scholarly journals Intravenous Lormetazepam during Sedation Weaning in a 26-Year-Old Critically Ill Woman

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Alawi Luetz ◽  
Bjoern Weiss ◽  
Claudia D. Spies
Keyword(s):  
Intracranial Hypertension ◽  
Critically Ill ◽  
Stress Reduction ◽  
Rare Case ◽  
Deep Sedation ◽  
Adverse Outcomes ◽  
Limited Period

Recent evidence revealed that sedation is related to adverse outcomes including a higher mortality. Despite this fact, patients sometimes require deep sedation for a limited period of time to control, for example, intracranial hypertension. In particular in these cases, weaning from sedation is often challenging due to emerging agitation, stress, and delirium. The submitted research letter reports a rare case of severe and persisting agitation that was unresponsive to all available treatments. Ultimately, lormetazepam which has recently become available for intravenous use in Germany resolved the problem by stress-reduction and anxiolysis without leading to measurable sedation.

scholarly journals Responsiveness Index versus the RASS-Based Method for Adjusting Sedation in Critically Ill Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Johanna E. Wennervirta ◽  
Mika O. K. Särkelä ◽  
Markus M. Kaila ◽  
Ville Pettilä
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Deep Sedation ◽  
Adverse Outcomes ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Sedation Level ◽  
Intensive Care Patients ◽  
Responsiveness Index ◽  
Larger Sample

Background. Sedation of intensive care patients is needed for patient safety, but deep sedation is associated with adverse outcomes. Frontal electromyogram-based Responsiveness Index (RI) aims to quantify the level of sedation and is scaled 0–100 (low index indicates deep sedation). We compared RI-based sedation to Richmond Agitation-Sedation Scale- (RASS-) based sedation. Our hypothesis was that RI-controlled sedation would be associated with increased total time alive without mechanical ventilation at 30 days without an increased number of adverse events. Methods. 32 critically ill adult patients with mechanical ventilation and administration of sedation were randomized to either RI- or RASS-guided sedation. Patients received propofol and oxycodone, if possible. The following standardized sedation protocol was utilized in both groups to achieve the predetermined target sedation level: either RI 40–80 (RI group) or RASS −3 to 0 (RASS group). RI measurement was blinded in the RASS group, and the RI group was blinded to RASS assessments. State Entropy (SE) values were registered in both groups. Results. RI and RASS groups did not differ in total time alive in 30 days without mechanical ventilation ( p = 0.72 ). The incidence of at least one sedation-related adverse event did not differ between the groups. Hypertension was more common in the RI group ( p = 0.01 ). RI group patients were in the target RI level 22% of the time and RASS group patients had 57% of scores within the target RASS level. The RI group spent significantly more time in their target sedation level than the RASS group spent in the corresponding RI level ( p = 0.03 ). No difference was observed between the groups ( p = 0.13 ) in the corresponding analysis for RASS. Propofol and oxycodone were administered at higher RI and SE values and lower RASS values in the RI group than in the RASS group. Conclusion. Further studies with a larger sample size are warranted to scrutinize the optimal RI level during different phases of critical illness.

Epidemiology and outcomes of obese critically ill patients in Australia and New Zealand

2020 ◽  
Vol 22 (1) ◽  
pp. 35-44
Author(s):  
Paul Secombe ◽  
◽  
Richard Woodman ◽  
Sean Chan ◽  
David Pilcher ◽  
...  
Keyword(s):  
New Zealand ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Adult Population ◽  
Diagnostic Category ◽  
Class Ii ◽  
Adverse Outcomes ◽  
Class I ◽  
Class I Obesity

