Surgical Intensive Care Patients Research Articles

Gender Differences With Ibutilide Effectiveness and Safety in Cardioversion of Atrial Fibrillation

IntroductionFew studies have examined the use of ibutilide in noncardiac surgical populations. Our study considered the effectiveness and safety of ibutilide in cardioversion of atrial fibrillation (AF) in medical and surgical intensive care patients. MethodsA retrospective chart review was performed for patients with a confirmed diagnosis of AF who were hemodynamically stable and received ibutilide after the initial diagnosis. Patients were administered 1 mg of ibutilide fumarate intravenous for 10 min with a second dose administered if AF persisted after 30 min. Patients were pretreated with intravenous magnesium sulfate if their blood magnesium level was <2 mg/dL. ResultsFifty seven total female patients and 99 male patients received ibutilide. Females had an 88% conversion rate to normal sinus rhythm (NSR) compared to 68% in males (P = 0.008). A 70% successful return to NSR was observed in patients from all groups pretreated with magnesium sulfate (P = 0.045). One year after discharge, 74% of the patients stayed in the NSR. ConclusionsWithin our population, pretreatment with magnesium sulfate followed by ibutilide was associated with increased conversion to NSR. Additionally, we noted that females had a higher conversion rate to NSR compared to males, regardless of whether they were pretreated with magnesium sulfate.

Pain Behaviors and Physiological Parameters During Painful Procedures in Surgical Intensive Care Patients

Pain Behaviors and Physiological Parameters During Painful Procedures in Surgical Intensive Care Patients

Sleep Quality and Related Factors in Surgical Intensive Care Patients

Sleep Quality and Related Factors in Surgical Intensive Care Patients

Comparison of infrared tympanic and non-contact temporal artery thermometer in determining the body temperature of patients in cardiovascular surgical intensive care

Accurate measurement of body temperature is crucial post-cardiovascular surgery, given the intricate and high-risk nature of cardiovascular procedures. In this prospective observational study, the safety and efficacy of infrared tympanic thermometers (ITT) and non-contact infrared temporal artery thermometers (NCTAT) were assessed in intensive care patients recovering from cardiovascular surgery. Conducted at a state hospital in Istanbul from April to July 2016, the study included 60 eligible patients meeting the specified criteria. Results indicated a slightly higher body temperature measurement with ITT (36.42±0.72) compared to NCTAT (36.02±0.79). NCTAT and ITT values were found (right ear: bias =0.39°C, limits of agreement: -1.99°C to 1.21°C; left ear: bias =0.29°C, limits of agreement: -1.59°C to 1.01°C) in the statistical evaluation by Bland and Altman analysis method. Repeatability, intragroup correlation and scatter plots of both measuring devices did not show a significant difference. In conclusion, within the cardiovascular surgical intensive care unit, both types of thermometers prove suitable for body temperature measurement. Healthcare professionals can make informed choices between the two based on the distinct advantages and disadvantages associated with each device.

Early extubation protocol post-coronary artery bypass graft &amp; open heart surgery

Fast-tracking in cardiac care refers to the complex intervention including early extubation, care during anesthesia, mobilization and hospital discharge to reduce perioperative morbidity, costs, and length of stay in the intensive care unit and the hospital. This review was designed to evaluate early extubation protocols, the differences in early and late extubation, the safety and efficacy of early extubation among the patients in surgical intensive care after coronary artery bypass graft (CABG) surgery. The analyzed studies showed many significant differences in the mortality and postoperative complications of time-directed extubation practices and low dose-based general anesthesia in patients with low to moderate risk undergoing early extubation (fast-track) and the conventional care methods. Different fast-track interventions could diminish extubation time, costs, and the length of hospital stay. However, several factors including patient’s stay in the intensive therapy ward vs general ward, patient selection, skills and experience of the staff, and fast-track anesthesia methods could be considered to perform safe fast-tracking in patients undergoing cardiac surgery. On the other hand, to achieve this safety for high-risk cardiosurgery patients multidisciplinary coordination is needed.

