Prolonged Intensive Care Unit Length Of Stay Research Articles

Early prediction of long hospital stay for Intensive Care units readmission patients using medication information

ObjectivePredicting Intensive Care Unit (ICU) Length of Stay (LOS) accurately can improve patient wellness, hospital operations, and the health system's financial status. This study focuses on predicting the prolonged ICU LOS (≥3 days) of the 2nd admission, utilizing short historical data (1st admission only) for early-stage prediction, as well as incorporating medication information. Materials and methodsWe selected 18,572 ICU patients’ records from the MIMIC-IV database for this study. We applied five machine learning classifiers: Logistic regression (LR), Random Forest (RF), Support Vector Machine (SVM), AdaBoost (AB) and XGBoost (XGB). We computed both the sum dose and the average dose for the medication and included them in our model. ResultsThe performance of the RF model demonstrates the highest level of accuracy compared to other models, as indicated by an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.716 and an Expected Calibration Error (ECE) of 0.023. DiscussionThe calibration improved all five classifiers (LR, RF, SVC, AB, XGB) in terms of ECE. The most important two features for RF are the length of 1st admission and the patient's age when they visited the hospital. The most important medication features are Phytonadione and Metoprolol Succinate XL. Also, both the sum and the average dose for the medication features contributed to the prediction task. ConclusionOur model showed the capability to predict the prolonged ICU LOS of the 2nd admission by utilizing the demographic, diagnosis, and medication information from the 1st admission. This method can potentially support the prevention of patient complications and enhance resource allocation in hospitals.

Clinical nomogram prediction model to assess the risk of prolonged ICU length of stay in patients with diabetic ketoacidosis: a retrospective analysis based on the MIMIC-IV database

BackgroundThe duration of hospitalization, especially in the intensive care unit (ICU), for patients with diabetic ketoacidosis (DKA) is influenced by patient prognosis and treatment costs. Reducing ICU length of stay (LOS) in patients with DKA is crucial for optimising healthcare resources utilization. This study aimed to establish a nomogram prediction model to identify the risk factors influencing prolonged LOS in ICU-managed patients with DKA, which will serve as a basis for clinical treatment, healthcare safety, and quality management research.MethodsIn this single-centre retrospective cohort study, we performed a retrospective analysis using relevant data extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Clinical data from 669 patients with DKA requiring ICU treatment were included. Variables were selected using the Least Absolute Shrinkage and Selection Operator (LASSO) binary logistic regression model. Subsequently, the selected variables were subjected to a multifactorial logistic regression analysis to determine independent risk factors for prolonged ICU LOS in patients with DKA. A nomogram prediction model was constructed based on the identified predictors. The multivariate variables included in this nomogram prediction model were the Oxford acute severity of illness score (OASIS), Glasgow coma scale (GCS), acute kidney injury (AKI) stage, vasoactive agents, and myocardial infarction.ResultsThe prediction model had a high predictive efficacy, with an area under the curve value of 0.870 (95% confidence interval [CI], 0.831–0.908) in the training cohort and 0.858 (95% CI, 0.799–0.916) in the validation cohort. A highly accurate predictive model was depicted in both cohorts using the Hosmer–Lemeshow (H-L) test and calibration plots.ConclusionThe nomogram prediction model proposed in this study has a high clinical application value for predicting prolonged ICU LOS in patients with DKA. This model can help clinicians identify patients with DKA at risk of prolonged ICU LOS, thereby enhancing prompt intervention and improving prognosis.

Impact of changes in skeletal muscle mass and quality during the waiting time on outcomes of lung transplantation.

The association of changes in skeletal muscle mass and quality during the waiting time with outcomes of lung transplantation (LT) remains unclear. We aimed to examine the association of changes in skeletal muscle mass and quality during the waiting time, as well as preoperative skeletal muscle mass and quality, with outcomes of LT. This study included individuals who underwent LT from brain-dead donors. Skeletal muscle mass (cm2 /m2 ) and quality (mean Hounsfield units [HU]) of the erector spinae muscle at the 12th thoracic level were evaluated using computed tomography. Preoperative skeletal muscle mass and quality, and their changes during the waiting time were calculated. We evaluated the associations among mechanical ventilation (MV) duration, intensive care unit (ICU) length of stay (LOS), hospital LOS, 6-minute walk distance at discharge, and 5-year survival after LT. This study included 98 patients. The median waiting time was 594.5days (interquartile range [IQR], 355.0-913.0). The median changes in skeletal muscle mass and quality were -4.4% (IQR, -13.3-3.1) and -2.9% (IQR, -16.0-4.1), respectively. Severe low skeletal muscle mass at LT was associated with prolonged ICU LOS (B=8.46, 95% confidence interval [CI]: .51-16.42) and hospital LOS (B=36.00, 95% CI: 3.23-68.78). Pronounced decrease in skeletal muscle mass during the waiting time was associated with prolonged MV duration (B=7.85, 95% CI: .89-14.81) and ICU LOS (B=7.97, 95% CI: .83-15.10). Maintaining or increasing skeletal muscle mass during the waiting time would be beneficial to improve the short-term outcomes of LT.

