Postoperative Intensive Care Unit Patients Research Articles

Former smoking, but not active smoking, is associated with delirium in postoperative ICU patients: a matched case-control study.

To examine the relationship between current and former smoking and the occurrence of delirium in surgical Intensive Care Unit (ICU) patients. We conducted a single center, case-control study involving 244 delirious and 251 non-delirious patients that were admitted to our ICU between 2018 and 2022. Using propensity score analysis, we obtained 115 pairs of delirious and non-delirious patients matched for age and Simplified Acute Physiology Score II (SAPS II). Both groups of patients were further stratified into non-smokers, active smokers and former smokers, and logistic regression was performed to further investigate potential confounders. Our study revealed a significant association between former smoking and the incidence of delirium in ICU patients, both in unmatched (adjusted odds ratio (OR): 1.82, 95% confidence interval (CI): 1.17-2.83) and matched cohorts (OR: 3.0, CI: 1.53-5.89). Active smoking did not demonstrate a significant difference in delirium incidence compared to non-smokers (unmatched OR = 0.98, CI: 0.62-1.53, matched OR = 1.05, CI: 0.55-2.0). Logistic regression analysis of the matched group confirmed former smoking as an independent risk factor for delirium, irrespective of other variables like surgical history (p = 0.010). Notably, also respiratory and vascular surgeries were associated with increased odds of delirium (respiratory: OR: 4.13, CI: 1.73-9.83; vascular: OR: 2.18, CI: 1.03-4.59). Medication analysis showed that while Ketamine and Midazolam usage did not significantly correlate with delirium, Morphine use was linked to a decreased likelihood (OR: 0.27, 95% CI: 0.13-0.55). Nicotine's complex neuropharmacological impact on the brain is still not fully understood, especially its short-term and long-term implications for critically ill patients. Although our retrospective study cannot establish causality, our findings suggest that smoking may induce structural changes in the brain, potentially heightening the risk of postoperative delirium. Intriguingly, this effect seems to be obscured in active smokers, potentially due to the recognized neuroprotective properties of nicotine. Our results motivate future prospective studies, the results of which hold the potential to substantially impact risk assessment procedures for surgeries.

Correlation of Ultrasound Guided Inferior Vena Cava Collapsibility Index with Central Venous Pressure to Assess the Volume Status in Postoperative Intensive Care Unit Patients: A Prospective Observational Study

Background: Accurate assessment of intravascular volume status is a vital aspect of management of intensive care unit (ICU) patients. Inferior vena cava (IVC) diameter and IVC collapsibility index have surfaced as promising methods to accurately predict hypovolemia. But no such study has evaluated it’s their utility in postoperative patients.
 Methods: The study aimed to assess the correlation between ultrasound guided IVC collapsibility index (IVC CI) and CVP for volume status in intensive care unit patients. Hundred spontaneously breathing patients receiving postoperative care in our surgical ICU between November 2019 to march 2021were enrolled into the study. Maximum IVC diameter (IVCdmax) at end-expiration, minimum IVC diameter at end-inspiration (IVCdmin) and IVC CI were measured. Simultaneous CVP recordings were obtained.
 Results: A positive correlation was noted between IVC maximum diameter and CVP (p = <0.001) and between IVC Minimum Diameter and CVP. (p = <0.001) A negative correlation between IVC CI and CVP was seen (p = <0.001). Mean IVC CI was highest in the hypovolemic group. The area under the ROC curve (AUROC) for IVC CI predicting hypovolemia was 0.943 (95% CI: 0.9 - 0.986), thus demonstrating excellent diagnostic performance. At a cut off of ≥58.416%, IVC CI predicts hypovolemia with a sensitivity of 93.8%, and a specificity of 84%.
 Conclusion: IVC CI can be used to guide fluid therapy due to its excellent diagnostic accuracy in predicting hypovolemia in postoperative patients in ICU.

