Intensive Care Units Of Public Hospitals Research Articles

Comparison of COVID-19 with influenza A in the ICU: a territory-wide, retrospective, propensity matched cohort on mortality and length of stay

ObjectivesDirect comparisons between COVID-19 and influenza A in the critical care setting are limited. The objective of this study was to compare their outcomes and identify risk factors for hospital...

The association between reduced calf and mid-arm circumferences and ICU mortality in critically ill COVID-19 patients

Patients with COVID-19 are at a high risk of malnutrition caused by inflammatory syndrome and persistent hypermetabolism, which may affect clinical outcomes. This study aimed to evaluate the changes in nutritional status indicators between two time points of nutritional assessments of COVID-19 patients during their stay in the intensive care unit (ICU). Moreover, the study also assessed the association of nutritional status with ICU mortality. This cohort study included retrospective data of adult patients admitted to a public hospital ICU in southern Brazil, between March and September 2020. These participants with confirmed COVID-19 diagnosis received nutritional assessment within the first 72h after ICU admission. The anthropometric measurements collected included mid-arm circumference (MAC) and calf circumference (CC). The percentage (%) of MAC adequacy was calculated, and values<50th percentile for sex and age were considered low. CC values of ≤33cm for women and ≤34cm for men were indicative of reduced muscle mass. Data on the date of discharge from the ICU and mortality outcome were collected. A total of 249 patients were included (53.4% men, 62.2±13.9 years of age, SOFA severity score 9.6±3.5). Of these, 22.7 and 39.1% had reduced MAC and CC at ICU admission, respectively. In these participants, weight, MAC, CC, and % MAC decreased significantly from the first to second nutritional assessment (p<0.05), but there was no significant difference between survivors and non-survivors. Patients with reduced CC (HR=2.63; 95% CI 1.65-4.18) or reduced MAC (HR=2.11; 95% CI 1.37-3.23) at the first nutritional assessment had approximately twice the risk of death in the ICU than those with normal CC and normal MAC, regardless of the severity assessed by the SOFA score and age. Reduced MAC and CC values were identified in approximately 20 and 40% of COVID-19 patients admitted to the ICU, respectively. Additionally, these indicators of nutritional depletion were associated with an approximately 2-fold increase in the risk of ICU mortality. A significant reduction in anthropometric indicators during the first weeks of ICU stay confirmed the deterioration of nutritional status in these patients, although this was not associated with mortality.

Evaluation of hospital acquired infections in intensive care unit

Aim: Hospital acquired infections are a serious problem in inpatients in terms of mortality and cost. The aim of this study is to present hospital acquired infections and risk factors, causative pathogens, antibiotic resistance status, and mortality relationship in a public hospital intensive care unit (ICU) over the scope of 5-years.Methods: Hospital acquired infections developed between January 2016 and December 2020 in Bolu İzzet Baysal State Hospital Adult ICUs were investigated retrospectively. Samples taken from areas such as central venous catheter, deep tracheal aspirate, urinary catheter and wound area were studied. Hospital acquired infections was diagnosed based on Centers for Disease and Control (CDC) criteria.Results: A total of 3587 patients were admitted to the ICUs between January 2016 and December 2020, and 309 (8.6%) patients were diagnosed with hospital acquired infections. When considered as comorbidity, neurological disorders were the most common, while sepsis was the most common hospitalization diagnosis in patients with hospital infection. The most common hospital acquired infections was ventilator associated pneumonia (VAP) with 38.8% (n=120) of the patients. Examining the culture isolate results, the most isolated agent as hospital acquired infections was Acinetobacter spp. (32.6%, n=101). Acinetobacter spp. and Klebsiella spp. It was resistant to all antibiotics with 4.9%.Conclusion: Hospital acquired infections rates may vary in intensive care units due to reasons such as awareness, physical conditions, education of working personnel, etc. Knowing the risk factors well, early culture isolate monitoring in suspected cases and selecting the appropriate antibiotic are effective in patient treatment and may reduce mortality.