Prognostic value of serum phosphate levels in sepsis: a systematic review and meta-analysis.

There remain controversies over the conclusion of different serum phosphate levels as prognostic predictors of sepsis patients. As such, this study investigated the association between different serum phosphate and the prognosis of sepsis. Data from PubMed, Embase, Cochrane Library, and Web of Science were systematically retrieved from the inception of databases to June 1, 2023 and independently screened and extracted by two authors. Binary variables in the study were estimated as relative risk ratio (RR) and 95% confidence interval (CI), and continuous variables were estimated as mean and standard deviation. The Newcastle-Ottawa Scale (NOS) was employed to evaluate the quality of the included studies, and subgroup analysis and sensitivity analysis were performed for all outcomes to explore the sources of heterogeneity. Ten studies were included in this study including 38,320 patients with sepsis or septic shock. Against normal serum phosphate levels, a high serum phosphate level was associated with an elevated all-cause mortality risk (RR = 1.46; 95% CI [1.22-1.74]; P = 0.000) and prolonged Intensive Care Unit (ICU) length of stay (LOS) (WMD = 0.63; 95% CI [0.27-0.98]; P = 0.001). However, there was no significant difference in the in-hospital LOS (WMD = 0.22; 95% CI [-0.61-1.05]; P = 0.609). A low serum phosphate level was not significantly associated with the all-cause mortality risk (RR = 0.97; 95% CI [0.86-1.09]; P = 0.588), ICU LOS (WMD = -0.23; 95% CI [-0.75-0.29]; P = 0.394) and in-hospital LOS (WMD = -0.62; 95% CI [-1.72-0.49]; P = 0.274). Sepsis patients with high serum phosphate levels before therapeutic interventions were associated with a significant increase in the all-cause mortality risk, prolonged ICU LOS, and no significant difference in in-hospital LOS. Sepsis patients with low serum phosphate levels before interventions may have a reduced risk of all-cause mortality, shorter ICU LOS, and in-hospital LOS, but the results were not statistically significant.

Feasibility and criterion validity of the GLIM criteria in the critically ill: A prospective cohort study.

This study aimed to evaluate the feasibility and validity of the GLIM criteria in the ICU. Cohort study involving critically ill patients. Diagnosis of malnutrition by the Subjective Global Assessment (SGA) and GLIM criteria within 24 h after ICU admission were prospectively performed. Patients were followed up until hospital discharge to assess the hospital/ICU length of stay, mechanical ventilation duration, ICU readmission, and hospital/ICU mortality. Three months after discharge, the patients were contacted to record outcomes (readmission and death). Agreement, accuracy tests and regression analyses were performed. GLIM criteria could be applied to 83.7% of 450 patients (64 [54-71] years, 52.2% men). Malnutrition prevalence was 47.8% by SGA and 65.5% by GLIM criteria, that presented an AUC equal to 0.835 (95%CI, 0.790-0.880), sensitivity of 96.6%, and specificity of 70.3%. Malnutrition by GLIM criteria increased the odds of prolonged ICU length of stay by 1.75 times (95%CI, 1.08-2.82) and ICU readmission 2.66 times (95%CI, 1.15-6.14). Malnutrition by SGA also increased the odds of ICU readmission and the risk of ICU and hospital death more than twice. The GLIM criteria were highly feasible and presented high sensitivity, moderate specificity, and substantial agreement with the SGA in critically ill patients. It was an independent predictor of prolonged ICU length of stay and ICU readmission, but it was not associated with death such as malnutrition diagnosed by SGA. This article is protected by copyright. All rights reserved.

Evaluating the impact of timing to rib fixation in patients with traumatic brain injury: A nationwide analysis.

