Postoperative ICU Patients Research Articles

Respiratory system compliance during anesthesia induction and postoperative mechanical ventilation needs: An observational study.

Respiratory system compliance (Crs) is a simple indicator of lung flexibility. However, it remains unclear whether a low Crs during anesthesia induction (iCrs) is associated with an increased risk of postoperative mechanical ventilation. This retrospective observational study was conducted using a local database. All mechanically ventilated postoperative ICU patients were included in this study. The duration of postoperative mechanical ventilation, length of hospital stay, and in-hospital mortality were compared between the low iCrs group (<25% of distribution) and the normal iCrs group. A total of 315 patients were classified into the low iCrs (<39 mL/cmH2O) group (n = 78) or the normal iCrs group (n = 237). Low iCrs was associated with a higher chance of mechanical ventilation in 28 days (log-rank test, p < 0.001). The duration of hospital stay was similar. Multivariate analysis showed that in-hospital mortality was higher in the low iCrs group than in the normal iCrs group (adjusted odds ratio, 6.04 [1.13, 32.26]; p = 0.04). Low iCrs was associated with an increased risk of requiring postoperative mechanical ventilation. An additional result of poor survival related to low iCrs may require further study.

Flow-controlled ventilation decreases mechanical power in postoperative ICU patients

BackgroundMechanical power (MP) is the energy delivered by the ventilator to the respiratory system and combines factors related to the development of ventilator-induced lung injury (VILI). Flow-controlled ventilation (FCV) is a new ventilation mode using a constant low flow during both inspiration and expiration, which is hypothesized to lower the MP and to improve ventilation homogeneity. Data demonstrating these effects are scarce, since previous studies comparing FCV with conventional controlled ventilation modes in ICU patients suffer from important methodological concerns.ObjectivesThis study aims to assess the difference in MP between FCV and pressure-controlled ventilation (PCV). Secondary aims were to explore the effect of FCV in terms of minute volume, ventilation distribution and homogeneity, and gas exchange.MethodsThis is a physiological study in post-cardiothoracic surgery patients requiring mechanical ventilation in the ICU. During PCV at baseline and 90 min of FCV, intratracheal pressure, airway flow and electrical impedance tomography (EIT) were measured continuously, and hemodynamics and venous and arterial blood gases were obtained repeatedly. Pressure–volume loops were constructed for the calculation of the MP.ResultsIn 10 patients, optimized FCV versus PCV resulted in a lower MP (7.7 vs. 11.0 J/min; p = 0.004). Although FCV did not increase overall ventilation homogeneity, it did lead to an improved ventilation of the dependent lung regions. A stable gas exchange at lower minute volumes was obtained.ConclusionsFCV resulted in a lower MP and improved ventilation of the dependent lung regions in post-cardiothoracic surgery patients on the ICU.Trial registration Clinicaltrials.gov identifier: NCT05644418. Registered 1 December 2022, retrospectively registered.

Accuracy and Feasibility of Real-time Continuous Glucose Monitoring in Critically Ill Patients After Abdominal Surgery and Solid Organ Transplantation.

Glycemia management in critical care is posing a challenge in frequent measuring and adequate insulin dose adjustment. In recent years, continuous glucose measurement has gained accuracy and reliability in outpatient and inpatient settings. The aim of this study was to assess the feasibility and accuracy of real-time continuous glucose monitoring (CGM) in ICU patients after major abdominal surgery. We included patients undergoing pancreatic surgery and solid organ transplantation (liver, pancreas, islets of Langerhans, kidney) requiring an ICU stay after surgery. We used a Dexcom G6 sensor, placed in the infraclavicular region, for real-time CGM. Arterial blood glucose measured by the amperometric principle (ABL 800; Radiometer, Copenhagen, Denmark) served as a reference value and for calibration. Blood glucose was also routinely monitored by a StatStrip bedside glucose meter. Sensor accuracy was assessed by mean absolute relative difference (MARD), bias, modified Bland-Altman plot, and surveillance error grid for paired samples of glucose values from CGM and acid-base analyzer (ABL). We analyzed data from 61 patients and obtained 1,546 paired glucose values from CGM and ABL. Active sensor use was 95.1%. MARD was 9.4%, relative bias was 1.4%, and 92.8% of values fell in zone A, 6.1% fell in zone B, and 1.2% fell in zone C of the surveillance error grid. Median time in range was 78%, with minimum (<1%) time spent in hypoglycemia. StatStrip glucose meter MARD compared with ABL was 5.8%. Our study shows clinically applicable accuracy and reliability of Dexcom G6 CGM in postoperative ICU patients and a feasible alternative sensor placement site.