The impact of language barriers & interpreters on critical care patient outcomes

BackgroundIn a multicultural society, the impact of language proficiency and interpreter use on critical care patient outcomes is unknown. ObjectiveTo investigate the relationship between English language preference, requirement for an interpreter and in-hospital mortality amongst non-elective intensive care unit (ICU) patients. MethodAdult patients admitted to all 23 public ICUs within the state of Victoria, Australia from July 2007 to June 2018, were extracted from The Australian New Zealand Intensive Care Society Adult Patient Database. De-identified patient data was matched using probabilistic methods and statistical linkage keys to the Victorian Admitted Episodes Database. Patients were classified into one of three groups: ‘English preferred’, ‘English not preferred’ and ‘Interpreter required’. Results126,891 ICU admissions were analysed, of whom 3394 (3%) were in the ‘English not preferred’ group and 6355 (5%) in the ‘Interpreter required’ group. Compared to the ‘English preferred’, both the ‘English not preferred’ and ‘Interpreter required’ groups were older, had more co-morbidities and higher severity of illness scores. In-hospital mortality was 13.1% in the ‘English preferred’ group, 19.6% in the ‘English not preferred’ group and 16.7% in the ‘Interpreter required’ group. However, after adjusting for sex, severity of illness and socio-economic status, the ‘English not preferred’ group remained with a higher risk adjusted mortality (OR 1.21, 95%CI 1.07–1.36, P = 0.002), whereas the ‘Interpreter required’ group had a lower adjusted risk of mortality (OR 0.81, 95%CI 0.74–0.89, P < 0.001). ConclusionBeing identified as having a requirement for an interpreter was associated with improved outcomes for adults admitted to public hospital ICUs in Victoria. Interpreter services should be more readily available in the hospital setting. It is recommended that patients, family members and clinicians actively use interpreter services when English is not the preferred language of an ICU patient.

Organization and Management of Intensive Care Unit, correlation of team climate with job satisfaction of the nurses in the ICU

Introduction: The correlation between team climate and job satisfaction has been studied by researchers worldwide, but only a handful of them have dealt with the reality of Intensive Care Units (ICU). Team climate can contribute to nurses’ job satisfaction, thus increasing their efficiency and effectiveness. Especially during a pandemic, such as Covid-19, the investigation of team climate and job satisfaction is of great importance.Purpose: The purpose of this study was to investigate the correlation between team climate and job satisfaction of nurses in ICU and among the fear of Covid-19.Methodology: This is a contemporary study. The sample of the study is consisted of nurses and nurses’ assistants of a Greek public hospital ICU and special units. The Anderson &amp; West Team Climate Inventory (TCI), the Paul E. Spector Job Satisfaction and the Fear of COVID-19 Scale were used for data collection. The statistical analysis of the data was done with the statistical program SPSS for Windows (version 21).Results: Out of the 212 nurses, 170 responded to the questionnaire (response rate 80.2%). The team climate was generally described as moderate. Especially, the dimensions of communication-innovation, team goals and the way they work assessed as moderate. Job satisfaction was described as moderate. Relationships with the manager, the nature of the work and communication, characteristics of job satisfaction, were evaluated with a high score, while payment, benefits and promotion were evaluated with low score. The fear of Covid-19 scale had low score, indicating that the feeling of fear was at low levels.Conclusions: The team climate and job satisfaction of ICUs nurses of the hospital was characterized as moderate, while the fear levels due to Covid-19 were low. Furthermore, the team climate was positively correlated with job satisfaction. In contrast, neither team climate nor job satisfaction were associated with fear of Covid-19.

Quantifying the burden of the post-ICU syndrome in South Africa: A scoping review of evidence from the public health sector.