Early surgical stabilization of rib fractures (SSRF) is associated with improved inpatient outcomes in patients with multiple rib fractures. However, there is still a paucity of data examining the optimal timing of SSRF in patients with concomitant traumatic brain injury (TBI). This study aimed to assess whether earlier SSRF was associated with improved outcomes in patients with multiple rib fractures and TBI. We performed a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program 2017-2020, including adult patients with TBI and multiple rib fractures who had undergone SSRF. The outcomes were post-procedural length of stay (LOS), hospital LOS, intensive care unit (ICU) LOS, in-hospital mortality, ventilator days, and tracheostomy rate. Multilevel mixed-effects regression analyses accounting for patient, injury, and hospital characteristics as well as institutional SSRF volume were used to assess the association between timing to SSRF and the outcomes of interest. As a sensitivity analysis, propensity-score matching was performed to compare patients who underwent early (<72 hours) versus late SSRF (≥72 hours). Of 1,041 patients included in this analysis, 430 (41.3%) underwent SSRF within the first 72 hours from admission. Delay to SSRF was associated with an increase in post-procedural LOS (partial regression coefficient (β) = 0.011; p = 0.036; 95% confidence interval [CI], 0.001-0.023), longer hospital LOS (β = 0.053; p < 0.001; 95% CI, 0.042-0.064), prolonged ICU LOS (β = 0.032; p < 0.001; 95% CI, 0.025-0.038), and more ventilator days (β = 0.026, p < 0.001; 95% CI, 0.020-0.032). In patients with concurrent multiple rib fractures and TBI, a delay in SSRF is associated with an increase in postprocedural LOS, hospital LOS, ICU LOS, and ventilator days. These findings suggest that the early patient selection and implementation of SSRF may play a beneficial role in patients presenting with concomitant TBI and multiple rib fractures. Therapeutic/Care Management; Level IV.

Influence of Congenital Heart Defect Types over Cardiopulmonary Bypass, Aortic Cross-Clamping, and Intensive Care Unit Length of Stay and Their Association with Genetic Factors

Aim: Surgical correction of congenital heart defects (CHD) often requires interruption of blood flow through cardiopulmonary bypass (CPB) and aortic cross-clamping (ACC), for which duration(s) are considered to be prognostic factors, along with intensive care unit (ICU) length of stay (ICULOS). The aim of this study was to evaluate these surgical prognostic factors in pediatric patients with different types of CHD regarding their type of lesion and associated genetic factors.&#x0D; Study Design: Cross-sectional cohort study with 307 pediatric patients.&#x0D; Place and Duration of Study: Pediatric Intensive Care Unit (ICU) of Hospital da Criança Santo Antônio, in Porto Alegre/RS, Brazil, from 2006-2009 (3 years)&#x0D; Methodology: After inclusion criteria, we studied 266 pediatric patients admitted for the first time in a reference cardiac pediatric ICU from Southern Brazil following cardiac surgery. Intraoperative prognostic factors such as duration of CPB, ACC and ICULOS, in addition to dysmorphological and cytogenetic examinations were compiled and analyzed. P-values of &lt;0.05 were considered significant.&#x0D; Results: CPB time was associated to four outflow tract defects (Tetralogy of Fallot [ToF], transposition of the great arteries [TGA], double outlet right ventricle, and truncus arteriosus [TA]), atrioventricular septal defect, and hypoplastic left heart syndrome (HLHS) (P &lt; 0.001). ACC duration was associated with three outflow tract defects (ToF, TGA, and TA) and HLHS (P &lt; 0.001). Moreover, CPB and ACC times showed an association with cyanotic and complex heart defects, as well as prolonged ICULOS (P &lt; 0.001). There was no relationship between these prognostic factors and syndromic aspects or cytogenetic findings.&#x0D; Conclusions: CHD type has an impact over CPB and ACC duration and ICULOS, whereas genetic factors are not associated with those prognostic factors.

Prevalence of Frailty in ICU and its Impact on Patients' Outcomes.