Red blood cell transfusion-related dynamics of extracellular vesicles in intensive care patients: a prospective subanalysis

Extracellular vesicles (EVs) accumulate during packed red blood cell (PRBC) storage. To date, the involvement of EVs in transfusion-related immunomodulation (TRIM) has not been prospectively evaluated in intensive care unit (ICU) patients. This was a prospective subanalysis of a recent observational feasibility study in postoperative ICU patients after: (1) open aortic surgery (Aorta), (2) bilateral lung transplantation (LuTx), and (3) other types of surgery (Comparison). Patient plasma was collected three times each before and after leukoreduced PRBC transfusion at 30-min intervals. The total number of EVs and EVs derived from erythrocytes (EryEVs), total platelets (total PEVs), activated platelets, granulocytes (GEVs), monocytes, and myeloid cells in PRBC samples and patient plasma were analyzed by flow cytometry. Statistical analysis was performed by Spearman’s correlation test, linear mixed models and pairwise comparisons by Wilcoxon matched-pairs test. Twenty-three patients (Aorta n = 5, LuTx n = 9, Comparison n = 9) were included in the final analysis. All EV subgroups analyzed were detectable in all PRBCs samples (n = 23), but concentrations did not correlate with storage time. Moreover, all EVs analyzed were detectable in all plasma samples (n = 138), and EV counts were consistent before transfusion. Concentrations of total EVs, EryEVs, total PEVs, and GEVs increased after transfusion compared with baseline in the entire cohort but not in specific study groups. Furthermore, the change in plasma EV counts (total EVs and EryEVs) after transfusion correlated with PRBC storage time in the entire cohort. Extracellular vesicles were detectable in all PRBC and plasma samples. Individual EV subtypes increased after transfusion in the entire cohort, and in part correlated with storage duration. Future clinical studies to investigate the role of EVs in TRIM are warranted and should anticipate a larger sample size.Trial registration: Clinicaltrials.gov: NCT03782623.

Ferroptosis and pyroptosis signatures in critical COVID-19 patients.

Critical COVID-19 patients admitted to the intensive care unit (ICU) frequently suffer from severe multiple organ dysfunction with underlying widespread cell death. Ferroptosis and pyroptosis are two detrimental forms of regulated cell death that could constitute new therapeutic targets. We enrolled 120 critical COVID-19 patients in a two-center prospective cohort study to monitor systemic markers of ferroptosis, iron dyshomeostasis, pyroptosis, pneumocyte cell death and cell damage on the first three consecutive days after ICU admission. Plasma of 20 post-operative ICU patients (PO) and 39 healthy controls (HC) without organ failure served as controls. Subsets of COVID-19 patients displayed increases in individual biomarkers compared to controls. Unsupervised clustering was used to discern latent clusters of COVID-19 patients based on biomarker profiles. Pyroptosis-related interleukin-18 accompanied by high pneumocyte cell death was independently associated with higher odds at mechanical ventilation, while the subgroup with high interleuking-1 beta (but limited pneumocyte cell death) displayed reduced odds at mechanical ventilation and lower mortality hazard. Meanwhile, iron dyshomeostasis with a tendency towards higher ferroptosis marker malondialdehyde had no association with outcome, except for the small subset of patients with very high catalytic iron independently associated with reduced survival. Forty percent of patients did not have a clear signature of the cell death mechanisms studied in this cohort. Moreover, repeated moderate levels of soluble receptor of advanced glycation end products and growth differentiation factor 15 during the first three days after ICU admission are independently associated with adverse clinical outcome compared to sustained lower levels. Altogether, the data point towards distinct subgroups in this cohort of critical COVID-19 patients with different systemic signatures of pyroptosis, iron dyshomeostasis, ferroptosis or pneumocyte cell death markers that have different outcomes in ICU. The distinct groups may allow 'personalized' treatment allocation in critical COVID-19 based on systemic biomarker profiles.

Retrospective investigation of acute kidney injury in postoperative patients in ICU

Aims: The development of acute kidney injury (AKI) in the postoperative period is associated with increased morbidity and mortality. This study aims to determine the incidence of postoperative acute kidney injury (AKI) and the factors affecting the development of AKI in the intensive care unit (ICU) and to evaluate the outcomes of the patients.
 Methods: Postoperative patients hospitalized in the ICU between December 2021 and January 2023 were retrospectively analyzed, and 192 patients were included in the study. Kidney disease: patients with and without AKI were identified using the improving global outcomes (KDIGO) criteria.
 Results: While 150 of the patients did not develop AKI (non-AKI group), 42 of them developed acute kidney injury (AKI group). The patients were operated on mostly by the orthopedics clinic (58.9%) and operated on at least by the urology clinic (2.1%) were taken to the intensive care unit. 39.6% of the patients underwent emergency surgery, and 60.4% underwent elective surgery. 57.1% of the AKI group and 34.7% of the non-AKI group had emergency surgery (p=0.008).
 Conclusion: In our study, age, timing of surgery, use of diuretics, and use of vasopressors were found to be associated with the development of postoperative AKI. In addition, comorbid diseases such as diabetes mellitus, hypertension, coronary artery disease, and cerebrovascular disease have also been found to be associated with AKI. Mortality, length of stay in the intensive care unit, and need for mechanical ventilation (MV) were also higher in our postoperative intensive care patients who developed AKI than in patients who did not develop AKI.

