Hospital-acquired pressure ulcers and risk of hospital mortality in intensive care patients on mechanical ventilation

2014 ◽  
Vol 20 (4) ◽  
pp. 362-368 ◽  
Author(s):  
Francisco Manzano ◽  
Ana M. Pérez-Pérez ◽  
Susana Martínez-Ruiz ◽  
Cristina Garrido-Colmenero ◽  
Delphine Roldan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Pressure Ulcers ◽  
Intensive Care Patients ◽  
Hospital Acquired

scholarly journals Reducing Hospital Acquired Pressure Ulcers

2015 ◽  
Author(s):  
Jessica LeBlanc
Keyword(s):  
Intensive Care ◽  
Pressure Ulcers ◽  
Tertiary Care ◽  
Occurrence Rate ◽  
Care Hospital ◽  
Intensive Care Patients ◽  
Silicone Foam ◽  
National Quality ◽  
Medical Intensive Care ◽  
Hospital Acquired

<p>Pressure ulcers have been a persistent issue in hospitals for many years and continue to remain a major cause of morbidity and mortality. Most hospital acquired pressure ulcers (HAPUs) are considered preventable and are identified by the National Quality Forum as a nurse-sensitive quality indicator. Intensive care patients in particular tend to be at a higher risk to develop PUs and prevention in the intensive care population continues to be a major challenge in many hospitals. Recently, some intensive care units have been utilizing a preventative silicone foam barrier dressing applied to patients admitted to the unit in order reduce the incidence of HAPUs. The purpose of this research was to determine if a silicone foam border dressing applied to medical intensive care patients would result in a decreased sacral HAPU occurrence rate in the medical ICU. The data collection took place at the Miriam Hospital, a 247-bed tertiary care hospital in Providence, Rhode Island. The medical ICU at the Miriam Hospital is a 16-bed unit. A retrospective chart review was conducted on 250 medical records that were coded with ICD-9 codes for pressure ulcers. Group One (treatment group) included medical intensive care unit patients who had preventative dressings applied to the sacrum. Group Two (comparison group) included patients who did not have a preventative dressing applied. Results demonstrated that there was a decrease in the occurrence rate of HAPUs after the preventative dressings were initiated. Recommendations and implications for advanced practice nursing are discussed.</p>

scholarly journals Use of Ventilator Bundle and Staff Education to Decrease Ventilator-Associated Pneumonia in Intensive Care Patients

2016 ◽  
Vol 36 (5) ◽  
pp. e1-e7 ◽  
Author(s):  
Maria Parisi ◽  
Vasiliki Gerovasili ◽  
Stavros Dimopoulos ◽  
Efstathia Kampisiouli ◽  
Christina Goga ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Staff Education ◽  
Hospital Acquired Infections ◽  
Intensive Care Patients ◽  
Greek Hospital ◽  
Hospital Acquired

BackgroundVentilator-associated pneumonia (VAP), one of the most common hospital-acquired infections, has a high mortality rate.ObjectivesTo evaluate the incidence of VAP in a multidisciplinary intensive care unit and to examine the effects of the implementation of ventilator bundles and staff education on its incidence.MethodsA 24-month-long before/after study was conducted, divided into baseline, intervention, and postintervention periods. VAP incidence and rate, the microbiological profile, duration of mechanical ventilation, and length of stay in the intensive care unit were recorded and compared between the periods.ResultsOf 1097 patients evaluated, 362 met the inclusion criteria. The baseline VAP rate was 21.6 per 1000 ventilator days. During the postintervention period, it decreased to 11.6 per 1000 ventilator days (P = .01). Length of stay in the intensive care unit decreased from 36 to 27 days (P = .04), and duration of mechanical ventilation decreased from 26 to 21 days (P = .06).ConclusionsVAP incidence was high in a general intensive care unit in a Greek hospital. However, implementation of a ventilator bundle and staff education has decreased both VAP incidence and length of stay in the unit.

scholarly journals A Comparison of Methylprednisolone and Dexamethasone in Intensive Care Patients With COVID-19