Frailty describes a state or syndrome of reduced physical, physiologic, and cognitive reserve that increases vulnerability to acute illness. To study the prevalence of frailty in critically ill patients and find its association with resource utilization and short-term intensive care unit (ICU) outcomes. This was a prospective observational study. All adult patients ≥50 years admitted to the ICU were included and frailty was assessed by the clinical frailty score (CFS). Data were collected on demography, coexisting illness, CFS, Acute Physiology and Chronic Health Evaluation II (APACHE-II), and Sequential Organ Failure Assessment Score (SOFA) scores. Patients were followed for 30 days. Outcome data were collected on organ supports provided, duration of ICU and hospital length of stay (LOS), and ICU and 30-day mortality. 137 patients were enrolled in the study. The prevalence of frailty was 38.6%. Frail patients were older and had a more comorbid illness. APACHE-II and SOFA scores were 22.1 ± 7.0 and 7.2 ± 3.29, significantly higher in frail patients, respectively. There was a trend towards higher requirement for organ supports in frail patients. Median ICU and hospital LOS were 8 vs 6 and 20 vs 12 (frail vs nonfrail) days, respectively (p < 0.05). Intensive care unit mortality in frail and nonfrail patients was 28.3% and 23.8%, respectively (p = 0.56). Thirty-day mortality in frail patients was 49%, significantly higher compared with nonfrail patients (28.5%). The prevalence of frailty in ICU patients was high. Frail patients were quite ill on ICU admission, and they had a prolonged ICU and hospital LOS. Increasing frailty score was associated with higher mortality at 30 days. Kalaiselvan MS, Yadav A, Kaur R, Menon A, Wasnik S. Prevalence of Frailty in ICU and its Impact on Patients' Outcomes. Indian J Crit Care Med 2023;27(5):335-341.

Age, Gender, and Preoperative LVEF Influence on ICU Length of Stay After CABG

Coronary artery bypass graft (CABG) surgery is a surgical therapy for coronary artery disease (CAD) patients who cannot be solely treated using pharmacological therapy. Patients undergoing CABG surgery require careful postoperative monitoring in the intensive care unit (ICU). This leads to the need for careful selection of patients due to the limited number of ICU beds available. A prolonged stay in ICU could delay surgery for other patients. This retrospective study analyzed how preoperative factors such as age, gender, and preoperative left ventricular ejection fraction (LVEF) may influence patient's length of stay (LOS) in the ICU. For this study, subjects were patients undergoing isolated CABG in Dr. Hasan Sadikin General Hospital Bandung, Indonesia, during the period of January 2019- December 2020 who were selected using the simple random sampling method. The subjects were categorized into &lt;65 years old and ≥65 years old age groups; man and woman gender; preoperative LVEF of &lt;40% and ≥40%; and prolonged ICU LOS (&gt;96 hours) and non-prolonged ICU LOS (&lt;96 hours). Deceased patients in the ICU were excluded. Results of the bivariate and multivariate analyses showed that age was the only factor (p-value of 0.017) that increased the risk of prolonged ICU LOS (OR of 3.34) after CABG surgery that was statistically significant. This study concluded that patient of old age (&gt;65 years old) is at a higher risk of having prolonged ICU LOS after CABG; thus, a careful scheduling of patients for CABG surgery by age is important to prevent prolonged ICU LOS after CABG.

Predicting factors associated with prolonged intensive care unit stay of patients with COVID-19.

Predicting the length of stay (LOS) for coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU) is essential for efficient use of ICU resources. We analyzed the clinical characteristics of patients with severe COVID-19 based on their clinical care and determined the predictive factors associated with prolonged LOS. We included 96 COVID-19 patients who received oxygen therapy at a high-flow nasal cannula level or above after ICU admission during March 2021 to February 2022. The demographic characteristics at the time of ICU admission and results of severity analysis (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation [APACHE] II), blood tests, and ICU treatments were analyzed using a logistic regression model. Additionally, blood tests (C-reactive protein, D-dimer, and the PaO2 to FiO2 ratio [P/F ratio]) were performed on days 3 and 5 of ICU admission to identify factors associated with prolonged LOS. Univariable analyses showed statistically significant results for SOFA score at the time of ICU admission, C-reactive protein level, high-dose steroids, mechanical ventilation (MV) care, continuous renal replacement therapy, extracorporeal membrane oxygenation, and prone position. Multivariable analysis showed that MV care and P/F ratio on hospital day 5 were independent factors for prolonged ICU LOS. For D-dimer, no significant variation was observed at admission; however, after days 3 and 5 days of admission, significant between-group variation was detected. MV care and P/F ratio on hospital day 5 are independent factors that can predict prolonged LOS for COVID-19 patients.

Evaluation of Dexmedetomidine as an Adjunct to Phenobarbital for Alcohol Withdrawal in Critically Ill Patients.