Incidence and outcomes of AKI in postoperative patients admitted to ICU using full KDIGO criteria – a cohort study

Study objectiveAcute kidney injury (AKI) is a serious complication in postoperative ICU patients. The incidence of AKI varies substantially based on the type of surgery and definition used. This study focuses on the incidence of AKI in postoperative ICU patients using full KDIGO criteria and related outcomes regarding to different types of surgery. DesignRetrospective cohort study. SettingTertiary level university hospital, eight anaesthesiological/surgical ICUs, between 2016 and 2018. Patients6261 adult patients. MeasurementsPrimary outcome was 28-day all-cause mortality in different stages of AKI according to complete KDIGO criteria. Main resultsWe found 3497 (55.9%) postoperative ICU patients with AKI. The severity distribution of AKI stage 1 to 3 was 19.7%, 28.4% and 7.8%, respectively, and 235 (4%) patients received RRT. The 28-day mortality was 3% (n = 205). Increasing AKI severity was associated with increased 28-day mortality when adjusted for other variables (AKI 2°: OR 2.81; 95% CI 1.55 to 5.24; p < 0.001 and AKI 3°: OR 11.37.; 95% CI 5.91 to 22.55; p < 0.001). Besides AKI stages 2 and 3, age (OR 1.02; 95% CI 1.01 to 1.04, p < 0.001), NYHA IV (OR 2.23; 95% CI 1.03 to 4.43, p = 0.042), need for surgical reintervention within 48 h (OR 2.92; 95% CI 1.76 to 4.72, p = 0.001), urgent surgery (OR 1.78; 95% CI 1.15 to 2.71, p = 0.01), emergency surgery (OR 2.63; 95% CI 1.58 to 4.31, p = 0.001), vascular surgery (OR 2.01; 95% CI 1.06 to 3.98, p = 0.033), and orthopedic and trauma surgery (OR 3.79; 95% CI 1.98 to 7.09, p < 0.001) versus cardiac surgery was significantly associated with increased risk for 28-days mortality in multivariate analysis. ConclusionAKI based on full KDIGO criteria is very common in postoperative ICU patients and it is associated with stepwise increase in 28-days mortality.

The Effect of Using Array Technique on Semi-Circular Patch Microstrip Antenna with 2.4 GHz Frequency in Supporting Wireless Body Area Network Technology

This paper aims to design a semi-circular patch microstrip antenna that can work at a frequency of 2.4 GHz (band 2360 MHz - 2400 MHz) to support Wireless Body Area Network technology (WBAN). One of the devices connected to WBAN technology is a Holter monitor and medical data recorder that forms a medical network for post-operative or monitoring ICU patients (Intensive Care Unit). To support one of the WBAN technologies, an antenna is needed that has considerable gain and bandwidth characteristics. To increase the gain and bandwidth, the array method is used on antennas with inset feed unification. The antenna design was simulated using CST Studio Suite 2019. The use of array methods on microstrip antennas can increase the gain by 132.9%, which is 5.73 dB. The simulation results obtained a return loss of -17.223 dB with a bandwidth of 88.3 MHz in the frequency range of 2357.6 MHz - 2445.9 MHz

Novel insights on association and reactivity of Bispectral Index, frontal electromyogram, and autonomic responses in nociception-sedation monitoring of critical care patients

