American Society of Anesthesiologists physical status score 4 and COPD/Asthma determined less mechanical ventilation needs since they were preoperatively optimized. Malnutrition (low albumin) before surgery was associated with 30-day mortality.ConclusionPPCs after abdominal surgery are still a major problem since they have profound effects on outcomes. Our results suggest that programs before surgery, involve preoperative lifestyle changes, such as nutritional supplementation, exercise, stress reduction, and smoking cessation, were an effective strategy in mitigating postoperative complications by decreasing mortality.