Background The post-ICU syndrome (PICS) comprises unexpected impairments in physical, cognitive, and mental health after intensive care unit (ICU) discharge, and is associated with a diminished health-related quality of life (HRQOL). A Cochrane review recommended more research in this field from low- and middle-income countries. Objectives This review aims to examine the extent and nature of publications in the field of PICS in the South African (SA) public health sector. Findings of available local research are contextualised through comparison with international data. Methods A comprehensive literature search strategy was employed. Inclusion criteria comprised publications enrolling adult patients following admission to SA public hospital ICUs, with the aim to study the main elements of PICS (ICU-acquired neuromuscular weakness, neurocognitive impairment, psychopathology and HRQOL). Results Three studies investigated physical impairment, 1 study psychopathology, and 2 studies HRQOL. Recommended assessment tools were utilised. High rates of attrition were reported. Neuromuscular weakness in shorter-stay patients had recovered at 3 months. Patients who were ventilated for ≥5 days were more likely to be impaired at 6 months. The study on psychopathology reported high morbidity. The HRQOL of survivors was diminished, particularly in patients ventilated for ≥5 days. Conclusion This review found a paucity of literature evaluating PICS in the SA public health sector. The findings mirror those from international studies. Knowledge gaps pertaining to PICS in medical, surgical and HIV-positive patients in SA are evident. No publications on neurocognitive impairment or the co-occurrence of PICS elements were identified. There is considerable scope for further research in this field in SA. Contributions of the study This review identified the available publications investigating the post ICU syndrome (PICS) in the South African public healthcare setting. A small number of ground-breaking studies were found. Knowledge gaps in this field were identified.

Knowledge, practice and associated factors of nurses towards prevention of catheter-associated urinary tract infection in intensive care unit of public hospitals administered by Federal Government in Addis Ababa, Ethiopia: a cross-sectional institutional-based study

BackgroundUrinary catheterization is one of the most common procedures performed in hospitals specifically, in the intensive care units and is associated with a high risk for acquired urinary tract infections. More than 70% of acquired urinary tract infections are due to catheter use. Nurses are the primary healthcare providers responsible for inserting and maintaining urinary catheters. The data regarding nurses’ knowledge, practice and associated factors towards prevention of catheter-associated urinary tract infections are limited in Ethiopia. Therefore, this study aimed to assess the knowledge, practice, and associated factors of nurses towards prevention of catheter-associated UTIs in the Intensive Care Unit (ICU) of public hospitals in Addis Ababa, Ethiopia.MethodsAn institutional-based descriptive cross-sectional study was conducted from March 01 to April 15, 2021, among nurses working in the ICU of public hospitals in Addis Ababa, Ethiopia. All 204 nurses working in the ICU of four public hospitals were included in the study using the census sampling method. Data were collected using a pretested self-administered semi-structured questionnaire. Data were cleaned and entered into Epi data version 4.6 and analyzed using Statistical Package for Social Sciences version 26.0. Pearson Chi-square and Fischer exact tests were performed to see the association between independent and dependent variables. The level of significance is considered at P-value less than 0.05.ResultsA total of 184 nurses participated in the study, making a response rate of 90.2%. The mean (±SD) age of the study participant was 29.07(±4.78). The study findings showed that more than half (63.04%) of nurses had poor knowledge and 88(47.83%) of nurses had poor practice towards prevention of catheter-associated UTIs. In this study, there was a statistically significant association between professional work experience and nurses’ knowledge in preventing catheter-associated UTIs (at P-value = 0.031).ConclusionIn this study, nurses’ knowledge and practice towards the prevention of catheter-associated urinary tract infection was relatively poor. Professional work experience had a significant statistical association with the level of knowledge. Therefore, increasing the knowledge of nurses through appropriate educational programs and training on the preventive measures of device-associated infections was recommended to prevent catheter-associated UTIs.

Did COVID-19-Related Alcohol Sales Restrictions Reduce Alcohol Consumption? Findings from a National Online Survey in South Africa.