BackgroundAssessing nociception and sedation in mechanically ventilated patients in the ICU is challenging, with few reliable methods available for continuous monitoring. Measurable cardiovascular and neurophysiological signals, such as frontal EEG, frontal EMG, heart rate, and blood pressure, have potential in sedation and nociception monitoring. The hypothesis of this explorative study is that derived variables from the aforementioned signals predict the level of sedation, as described by the Richmond Agitation-Sedation score (RASS), and respond to painful stimuli during critical care.MethodsThirty adult postoperative ICU patients on mechanical ventilation and receiving intravenous sedation, excluding patients with primary neurological disorders, head injury, or need for continuous neuromuscular blockage. Bispectral Index (BIS), EMG power (EMG), EMG-derived Responsiveness Index (RI), and averaged blood pressure variability (ARV) were tested against RASS measurements. The aforementioned variables together with blood pressure and Surgical Pleth Index (SPI) were explored before and after painful stimuli (for example bronchoscopy, or pleural puncture) at varying RASS levels, to test variable responsiveness.ResultsBIS, EMG, and RI predicted RASS levels with a prediction probability (PK) of 0.776 for BIS, 0.761 for EMG, and 0.763 for RI. In addition, BIS, EMG, and ARV demonstrated responsiveness to painful stimuli during deep sedation (RASS score ≤ -3).ConclusionVariables derived from EEG and EMG are associated with sedation levels, as described by the RASS score. Furthermore, these variables, along with ARV, react with consistency to painful stimuli during deep sedation (RASS -5 to -3), offering novel tools for nociception-sedation monitoring of mechanically ventilated ICU patients requiring deep sedation.

Negative drift of sedation depth in critically ill patients receiving constant minimum alveolar concentration of isoflurane, sevoflurane, or desflurane: a randomized controlled trial

BackgroundIntensive care unit (ICU) physicians have extended the minimum alveolar concentration (MAC) to deliver and monitor long-term volatile sedation in critically ill patients. There is limited evidence of MAC’s reliability in controlling sedation depth in this setting. We hypothesized that sedation depth, measured by the electroencephalography (EEG)-derived Narcotrend-Index (burst-suppression N_Index 0—awake N_Index 100), might drift downward over time despite constant MAC values.MethodsThis prospective single-centre randomized clinical study was conducted at a University Hospital Surgical Intensive Care Unit and included consecutive, postoperative ICU patients fulfilling the inclusion criteria. Patients were randomly assigned to receive uninterrupted inhalational sedation with isoflurane, sevoflurane, or desflurane. The end-expiratory concentration of the anaesthetics and the EEG-derived index were measured continuously in time-stamped pairs. Sedation depth was also monitored using Richmond-Agitation-Sedation-Scale (RASS). The paired t-test and linear models (bootstrapped or multilevel) have been employed to analyze MAC, N_Index and RASS across the three groups.ResultsThirty patients were recruited (female/male: 10/20, age 64 ± 11, Simplified Acute Physiology Score II 30 ± 10). In the first 24 h, 21.208 pairs of data points (N_Index and MAC) were recorded. The median MAC of 0.58 ± 0.06 remained stable over the sedation time in all three groups. The t-test indicated in the isoflurane and sevoflurane groups a significant drop in RASS and EEG-derived N_Index in the first versus last two sedation hours. We applied a multilevel linear model on the entire longitudinal data, nested per patient, which produced the formula N_Index = 43 − 0.7·h (R2 = 0.76), showing a strong negative correlation between sedation’s duration and the N_Index. Bootstrapped linear models applied for each sedation group produced: N_Index of 43–0.9, 45–0.8, and 43–0.4·h for isoflurane, sevoflurane, and desflurane, respectively. The regression coefficient for desflurane was almost half of those for isoflurane and sevoflurane, indicating a less pronounced time-effect in this group.ConclusionsMaintaining constant MAC does not guarantee stable sedation depth. Thus, the patients necessitate frequent clinical assessments or, when unfeasible, continuous EEG monitoring. The differences across different volatile anaesthetics regarding their time-dependent negative drift requires further exploration.Trial registration: NCT03860129.

The Impact of Earplugs and Eye Masks on Sleep Quality in Surgical ICU Patients at Risk for Frequent Awakenings.