OBJECTIVE: The apparent survival benefit of being overweight or obese in critically ill patients (the obesity paradox) remains controversial. Our aim is to report on the epidemiology and outcomes of obesity within a large heterogenous critically ill adult population. DESIGN: Retrospective observational cohort study. SETTING: Intensive care units (ICUs) in Australia and New Zealand. PARTICIPANTS: Critically ill patients who had both height and weight recorded between 2010 and 2018. OUTCOME MEASURES: Hospital mortality in each of five body mass index (BMI) strata. Subgroups analysed included diagnostic category, gender, age, ventilation status and length of stay. RESULTS: Data were available for 381 855 patients, 68% of whom were overweight or obese. Increasing level of obesity was associated with lower unadjusted hospital mortality: underweight (11.9%), normal weight (7.7%), overweight (6.4%), class I obesity (5.4%), and class II obesity (5.3%). After adjustment, mortality was lowest for patients with class I obesity (adjusted odds ratio, 0.78; 95% CI, 0.74– 0.82). Adverse outcomes with class II obesity were only seen in patients with cardiovascular and cardiac surgery ICU admission diagnoses, where mortality risk rose with progressively higher BMIs. CONCLUSION: We describe the epidemiology of obesity within a critically ill Australian and New Zealand population and confirm that some level of obesity is associated with lower mortality, both overall and across a range of diagnostic categories and important subgroups. Further research should focus on potential confounders such as nutritional status and the appropriateness of BMI in isolation as an anthropometric measure in critically ill patients.

Urinary biomarkers predict progression and adverse outcomes ofacute kidney injury in critical illness

2021 ◽  
Author(s):  
Stephen Duff ◽  
Ruairi Irwin ◽  
Jean Maxime Cote ◽  
Lynn Redahan ◽  
Blaithin A McMahon ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Urinary Biomarkers ◽  
High Morbidity ◽  
Diagnostic Analysis ◽  
Prognostic Analysis ◽  
Stage 1

Abstract Background Acute Kidney Injury (AKI) is common in hospitalized patients and is associated with high morbidity and mortality. The Dublin Acute Biomarker Group Evaluation (DAMAGE) Study is a prospective cohort study of critically ill patients (n = 717). We hypothesised that novel urinary biomarkers would predict progression of AKI and associated outcomes. Methods The primary (diagnostic) analysis assessed the ability of biomarkers levels at the time of early Stage 1 or2 AKI to predict progression to higher AKI Stage, RRT or Death within 7 days of ICU admission. In the secondary (prognostic) analysis, we investigated the association between biomarker levels and RRT or Death within 30 days. Results In total, 186 patients had an AKI within 7 days of admission. In the primary (diagnostic) analysis, eight of the 14 biomarkers were independently associated with progression. The best predictors were Cystatin C (aOR 5.2; 95% CI, 1.3-23.6), IL-18 (aOR 5.1; 95% CI, 1.8-15.7), Albumin (aOR 4.9; 95% CI, 1.5-18.3) and NGAL (aOR 4.6; 95% CI, 1.4-17.9). ROC and Net Reclassification Index analyses similarly demonstrated improved prediction by these biomarkers. In the secondary (prognostic) analysis of Stage 1-3 AKI cases, IL-18, NGAL, Albumin, and MCP-1 were also independently associated with RRT or Death within 30 days. Conclusions Among 14 novel urinary biomarkers assessed, Cystatin C, IL-18, Albumin and NGAL were the best predictors of Stage 1-2 AKI progression. These biomarkers, after further validation, may have utility to inform diagnostic and prognostic assessment and guide management of AKI in critically ill patients.

scholarly journals Comparison of Sarcopenia with Modified Frailty Index as a Predictor of Adverse Outcomes in Critically Ill Elderly Patients

2021 ◽  
pp. 200-206
Author(s):  
Shrirang Bhurchandi ◽  
Sachin Agrawal ◽  
Sunil Kumar ◽  
Sourya Acharya
Keyword(s):  
Elderly Patients ◽  
Critically Ill ◽  
Health Care Cost ◽  
Frailty Index ◽  
The Elderly ◽  
Time Frame ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Parametric Data ◽  
Modified Frailty Index

Background: Ageing is a global fact affecting both developed and developing countries.It brings out various catabolic changes in body resulting in frailty(i.e. the person is not able to with stand minor stresses of the environment, due to reduced reserves in psychologicalreserve of several organ system).Thus causing a great burden of disease, dependence & health care cost. Sarcopenia is the leading component for frailty in the elderly population, but very few studies have been done in India for correlating frailty with sarcopenia. Aim: To compare sarcopenia with modified frailty index (MFI) as a predictor of adverse outcomes in critically ill elderly patients. Methodology: Cross-sectional study will be performed on all the critically ill geriatric subjects/patients coming to all the ICU's of AVBRH, Sawangi (M), Wardha who will satisfy various inclusion and exclusion criteria for selection and all standard parametric & non-parametric data will be assessed by using standard descriptive & inferential statistics. Expected Results: In our study, we are anticipating that the Modified frailty index to be a better predictor of adverse outcomes in terms of mortality as compared to sarcopenia in the critically ill elderly patients. Also, we are anticipating that sarcopenia to be the most important contributor of frailty in critically ill elderly patients and the prevalence of frailty will be high in critically ill elderly patients. Limitation: Due to limited time frame & resources we will not be able to follow up the patients.