Prognostic nutritional index to predicting mortality in surgical intensive care patients

INTRODUCTION: It is known that immuno-nutritional status affects clinical outcomes in intensive care (ICU) patients. This study aimed to evaluate the relationship of the Prognostic Nutritional Index (PNI) with mortality in surgical ICU patients. MATERIAL AND METHODS: The single-center, retrospective, observational study was conducted in a 17-bed surgical ICU. Patients over the age of 18 who were hospitalized between May 1, 2018, and May 1, 2019, were evaluated. RESULTS: 217 patients followed in the surgical ICU were evaluated. The mean age of the study population was 51.84 ± 21.25 years, and 150 (69.10%) patients were male. ICU mortality was calculated as 16.10%. Trauma was the most common reason for hospitalization in both groups, and there was no difference between the two groups in terms of hospitalization reasons. The PNI score was found to be significantly lower in the non-survivor group compared to the survivors (p &lt; 0.001). The PNI cut-off value in predicting mortality was found to be 32.01 with a sensitivity of 0.829 and a specificity of 0.956 [AUC = 0.957 (95% CI from 0.929 to 0.984); p &lt; 0.001]. CONCLUSIONS: PNI is a cost-effective scoring system that can be calculated with a simple formulation. In our study, in which surgical ICU cases were evaluated, lower PNI values were found in patients with mortality compared to those who survived. We believe that PNI can be used in the prediction of mortality in surgical ICU cases, and our study will shed light on future studies on this subject.

Delta-like canonical Notch ligand 1 is predictive for sepsis and acute kidney injury in surgical intensive care patients

The early identification of sepsis in surgical intensive care patients is challenging due to the physiological postoperative alterations of vital signs and inflammatory biomarkers. Soluble Delta-like protein 1 (sDLL1) may be a potential discriminatory biomarker for this purpose. For this reason, this study aimed to evaluate sDLL1 for the identification of sepsis in a cohort of surgical intensive care patients. This study comprises a secondary analysis of a prospective observational study including 80 consecutive patients. The study groups included 20 septic shock patients, 20 patients each undergoing major abdominal surgery (MAS) and cardiac artery bypass surgery (CABG), and 20 matched control subjects (CTRL). The surveillance period was 72 h. The plasma concentration of sDLL1 was measured with ELISA. The plasma levels of sDLL1 were significantly elevated in septic patients compared to both surgical cohorts (septic vs. all postoperative time points, data are shown as median and interquartile range [IQR]; septic shock: 17,363 [12,053–27,299] ng/mL, CABG 10,904 [8692–16,250] ng/mL; MAS 6485 [4615–9068] ng/mL; CTRL 5751 [3743–7109] ng/mL; septic shock vs. CABG: p < 0.001; septic shock vs. MAS: p < 0.001). ROC analysis showed a sufficient prediction of sepsis with limited specificity (AUCROC 0.82 [0.75–0.82], sensitivity 84%, specificity 68%). The plasma levels of sDLL correlated closely with renal parameters (creatinine: correlation coefficient = 0.60, r2 = 0.37, p < 0.0001; urea: correlation coefficient = 0.52, r2 = 0.26, p < 0.0001), resulting in a good predictive performance of sDLL1 for the identification of acute kidney injury (AKI; AUCROC 0.9 [0.82–0.9], sensitivity 83%, specificity 91%). By quantifying the plasma concentration of sDLL1, sepsis can be discriminated from the physiological postsurgical inflammatory response in abdominal and cardiac surgical patients. However, sDLL1 has only limited specificity for the detection of sepsis in cardiac surgical patients, which may be explained by impaired renal function. Based on these findings, this study identifies the predictive value of sDLL1 for the detection of AKI, making it a potential biomarker for surgical intensive care patients.Trial registration DRKS00013584, Internet Portal of the German Clinical Trials Register (DRKS), registration date 11.07.2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013584.

Nasal pillow noninvasive ventilation versus high-flow nasal therapy after extubation in surgical intensive care patients: A propensity-matched cohort study.

ObjectiveTo evaluate the tolerability and efficacy of nasal pillow-noninvasive ventilation (NP-NIV) compared with high-flow nasal therapy (HFNT) in postsurgical patients.MethodsThis propensity score-matched retrospective study enrolled postoperative patients that received NP-NIV (NP-NIV group) or HFNT (HFNT group) in the intensive care unit. Data were collected from their medical records and the tolerability and respiratory status before and after extubation were compared between the two groups.ResultsThe study enrolled 83 patients in the NP-NIV group and 27 patients in the HFNT group. After propensity score matching, there were 19 patients in each group. After matching, there were no significant differences in the baseline demographic and clinical characteristics before extubation. The tolerability was similar in both groups. When the NP-NIV group was compared with the HFNT group, the respiratory rate was significantly lower (median 16 [interquartile range, 14–17] versus median 19 [interquartile range, 18–26], respectively) and the partial pressure of arterial oxygen/fraction of inspired oxygen ratio was significantly higher (median 205 [174–256] versus median 155 [130–192], respectively) at 1 h after extubation.ConclusionNP-NIV was equally well tolerated and provided better respiratory support than HFNT in postsurgical patients.