Sleep disturbances may contribute to the development of delirium, prolonged ICU stay, and increased mortality. There is conflicting data on the effectiveness of earplugs and eye masks for sleep promotion in the ICU. This study evaluates the impact of earplugs and eye masks on sleep quality in postoperative surgical ICU patients at risk for frequent awakenings. Prospective randomized controlled trial. Surgical ICU within the University of Texas Southwestern Medical Center. Adult, female patients admitted to the surgical ICU requiring hourly postoperative assessments following breast free flap surgery between February 2018 and October 2019. Patients were randomized into an intervention group or a control group. The intervention group received earplugs and eye masks in addition to standard postoperative care, whereas the control group received standard postoperative care. The primary outcome was overall sleep quality assessed via the Richards-Campbell Sleep Questionnaire. Secondary outcomes of patient satisfaction and rates of ICU delirium were assessed with a modified version of the Family Satisfaction in the ICU survey and the Confusion Assessment Method for the ICU. After a planned interim analysis, the study was stopped early because prespecified criteria for significance were attained. Compared with the control group's average Richards-Campbell Sleep Questionnaire total score of 47.3 (95% CI, 40.8-53.8), the intervention group's average Richards-Campbell Sleep Questionnaire total score was significantly higher at 64.5 (95% CI, 58.3-70.7; p = 0.0007). There were no significant between-group differences for Confusion Assessment Method for the ICU scores or modified Family Satisfaction in the ICU survey scores. These results suggest that earplugs and eye masks are effective in improving sleep quality in ICU patients undergoing frequent assessments. The results strengthen the evidence for nonpharmacologic sleep-promoting adjuncts in the ICU.

Role of lung ultrasound in weaning from mechanical ventilation in postoperative neurosurgical ICU patients

Background: Prolonged postoperative mechanical ventilation after intracranial surgery is associated with significant morbidity and mortality. Many traditional tools could help in prediction of weaning success as blood gas analysis (ABG), chest radiography, ventilator parameters and rapid shallow breathing index (RSBI). These tools have a significantly higher failure rate. The aim of this study was to describe the role of transthoracic lung ultrasound (LUS) as a clinical tool in predicting weaning of postoperative mechanically ventilated patients after intracranial surgery. Patients and method:130 patients who were scheduled for weaning from mechanical ventilation (MV), were prospectively enrolled in the study, age 20-70 years, of either sex. They were randomly allocated into two groups- group C (n=65) were examined by traditional methods chest X- ray, ABG, ventilator parameters and RSBI, and group US (n=65) were examined by traditional methods plus LUS. Diaphragm thickness (DT) and fraction (DTF), lung aeration and extravascular lung water (EVLW) were assessed by LUS. A failure of weaning was considered when reintubation was needed within 48 hours. Results: The success rate in group US (LUS+ traditional methods) was 84.6% compared to 66.2% in group C (traditional methods only). The value of diaphragm thickness and fraction were significantly more in the weaning success group than in failure group. B-lines detected by LUS in success and failure groups were ≤2, 3 respectively with no significant difference. Conclusion: Lung ultrasound as an added tool could decrease failure rate of weaning in postoperative mechanically ventilated patients after intracranial surgery.

Incidence and Outcomes of Acute Kidney Injury in Postoperative ICU Patients - a Retrospective Data Analysis

Incidence and Outcomes of Acute Kidney Injury in Postoperative ICU Patients - a Retrospective Data Analysis

Role of Lung Ultrasound in Weaning From Mechanical Ventilation in Postoperative Neurosurgical ICU Patients

Role of Lung Ultrasound in Weaning From Mechanical Ventilation in Postoperative Neurosurgical ICU Patients

Application and efficacy of endotracheal tube of drug injection for postoperative patients