Background: South Africa has a high prevalence of heavy episodic drinking (HED). Due to the high levels of alcohol misuse and violence, public hospital intensive care units were often overrun during the COVID-19 pandemic. This research investigated alcohol intake behaviour change during differing levels of lockdown restrictions, which included bans on alcohol sales. Methods: A self-reported Facebook survey ran from July to November 2020. The questions included socio-demographics, income, alcohol intake, purchasing behaviour, and reasoning. Chi-square tests/Fisher’s exact test for categorical data, Student’s t-test for normal continuous data, and the Mann–Whitney U test for non-normal data were applied. Multiple logistic regression was run for HED versus moderate drinkers. Results: A total of 798 participants took part in the survey, of which 68.4% were female. Nearly 50% of participants fell into the HED category and the majority bought alcohol illegally during restrictions. HED respondents who drank more alcohol than usual during restrictions reported that they felt stressed, needed to relax, and were bored. Conclusions: Policies intended to increase the pricing of alcohol may have the potential to reduce alcohol intake. Reducing stress and anxiety may be key to curtailing HED during emergency situations.

Critical care capacity in Addis Ababa, Ethiopia: A citywide survey of public hospitals

We evaluated critical care capacity in the 15 intensive care units (ICUs) in public hospitals in Addis Ababa, Ethiopia to determine the current state of critical care in the city and inform capacity-building efforts. We conducted a cross-sectional survey of ICU medical and nursing directors or their delegates using a standardized questionnaire based on World Federation of Society of Intensive and Critical Care Medicine (WFSICCM) criteria. ICU size ranged from 3 to 15 beds. All ICUs had capacity for mechanical ventilation and vasopressor support, and 53% had intensivists on staff. Ultrasound was available in 93%, while 40% had capacity for invasive blood pressure monitoring. Identified barriers to care included a lack of essential equipment, supplies, medications and specially trained providers. Respondents considered increasing available beds and coordinating between hospitals crucial for capacity building. There is burgeoning critical care capacity in Addis Ababa, Ethiopia with 103 ICU beds in public hospitals, and the WFSICCM criteria provide a useful framework for evaluating critical care capacity and identifying priorities for capacity building. All ICUs in public hospitals in Addis Ababa were able to provide basic support for patients with life-threatening organ failure but demonstrated marked heterogeneity in critical care capacity.

Perception, experience and knowledge of early physiotherapy in intensive care units of Rome: a survey.

Early physiotherapy (EP) programs on critically ill patients in the intensive care unit (ICU) have proven to be safe, feasible and effective. However, despite being considered by all the professionals involved as a fundamental aspect of integrated care, in most cases they are inadequately applied or not performed at all. The main objective of this study is to evaluate the knowledge, perceptions and activities related to EP among physician, nurses and physiotherapists who practice in ICUs of Rome. Obstacles to its application and possible strategies to overcome them are also examined. The study was conducted according to the CHERRIES recommendations. Two questionnaires with 29 questions were created on the Google Form platform and were sent by mail to all the ICUs of public hospitals or accredited private hospitals with the National Health Service in Rome. Thirty (60%) of the contacted ICUs responded. The physiotherapist is present in 76.7% of ICUs and carries out its activities mainly during daytime hours (60.9%), for less than 3 hours in 39.1% of cases and only after a request for specialist advice (65.2%). Only in 4.3% of cases the service is guaranteed even at weekends but only after a request. All 29 professionals interviewed consider both the presence of a physiotherapist within the interdisciplinary team of the ICU and the implementation of an EP program to be necessary, supporting the positive effects of this program. The most frequently obstacles to the implementation of an EP program are clinical instability (69%), low priority to EP practice (62.1%), cardiovascular instability (58.6%) and lack of experience (58.6%). The most frequently indicated strategies to overcome these obstacles are to organize interdisciplinary briefings (86.2%), to avoid excluding patients from treatment without specific motivation (75.9%), to invest in staff training (75.9%), to use protocols and guidelines (58.6%). EP is not currently exploited to its full potential due to lack of funds, culture, experience, training and a hospital organization that limits the provision of effective patient care and efficient service to the National Health Service.

