Patients In Respiratory Intensive Care Unit Research Articles

End-tidal-to-arterial PCO2 ratio as a prognostic value in mechanically ventilated patients at respiratory intensive care unit

Background Dead space refers to the part of each tidal volume that does not contribute to gas exchange. It serves as an indicator of lung function efficiency. Aim To evaluate the end-tidal-to-arterial PCO2 ratio and Acute Physiological and Chronic Health Assessment (APACHE IV) scoring system as prognostic values in mechanically ventilated patients at the respiratory intensive care unit (ICU). Patients and methods This prospective cohort research was done on 40 mechanically ventilated patients due to different respiratory causes who were admitted at the respiratory ICU at Ain Shams University hospitals. Results This study found that decreasing end tidal PCO2 (PETCO2)/arterial carbon dioxide (PaCO2) is associated with higher mortality amongst mechanically ventilated cases in respiratory ICU. A significant negative association between APACHE IV score and end-tidal to arterial PCO2 ratio following 1 h and after 24 h of mechanical ventilation. APACHE IV score showed a significant relation with mortality, being higher in survivors than nonsurvivors. Conclusion PETCO2/PaCO2 is a relevant prognostic value that reflects dead space ventilation among mechanically ventilated patients in respiratory ICU. APACHE IV score is a good mortality predictor in respiratory ICU.

Role of point of care ultrasound in management of deteriorating respiratory intensive care unit patients and its impact on outcome

BackgroundPoint of care ultrasonography (POCUS) is a real time examination that can be used in the emergency room and intensive care unit (ICU). It can provide low-cost modality in short period of time that can help the clinician in better management the ICU patients. The aim of the current work was to evaluate the impact of POCUS (focused heart, lung, IVC and Doppler lower limb) in improving the outcome of deteriorating patients in the respiratory intensive care unit (RICU), via narrowing differential diagnosis and earlier start of target therapy.MethodsThis prospective study included 126 deteriorated patients in the RICU. The POCUS was performed to all included patients, together with the indicated laboratory and radiological investigations (Chest x-ray, computerized tomography, and conventional echocardiography) to detect the agreement between POCUS and the gold standard techniques to assess the POCUS effectiveness. The impact of applying POCUS on the outcome of the studied patients was evaluated regarding ICU and in hospital length of stay and the 30-day mortality.ResultsThe included patients were 51 males (40.5%) and 75 females (59.5%) with a mean ±SD of age 45.4 ± 15.7 years. POCUS showed a good agreement with the gold standard techniques. There was significant improvement in outcome of the studied patients as regard ICU and in hospital stay with early using of POCUS examination but no significant difference in 30 days mortality rate of the studied patients.ConclusionPOCUS is an effective modality in the management of deteriorating patients in the RICU with a good impact on the patient outcome.

Incidence of and risk factors for post–intensive care syndrome among Chinese respiratory intensive care unit patients: A cross-sectional, prospective study

BackgroundPatients transferred from the respiratory intensive care unit (ICU) can experience post–intensive care syndrome (PICS), which comprises cognitive, psychological, and physical disorders that seriously affect the quality of life. Therefore, it was necessary to explore the incidence of and the risk factors for PICS among respiratory ICU patients. ObjectivesThis study evaluated PICS among respiratory ICU patients and explored the risk factors for PICS. MethodsThis cross-sectional, prospective study was performed at one hospital in China. Using convenience sampling, 125 respiratory ICU patients from August 2018 to June 2019 were recruited for the study. The Mini-Mental State Examination, Confusion Assessment Method for the Intensive Care Unit, Hospital Anxiety and Depression Scale, Medical Research Council Scale, activities of daily living scale, Pittsburgh Sleep Quality Index, and the 14-item fatigue scale were used to comprehensively assess the patients' cognitive status, psychological status, and physiological status when entering the ICU and 2 weeks after leaving the ICU. Factors affecting PICS were measured using researcher-created questionnaires of patients’ general information and disease-related information. ResultsFifteen patients were lost to follow-up. Fifty-nine patients had PICS (incidence rate, 53.6%). Logistic regression showed that risk factors for PICS were age, invasive mechanical ventilation, noninvasive ventilator-assisted ventilation, and coronary heart disease (P < 0.05). ConclusionThe PICS incidence was high. Older age, longer invasive mechanical ventilation times, longer noninvasive ventilator times, and coronary heart disease were risk factors for PICS. ICU medical workers in China should pay more attention on PICS, know the risk factors, and implement preventive measures.