228-OR: Accuracy and Reliability of Real-Time Continuous Glucose Monitoring in the Intensive Care Unit after Major Abdominal Surgery

Introduction: Blood glucose control in patients requiring intensive care remains a therapeutic challenge; however, recent advancements in glucose sensing technologies have sparked interest in the potential use of real-time continuous glucose monitoring in the subcutaneous compartment (rtCGM) also in the intensive care unit (ICU) setting. We performed a clinical trial assessing the accuracy and reliability of rtCGM in postoperative ICU patients after major abdominal surgery. Methods: Patients undergoing pancreatic surgery, liver transplantation, pancreas (or pancreatic islets) and kidney transplantation were enrolled in the trial. Dexcom G6 (Dexcom, Inc., San Diego, USA) was used for rtCGM. Arterial blood glucose measured by the amperometric principle (ABL 800, Radiometer, Copenhagen, Denmark) served as reference and to calibrate the Dexcom G6 (every 6 hours on day 1, once daily day 2 and 3). Sensor accuracy was assessed by computing mean absolute relative difference (MARD), bias, modified Bland-Altman plot and surveillance error grid for paired samples of glucose values from CGM and ABL. Results: Sixty-one patients after major abdominal surgery staying in ICU post-operatively were included into this analysis. Median monitoring length was 7 days with a 97.1 ± 6.5% proportion of active CGM use. Overall, 1566 paired glucose values measured with CGM and ABL were obtained. MARD for CGM compared with ABL-measured glucose was 9.7% with a bias of 0.9% and coefficient of variation of 14%. In the surveillance error grid analysis, 90.9% of pairs were in the 0 risk zone and 7.9% in the risk zone 1 (out of 7). Throughout the study 3 sensors needed to be replaced due to technical problems. Conclusion: Our results show a clinically applicable accuracy and reliability of the Dexcom G6 continuous glucose monitoring system in postoperative ICU. This opens up new possibilities in intensifying ICU glucose control, lowering hypoglycaemia risk and reducing nursing staff workload. Disclosure B.Hagerf (voglová): None. M.Protus: None. L.Nemetova: None. M.Mraz: None. M.Haluzik: Advisory Panel; Novo Nordisk, Lilly Diabetes, Boehringer-Ingelheim, Research Support; Sanofi, Speaker's Bureau; Abbott, AstraZeneca. P.Girman: None. J.Franekova: None. V.Svirlochova: None. A.Jabor: None. Funding Charles University; Czech Ministry of Health; Institute for Clinical and Experimental Medicine (IKEM, IN00023001); National Institute for Research of Metabolic and Cardiovascular Diseases (EXCELES, LX22NPO5104)

Acceptability and Feasibility of a Patient-Oriented Music Intervention to Reduce Pain in the Intensive Care Unit: Protocol for a Crossover Pilot Randomized Controlled Trial

Many patients experience pain in the intensive care unit (ICU) despite receiving pain medication. Research has shown that music can help reduce pain. Music interventions studied so far have not used music streaming to generate playlists based on patient preferences while incorporating recommended tempo and duration. Previous research has focused on postoperative ICU patients able to self-report, which is underrepresentative of the ICU population that might benefit from a music intervention for pain management. We developed a new patient-oriented music intervention (POMI) that incorporates features based on theoretical, empirical, and experiential data intended to be used in the ICU. Such a music intervention should consider the expertise of ICU patients, family members, and nursing staff, as well as the practicality of the intervention when used in practice. The primary objectives of this study are to (1) evaluate the acceptability and feasibility of the POMI to reduce pain in ICU patients and (2) evaluate the feasibility of conducting a crossover pilot randomized controlled trial (RCT) for intervention testing in the ICU. A secondary objective is to examine the preliminary efficacy of the POMI to reduce pain in ICU patients. A single-blind 2×2 crossover pilot RCT will be conducted. Patients will undergo 1 sequence of 2 interventions: the POMI which delivers music based on patients' preferences via headphones or music pillow for 20-30 minutes and the control intervention (headphones or pillow without music). The sequence of the interventions will be inverted with a 4-hour washout period. Timing of the interventions will be before a planned bed turning procedure. Each patient will undergo 1 session of music. Twenty-four patients will be recruited. Patients able to self-report (n=12), family members of patients unable to self-report (n=12), and nursing staff (n=12) involved in the bed turning procedure will be invited to complete a short questionnaire on the POMI acceptability. Data will be collected on the feasibility of the intervention delivery (ie, time spent creating a playlist, any issue related to headphones/pillow or music delivery, environmental noises, and intervention interruptions) and research methods (ie, number of patients screened, recruited, randomized, and included in the analysis). Pain scores will be obtained before and after intervention delivery. Recruitment and data collection began in March 2022. As of July 5, 2022, in total, 22 patients, 12 family members, and 11 nurses were recruited. Methodological limitations and strengths are discussed. Study limitations include the lack of blinding for patients able to self-report. Strengths include collecting data from various sources, getting a comprehensive evaluation of the intervention, and using a crossover pilot RCT design, where participants act as their own control, thus reducing confounding factors. ClinicalTrials.gov NCT05320224; https://clinicaltrials.gov/ct2/show/NCT05320224. DERR1-10.2196/40760.