Families’ control preference for participation in patient care in adult intensive care

ObjectiveUnderstand families’ preferences and observed participation in patient care in an adult ICU. Research methodologyThe mixed-methods design used survey and naturalistic observation to collect data from a convenience sample of 30 family members of critically ill patients. SettingTwo public hospital intensive care units in Australia. Main outcome measures1) Families’ preferences for participation in decision-making and physical patient care activities in the adult intensive care unit, measured using a modified Control Preference Scale; 2) the type and frequency of family participation in patient care activities in the intensive care unit. ResultsAlmost half (47%) reported a preference to share in decision-making about care for their relative with healthcare professionals; 17% reported a preference for active participation in decision-making. Alternatively, most families preferred a passive (60%) role in the physical care of their relative ; 33% preferred shared participation with staff and very few (3%) preferred active participation with little involvement of staff. Of the 193 activities observed, family participation in physical care was the least frequent (24%). ConclusionDifferences emerged in family preferences for participation in physical care compared to their involvement in decision-making about care for their relative. The findings indicate a need for tailored interventions to support family participation aligned with their preferences.

Exploring Incontinence-Associated Dermatitis in a Single Center Intensive Care Unit: A Longitudinal Point Prevalence Survey.

The purpose of this study was to provide longitudinal prevalence rates of incontinence-associated dermatitis (IAD) in patients in an intensive care unit (ICU) and to identify patient characteristics associated with IAD development. Prospective observational. The sample comprised 351 patients aged 18 years and older in a major metropolitan public hospital ICU in Queensland, Australia. All consenting, eligible participants at risk of developing IAD underwent weekly skin inspections to determine the presence of IAD. Data were collected weekly for 52 consecutive weeks. Descriptive statistics described the study sample and logistic regression analysis was used to identify patient characteristics associated with development of IAD. The weekly IAD prevalence ranged between 0% and 70%, with IAD developing in 17% (n = 59/351) of ICU patients. The odds of IAD developing increased statistically significantly with increasing age (odds ratio [OR]: 1.029, 95% confidence interval [CI]: 1.005-1.054, P = .016), time in the ICU (OR = 1.104; 95% CI: 1.063-1.147, P < .001), and Bristol Stool chart score (OR = 4.363, 95% CI: 2.091-9.106, P < .001). Patients with respiratory (OR = 3.657, 95% CI: 1.399-9.563, P = .008) and sepsis (OR = 3.230, 95% CI: 1.281-8.146, P = .013) diagnoses had increased odds of developing IAD. These data show the high variability of IAD prevalence over a 1-year period. Characteristics associated with the development of IAD in patients in the ICU included older age, longer lengths of ICU stay, incontinent of liquid feces, and having respiratory or sepsis diagnoses.