Dexmedetomidine (DEX) is commonly used with benzodiazepines for the management of alcohol withdrawal syndrome (AWS), but limited data exist regarding its use with phenobarbital (PHB). This analysis evaluated the utility of DEX in addition to PHB for AWS in adult patients admitted to the intensive care unit (ICU). This was a single-center, retrospective cohort analysis of critically ill adult patients who received PHB plus either DEX or different adjunctive therapies (NO-DEX) for AWS between 2018 and 2021. Patients were excluded if they had underlying altered mental status or seizure disorder unrelated to AWS or received PHB at outside hospitals. Coarsened exact matching (CEM) was performed to match patients on baseline characteristics in a 1:1 ratio. The primary outcome was ICU length of stay (LOS). A multivariate linear regression analysis was performed to assess the effects of DEX on ICU LOS when accounting for confounders. Secondary outcomes included days with delirium and incidence of mechanical ventilation after PHB administration. Of the 606 encounters evaluated, 197 met criteria for inclusion. After CEM, 56 encounters remained in each group for analysis. The median ICU LOS was 97.2 [50.1:139.5] hours for the DEX group and 47.5 [28.8:88.1] hours for the NO-DEX group (P = .002). The multivariate linear regression analysis showed the use of DEX (P = .008) was independently associated with an increased ICU LOS by 49.8 h. The DEX group had higher rates of total delirium days (208 vs 143 days, P < .001) and a higher incidence of mechanical ventilation after PHB administration (32% vs 9%, P < .001). This analysis suggests the use of adjunctive DEX with PHB for AWS was associated with a prolonged ICU LOS. Additional studies are needed to further understand the role of adjunctive DEX in the treatment of AWS in critically ill patients.

Factors associated with prolonged intensive care unit treatment and organ failure in pediatric patients with diabetic ketoacidosis

Context: Patients with diabetic ketoacidosis (DKA) have potential complications, such as respiratory failure, cerebral edema, or acute renal injury, all of which can lead to a prolonged hospital course. Aims: This study identified risk factors for prolonged intensive care unit (ICU) stay and organ failure in pediatric patients with DKA. Materials and Methods: Patients with DKA aged <19 years admitted to the pediatric ICU of our hospital between June 2011 and May 2021 were enrolled. Demographic characteristics, initial Glasgow Coma Scale score, source of admission, biochemical values, ICU length of stay (LOS), and hospital LOS were collected. The primary outcome was to identify factors associated with prolonged (≥48 h) ICU treatment. The secondary outcomes were to identify factors associated with respiratory failure, cerebral injury, or acute renal failure. Results: This study enrolled 137 patients. Nonemergency room admission was associated with longer ICU LOS [adjusted odds ratio (aOR), 3.14; 95% confidence interval (CI) 1.01–9.82] compared with admission from the emergency room. Older age (aOR, 0.89; 95% CI, 0.80–0.99) and underweight (aOR, 0.33; 95% CI, 0.12–0.95) were associated with shorter ICU LOS. Conclusions: Recognizing the risk factors associated with prolonged ICU LOS in pediatric patients with DKA may help clinicians with the early identification of critical DKA cases.

Association of chloride-rich fluids and medication diluents on the incidence of hyperchloremia and clinical consequences in aneurysmal subarachnoid hemorrhage

Background: Chloride-rich fluid administration is frequently employed in the management of aneurysmal subarachnoid hemorrhage (aSAH). However, the incidence and consequences of hyperchloremia in aSAH remain poorly defined. This study aimed to describe the incidence of hyperchloremia in aSAH, the contribution of fluid sources to chloride exposure, and the potential associations of hyperchloremia with patient outcomes.Methods: This was a single-center retrospective cohort study of patients admitted to a neurointensive care unit with aSAH. The primary outcome was incidence of hyperchloremia (chloride &gt;109 mEq/L). Secondary outcomes included incidence of severe hyperchloremia (chloride &gt;115 mEq/L), incidence of acute kidney injury (AKI), need for renal replacement therapy (RRT), intensive care unit (ICU) length of stay (LOS), hospital LOS, and in-hospital mortality.Results: Of the 234 patients included in the analysis, hyperchloremia occurred in 75% (n=175), and 58% (n=101) developed severe hyperchloremia. Median time to onset was 3 days (interquartile range, 1–5) after admission. Hyperchloremia was associated with prolonged ICU LOS (12 vs. 8 days, P&lt;0.001), duration of mechanical ventilation (16 vs. 10 days, P&lt;0.001), hospital LOS (15 vs. 9 days, P&lt;0.001), and in-hospital mortality (14.3% vs. 0%, P=0.002) compared to no hyperchloremia. No significant difference was observed in the incidence of AKI or the need for RRT. Maintenance intravenous fluids accounted for the highest proportion of the cumulative chloride burden.Conclusion: Hyperchloremia occurs at a high frequency in aSAH and is associated with poor patient outcomes. Maintenance intravenous fluids accounted for the highest proportion of cumulative chloride burden.