Objective: To evaluate the efficacy of endotracheal tube for drug injection in postoperative ICU patients. Methods: A total of 60 ICU patients who were given mechanical ventilation after surgical treatment were enrolled in this study from January 2015 to August 2016 at our hospital. All the patients were divided into the observation group (30 cases) and the control group (30 cases). In the observation group, the patients were treated with the endotracheal tube for surface anesthesia by injecting 2% lidocaine into the trachea, and patients in the control group were treated with saline instead of lidocaine. Patients' tolerance to endotracheal tube, cardiovascular system adverse reactions, the frequency and dosage of sedative and analgesic drug within 12 h mechanical ventilation post operation were analyzed and compared between the two groups. Results: The occurrence rate of cough, hypertension and tachycardia in the observation group were(0.6±0.3), (0.8±0.3)and(1.3±0.6), respectively, which were significantly lower than the control group (5.9±2.1), (6.0±1.9)and(4.9±1.8), the differences were statistically significant (P<0.05). In addition, the frequency of sedative drug was (0.8±0.3), with a dosage of midazolam(1.2±0.3)mg. While in the control group, the frequency of sedative drugs was (5.1±1.9), with a dosage of midazolam (9.9±3.2) mg. The frequency and dosage of sedative drug administration in the observation group were significantly lower than those in the control group, the difference was significant difference (P<0.05). Conclusions: The use of endotracheal tube for drug injection can improve the tolerance of ICU patients to endotracheal tube, reduce the dosage of sedative drugs, and reduce the adverse cardiovascular reactions.

English

Patients requiring mechanical ventilation usually needs adequate sedation and analgesia to facilitate their care. Dexmedetomidine, a short-acting alpha-2-agonist, possesses anxiolytic, anesthetic, hypnotic, and analgesic properties. AIM: The objective of this study is to evaluate and compare the safety and efficacy of iv infusion of Dexmedetomidine with iv infusion of propofol for sedation in post-operative ICU patients. MATERIALS AND METHODS: Fifty patients who were ambulatory and who required the post-operative mechanical ventilation or post-operative sedation were enrolled, in which 25 patients received Dexmedetomidine and remaining 25 patients received propofol. All these patients were treated for the period of 8 to 24 h. STATISTICAL ANALYSIS USED: Data were analyzed using Student's t-test and Chi-square test. The value of P< 0.05 was considered as statistically significant. RESULTS: Demographic data were comparable. Pulse rate, respiratory rate and blood pressure were comparable. Depth of sedation is similar. To maintain analgesia throughout the study period, patients receiving propofol infusions required significantly more analgesics than patients receiving Dexmedetomidine. CONCLUSIONS: Dexmedetomidine appears to be a safe and acceptable ICU sedative agent.

Risk factors of candidemia in postoperative ICU patients: a prospective study

The prediction for and the mortality of patients with candidemia are highly adverse. The aim of this study was to identify the risk factors for the development of candidemia in postoperative patients.

SMOFlipid versus Intralipid in Postoperative ICU Patients

Aim of the work Lipids are important components of total parentral nutrition, especially for patients after major abdominal surgery. Traditionally used intralipid has many complications and can lead to increased infection rate and sepsis, that is why, it is not indicated in cases with low immunity and sepsis. So, in this study, we compared the effect of intralipid and SMOFlipid on the level of IL-6, in addition to lipid profile, liver enzymes, coagulation profile and renal functions.

Suitability, Efficacy, and Safety of Vernakalant for New Onset Atrial Fibrillation in Critically Ill Patients

Objectives. This study investigates the suitability, safety, and efficacy of vernakalant in critically ill patients with new onset atrial fibrillation (AF) after cardiac surgery. Methods. Patients were screened for inclusion and exclusion criteria according to the manufacturers' recommendations. Included patients were treated with 3 mg/kg of vernakalant over 10 min and, if unsuccessful, a second dose of 2 mg/kg. Blood pressure was measured continuously for 2 hours after treatment. Results. Of the 191 patients screened, 159 (83%) were excluded, most importantly due to hemodynamic instability (59%). Vernakalant was administered to 32 (17% of the screened) patients. Within 6 hours, 17 (53%) patients converted to sinus rhythm. Blood pressure did not decrease significantly 10, 30, 60, and 120 minutes after the vernakalant infusion. However, 11 patients (34%) experienced a transient decrease in mean arterial blood pressure <60 mmHg. Other adverse events included nausea (n = 1) and bradycardia (n = 2). Conclusions. Applying the strict inclusion and exclusion criteria provided by the manufacturer, only a minority of postoperative ICU patients with new onset AF qualified for vernakalant. Half of the treated patients converted to sinus rhythm. The drug was well tolerated, but close heart rate and blood pressure monitoring remains recommended.