Predictors of reintubation in respiratory intensive care unit patients

Background Weaning and extubation follow each other in clinical practice, and are two isolated processes that pose distinct problems. Extubation failure is the need for reinstitution of ventilatory support within 24 to 72 hours of planned removal of endotracheal tube. Nearly 20% of patients require reintubation. Reintubation is more serious and may be associated with more adverse effect than the initial intubation procedure. Patients needing reintubation had significantly increase the duration of mechanical ventilation as well as ICU, hospital stay and mortality. Objective of the study To predict risk factors of reintubation in respiratory patients. Patients and methods The present study was a prospective observational study. It involved 100 mechanically ventilated patients who were admitted to RICU with different respiratory diseases. All patients met the criteria for readiness to wean: 50 patients need to be reintubated (group 1), and the other 50 patients were successfully extubated without needing for reintubation within 48–72 hours of extubation process (group 2). Different clinical, laboratory analysis, hemodynamic and respiratory variables, ventilator parameter and SAPS II score were collected in both groups. Results The mean age of reintubated patients was (66.06±10.3 years) and most of them were males (58%). We found that heamoglobin level (11.4±1.93) and Albumin level (2.47±0.61 g/dl) were significantly lower in reintubated group. Also, PH (7.11±0.032) and PaO2 (38.3±4.85 mmHg) at time of first intubation were significantly lower in reintubated cases. Half (50%) of reintubated cases expressed difficult weaning. On the other hand, 64% in non reintubated patients expressed simple weaning. Age (≥64 years old), PH (≤7.13), PaO2 (≤45) at first intubation, SAPS II Score, hemoglobin level (≤10.1), albumin level (≤3.1) were independent predictors of reintubation in respiratory ICU patients. Conclusion Age, arterial PH, PaO2 at first intubation, SAPS II Score, hemoglobin, albumin, higher length of ICU stay and hospital stay were an independent predictors of reintubation in respiratory ICU patients.

Are diaphragmatic indices assessed by ultrasound good predictors of weaning outcome in mechanically ventilated respiratory patients?

Background Prediction of weaning outcome is still challenging. Among the reported causes of weaning failure is the diaphragmatic dysfunction. Diaphragmatic ultrasound indices were endorsed for predicting weaning outcome but with conflicting results. Therefore, this study aimed to evaluate ultrasonographic diaphragmatic indices for predicting weaning outcome in respiratory intensive care unit (RICU) patients. Patients and methods The study enrolled 40 RICU patients who were considered eligible for spontaneous breathing trial (SBT). Ultrasound of the right hemidiaphragm was performed immediately after the start of SBT. Assessment of the diaphragmatic excursion using M-mode in semisitting position was done. Moreover, the diaphragmatic thickness at the end of inspiration (Tdi) and expiration (Tdex), with the patient in supine position, was assessed. Diaphragmatic thickness fraction was then calculated. During SBT, patients’ respiratory rate, heart rate, rapid shallow breathing index (RSBI), and minute ventilation were recorded. Tracheal airway occlusion pressure (P0.1) and negative inspiratory force were measured using the ventilator software. Results The diaphragmatic indices did not appear to have a significant role in predicting successful weaning with area under the curve less than 0.56 for all of them. Moreover, no statistically significant difference in Tdi, Tdexe, thickness fraction, and diaphragmatic excursion was observed between the success and failure weaning groups. However, the RSBI performed as the best parameter in predicting weaning success, with area under the curve of 0.831. A cutoff value of 78 had 91% sensitivity and 84% specificity. Conclusion Ultrasonographic diaphragmatic indices are not satisfactory tools to predict weaning outcome in RICU compared with RSBI and other reported traditional indices.

The role of tracheal ultrasonography in confirming endotracheal tube placement in respiratory intensive-care unit patients

The role of tracheal ultrasonography in confirming endotracheal tube placement in respiratory intensive-care unit patients

Validity of three scoring systems in assessing the severity and outcome in Al-Abbassia Chest Hospital Respiratory Intensive Care Unit patients

BackgroundICU scoring systems allowed an assessment of the severity of disease and death prediction. As ICU populations, investigations and management were changed, scoring systems should be updated.AimThe aim of this study was to evaluate three scoring systems in predicting outcome in Al-Abbassia Chest Hospital Respiratory ICU patients in 6 months.Patients and methodsIt was conducted on newly admitted cases in Al-Abbassia Respiratory ICU from July 2016 till January 2017. All patients were evaluated on admission and after 48 h by Acute Physiology and Chronic Health Evaluation IV (APACHE IV), Sequential Organ Failure Assessment (SOFA), and Simplified Acute Physiology Score II (SAPS II).ResultsAPACHE IV and SAPS II scores were significantly higher between dead than alive patients on admission and after 48 h, but were not able to predict death in ICU. SOFA score was insignificantly higher on admission and after 48 h between nonsurvivors. None of the three scores could predict the length of stay in ICU.ConclusionAPACHE IV and SAPS II scores were better than SOFA score as they were significantly higher between nonsurvivors but not to the extent to predict mortality or length of stay.