Intensive Care Experiences of Postoperative Patients.

Objective: The aim of this study is to examine the intensive care experience of postoperative patients. Methods: This descriptive study was conducted between February and May 2021 with the participation of 75 surgical intensive care patients. Data were collected using the patient identification form and The Intensive Care Experiences Scale (ICES). Shapiro-Wilks test, Mann-Whitney U, Kruskal-Wallis H test, Bonferroni Corrected Mann-Whitney U test, and Spearman correlation analysis were used in analyzing the data. Results: The mean patient age was 62.8 ± 14.9 year (min: 23 and max: 95); 53.3% (n = 40) were male. The patients’ mean length of stay in the intensive care unit was 1.4 ± 1.0 days. The mean ICES score of the patients was 57.4 ± 3.9. It was found that the patients’ mean scores of the “satisfaction with care” subscale varied according to the surgical procedure applied, connection to mechanical ventilation, and status of seeing other individuals receiving treatment. Conclusions: Patients’ intensive care experiences were partially positive. Being aware of the patients’ experiences, supporting them in biopsychosocial aspects, and being in contact will contribute to the improvement of their postsurgical intensive care experience.

Isoflurane promotes early spontaneous breathing in ventilated intensive care patients: A post hoc subgroup analysis of a randomized trial.

Spontaneous breathing is desirable in most ventilated patients. We therefore studied the influence of isoflurane versus propofol sedation on early spontaneous breathing in ventilated surgical intensive care patients and evaluated potential mediation by opioids and arterial carbon dioxide during the first 20h of study sedation. We included a single-center subgroup of 66 patients, who participated in a large multi-center trial assessing efficacy and safety of isoflurane sedation, with 33 patients each randomized to isoflurane or propofol sedation. Both sedatives were titrated to a sedation depth of -4 to -1 on the Richmond Agitation Sedation Scale. The primary outcome was the fraction of time during which patients breathed spontaneously. Baseline characteristics of isoflurane and propofol-sedated patients were well balanced. There were no substantive differences in management or treatment aside from sedation, and isoflurane and propofol provided nearly identical sedation depths. The mean fraction of time spent spontaneously breathing was 82% [95% CI: 69, 90] in patients sedated with isoflurane compared to 35% [95% CI: 22, 51] in those assigned to propofol: median difference: 61% [95% CI: 14, 89], p<.001. After adjustments for sufentanil dose and arterial carbon dioxide partial pressure, patients sedated with isoflurane were twice as likely to breathe spontaneously than those sedated with propofol: adjusted risk ratio: 2.2 [95%CI: 1.4, 3.3], p<.001. Isoflurane compared to propofol sedation promotes early spontaneous breathing in deeply sedated ventilated intensive care patients. The benefit appears to be a direct effect isoflurane rather than being mediated by opioids or arterial carbon dioxide.

RISK FACTORS AND OUTCOMES OF NEW ONSET ARRHYTHMIA IN SURGICAL INTENSIVE CARE UNIT: A RETROSPECTIVE STUDY

Objective: To assess the frequency of new-onset cardiac arrhythmias among patients admitted in surgical intensive care unit as well as associated risk factors.&#x0D; Study Design: Retrospective observational study.&#x0D; Place and Duration of Study: Surgical Intensive Care Unit, Aga Khan University Hospital, Karachi, from Jan 2018 to Dec 2019.&#x0D; Methodology: The medical record numbers of all patients admitted in surgical intensive care unit were obtained from Surgical intensive care unit case log entries and reviewed. Patients` and healthcare providers` identification were kept confidential. Data was analyzed using SPSS version 19.&#x0D; Results: Only 13/1076 patients included in the study had cardiac arrhythmias during their stay in Surgical intensive care unit. Among all patients with arrhythmias (n=13), atrial fibrillation was the most common type of arrhythmia 7 (53.8%). The study found higher occurrence of arrhythmias among the patients in the age category of 66 years or above 8 (4.6%) and when compared to younger patients with age categories 18-40 years 2 (0.3%) and 41-65 years 3 (0.3%) respectively (p-value&lt;0.05). Similarly, arrhythmias were higher among patients who had relatively prolong intensive care unit stay and post-operative status as the primary cause of intensive care unit admission.&#x0D; Conclusion: Occurrence of cardiac arrhythmias is relatively low among patients admitted to surgical intensive care patient population. Patients age (&gt;65 years), prolong intensive care unit stay, post-operative status are positively associated with development of cardiac arrhythmias among critically ill patients admitted in surgical intensive care unit.