Inflammatory response in patients requiring parenteral nutrition: comparison of a new fish-oil-containing emulsion (SMOF®) versus an olive/soybean oil-based formula

Lipid emulsions are an essential part of parenteral nutrition (PN), such as energy supply and source of essential fatty acids. It has been shown that the composition of cell membranes is influenced by the fatty acid profile of dietary lipids, and may therefore be responsible for modulations in immune response. The aim of this study was to assess the effects of a new lipid emulsion based on soybean oil, medium-chain triglycerides, olive oil and fish oil (SMOF®) compared with a lipid emulsion based on olive and soybean oil (ClinOleic®) on the inflammatory response in postoperative ICU patients.

Comparing Entropy and the Bispectral Index with the Ramsay Score in Sedated ICU Patients

ENTROPY is a new anesthetic depth monitor based on the analysis of the EEG signal. Our aim has been to evaluate sedation of intubated surgical critically ill patients by means of the Ramsay sedation score, the Bispectral index and ENTROPY, and to analyse the correlation between these variables. Sedation was evaluated every 15 min for a 1 h period in 50 non-paralysed postoperative critically ill, intubated patients, enrolled over a 6 month period. A 5 min steady-state period was allowed before each assessment. Both the Bispectral index and the Entropy parameters Response Entropy (RE) and State Entropy (SE), were collected before assessing the Ramsay scale. Mean values for SE, RE and BIS were 53 +/- 27, 60 +/- 30, and 62 +/- 24 respectively. The median value for the Ramsay was 6 (range 1-6). Significant correlation was found between the four variables (SE-BIS: r = 0.79, p < 0.001; RE-BIS: r = 0.80, p < 0.001; SE-Ramsay: rho = -0.71, p < 0.001, RE-Ramsay: rho = -0.72, p < 0.001; BIS-Ramsay: rho = -0.78, p < 0.001; RE-SE: r = 0.98, p < 0.001). An overlap of BIS and Entropy values for every Ramsay score value between 4-6 was found. ENTROPY, BIS and Ramsay score values correlate significantly in sedated postoperative ICU patients. ENTROPY does not appear superior to BIS for the assessment of sedation in this context.

Nosocomial infection: main cause in development of septic complications in surgical postoperative patients

In this first attempt to prove the main cause of septic complications in postoperative ICU patients in Bulgaria's biggest hospital (more than 1000 beds) we analyzed all patient admitted in general ICU during 5 year period (1993-1997).

Semi-continuous versus injectate cardiac output measurement in intensive care patients after cardiac surgery

ObjectiveCommercially available semi-continuous cardiac output (SCCO) monitoring systems are based on the pulsed warm thermodilution technique. There is evidence that SCCO fails to correlate with standard intermittent bolus cardiac output (ICO) in clinical situations with thermal instability in the pulmonary artery. Furthermore, ventilation may potentially influence thermodilution measurements by enhanced respiratory variations in pulmonary artery blood temperature and by cyclic changes in venous return. Therefore, we evaluated the correlation, accuracy and precision of SCCO versus ICO measurements before and after extubation.DesignProspective cohort study.SettingIntensive care unit (ICU) of a university hospital.Patients and participants22 cardiac surgical ICU patients.InterventionsNone.Measurements and resultsSCCO and ICO data were obtained at nine postoperative time points while the patients were on controlled mechanical ventilation. Further sets of measurements were taken during the weaning phase 20 min before extubation, and 5 min, 20 min and 1 h after extubation. SCCO and ICO measurements yielded 286 data pairs with a range of 1.8–9.9 l/min for SCCO and 1.9–9.8 l/min for ICO. The correlation between SCCO and ICO was highly significant (r=0.92;p<0.01), accompanied by a bias of −0.052 l/min and a precision of 0.56 l/min. Correlation, accuracy and precision were not influenced by the mode of respiration.ConclusionsOur results demonstrate excellent correlation, accuracy and precision between SCCO and ICO measurements in postoperative cardiac surgical ICU patients. We conclude that SCCO monitoring offers a reliable clinical method of cardiac ouput monitoring in ICU patients following cardiac surgery.