Endotracheal Tube Position Confirmation by the Bedside Ultrasound in Respiratory Intensive Care Unit Patients

Endotracheal Tube Position Confirmation by the Bedside Ultrasound in Respiratory Intensive Care Unit Patients

Patterns of admitted cases to Respiratory Intensive Care Unit at Zagazig University Hospitals, Egypt

BackgroundIt is well accepted that early appropriate referral of patients to an ICU can significantly reduce early and possibly late mortality in the critically ill. At the same time improper selection of patients for ICU, often limits bed availability in ICUs. This in turn, adversely affects the dynamics of the whole hospital. ObjectiveTo determine the admission pattern and outcome of patients in the Respiratory Intensive Care Unit (RICU) of Zagazig University Hospitals, Egypt. DesignThe study was carried out as a prospective analytical study. Patients and methodsAll cases admitted to RICU during the period from March 2010 to October 2010. They were 200 cases {126 males (63%) and 74 females (37%)} with an age range from 11 to 86years. They were classified according to the causes of admission to RICU into 162 cases due to primary respiratory causes (81%) and 38 cases due to secondary respiratory causes (19%). On admission the following were carried out for all patients: full medical history, chest examination, assessment of Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation II (APHCHE II) score, arterial blood gases analysis, plain chest and heart X-ray, computerized tomography (CT) electrocardiography (ECG) or echocardiography (ECHO) study when needed and assessment of the outcome. ResultsTwo hundred cases were admitted during the study period: 57% were referred by chest physicians, 14.5% from other hospitals, 13.5% from other departments and others from chest ward and emergency room (ER). The mean GCS and APHACHE II score were 12.7±3.97 and 14.4±6.5 respectively. The length of stay in RICU was 7.2±7.4days. Analysis of outcome of the cases showed that 70 patients (35%) were transferred to chest ward, 61patients (30.5%) died and 54 patients (27.0%) were discharged to home. There was a significant difference between cases with primary (1ry) and secondary (2ry) respiratory causes regarding outcome (P<0.005) with mortality rate (26.6%) among cases with 1ry respiratory causes while in cases with 2ry respiratory causes were 60.4%. Outcome as regards source of admission showed that the highest percentage of death occurred among cases referred from chest ward and non chest physicians (63.7% and 62.5%) respectively. There was a significant association between outcome and duration of stay (P<0.001). Concerning the outcome on using mechanical ventilation, the mortality rate in mechanically ventilated patients was 52.05% while in non mechanically ventilated patients it was 47.5%. ConclusionThis study showed that the best prognosis of admitted patients to RICU was for those who were transferred earlier especially those transferred by chest physicians and patients with 1ry respiratory diseases than those with 2ry respiratory diseases. Also, cases with high Glasgow Coma Scale and low APACH II score and those with a short duration of stay in RICU, especially without the need for mechanical ventilation had a good prognosis. Therefore, considering those aspects in the clinical practice would be reflected as a better outcome on dealing with RICU patients.

P013: Prevalence rate of healthcare associated infection in emergency critical care for surgery, burns and neurology ward

IntroductionMany Healthcare Associated Infections (HAI) arerelated to the use of a medical device, especially invasivedevices that buy-pass the normal barriers to entry ofmicroorganisms into the body. HAI rates of CA-UTI,CLA-BSI and VAP are significantly greater amongpatients when a medical device is used.ObjectivesDetermine Healthcare Associated infection risk withmedical devices.To make recommendations for performance improve-ment.MethodsObservation study of pilot study. Data was collected foraperiodoffiveweeks.Activesurveillancebyconsider-ing laboratory results and regular visits to patients inrespiratory intensive care unit was a method used toassess patients at-risk of healthcare associated infection.The Structured audit sheet was used.ResultsThe sample consisted of 92% pa tients received urinarycatheter, 83% patients are exposed on the peripherallines, 50% patients obtained cen tral lines and 58%patients acquired endotracheal tube in situ. The meanlength of stay was 4.04. The prevalence rate of HAI was50% infections. The predominance of prevalnce rate wasfound for VAP by 36%, while incidence rate of CLA-BSIwas 25% and incidence rate in CA-UTI with Urinarytract infection was 14%.ConclusionThe HAI is very high in C1 Resuscitation ward. Theimproved IPC practice is required and further researchis needed to identify the effect of medical devices withprevalence of infection in C1 Resuscitation ward.Disclosure of interestNone declared.