Can omentin-1 be a prognostic marker in surgical intensive care patients?

Background/aimA member of the adipokine family, omentin-1 is selectively secreted from visceral fat tissue and the omentum. It has been shown that omentin-1 is involved in the pathogenesis of certain diseases and can be used as a prognostic marker. This study first investigated the prognostic significance of omentin-1 in surgical intensive care patients. In addition, the relationship between omentin-1 and laboratory and clinical parameters commonly used in intensive care units (ICUs) was evaluated.Materials and methodsOne hundred and fifty-four patients hospitalized in the surgical ICU were included in the study. Blood samples for omentin-1 were collected from the patients displaying clinical condition changes. Changes in omentin-1 levels were observed during the hospital stay of the patients. A total of 423 blood samples were evaluated. Omentin-1 levels were compared to the laboratory parameters routinely monitored in the ICU and the prognostic significance of omentin-1 for surgical intensive care patients was investigated.Results The median APACHE II score of all patients was (median-IQR, 8.0–6.0 ng/mL). Omentin-1 levels of the alive patients in the ICU (median-IQR, 339.04–407.68 ng/mL) were significantly higher compared to dead patients (median-IQR, 166.40–363.60 ng/mL). Omentin-1 levels were higher in nonsepsis patients compared to the levels of the patients in sepsis and septic shock (p < 0.001). Omentin-1 values were negatively correlated with the C-reactive protein and procalcitonin levels, body temperature, and the SOFA (sequential organ failure assessment score) scores and they were positively correlated with albumin, prealbumin, and glucose levels. Conclusion Omentin-1 may play a role in the complex constructs of inflammation and metabolic events in intensive care patients. Reduced omentin-1 levels in surgical intensive care patients were associated with poor prognosis and increased mortality.

Predictive value of the negative inspiratory force index as a predictor of weaning success: a crosssectional study.

Background Identifying when intubated patients are ready to be extubated remains challenging. The negative inspiratory force (NIF) is a recommended predictor of weaning success. However, little is known about the role of NIF in the weaning process for the Asian surgical intensive population, especially for the Vietnamese population. Here, we aimed to investigate the cutoff threshold and predictive value of the NIF index for predicting the success of ventilator weaning in Vietnamese surgical intensive care patients.Methods A cross-sectional study was conducted at the Surgical Intensive Care Unit of Viet Duc Hospital from October 2016 to August 2017. A total of 64 patients aged 16–70 years undergoing ventilatory support through an orotracheal tube satisfied the criteria for readiness to begin weaning. The correlation between the NIF index with outcomes of the weaning process was analyzed. Specificity (Sp), sensitivity (Se), positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristic (ROC) curve, and area under the curve (AUC) were calculated.Results The success rate of the entire weaning process was 67.2% (43/64). The median NIF values were –26.0 cm H2O (interquartile range [IQR], –28.0 to –25.0) in the successful weaning group and –24.0 cm H2O (IQR, –25.0 to –23.0) in the weaning failure group (P<0.001). According to ROC analysis, an NIF value ≤–25 cm H2O predicted weaning success (AUC, 0.836) with 91% Se, 62% Sp, 83% PPV, and 77% NPV.Conclusions An NIF cutoff threshold ≤–25 cm H2O can be used as predictor of weaning success in Vietnamese surgical intensive care patients.

Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients

BackgroundIt is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) scores are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the regular ward. This study aimed to examine the ability of SOFA and qSOFA scores to predict suspected infection and mortality in IMCU patients.MethodsRetrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between January 01, 2012, and September 30, 2018. Patients were screened for suspected infection (i.e., the commencement of broad-spectrum antibiotics) and then evaluated for the SOFA score, qSOFA score, and the 1992 defined systemic inflammatory response syndrome (SIRS) criteria.ResultsSuspected infection was detected in 1306 (18.3%) of IMCU, 1365 (35.5%) of ICU, and 1734 (62.0%) of IMCU/ICU encounters. Overall, 458 (3.3%) patients died (IMCU 45 [0.6%]; ICU 250 [6.5%]; IMCU/ICU 163 [5.8%]). All investigated scores failed to predict suspected infection independently of the analyzed subgroup. Regarding mortality prediction, the qSOFA score performed sufficiently within the IMCU cohort (AUCROC SIRS 0.72 [0.71–0.72]; SOFA 0.52 [0.51–0.53]; qSOFA 0.82 [0.79–0.84]), while the SOFA score was predictive in patients of the IMCU/ICU cohort (AUCROC SIRS 0.54 [0.53–0.54]; SOFA 0.73 [0.70–0.77]; qSOFA 0.59 [0.58–0.59]).ConclusionsNone of the assessed scores was sufficiently able to predict suspected infection in surgical ICU or IMCU patients. While the qSOFA score is appropriate for mortality prediction in IMCU patients, SOFA score prediction quality is increased in critically ill patients.

Appropriate Source Control and Antifungal Therapy are Associated with Improved Survival in Critically Ill Surgical Patients with Intra-abdominal Candidiasis

BackgroundIntra-abdominal candidiasis (IAC) is the predominant type of invasive candidiasis with high mortality in surgical intensive care patients. The purpose of this study was to investigate the impact of appropriate source control and antifungal therapy on the outcomes of critically ill surgical patients with IAC.MethodsThis was a retrospective single-center cohort study. Adult surgical patients who were admitted to the intensive care unit and diagnosed with IAC from January 1, 2003, to December 31, 2016, were enrolled. The patients’ data including risk factors of IAC, infection-related information, antifungal treatment and 30-day outcomes were collected. The primary endpoint was 30-day mortality. A COX proportional hazards model was used to analyze the association between appropriate treatment and 30-day survival.ResultsA total of 82 patients were included in the analysis. Of these, 45 (54.9%) were complicated with septic shock at IAC diagnosis. Types of IAC included peritonitis (61.0%), intra-abdominal abscesses (23.2%) and biliary tract infections (15.9%). Of the included patients, 53 (64.6%) received appropriate source control and 44 (53.7%) appropriate antifungal therapy. Compared with patients with neither of these treatments, appropriate source control (HR 0.08, 95% CI 0.02–0.30; P < 0.001), appropriate antifungal therapy (HR 0.14, 95% CI 0.04–0.55; P = 0.005), and a combination of these treatments (HR 0.02, 95% CI 0.00–0.08; P < 0.001) were associated with reduced risk of death within 30 days after IAC diagnosis.ConclusionFor critically ill surgical patients with IAC, both appropriate source control and appropriate antifungal therapy were associated with reduced risk of 30-day mortality, and the protective effects of the two appropriate treatments were additive.

The effects of C-reactive protein/albumin ratio and hematologic parameters on predicting the prognosis for emergency surgical patients in intensive care.

Diagnosis and treatment of emergency surgical pathologies should be addressed within hours, and the prognosis of the patient may deteriorate further in cases of delay. Easy and effective markers are needed in this regard. Our aim in this study is to evaluate the CRP/albumin ratio and the usability of hematological parameters in predicting prognosis in emergency surgical patients in intensive care. This study was performed by retrospectively scanning the files of the patients who were followed up in the intensive care unit. Patients hospitalized after emergency surgery were taken as 'emergency group' and patients hospitalized after elective major surgery were taken as 'control group'. In addition to the demographic characteristics of the patients, the length of hospitalization in the intensive care unit, whether there was a need for mechanical ventilation, platelet/lymphocyte (P/L), neutrophil/lymphocyte (N/L), C-reactive protein (CRP)/albumin values were recorded and the values of both groups were compared statistically. In this study, 341 patients were included, of which 111 were emergency (32.6%) (Group 1), 230 were elective (67.4%) (Group 2) cases. When the emergency and elective cases were compared, the average CRP/albumin value was 49.05 in Group 1 and 32.8 in Group 2 (p=0.001). N/L values were 11.9 in Group 1 and 9.87 in Group 2 (p=0.04). When looking at another hematological parameter, P/L, it was found 272.62 in Group 1 and 229.17 in Group 2 (p=0.03). Hospitalization days were 13.61 days in Group 1, while 12.43 days in Group 2. When CRP/albumin >40, its sensitivity was determined as 80.49% and its selectivity as 67.22% (p<0.001). The CRP/albumin ratio can be used as an effective marker in determining the urgency of surgical cases and predicting mortality.