2021 ◽  
pp. 088506662199405
Author(s):  
Justine J. Ko ◽  
Clay Wu ◽  
Neha Mehta ◽  
Noah Wald-Dickler ◽  
Wei Yang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Los Angeles ◽  
Usual Care ◽  
Low Income ◽  
Corticosteroid Treatment ◽  
Intensive Care Patients ◽  
Institutional Review ◽  
Mortality Effect ◽  
All Cause Mortality

Objectives: This study retrospectively compares the effectiveness of methylprednisolone to dexamethasone in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) requiring intensive care. Design: This is an institutional review board approved cohort study in patients with COVID-19 requiring intensive care unit (ICU) admission. Patients admitted and requiring oxygen supplementation were treated with no steroids, methylprednisolone, or dexamethasone. Setting: This study takes place in the ICU’s at a large, tertiary, public teaching hospital serving a primarily low-income community in urban Los Angeles. Patients: All eligible patients admitted to the ICU for COVID-19 respiratory failure from March 1 to July 31, 2020 were included in this study. Interventions: A total of 262 patients were grouped as receiving usual care (n = 75), methylprednisolone dosed at least at 1mg/kg/day for ≥ 3 days (n = 104), or dexamethasone dosed at least at 6 mg for ≥7 days (n = 83). Measurements and Main Results: All-cause mortality within 50 days of initial corticosteroid treatment as compared to usual care was calculated. The mortality effect was then stratified based on levels of respiratory support received by the patient. In this cohort of 262 patients with severe COVID-19, all-cause mortalities in the usual care, methylprednisolone, and dexamethasone groups were 41.3%, 16.4% and 26.5% at 50 days ( P < 0.01) respectively. In patients requiring mechanical ventilation, mortality was 42% lower in the methylprednisolone group than in the dexamethasone group (hazard ratio 0.48, 95% CI: 0.235-0.956, P = 0.0385). Conclusions: In COVID-19 patients requiring mechanical ventilation, sufficiently dosed methylprednisolone can lead to a further decreased mortality as compared to dexamethasone.

scholarly journals Global Muscle Strength But Not Grip Strength Predicts Mortality and Length of Stay in a General Population in a Surgical Intensive Care Unit

2012 ◽  
Vol 92 (12) ◽  
pp. 1546-1555 ◽  
Author(s):  
Jeanette J. Lee ◽  
Karen Waak ◽  
Martina Grosse-Sundrup ◽  
Feifei Xue ◽  
Jarone Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Grip Strength ◽  
Muscle Weakness ◽  
Manual Muscle Testing ◽  
Surgical Intensive Care Unit ◽  
Muscle Testing

Background Paresis acquired in the intensive care unit (ICU) is common in patients who are critically ill and independently predicts mortality and morbidity. Manual muscle testing (MMT) and handgrip dynamometry assessments have been used to evaluate muscle weakness in patients in a medical ICU, but similar data for patients in a surgical ICU (SICU) are limited. Objective The purpose of this study was to evaluate the predictive value of strength measured by MMT and handgrip dynamometry at ICU admission for in-hospital mortality, SICU length of stay (LOS), hospital LOS, and duration of mechanical ventilation. Design This investigation was a prospective, observational study. Methods One hundred ten patients were screened for eligibility for testing in the SICU of a large, academic medical center. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, diagnoses, and laboratory data were collected. Measurements were obtained by MMT quantified with the sum (total) score on the Medical Research Council Scale and by handgrip dynamometry. Outcome data, including in-hospital mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation, were collected for all participants. Results One hundred seven participants were eligible for testing; 89% were tested successfully at a median of 3 days (25th–75th percentiles=3–6 days) after admission. Sedation was the most frequent barrier to testing (70.6%). Manual muscle testing was identified as an independent predictor of mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation. Grip strength was not independently associated with these outcomes. Limitations This study did not address whether muscle weakness translates to functional outcome impairment. Conclusions In contrast to handgrip strength, MMT reliably predicted in-hospital mortality, duration of mechanical ventilation, SICU LOS, and hospital LOS.

scholarly journals COVID-19 in-hospital mortality of a secondary care center of Mexico City in a marginated area during the first months of the Mexican epidemic

2021 ◽  
Author(s):  
José Martín Alanís-Naranjo ◽  
Víctor Manuel Anguiano-Álvarez ◽  
Eduardo Federico Hammeken-Larrondo
Keyword(s):  
Intensive Care ◽  
Hospital Mortality ◽  
Mexico City ◽  
Secondary Care ◽  
Care Center ◽  
Severe Pneumonia ◽  
P Value ◽  
Intravenous Antibiotics ◽  
Tertiary Hospitals ◽  
Hospital Acquired