A Case Series of Parechovirus Encephalopathy: Apnea and Autonomic Dysregulation in Critically Ill Infants

2018 ◽  
Vol 33 (12) ◽  
pp. 788-793
Author(s):  
Elizabeth H. Ristagno ◽  
Sonam C. Bhalla ◽  
Lindsey K. Rasmussen
Keyword(s):  
Intracranial Hypertension ◽  
Critically Ill ◽  
Rapid Detection ◽  
Early Recognition ◽  
Case Series ◽  
Clinical Entity ◽  
Detection Methods ◽  
Autonomic Dysregulation

This article aims to describe a rare cause of severe encephalitis in 2 cases of infants with signs of intracranial hypertension and severe autonomic dysregulation. The authors conclude that human parechoviruses are becoming a more recognized cause of encephalitis because of the increasing use of rapid detection methods. With early recognition of this clinical entity, improved care can be administered.

scholarly journals A Rare Case of Intracranial Hypertension

2016 ◽  
Vol 04 (12) ◽  
pp. 14689-14692
Author(s):  
Mohammad Fakruddin ◽  
Keyword(s):  
Intracranial Hypertension ◽  
Rare Case

Abstract 13910: Importance of Non-invasive Estimates of Left Ventricular Filling Pressures in Critically Ill Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Abdelrahman M Ahmed ◽  
Brandon Wiley ◽  
Jacob C Jentzer ◽  
Nandan S Anavekar ◽  
Allan S Jaffe
Keyword(s):  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Troponin T ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Icu Mortality ◽  
Lv Diastolic Function

Introduction: The presence of cardiac dysfunction predicts adverse outcomes in the intensive care unit (ICU). We explored the relationship of cardiac injury and left ventricular (LV) systolic and diastolic dysfunction (LVDD) to outcomes in critically ill patients. Methods: This is a retrospective analysis of adult medical ICU admissions from May, 2018 through October 2019. Patients with elevated high-sensitivity troponin T (hs-cTnT) and an echocardiogram performed within 72 hours of admission were included. Patients were classified as having normal LV diastolic function, isolated LVDD, concomitant LV diastolic and systolic dysfunction (LVDDSD) or indeterminate LV diastolic function based on American Society of Echocardiography 2016 guidelines. LV systolic dysfunction was defined as an ejection fraction (EF) < 50%. Results: Overall, 222 patients were included. LVDD was seen in 123 patients (55.4%). Thirty patients (13.5%) were classified with indeterminate diastolic function and 56 normal diastolic function (25.2%). Of those with LVDD , 59.3% had LVDDSD while isolated LVDD was seen in 40.7%.Patients with LVDDSD had a higher median hs-cTnT at baseline compared to patients with isolated LVDD [102ng/L IQR (50-257) vs. 77 ng/L (33.5-166); p=0.047]. Medial e’ velocity and tricuspid valve systolic regurgitant velocity were often associated with LV systolic dysfunction (p=0.0172 and 0.0013, respectively). LVDDSD was associated with a longer length of stay than patients with isolated LVDD [2.9 (1.6-4.0) vs.1.8 (1.1-3.3); p-value 0.03].Twenty-nine patients died during their ICU stay (13%). Patients with LVDDSD had 9.6-fold higher odds of dying in the ICU than patients with isolated LVDD (p=0.0048). Reduced medial e’ velocity (OR 0.63, CI 0.4-1.0, p=0.0285) and increased E/e’ (OR 1.08, CI 1.01-1.15, p=0.0192) were associated with ICU mortality. The association between LVEF<50% and ICU mortality was less pronounced (OR 0.95, CI 0.01-0.98; p=0.0023). Conclusions: Concomitant LV systolic and diastolic dysfunction and measures of increased cardiac filling pressures are strong predictors of mortality.

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