"Drug Interaction Stewardship" (DIS) and Therapeutic Drug Monitoring for Anti-infective Treatment in Intensive Care, a Single Centre Observational Study

Appropriate medication of intensive care patients is complicated by disturbed organ functions and organ failure, pathophysiological changes in severely ill patients as well as possible sepsis, ongoing haemodialysis for renal and hepatic insufficiency, varying pharmacokinetics/-dynamics (PK/PD) of drugs as well as numerous drug interactions. Illustration of an interdisciplinary approach in daily clinical practice to optimise regular "polymedication" as well as the ongoing medication of patients prior to surgical interventions as indicated and as part of the appropriate peri- and postoperative intensive care management. A so-called "drug interaction stewardship" (DIS) is very similar to the already established "antibiotic stewardship" (ABS) during daily clinical routine of an intensive care unit and has been implemented. In addition, therapeutic drug monitoring (TDM) has been extended to antibiotics/antimycotics (such as meropenem, piperacillin-tazobactam, ceftazidime, linezolide, voriconazole, fluconazole, caspofungin), for which TDM had not yet been established. This was in a consecutive cohort of patients with abdominal surgery over a defined time period and was part of a systematic clinical single centre observational study (tertiary centre). From 01 - 2012 to 08 - 2016, 1,454 single drug patient consultations led to 385 (26.5%) changes in medical treatment, which had been previously initiated by an experienced intensive care physician. Most frequently in 156 cases (10.7%) this was due to newly calculated PK/PD. Analysis of 2,333 TDM samples resulted in a minimum serum level within the adequate range in 1,130 cases (48.4%). In 427 cases (18.3%), the drug serum level was too low and in 776 subjects (33.3%), prompting a change in the type, dose, dose interval and application route. DIS and TDM provide a high rate of detection of unwanted drug interactions and inappropriate drug levels in surgical intensive care patients and help to assure targeted therapy changes.

Analgesic sparing effects of Dexmedetomidine in surgical intensive care patients

Background: Dexmedetomidine (Dex) is a sedative agent with analgesic property.1,2 A recent review of the literature has shown clear advantages over the traditional sedation namely lesser respiratory depression, less delirium, better sedation, analgesia, organ protection and anti-shivering effect.3,4 Optimal sedation in critically ill patients is of vital importance, under sedation will raise work of breathing and causes adverse hemodynamic effects. Whereas over sedation will lead to increased number of imaging studies and higher morbidity and mortality.4,5 The aim of our study was to investigate the efficacy of dexmedetomidine (Dex), its use in intubated patients and post-extubation period, rescue sedation, safety and analgesic sparing effect in critically ill surgical patients. Patients and Methods: All patients sedated with dexmedetomidine (Dex) in the surgical intensive unit of a tertiary healthcare facility were included prospectively in the study. Patients' demographic data, diagnosis, surgical interventions, traditional sedation, Dex dosage and days, post-extubation Dex use, general adverse effects, adverse effects associated with lower or higher Dex doses, analgesic, and rescue sedation requirements were recorded. Patients were intubated and ventilated, the initial dose of Dex infusion was 0.5 mcg/kg/hr along with either fentanyl or remifentanil infusion. Dex infusion was titrated to keep the Ramsay sedation score of 3 to 4. Analgesia was titrated according to the NRS (numeric rating scale) in extubated patients and the Critical-Care Pain Observation Tool (CPOT) score in intubated patients. The infusion of fentanyl and remifentanil were titrated and decreased according to the CPOT score. Some of the patients extubated required continuation of the Dex infusion in the post-extubation period to maintain analgesia and to keep them calm.Chi-square test was performed to compare among the groups. P-value ≤ 0.05 was considered as statistically significant. Results: A total of 428 patients were enrolled in the study. The majority of patients were male (73.3%). The most common diagnosis was acute abdomen and frequently the performed surgery was laparotomy (28.9%) (Figure 1a). The duration of Dex treatment ranged from 2 to 28 days; the most commonly used dose was 0.5 to 1.4 μg/kg/hours (Figure 1b). Seventy-eight percent (78%) of patients required Dex in the post-extubation period at a dose of 0.2 μg /kg/hours. There was significant reduction in the analgesic requirements in the post-Dex period (p < 0.001) (Table 1(a)). Adverse effects such as bradycardia 6.1%, hypertension 4% and hypotension 1.6% were observed (Figure 2) and there was no significant difference in lower and higher dose of Dex and occurrence of adverse effects (p < 0.82). Patients administered a higher dose of Dex required significantly higher rescue traditional sedation (p < 0.01) (Table 1(b)). Conclusion: We used dexmedetomidine in different surgical critical patients. The occurrence of adverse effects such as bradycardia, hypotension and hypertension were comparable to that mentioned in the literature. There was a significant analgesia sparing effect of dexmedetomidine. We continued Dex in the post-extubation period and the effective dose used was 0.2 mcg/kg/hour. There was no significant difference in occurrence of adverse effects with lower and higher range of Dex. The patients on a higher dose of Dex needed more rescue traditional sedation.