Association of circulating histone H3 and high mobility group box 1 levels with postoperative prognostic indicators in intensive care unit patients: a single-center observational study.

Damage associated molecular patterns (DAMPs) levels are associated with sepsis severity and prognosis. Histone and high mobility group box 1 (HMGB1) levels are also potential indicators of prognosis. We investigated the relationship between serum histone H3 and HMGB1 levels and the illness severity score and prognosis in postoperative patients. Postoperative serum histone H3 and HMGB1 levels in 39 intensive care unit (ICU) patients treated at our institution were measured. The correlation between peak histone H3 and HMGB1 levels in each patient and clinical data (age, sex, surgical time, length of ICU stay, and survival after ICU discharge), which also included the patients' illness severity score, was examined. Histone H3 but not HMGB1 levels were positively correlated with surgical time, the Sequential Organ Failure Assessment score, the Japanese Association for Acute Medicine acute phase disseminated intravascular coagulation diagnosis score, and the length of ICU stay. Both histone H3 and HMGB1 levels were negatively correlated with age. However, survival post-ICU discharge was not correlated with histone H3 or HMGB1 levels. Histone H3 levels are correlated with severity scores and the length of ICU stay. Serum histone H3 and HMGB1 levels are elevated postoperatively. These DAMPs, however, are not prognostic indicators in postoperative ICU patients.

Red blood cell transfusion-related eicosanoid profiles in intensive care patients-A prospective, observational feasibility study.

Introduction: Eicosanoids are bioactive lipids present in packed red blood cells (PRBCs), and might play a role in transfusion-related immunomodulation (TRIM). We tested the feasibility of analyzing eicosanoid profiles in PRBC supernatant and in plasma samples of postoperative intensive care unit (ICU) patients transfused with one unit of PRBCs. Methods: We conducted a prospective, observational feasibility study enrolling postoperative ICU patients: 1) patients treated with acetylsalicylic acid following abdominal aortic surgery (Aorta); 2) patients on immunosuppressants after bilateral lung transplantation (LuTx); and 3) patients undergoing other types of major surgery (Comparison). Abundances of arachidonic acid (AA) and seven pre-defined eicosanoids were assessed by liquid chromatography and tandem mass spectrometry. PRBC supernatant was sampled directly from the unit immediately prior to transfusion. Spearman's correlations between eicosanoid abundance in PRBCs and storage duration were assessed. Patient plasma was collected at 30-min intervals: Three times each before and after transfusion. To investigate temporal changes in eicosanoid abundances, we fitted linear mixed models. Results: Of 128 patients screened, 21 were included in the final analysis (Aorta n = 4, LuTx n = 8, Comparison n = 9). In total, 21 PRBC and 125 plasma samples were analyzed. Except for 20-hydroxyeicosatetraenoic acid (HETE), all analyzed eicosanoids were detectable in PRBCs, and their abundance positively correlated with storage duration of PRBCs. While 5-HETE, 12-HETE/8-HETE, 15-HETE, 20-HETE, and AA were detectable in virtually all plasma samples, 9-HETE and 11-HETE were detectable in only 57% and 23% of plasma samples, respectively. Conclusions: Recruitment of ICU patients into this transfusion study was challenging but feasible. Eicosanoid abundances increased in PRBC supernatants during storage. In plasma of ICU patients, eicosanoid abundances were ubiquitously detectable and showed limited fluctuations over time prior to transfusion. Taken together, larger clinical studies seem warranted and feasible to further investigate the role of PRBC-derived eicosanoids in TRIM.