C-reactive protein as a non-linear predictor of prolonged length of intensive care unit stay after gastrointestinal cancer surgery.

The relationship between C-reactive protein (CRP) levels and prolonged intensive care unit (ICU) length of stay (LoS) has not been well defined. To explore the association between CRP levels at ICU admission and prolonged ICU LoS in gastrointestinal cancer (GC) patients after major surgery. A retrospective study was performed to quantify serum CRP levels and to establish their association with prolonged ICU LoS (≥ 72 h) in GC patients admitted to the ICU. Univariate and multivariate regression analyses were conducted, and restricted cubic spline curves with four knots (5%, 35%, 65%, 95%) were used to explore non-linearity assumptions. A total of 408 patients were enrolled. Among them, 83 (20.3%) patients had an ICU LoS longer than 72 h. CRP levels were independently associated with the risk of prolonged ICU LoS [odds ratio (OR) 1.47, 95% confidence interval (CI) 1.00-2.17]. Restricted cubic spline analysis revealed a non-linear relationship between CRP levels and OR for the prolonged ICU LoS (P = 0.035 for non-linearity). After the cut-off of 2.6 (log transformed mg/L), the OR for prolonged ICU LoS significantly increased with CRP levels. The adjusted regression coefficient was 0.70 (95%CI 0.31-1.57, P = 0.384) for CRP levels less than 2.6, whereas it was 2.43 (95%CI 1.39-4.24, P = 0.002) for CRP levels higher than 2.6. Among the GC patients, CRP levels at ICU admission were non-linearly associated with prolonged ICU LoS in survivors. An admission CRP level > 2.6 (log transformed mg/L) was associated with increased risk of prolonged ICU LoS.

Treatment with Impella and veno-arterial extracorporeal membrane oxygenation during cardiac arrest on survival in a multicenter cohort

Abstract Background International organisations advocate the use of extracorporeal cardio-pulmonary resuscitation (ECPR) with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in selected patients with therapy-refractory cardiac arrest [1–3]. Although VA-ECMO allows for full circulatory support, it is inherent to increased left ventricular (LV) pressure due to retrograde aortic perfusion, which may hamper myocardial recovery and aggravate pulmonary oedema. In order to mitigate these negative sequelae, adjunct LV unloading with an Impella microaxial flow pump may be considered. The effects of concomitant treatment with VA-ECMO and Impella (ECMELLA) in patients with therapy-refractory cardiac arrest due to acute myocardial infarction (AMI) remains unclear. Objectives To the best of our knowledge this is the first study to investigate whether treatment with ECMELLA is associated with improved 30-day mortality rate in patients with therapy-refractory cardiac arrest caused by AMI, compared to treatment with VA-ECMO alone. Methods Patients treated with ECMELLA were propensity score (PS)-matched to patients receiving VA-ECMO based on age, electrocardiogram (ECG) rhythm, cardiac arrest location (out-of-hospital or in-hospital) and Survival After Veno-Arterial ECMO (SAVE) score. Cox proportional-hazard and Poisson regression models were used to analyse 30-day mortality rate (primary outcome), hospital and intensive care unit (ICU) length of stay (LOS) (secondary outcomes). Multiple sensitivity analyses on patient demographics and cardiac arrest parameters were performed. Results 95 adult patients from three tertiary care centers were included, out of whom 34 pairs were PS-matched. ECMELLA treatment was associated with 47% decreased 30-day mortality risk [95% Confidence Interval (CI) 0.31–0.91, P=0.021], 71% prolonged hospital [95% CI 1.50–1.95, P&amp;lt;0.001] and 81% prolonged ICU LOS [95% CI 1.57–2.08, P&amp;lt;0.001]. Kaplan-Meier analyses (Figure 1) and multiple sub-group analyses (age, sex, initial ECG rhythm, Charlson comorbidity index, body mass index, SAVE score, cardiac arrest location, lactate and pH levels) confirmed survival benefits in the ECMELLA group. Especially patients with prolonged low-flow time and high initial lactate benefited from ECMELLA therapy. Moreover, LV ejection fraction strongly improved in the ECMELLA group between ICU admission and ICU discharge from 15% to 40%, compared 15% and 20% in the VA-ECMO group. Conclusion In this multicenter propensity score-matched cohort of patients with ECPR during therapy-refractory cardiac arrest caused by AMI, treatment with ECMELLA was associated with improved survival compared to treatment with VA-ECMO alone. These findings support current guideline recommendations on early evaluation of ECPR in well selected patients with therapy-refractory cardiac arrest. A clinical trial is urgently needed to further evaluate the role of LV unloading in patients with therapy-refractory cardiac arrest. Funding Acknowledgement Type of funding sources: None.