Risk factors for acquired multidrug-resistant Acinetobacter baumannii colonization in respiratory intensive care unit

To determine the risk factors for respiratory intensive care unit (RICU)-acquired colonization of multidrug-resistant Acinetobacter baumannii (MDR-AB). From January 2010 to June 2011, active screening was performed to define patients with RICU-acquired colonization of MDR-AB. And environment surveillance was carried out and patient data were collected. Logistic regression was applied to identify the risk factors of RICU-acquired colonization of MDR-AB. Active screening for MDR-AB was performed for 110 patients in RICU and 50 patients turned out to be positive. After eliminating 3 input positive patients, the RICU-acquired colonization rate of MDR-AB was 43.9% (47/107). The environmental contaminated rate of MDR-AB was 66.0% (31/47) for 47 positive patients and 33.9% (19/56) for 56 negative ones (χ(2) = 10.494, P < 0.01). Five risk factors were associated with the colonization of MDR-AB through univariate analysis: consciousness disturbance, use of carbapenems, nasal feeding tube, endotracheal intubation and mechanical ventilation (all P < 0.05). The Logistic regression equation contained 3 risk factors of conscious disturbance, use of carbapenems and mechanical ventilation (OR = 3.412, 3.211, 3.002; 95% CI: 1.165 - 9.992, 1.117 - 9.233, 1.101 - 8.182). Three risk factors are independently associated with the RICU-acquired colonization of MDR-AB: consciousness disturbance, use of carbapenems and mechanical ventilation.

The effect of acute internal problems for mortality in respiratory intensive care unit patients

Acute internal problems in the respiratory intensive care unit (ICU) and risk factors affecting mortality in the acute treatment applications were investigated. All patients in 20-bed intensive care unit for chest diseases enrolled to this prospective observational cohort study during 2008. Patients were classified as living in group 1 and deaths in group 2. Demographics and acute internal problems (arrhythmias, acute kidney-liver failure, dopamine, doputamin, perlinganit infusion) were recorded. Multiple regression analysis was performed for factors affecting mortality. There were 603 patients during the study period, group 1, n= 503 (83.4%), group 2, n= 100 (16.6%). Both groups were similar in terms of age and gender. Odds ratio (OR), 95% confidence interval (CI), p value for internal problems of acute risk factors for mortality were found as; septic shock OR: 22.52, CI 8.11-62.57, p< 0.000; need of perlinganit infusion OR: 9.28, CI: 1.61-53.37, p< 0.012; the presence of arrhythmia, OR: 7.81, CI: 3.46-17.65, p< 0.000; acute renal failure, OR: 2.88, CI: 1.24-6.65, p< 0.013 and the need for dopamine OR: 2.83, CI: 1.06-7.65, p< 0.037, respectively. Internal problems such as cardiac and renal dysfunction can devolop in respiratory ICU patients with pulmonary diseases and these problems constitude additional risk factors for mortalitiy. While the number of ICU is increasing with new health policies, each internal requirement and personnel equipped to treat the problem quickly must be considered.

C-Reactive Protein Alone or Combined With Cardiac Troponin T for Risk Stratification of Respiratory Intensive Care Unit Patients