Prediction of persistent acute kidney injury in postoperative intensive care unit patients using integrated machine learning: a retrospective cohort study

Acute kidney injury (AKI) often occurs in patients in the intensive care unit (ICU). AKI duration is closely related to the prognosis of critically ill patients. Identifying the disease course length in AKI is critical for developing effective individualised treatment. To predict persistent AKI at an early stage based on a machine learning algorithm and integrated models. Overall, 955 patients admitted to the ICU after surgery complicated by AKI were retrospectively evaluated. The occurrence of persistent AKI was predicted using three machine learning methods: a support vector machine (SVM), decision tree, and extreme gradient boosting and with an integrated model. External validation was also performed. The incidence of persistent AKI was 39.4–45.1%. In the internal validation, SVM exhibited the highest area under the receiver operating characteristic curve (AUC) value, followed by the integrated model. In the external validation, the AUC values of the SVM and integrated models were 0.69 and 0.68, respectively, and the model calibration chart revealed that all models had good performance. Critically ill patients with AKI after surgery had high incidence of persistent AKI. Our machine learning model could effectively predict the occurrence of persistent AKI at an early stage.

Effect of low-dose dexmedetomidine on sleep quality in postoperative patients with mechanical ventilation in the intensive care unit: A pilot randomized trial

BackgroundSleep disturbances are prevalent in patients requiring invasive mechanical ventilation in the intensive care unit (ICU) and are associated with worse outcomes. Sedative-dose dexmedetomidine may improve sleep quality in this patient population but is associated with adverse events. Herein, we tested the effect of low-dose dexmedetomidine infusion on nighttime sleep quality in postoperative ICU patients with invasive ventilation.MethodsIn this pilot randomized trial, 80 adult patients who were admitted to the ICU after non-cardiac surgery and required invasive mechanical ventilation were randomized to receive either low-dose dexmedetomidine (0.1 to 0.2 μg/kg/h, n = 40) or placebo (n = 40) for up to 72 h. The primary endpoint was overall subjective sleep quality measured using the Richards–Campbell Sleep Questionnaire (score ranges from 0 to 100, with a higher score indicating better quality) in the night of surgery. Secondary outcomes included sleep structure parameters monitored with polysomnography from 9:00 PM on the day of surgery to the next 6:00 AM.ResultsAll 80 patients were included in the intention-to-treat analysis. The overall subjective sleep quality was median 52 (interquartile 20, 66) with placebo vs. 61 (27, 79) with dexmedetomidine, and the difference was not statistically significant (median difference 8; 95% CI: −2, 22; P = 0.120). Among 68 patients included in sleep structure analysis, those in the dexmedetomidine group tended to have longer total sleep time [median difference 54 min (95% CI: −4, 120); P = 0.061], higher sleep efficiency [median difference 10.0% (95% CI: −0.8%, 22.3%); P = 0.060], lower percentage of stage N1 sleep [median difference −3.9% (95% CI: −11.8%, 0.5%); P = 0.090], higher percentage of stage N3 sleep [median difference 0.0% (95% CI: 0.0%, 0.4%); P = 0.057], and lower arousal index [median difference −0.9 (95% CI −2.2, 0.1); P = 0.091] but not statistically significant. There were no differences between the two groups regarding the incidence of adverse events.ConclusionAmong patients admitted to the ICU after surgery with intubation and mechanical ventilation, low-dose dexmedetomidine infusion did not significantly improve the sleep quality pattern, although there were trends of improvement. Our findings support the conduct of a large randomized trial to investigate the effect of low-dose dexmedetomidine in this patient population.Clinical trial registrationClinicalTrial.gov, identifier: NCT03335527.

A study of mechanical ventilation in the ICU after cardiac surgery: a bibliometric analysis.

BackgroundAfter cardiac surgery, patients are often admitted to the intensive care unit (ICU) due to various preoperative factors and continue to receive mechanical ventilation. This study sought to conduct a bibliometric analysis to summarize studies on mechanical ventilation among postoperative ICU patients who had undergone cardiac surgery.MethodsWe searched the Science Citation Index Expanded (SCI-E) database using the following terms: “cardiac surgery (Topic)”, “intensive care (Topic)” and “ventilation (Topic)”. The search results were analyzed using R software. The analysis examined the number of publications of relevant articles and the annual change trend, the number of times an article was cited and the annual change trend, the distribution of countries conducting the research, the cooperation between countries and the citation frequency, the distribution of institutions conducting research, the cooperation between institutions, and the citation frequency, the number of published articles, the cooperation among researchers, and the citations frequency of researchers, the journals in which the articles were published, and the use of keywords.ResultsA total of 1,969 relevant research papers were included in this study. The main countries that conducted the relevant research included the United States (US), China, Germany, and Canada. The research institutions were mainly located in the US and Canada, and the main researchers were from research institutions in these countries. The most cited authors were Zappitelli, Hichey, and Wypij. According to Bradford's law, 9 core journals in this field were identified. The results of the keyword analysis showed that in the past 10 years, research has focused on the mortality of patients, but only a few related random controlled trials have been conducted.ConclusionsMore randomized controlled trials need to be conducted in this field to provide higher evidence-based medical evidence.