Preoperative red cell distribution width to lymphocyte ratio as biomarkers for prolonged intensive care unit stay among older patients undergoing cardiac surgery: a retrospective longitudinal study.

Introduction: Our aim was to use the redcell distribution width-lymphocyte ratio(RLR)as a novel biomarker to predict prolonged intensive-care unit (ICU) length of stay (LOS) among older patients undergoing cardiovascular surgery. Methods: This longitudinal study included older patients admitted to a tertiary cardiovascular surgery hospital between January 2017 and January 2022. Results: A total of 574 patients were studied, including 83 patients (14.5%) who had prolonged ICU LOS and 471 (85.5%) control subjects. After adjustment for the European System for Cardiac Operative Risk Evaluation 2, the RLR score showed a 10% increased risk of prolonged ICU LOS (odds ratio: 1.10; CI: 1.05-1.16; p=0.01). Conclusion: Preoperative RLR can be used to predict the risk of long-term intensive care stay in older cardiac surgery patients.

Association of In-Hospital Mortality and Trauma Team Activation: A 10-Year Study.

Background: Early trauma team activation (TTA) may improve clinical outcomes through early diagnosis and timely intervention by a dedicated multidisciplinary team. Controversy seems to exist about the effect of establishing trauma team systems in traumatic injury populations. Our aim was to identify factors that may be associated with clinical outcomes in trauma injury and to investigate the effect of trauma team activation. Method: This retrospective descriptive study included all traumatic patients from the Taipei Tzu Chi Hospital Trauma Database. All prehospital vital signs, management, injury type, injury mechanisms, hospitalization history, and clinical outcomes were analyzed, and multivariable logistic regression was used to investigate the association between trauma team activation and clinical outcomes. Subgroups of TTA in minor injury and non-TTA in major injury were also analyzed. Result: In this study, a total of 11,946 patients were included, of which 10,831 (90.7%) patients were minor injury (ISS < 16), and 1115 (9.3%) patients were major injury (ISS ≥ 16). In the minor injury population, TTA had a higher intensive care unit (ICU) admission rate, operation rate, re-operation rate, and prolonged total length of stay (LOS). In the major injury population, TTA had a higher mortality rate, prolonged total LOS, and prolonged ICU LOS. After adjusting for mechanism of injury and injury severity, there was no association between in-hospital mortality and TTA, compared with the non-TTA group. However, the TTA group had a higher risk of ICU admission, prolonged ICU LOS, and prolonged total LOS. The subgroup analysis showed trauma team activation had a higher risk of mortality in the 60- to 80-year-old population, major injury (ISS ≥ 16), consciousness clear population, and non-head injury group. Conclusions: We found there was no significant association between in-hospital mortality and TTA. However, in the TTA group, there was a higher risk of ICU admission, prolonged total, LOS, and prolonged ICU LOS. In the subgroup analysis, TTA had a higher risk of mortality in the 60- to 80-year-old population, major injury (ISS ≥ 16), consciousness clear population, and non-head injury group. Our results reflect TTA-criteria-selected patients with greater ISS and a high risk of mortality.

Prognostic value of combined preoperative phase angle and handgrip strength in cardiac surgery

ObjectivesPhase angle (PA) constitutes a bioelectrical impedance measurement, indicating cell membrane health and integrity, hydration, and nutritional status. Handgrip strength (HS) has been also associated with body composition, nutritional status, inflammation, and functional ability in several chronic diseases. Although their prognostic significance as independent biomarkers has been already investigated regarding the outcomes of a cardiac surgery, our study is the first one to assess the combined predictive value of preoperative PA and HS.Design and methodsHS and PA measurements were performed preoperativelyin 195 patients undergoing cardiac surgery. The association ofthe combination of HS and PAwith all-cause mortality rates was the primary study outcome, while its association with the intensive care unit (ICU) length of stay (LOS) was the secondary one.ResultsPA was positively correlated with HS (r = 0.446, p < 0.005) and negatively with EuroSCORE II (r = − 0.306 p < 0.005). The combination of PA < 5.15 and HS < 25.5 was associated with higher one-year all-cause mortality (OR = 9.28; 95% CI 2.50–34.45; p = 0.001) compared to patients with PA > 5.15 and HS > 25.5, respectively. Patients with combined lower values of PA and HS (PA < 5.15 and HS < 30.7) were at higher risk of prolonged ICU LOS (OR = 4.02; 95% CI 1.53–10.56; p = 0.005) compared to those with higher PA–HS (PA > 5.15–HS > 30.7). The combination of PA–HS was also significantly linked with EuroSCORE II.ConclusionThe combination of low preoperative PA and HS values was significantly associated with higher risk of all-cause mortality at 12 months and prolonged ICU LOS; thereby it might serve as a clinically useful prognostic biomarker after cardiac surgery procedures.