Abstract Introduction: Low socioeconomic conditions and hospital saturation have been associated with higher mortality rates in hospitalized patients with COVID-19. Mexico City has become the country’s highest death toll. Iztapalapa is the district with the highest population density and marginalization in Mexico City. Most of the information on COVID-19 in-hospital mortality in Mexico comes from intensive care units or tertiary hospitals without considering the level of income. Data regarding hospital mortality in care centers with low availability of intensive care beds has not been explored.Material and methods: A retrospective cohort study in consecutive patients with COVID-19 hospitalized managed outside the intensive care unit in a secondary care center in Mexico City from April 1st, 2020, to May 31st, 2020. Analysis was performed between subgroups with a p-value <0.05 considered statistically significant.Results: A total of 164 patients were recruited; the median age was 52.5 years (IQR 44 - 64.5), 68% were males, 48.7% were obese, and 59.7% had comorbidities. Among those patients, 67% required mechanical ventilation and 32.3% vasopressor support. In this population, 52 recovered (31.7%) and 112 died (68.3%). The main risk factors associated with death were male sex, age > 50 years, diabetes, severe pneumonia on admission, PORT / PSI > 91, SMART-COP > 5, SCAP score > 10, dyspnea on admission, fever during hospitalization [p <0.05] and the administration of intravenous antibiotics [RR 3.45, 95% CI 1.69-7.06, p <0.001].Conclusion: In this study, we found higher in-hospital mortality compared to previous reports. We suggest that the administration of intravenous antibiotics could impact patient survival for the risk of developing hospital-acquired infections.

Risk factors of relative adrenocortical deficiency in intensive care patients needing mechanical ventilation

2005 ◽  
Vol 31 (3) ◽  
pp. 388-392 ◽  
Author(s):  
Gabriel Malerba ◽  
Florence Romano-Girard ◽  
Aur�lie Cravoisy ◽  
Brigitte Dousset ◽  
Lionel Nace ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Patients

scholarly journals Intensive Care Unit Outcomes Among Patients With Lung Cancer in the Surveillance, Epidemiology, and End Results–Medicare Registry

2012 ◽  
Vol 30 (14) ◽  
pp. 1686-1691 ◽  
Author(s):  
Christopher G. Slatore ◽  
Laura M. Cecere ◽  
Jennifer L. LeTourneau ◽  
Maya E. O'Neil ◽  
Jonathan P. Duckart ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Surgical Resection ◽  
Cox Regression ◽  
Patient Characteristics ◽  
Patient Centered ◽  
End Results

Purpose Lung cancer is the leading cause of cancer-related mortality. Intensive care unit (ICU) use among patients with cancer is increasing, but data regarding ICU outcomes for patients with lung cancer are limited. Patients and Methods We used the Surveillance, Epidemiology, and End Results (SEER) –Medicare registry (1992 to 2007) to conduct a retrospective cohort study of patients with lung cancer who were admitted to an ICU for reasons other than surgical resection of their tumor. We used logistic and Cox regression to evaluate associations of patient characteristics and hospital mortality and 6-month mortality, respectively. We calculated adjusted associations for mechanical ventilation receipt with hospital and 6-month mortality. Results Of the 49,373 patients with lung cancer admitted to an ICU for reasons other than surgical resection, 76% of patients survived the hospitalization, and 35% of patients were alive 6 months after discharge. Receipt of mechanical ventilation was associated with increased hospital mortality (adjusted odds ratio, 6.95; 95% CI, 6.89 to 7.01; P < .001), and only 15% of these patients were alive 6 months after discharge. Of all ICU patients with lung cancer, the percentage of patients who survived 6 months from discharge was 36% for patients diagnosed in 1992 and 32% for patients diagnosed in 2005, whereas it was 16% and 11% for patients who received mechanical ventilation, respectively. Conclusion Most patients with lung cancer enrolled in Medicare who are admitted to an ICU die within 6 months of admission. To improve patient-centered care, these results should guide shared decision making between patients with lung cancer and their clinicians before an ICU admission.

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