A study of serum magnesium levels in postoperative ICU patients undergoing major GI surgeries

BackgroundMagnesium (Mg++) deficiency can result in life-threatening complications. The incidence of hypomagnesemia, as well as any coexisting hypokalemia and Electrocardiography (ECG) abnormalities, was studied in patients undergoing major gastrointestinal (GI) surgeries. MethodsThis observational study on 51 consecutive adult Intensive Care Unit (ICU) patients recorded serum Mg++ and serum potassium (K+) levels, and 12 lead ECGs, preoperatively and postoperatively, at 48 h and 72 h. Paired “t” test, Pearson Correlation Coefficient and chi-square test were used to statistically assess the difference, correlation, and association between serum Mg++, serum K+, and abnormal ECGs, respectively. ResultsMean values for serum Mg++ were 1.72 mg/dl and 1.71 mg/dl on day 2 and 3 postops, respectively, while for serum K+ it was 4.14 meq/l and 4.02 meq/l. The incidence of postop hypomagnesemia was 52.9% with a 95% confidence interval (39.2–66.2) on Day 2 and 47.1%, with a 95% confidence interval (33.7–60.7) on Day 3. The incidence of coexisting hypokalemia was 33.3% on Day 2 and 29.2% on Day 3. There was no significant difference between pre and postop serum Mg++ and serum K+ values. The incidence of abnormal ECG was 33.3% on Day 2 postop and 28.6% on Day 3 and had a significant association with incidence of hypomagnesemia on Day 2 (P = 0.02). ConclusionIncidence of hypomagnesemia showed no significant difference pre and postoperatively. A significant association was present between the incidence of hypomagnesemia with abnormal ECG on the second postop day, but this was not found significant when compared with cases of hypomagnesemia with coexisting hypokalemia.

Validation of NANDA international nursing diagnoses at postoperative intensive care unit: quasi-experimental study

Abstract Aim. 1. Implement repeated validation of three NANDA International nursing diagnoses before and after their experimental classification in daily nursing practice at an intensive care unit for adults, at a medium-sized hospital. 2. Identify statistically significant differences in Diagnostic Content Validation (DCV) values between the two validations. Material and methods. Fehring’s DCV model was used for validation of NANDA International diagnoses. The sample of assessors consisted of 33 experts in the first stage and of 31 experts in the second stage, the experts were in both cases ICU nurses. Nursing diagnoses were experimentally applied in practice for 3 months. The data were processed using descriptive statistics, Wilcoxon matched pairs test and paired t-test. Results. Total DCV scores of diagnoses after the first validation: Impaired gas exchange 00030 with DCV 0.67; Risk for disuse syndrome 00040 with DCV 0.69 and Risk for aspiration 00039 with DCV 0.73. The DCV values after the second validation were as follows: 0.63; 0.64 and 0.78 respectively. Conclusions. Nursing diagnoses: Impaired gas exchange 00030, Risk for disuse syndrome 00040 and Risk for aspiration 00039 are valid for nursing diagnostics of adult lucid postoperative intensive care unit patients at a medium-sized hospital.

Perioperative factors and pressure ulcer development in postoperative ICU patients: a retrospective review.

To identify variables during surgery that may contribute to the development of pressure ulcers (PUs) in postoperative, intensive care unit (ICU) patients within 72 hours of admission, as well as over their entire ICU admission. Furthermore, to investigate how these variables may impact on the number of PUs acquired. In a three-year retrospective audit, from 1 January 2014 to 31 December 2016, data from the electronic medical records of 3484 postoperative ICU patients in a major Australian metropolitan public hospital were retrieved and analysed to investigate associations between perioperative variables and PU occurrence. A total of 69 ICU admissions (1.98%) out of 3484 resulted in at least one PU developing within the ICU. No specific variables were associated with the development of a PU within 72 hours of the patient's ICU admission. Multiple regression Cox analysis showed that length of time in the operating theatre (OT) (p=0.045), surgical specialty (p<0.001), 1-4 hypotensive episodes (p=0.017) and >5 hypotensive episodes (p<0.0005) were significantly associated with PU risk. Multivariable negative binomial regression demonstrated APACHE II score (p<0.01), OT time (p<0.01) and surgical specialty (p<0.01) were associated with PU number. There are many risks to skin integrity at the perioperative period, and these risks may exert their effect well into the ICU admission period. It is imperative to identify and mitigate these factors in order to reduce PU incidence, morbidity and mortality.