ВИДОВИЙ ПРОФІЛЬ МІКРОБНИХ ЧИННИКІВ НОЗОКОМІАЛЬНИХ ІНФЕКЦІЙ

Nosocomial infections, also known as health care-associated infections (HAIs) are infections that appear in patients under medical care in hospitals or other health care facilities and were absent at the time of admission. From 5 to 7 thousand cases of HAIs are registered in Ukraine every year, but according to experts, the actual number is 900 thousand cases per year. Intensive care unit (ICU) represents a prominent tool in HAIs control and quality assurance in many developed countries. In this respect, the US Center for Disease Control and Prevention (CDC) recommends monitoring HAI as a leading tool for the reduction of HAIs. Therefore, the aim of this research was to investigate microbiological profile of nosocomial infections in ICU of public hospitals in Lviv, Ukraine. Material and methods. 105 clinical materials from 50 patients in two public hospitals in Lviv (Lviv Regional clinical hospital and Military Medical Clinical Center of the Western Region) were analyzed during July-December 2018. 114 strains of pathogens were isolated. HAIs was defined as an infection that appeared in patients later than 48 hours after admission to the hospital. Urinary tract infections (UTI), blood stream infection (BI), respiratory tract infection (RTI) and surgical site infections (SSI) were diagnosed using the criteria defined by the CDC and clinical protocols. Causative bacterial strains were isolated and identified using standard methods and chromogenic media CHROMID*S.aureusElite, CHROMID*VRE, CHROMID*MRSASMART, CHROMID*CARBASMART, CHROMID* ESBL, CHROMID*OXA-48, CHROMID*Candida (Biomerieux) and biochemical identification kitsMIKRO-LA-TESTNEFERMtest24, ENTEROtest24, CANDIDAtest21, STAPHYtest24, STREPTOtest24 (ErbaLacema, Czech Republic). Antibiotic sensitivity test was done using Kirby-Bauer disc diffusion technique. (Ethical Committee or Institutional Animal Care and Use Committee Approval Danylo Halytsky Lviv National Medical University: 25/06/2018 № 6). HAIs structure was as follows: Staphylococcus lentus (22%), Eschrichia coli (22%), Klebsiella pneumoniae subsp.ozaenae (9.8%), Pseudomonas aeruginosa (43.9%), Klebsiella pneumoniae subsp.pneumonia (8.8%), Srreptococcus spp. (7.0%), Burkholderia pseudomallei (5.3%), Staphylococcus haemolyticus (3.5), Staphylococcus aureus (3.5%). There were several types of HAIs which are rarely found, such as Staphylococcus lentus, Staphylococcus simulans, Staphylococcus lugdunensis, Aerococcus viridans, Pragia fontium, Aeromonasichthiosmia, Raoultella terrigena, Macrococcus caseolyticus. Conclusions. In the era of antibiotics, HAIs are still uncontrollable. It is assessed that over 90.0% of HAIs are not recognized as epidemics. It is important to remember this fact when attempting to design prevention or control strategy to reduce HAIs either at WHO level, or at the level of local health care unit.

Organ donation within the intensive care unit: A retrospective audit

BackgroundDespite many Australians supporting organ donation, national posthumous organ donation rates have not increased as expected over the last three decades. Little is known about the barriers to organ donation for patients in intensive care that meet the criteria for organ donation. ObjectiveThe aim of this study was to describe the characteristics of patients identified as potentially suitable for organ donation and to explore the variables associated with the success, or failure, of solid organ donation within the context of an Australian public hospital intensive care unit (ICU). MethodsA retrospective audit examined electronic records of 280 potential organ donors aged 18–80 years, admitted into the ICU between 1 July 2012 and 30 June 2016. Data extracted from three separate electronic hospital databases were amalgamated for analysis. ResultsOf the 280 potential organ donors identified, conversations with families of 182 (65%) patients resulted in their agreement to organ donation. Consent to organ donation was most often provided by the patient's spouse (65, 35.7%); however, only 63.7% (n = 116) were successful organ donors. The remaining 36.3% (n = 66) of patients did not donate organs for medical reasons. Compared with those who did not donate, the typical organ donor was significantly younger (M 49.9 years, p = 0.020), Australian-born (p = 0.031), and had a shorter length of ICU stay (M 64.9 h, p = 0.002). The most frequently donated organs were kidneys (103, 88.8%), lungs (59, 50.9%), and livers (52, 44.8%). ConclusionThis study provided insights into patient, family, and organisational factors contributing to the success of organ donation outcomes in the ICU. Two factors that adversely impacted donation outcomes were the following: (1) the family did not consent to organ donation on behalf of the patient and (2) consent was provided, but donation did not proceed for medical reasons. Although the focus on the consenting process has been raised, this study highlights the additional impact of medical suitability on rates of organ donation. Family members may experience significant disappointment after consent that may have repercussions on their health and also future donation considerations. This study also highlighted some deficiencies in the databases that, if addressed, could better inform organisational processes in the consent and support of those making decisions about consent.