Perioperative Infusion of Glucagon-Like Peptide-1 Prevents Insulin Resistance After Surgical Trauma in Female Pigs.

Insulin resistance is an independent negative predictor of outcome after elective surgery and increases mortality among surgical patients in intensive care. The incretin hormone glucagon-like peptide-1 (GLP-1) potentiates glucose-induced insulin release from the pancreas but may also increase insulin sensitivity in skeletal muscle and directly suppress hepatic glucose release. Here, we investigated whether a perioperative infusion of GLP-1 could counteract the development of insulin resistance after surgery. Pigs were randomly assigned to three groups; surgery/control, surgery/GLP-1, and sham/GLP-1. Both surgery groups underwent major abdominal surgery. Whole-body glucose disposal (WGD) and endogenous glucose release (EGR) were assessed preoperatively and postoperatively using D-[6,6-2H2]-glucose infusion in combination with hyperinsulinemic euglycemic step-clamping. In the surgery/control group, peripheral insulin sensitivity (i.e., WGD) was reduced by 44% relative to preoperative conditions, whereas the corresponding decline was only 9% for surgery/GLP-1 (P < 0.05). Hepatic insulin sensitivity (i.e., EGR) remained unchanged in the surgery/control group but was enhanced after GLP-1 infusion in both surgery and sham animals (40% and 104%, respectively, both P < 0.05). Intraoperative plasma glucose increased in surgery/control (∼20%) but remained unchanged in both groups receiving GLP-1 (P < 0.05). GLP-1 diminished an increase in postoperative glucagon levels but did not affect skeletal muscle glycogen or insulin signaling proteins after surgery. We show that GLP-1 improves intraoperative glycemic control, diminishes peripheral insulin resistance after surgery, and suppresses EGR. This study supports the use of GLP-1 to prevent development of postoperative insulin resistance.

An Evaluation of Risk Factors for Extubation Failure in Surgical Patients in Intensive Care.

Reintubations following extubation from mechanical ventilation are costly, resulting in increased morbidity and mortality. The preparation for and timing of extubation from mechanical ventilation can reduce unplanned reintubations. Few studies have investigated reintubation in the surgical intensive care unit (SICU) population. To identify risk factors that predict extubation failure in nontrauma surgical postoperative intensive care patients. Retrospective analysis utilizing American College of Surgeons National Surgical Quality Improvement Program data and institutional clinical variables from July 1, 2013, to December 31, 2015, in a sample (N = 93) of surgical patients admitted postoperatively to a SICU with an endotracheal tube in place, requiring invasive mechanical ventilation. Logistic regression analysis was used to model extubation failure as a function of clinical variables in the 24 hours preceding extubation. Of 93 patients, 70 were successfully extubated, and 23 experienced failure. Increasing respiratory rate in the 24 hours preceding extubation significantly predicted failure (odds ratio, 1.086; 95% confidence interval, 1.006-1.172; P = .034). Elevated respiratory rates during the 24 hours preceding extubation are an underappreciated risk factor for extubation failure. This has direct implications for nurses who are assessing intensive care unit patients' readiness for extubation. Opportunity exists for nurses to better integrate respiratory rate data into extubation planning to improve unplanned reintubation rates in SICU patients.