Impact of timing and duration of postoperative delirium: a retrospective observational study

BackgroundRecent reports suggest that not all critically ill patients with delirium share the same consequences. The outcomes of surgical intensive care unit patients with postoperative delirium were evaluated depending on the onset and duration of delirium. MethodsA total of 527 patients who were admitted from the operating theater and cared for in the surgical intensive care unit for >24 hours were evaluated for delirium using the Confusion Assessment Method for intensive care unit, 3 times a day. Patients were analyzed according to the onset time and duration of delirium. Patients were classified into 4 groups according to the onset and duration of delirium: no delirium, early brief delirium (delirium for <1 day on postoperative day 0), late brief delirium (delirium for <1 day after postoperative day 0), and persistent delirium (delirium for ≥1 days). Duration of stay (intensive care unit and hospital) and mortality (intensive care unit, hospital, and 1-year) were outcomes of interest. ResultsOf the 527 patients, delirium developed in 119 (22.6%) patients. More than two-thirds of the patients developed delirium on postoperative day 0 or 1, and 70% of patients developed delirium for >24 hours (persistent). Persistent delirium was associated with longer intensive care unit (4.6 [1.1–53.3] vs 1.6 [1.1–37.5] days) and hospital duration of stay (24 [3–112] vs 16 [2–225] days) and higher hospital mortality (14.5% vs 2.2%) compared to no delirium (P < .01). ConclusionFor postoperative intensive care unit patients, intensive care unit and hospital duration of stay did not seem to differ between patients with early brief delirium or no delirium, whereas patients with late brief or persistent delirium seemed to show longer intensive care unit and hospital duration of stay and higher mortality.

The optimal effect-site concentration of propofol for endotracheal suctioning in intensive care unit patients

Objective: To evaluate the optimal effect-site concentration (Ce) of propofol during endotracheal suction (ETS) in the postoperative Intensive Care Unit (ICU) sedated patients. Design and Setting: The study design was a prospective randomized clinical study in a 13-bed ICU in a medical center. Patients: Thirteen mechanically ventilated patients were included in this study. Methods: All included postoperative patients received sedation by target-controlled infusion (TCI) of propofol under bispectral index (BIS) monitoring and 2–4 μg/kg/h fentanyl infusion for analgesia to keep numerical rating scale ≤4. While ETS was need, the sedation interventions were performed. We used the up-and-down method with a step size of propofol Ce 0.2 μg/ml for the next intervention. The sedation interventions of 1, 2, and 3 were baseline propofol Ce, baseline propofol Ce +0.2 mg/ml, and baseline propofol Ce +0.4 μg/ml, respectively. The predetermined propofol Ce was maintained for 5 min before ETS. Arterial systolic blood pressures (SBPs), arterial diastolic blood pressure (DBP), heart rates (HRs), and BIS before and after ETS were recorded. No moderate or severe coughing with limb movement was the primary outcome, and the surge of SBP, DBP, and HR ≤20% of baseline was the secondary outcome. Results: There were 39, 72, and 45 ETS were performed in the intervention 1, 2, and 3, respectively. In the primary outcome, the successful rates of ETS were 100%, 37.5%, and 15.4% in the intervention 3, 2, and 1, respectively (P < 0.001). In the secondary outcomes, the successful rates were 100% in all interventions. However, the surge of SBP (P = 0.009), DBP (P = 0.025), and HR (P = 0.009) were significant higher in the intervention 1 and 2 than the intervention 3. Right after the ETS, significant increase in BIS level was observed in the intervention 1 (13.9± 7.9) and 2 (14.4± 7.5) except for intervention 3 (−2.8± 14.5) (P = 0.003). Conclusions: An increase of propofol Ce 0.4 mg/ml for 5 min before ETS provided adequate sedation result in markedly attenuated ETS-induced coughing, limb movement, and hyperdynamic status during ETS while the use of TCI propofol sedation in postoperative ICU patients.