The effect of the Greek financial crisis on the operation of public intensive care units

SUMMARYThe National Healthcare System in Greece has taken a serious blow by the financial crisis the country has been experiencing for the past 9 years. The operation of the Intensive Care Units (ICUs) in public hospitals could not remain unaffected, since the largest part of their funding comes from the state’s budget.Objective: To investigate the effect of the financial crisis on the operation of public ICUs in Greek hospitals.Method: Narrative literature review including Greek and English language articles in medical databases such as PUBMED, CINAHL, and in websites of Greek newspapers and other media.Results: During the crisis years, a clear shift of healthcare users from the private sector to public hospitals, together with a significant reduction of functional beds in the ICUs of public hospitals have created significant ICU bed shortages and rendered Greek ICUs clearly incapable of meeting nationwide needs. The doctors and nurses employed in public ICUs are not sufficient, and, subsequently, a decline in the quality of the healthcare provided to the critically ill has been noted.Conclusions: The situation in Greek public ICUs is critical. Without sufficient state funding, staff and ICU-bed shortages increase the likelihood that the care provided within Greek ICUs will deviate from international standards.

Nursing Workload in Relation to Nosocomial Infection in Public Hospital Intensive Care Unit, Malaysia

Nosocomial infections (NIs) is an infection acquired in the hospital and becomes evident 48 hours after admission to the hospital.It continues to be a major problem affecting patient safety and quality of care in Intensive Care Unit (ICU).One of the most pertinent factors leading to NIs is nursing workload. The aim of the study is to determine nursing workload on NIs rate in the ICU, Hospital Serdang. A retrospective cross sectional study was used. Data were collected from NIs surveillance,staff nurses’ duty roster and patient census by using a performa.The result in this study shows,19 %( n=88)cases of NIs were detected in 12 %( n=57) of patient. There was significant moderate positive relationship between the number of infection and the total number of nurses working overtime (r= 0.66,n=88, p = 0.001) and the number of infection and the total number of new staffs (r= 0.51, n=88, p = 0.001). There was significant weak positive relationship between the number of infection and the total number of nurses taking medical leave or emergency leave (r= 0.33, n=88, p = 0.001). This study provide a baseline to improve nursing staffing in ICU. Future planning of ICU staffing should be comprehensive so that patients are not disadvantaged.

National survey of outcomes and practices in acute respiratory distress syndrome in Singapore.

IntroductionIn the past 20 years, our understanding of acute respiratory distress syndrome (ARDS) management has improved, but the worldwide incidence and current outcomes are unclear. The reported incidence is highly variable, and no studies specifically characterise ARDS epidemiology in Asia. This observation study aims to determine the incidence, mortality and management practices of ARDS in a high income South East Asian country.MethodsWe conducted a prospective, population based observational study in 6 public hospitals. During a one month period, we identified all ARDS patients admitted to public hospital intensive care units (ICU) in Singapore, according to the Berlin definition. Demographic information, clinical management data and ICU outcome data was collected.ResultsA total of 904 adult patients were admitted to ICU during the study period and 15 patients met ARDS criteria. The unadjusted incidence of ARDS was 4.5 cases per 100,000 population, accounting for 1.25% of all ICU patients. Most patients were male (75%), Chinese (62%), had pneumonia (73%), and were admitted to a Medical ICU (56%). Management strategies varied across all ICUs. In-hospital mortality was 40% and median length of ICU stay was 7 days.ConclusionThe incidence of ARDS in a developed S.E Asia country is comparable to reported rates in European studies.

Stress Induced Hyperglycemia and the Subsequent Risk of Type 2 Diabetes in Survivors of Critical Illness.