Mortality is high among patients admitted to intensive care units (ICUs). Several prognostic markers have been described in such patients, but the literature contains no data comparing C-reactive protein (CRP) and cardiac troponin T (cTn-T), nor of a combination of CRP and cTn-T in the same patient group in the ICU. This was a retrospective electronic data review of patients who presented to the emergency department for respiratory reasons between December 2007 and December 2009 and in whom CRP and cTn-T levels were measured. Patients with a diagnosis of pulmonary embolism and acute coronary syndrome were excluded. We recorded demographics, chronic diseases, admission diagnosis, Simplified Acute Physiology Score II (SAPS II), ICU stay, and CRP and cTn-T concentrations. We included the records of 158 patients. Mean ICU stay was 9.9 days (range 1-65 d), and mean hospital stay was 14.1 days (range 1-72 d). For predicting mortality, receiver operating characteristic analysis gave a CRP cutoff value of ≥ 10 mg/dL, and a CTn-T cutoff value of ≥ 0.01 ng/mL. For CRP the mortality area under the curve was 0.691 (95% CI 0.608-0.775), the sensitivity was 65%, and the specificity was 70%. For cTn-T the mortality area under the curve was 0.733 (95% CI 0.655-0.812), the sensitivity was 78%, and the specificity was 56%. Of the patients who died, 65% had CRP ≥ 10 mg/dL and 78% had cTn-T ≥ 0.01 ng/mL. On multivariable regression analysis, CRP ≥ 10 mg/dL was associated with 6.6-fold higher (95% CI 1.7-21.3) ICU mortality. There was no advantage for models that combined CRP and cTn-T. CRP alone was more valuable in predicting ICU mortality than in combination with troponin or SAPS II. Elevated CRP is an independent early prognostic marker of mortality risk in ICU patients. We suspect that a CRP-based prognosis strategy may be useful.

Hypothyroidism complicated by low T3 state: An issue in intensive care unit

A variety of severe clinical situations, such as organ failure, can determine low serum T3 state in euthyroid patients. Recently various low triiodothyronine (T3) states have been correlated with a poor prognosis in cardiac and respiratory patients. These conditions could have an important impact especially in hypothyroidism. We described one case admitted to our respiratory intensive care unit (RICU) in comatose state, suffering from acute respiratory failure due to pneumonia with untreated subclinical hypothyroidism complicated by low T3 state. In this patient the treatment with levothyroxin alone was ineffective while replacement therapy with synthetic sodic liothyronine proved effective and lead to clinical improvement. The low T3 state is common in RICU patients and this finding could be very important in clinical practice especially when hypothyroidism might be complicated by low T3 state. This report suggest that in this case only the addition of T3 to T4 replacement therapy may improve clinical status.

Features of severe pneumonia in patients with undiagnosed pulmonary tuberculosis in an intensive care unit.

Early antituberculosis (anti-TB) therapy in hospitalized, severely ill patients with pulmonary tuberculosis (PTB) diminishes the mortality and morbidity rate and also reduces nosocomial transmission. However, delayed diagnosis of PTB is common in the respiratory intensive care unit (RICU), especially in patients with respiratory failure. This retrospective study evaluated the clinical features of RICU patients with severe pneumonia and undiagnosed active PTB, in order to determine which specific features might help in the screening of these patients. Patients with severe pneumonia with undiagnosed active PTB and those without active PTB on admission to the RICU, from March 1, 2000 to August 31, 2002, were compared. The 2 groups of patients were matched for age, gender, and Acute Physiology and Chronic Health Evaluation (APACHE) II score prior to the analysis. Data on clinical course, chest radiographic patterns, and laboratory findings were collected. Thirty five patients in the case group were matched with 35 controls who were similar with regard to age, gender, smoking history, acute lung injury score, and the presence of underlying disease. The duration of symptoms before admission was significantly longer in the case group than in the control group (15.1 +/- 13.9 vs 7.8 +/- 7.6 days, p = 0.012). The mean interval from admission to the RICU to the initiation of anti-TB therapy was 10.0 +/- 9.8 days. Small nodular lesions (p = 0.044) and cavitary lesions (p = 0.013) predominated on the chest radiograph in the case group. The mortality rates at discharge were not significantly different between the case group and the control group. These data suggest that when a patient developing severe pneumonia has a history of a sub-acute or chronic illness longer than 2 weeks in duration, and predominant small nodular or cavitary patterns on chest radiograph, active PTB should be considered.

Prevention of Pulmonary Emboli in a Respiratory Intensive Care Unit: Efficacy of Low-dose Heparin

Ninety-eight patients admitted to our respiratory intensive care unit during a one-year period were compared retrospectively with 99 well-matched patients admitted during a second one-year period. The use of prophylactic low-dose heparin in the second year was associated with a significant decrease in pulmonary emboli documented by ventilation-perfusion scan, pulmonary angiography, and autopsy. No specific bleeding complications could be directly attributed to the use of low-dose heparin. The frequency and severity of gastrointestinal hemorrhage as determined by hemoglobin fall and transfusion requirements were not significantly affected by the prophylactic use of low-dose heparin. Low-dose heparin appears to be effective and safe in respiratory intensive care unit patients in the prevention of pulmonary emboli.