Serum Calprotectin Expression as a Diagnostic Marker for Sepsis in Postoperative Intensive Care Unit Patients.

The research was performed to explore the diagnosis value of dynamic serum calprotectin (SC) expression for sepsis in postoperative intensive care unit patients. One hundred sixty-three patients who met the inclusion criteria served as the study group. All cases in the study group were further divided into the sepsis subgroup (51 cases) and the nonsepsis subgroup (112 cases). Fifty healthy volunteers served as the control group. The levels of SC and other laboratory indexes including complete blood counts, leukocytes, the immature-to-total-neutrophil ratio, procalcitonin (PCT), C-reactive protein, and blood lactate were detected, cytokines [interleukin (IL)-2, IL-6, and interferon-γ] released by neutrophils were also determined. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the Sequential Organ Failure Assessment score were calculated. The factors related to prognosis were analyzed with multivariate logistic regression analysis. The diagnostic accuracies of ΔSC [the differences of SC levels between postoperative day (POD) 1 and POD 2, 3, 5, 7] and ΔPCT (the differences of PCT levels between POD 1 and POD 2, 3, 5, 7) on sepsis were compared with other markers for sepsis. The levels of SC and cytokines were markedly increased on POD 1, 2, 3, 5, and 7 in the study group compared with the control group (P < 0.05 or P < 0.01). The same results were found in the sepsis subgroup compared with the nonsepsis subgroup (P < 0.05 or P < 0.01). Significant positive correlations between SC and cytokines were confirmed in patients of the study group (P < 0.05 or P < 0.01). APACHE II scores and the levels of SC and PCT on POD 1 were the variables significantly associated with sepsis. The diagnostic accuracies of ΔSC1-3 (sensitivity 87%, specificity 89%) and ΔPCT1-3 (sensitivity 89%, specificity 90%) for sepsis were greater than other ΔSCs and ΔPCTs. It appears that the dynamic changes in SC are of the predictive values for septic patients after major surgeries.

Telemedicine coverage for post-operative ICU patients

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical care service from January 1st 2008 to July 31st 2011 was conducted at an urban, academic, tertiary centre and level 1 trauma centre. Results Compared to the SICU group (n = 6652), patients in the VICU group (n = 1037) were slightly older (median age 60 (IQR 47–69) versus 58 (IQR 44–70) years, p = 0.002) and had lower acute physiology and chronic health evaluation (APACHE) II scores (median 10 (IQR 7–14) versus 15 (IQR 11–21), p < 0.001). The average amount of time patients spent in the VICU was 13.7 + /–9.6 hours. In the VICU group, 750 (72%) of patients were able to be transferred directly to the floor; 287 (28%) required subsequent admission to the surgical intensive care unit. All patients in the VICU group were alive upon transfer out of the PACU while mortality in the surgical intensive unit cohort was 5.5%. Discussion A collaborative care model between a surgical critical care service and a telemedicine ICU service may safely provide surge capacity during peak periods of ICU bed demand. The specific patient populations for which this approach is most appropriate merits further investigation.

The prevalence of long QT interval in post-operative intensive care unit patients.

The severity of patient illnesses and medication complexity in post-operative critically ill patients increase the risk for a prolonged QT interval. We determined the prevalence of prolonged QTc in surgical intensive care unit (SICU) patients. We performed a prospective cross-sectional study over a 15-month period at a major academic center. SICU pre-admission and admission EKGs, patient demographics, and laboratory values were analyzed. QTc was evaluated as both a continuous and dichotomous outcome (prolonged QTc>440ms). 281 patients were included in the study: 92% (n=257) post-operative and 8% (n=24) non-operative. On pre-admission EKGs, 32% of the post-operative group and 42% of the non-operative group had prolonged QTc (p=0.25); on post-admission EKGs, 67% of the post-operative group but only 33% of the non-operative group had prolonged QTc (p<0.01). The average change in QTc in the post-operative group was +30.7ms, as compared to +2ms in the non-operative group (p<0.01). On multivariable adjustment for long QTc as a dichotomous outcome, pre-admission prolonged QTc (OR 3.93, CI 1.93-8.00) and having had an operative procedure (OR 4.04, CI 1.67-9.83) were associated with developing prolonged QTc. For QTc as a continuous outcome, intra-operative beta-blocker use was associated with a statistically-significant decrease in QTc duration. None of the patients developed a lethal arrhythmia in the ICU. Prolonged QTc is common among post-operative SICU patients (67%), however lethal arrhythmias are uncommon. The operative experience increases the risk for long QTc.