ObjectiveStress induced hyperglycemia occurs in critically ill patients who have normal glucose tolerance following resolution of their acute illness. The objective was to evaluate the association between stress induced hyperglycemia and incident diabetes in survivors of critical illness.DesignRetrospective cohort study.SettingAll adult patients surviving admission to a public hospital intensive care unit (ICU) in South Australia between 2004 and 2011.PatientsStress induced hyperglycemia was defined as a blood glucose ≥ 11.1 mmol/L (200 mg/dL) within 24 hours of ICU admission. Prevalent diabetes was identified through ICD-10 coding or prior registration with the Australian National Diabetes Service Scheme (NDSS). Incident diabetes was identified as NDSS registration beyond 30 days after hospital discharge until July 2015. The predicted risk of developing diabetes was described as sub-hazard ratios using competing risk regression. Survival was assessed using Cox proportional hazards regression.Main ResultsStress induced hyperglycemia was identified in 2,883 (17%) of 17,074 patients without diabetes. The incidence of type 2 diabetes following critical illness was 4.8% (821 of 17,074). The risk of diabetes in patients with stress induced hyperglycemia was approximately double that of those without (HR 1.91 (95% CI 1.62, 2.26), p<0.001) and was sustained regardless of age or severity of illness.ConclusionsStress induced hyperglycemia identifies patients at subsequent risk of incident diabetes.

Avoidable factors associated with pregnant and postpartum patients admitted to two intensive care units in South Africa

Background. Identification and prevention of any avoidable factor (AVF) associated with pregnancy may reduce critical illnesses and the need for intensive care unit (ICU) admission. Objectives. To determine AVFs that occurred prior to the admission of pregnant and postpartum patients to two ICUs in South Africa (SA) and the resulting maternal outcomes. Methods. The hospital records of all pregnant and postpartum patients in two public hospital ICUs in Pietermaritzburg, SA, between 1 July 2010 and 30 April 2011 were assessed to identify pre-ICU AVFs. Each patient was followed up until the 7th day after ICU discharge or until hospital discharge (whichever came first), to observe maternal outcomes: survival, death or hypoxic ischaemic brain injury (HIBI). Results. Of 84 patients assessed, 41 (48.8%) had ≥1 AVF. Patient-related, administrative and health-worker-related AVFs were identified in 32.1% (27/84), 19.0% (16/84) and 7.1% (6/84) of patients, respectively. The most common patient-related AVF was the commencement of antenatal care after 20 weeks’ gestation. Unavailability of ICU beds was the most common administrative AVF. Iatrogenic pulmonary oedema associated with intravenous fluid resuscitation was the most frequent health-worker-related AVF. Of women who had AVFs, 9 (22.0%) died, 2 (4.9%) had HIBI and 30 (73.2%) suurvived. The relative risk of death or HIBI among patients with AVF/s was 1.2 ( p =0.7). Conclusions. The principal interventions that may prevent AVFs are ongoing community health promotion, strengthening of obstetric skills training on fluid resuscitation and expansion of critical care services.

Medical conditions and risk associated with pressure ulcers

Introduction: pressure ulcers constitute a grievance inherent in bedridden patients, with little or no mobility.Objetivo: to determine the pressure ulcers prevalence and analyze their association to clinical conditions and to risk factors in intensive care unit (ICU) patients.Method: it is a prospective and quantitative study, conducted with 45 patients in the public hospital ICU in Joao Pessoa, Paraiba, Brazil. Data were collected through hospital records, physical examination and the Braden Scale application. Data were analyzed using descriptive statistics and association tests.Results: it presented a 37.8% pressure ulcers prevalence, verifying significant association between the occurrence and the consciousness level, hydration and skin texture. It was also significant the association to the subscale friction and shear.Conclusion: the necessary involvement of the nursing staff to the preventive development in primary care to pressure ulcers is reaffirmed.