Outcomes following burn injury in intensive care patients with major psychiatric disorders

AimsPatients with psychiatric comorbidity have been shown to experience high rates of burn injury. Burn epidemiology, etiology, and outcomes have been sparsely documented for patients with major psychiatric disorders. The aim of this study was to analyze the epidemiologic characteristics and outcomes in intensive care burn patients with pre-existing and acute major psychiatric disorders . MethodsA retrospective study was performed including intensive care burn patients admitted between March 2007 and December 2020. Demographic, clinical and epidemiological data were collected and analyzed. Major psychiatric co-morbidities were collected according to ICD-9 and ICD-10 classifications. Patients were stratified according to F-diagnoses. ResultsA total of 1325 patients were included. 16.6 % of all patients had one or more major psychiatric disorders- 9.3 % with anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders, 9.2 % with mood (affective) disorders, 3.5 % with schizophrenia and other non-mood psychotic disorders, and 1.8 % with disorders of adult personality and behavior. Patients with major psychiatric disorders presented with significantly higher burn severity, reflected by higher abbreviated burn severity index (ABSI) scores (5.9 vs. 5.3, p < 0.001) and larger total body surface area (TBSA) affected (15.9 vs. 12.5 %, p = 0.002). Burned TBSA ≥ 30 and inhalation injuries were observed more frequently in patients with MDP, however without statistical significance. They also experienced prolonged hospital length-of-stay (LOS) (25.5 vs. 16.3 days, p < 0.001), prolonged intensive care unit LOS (14.8 vs. 7.7 days, p < 0.001), underwent surgical interventions (3.5 vs. 2.3, p < 0.001) and mechanical ventilation more frequently (34.1 % vs. 16.5 %, p = 0.43) and had significantly longer ventilation durations (73.5 vs. 31.2 h, p = 0.002). Mortality rates were lower compared to patients without major psychiatric disorders (5.9 vs. 8.1, p < 0.001). ConclusionsThe prevalence of major psychiatric disorders in burn patients is considerably high. Patients with psychiatric comorbidities were found to have greater burn severity, prolonged total hospital and ICU LOS, underwent surgical interventions and mechanical ventilation more frequently and had prolonged ventilation duration. Our results highlight the importance of identifying burn patients with major psychiatric disorders who may necessitate additional resources and require extensive inpatient psychiatric care and counseling.

Epidemiology of Candidemia and Fluconazole Resistance in an ICU before and during the COVID-19 Pandemic Era.

The objectives of this study were to investigate the incidence of candidemia, as well as the factors associated with Candida species distribution and fluconazole resistance, among patients admitted to the intensive care unit (ICU) during the COVID-19 pandemic, as compared to two pre-pandemic periods. All patients admitted to the ICU due to COVID-19 from March 2020 to October 2021, as well as during two pre-pandemic periods (2005–2008 and 2012–2015), who developed candidemia, were included. During the COVID-19 study period, the incidence of candidemia was 10.2%, significantly higher compared with 3.2% and 4.2% in the two pre-pandemic periods, respectively. The proportion of non-albicans Candida species increased (from 60.6% to 62.3% and 75.8%, respectively), with a predominance of C. parapsilosis. A marked increase in fluconazole resistance (from 31% to 37.7% and 48.4%, respectively) was also observed. Regarding the total patient population with candidemia (n = 205), fluconazole resistance was independently associated with ICU length of stay (LOS) before candidemia (OR 1.03; CI: 1.01–1.06, p = 0.003), whereas the presence of shock at candidemia onset was associated with C. albicans (OR 6.89; CI: 2.2–25, p = 0.001), and with fluconazole-susceptible species (OR 0.23; CI: 0.07–0.64, p = 0.006). In conclusion, substantial increases in the incidence of candidemia, in non-albicans Candida species, and in fluconazole resistance were found in patients admitted to the ICU due to COVID-19, compared to pre-pandemic periods. At candidemia onset, prolonged ICU LOS was associated with fluconazole-resistant and the presence of shock with fluconazole-susceptible species.