scholarly journals Comorbidity and survival after admission to the intensive care unit: A population-based study of 41,230 patients

2020 ◽  
pp. 175114372091422
Author(s):  
Alasdair Simpson ◽  
Kathryn Puxty ◽  
Philip McLoone ◽  
Tara Quasim ◽  
Billy Sloan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Intensive Care Units ◽  
Odds Ratio ◽  
Intensive Care Unit Mortality ◽  
Population Based ◽  
Logistic Regression Models ◽  
Rheumatological Disease ◽  
The Relationship

Purpose To describe the relationship between comorbidities and survival following admission to the intensive care unit. Methods Retrospective observational study using several linked routinely collected databases from 16 general intensive care units between 2002 and 2011. Comorbidities identified from hospitalisation in the five years prior to intensive care unit admission. Odds ratios for survival in intensive care unit, hospital and at 30 days, 180 days and 12 months after intensive care unit admission derived from multiple logistic regression models. Results There were 41,230 admissions to intensive care units between 2002 and 2011. Forty-one percent had at least one comorbidity – 24% had one, 17% had more than one. Patients with comorbidities were significantly older, had higher Acute Physiology and Chronic Health Evaluation II scores and were more likely to have received elective rather than emergency surgery compared with those without comorbidities. After excluding elective hospitalisations, intensive care unit and hospital mortality for the cohort were 24% and 29%, respectively. Asthma (odds ratio 0.79, 95% confidence interval 0.63–0.99) and solid tumours (odds ratio 0.74, 0.67–0.83) were associated with lower odds of intensive care unit mortality than no comorbidity. Intensive care unit mortality was raised for liver disease (odds ratio 2.98, 2.43–3.65), cirrhosis (odds ratio 2.61, 1.9–3.61), haematological malignancy (odds ratio 2.29, 1.85–2.83), chronic ischaemic heart disease (odds ratio 1.53, 1.19–1.98), heart failure (odds ratio 1.79, 1.35–2.39) and rheumatological disease (odds ratio 1.53, 1.18–1.98). Conclusions Comorbidities affect two-fifths of intensive care unit admission and have highly variable effects on subsequent outcomes. Information on the differential effects of comorbidities will be helpful in making better decisions about intensive care unit support and understanding outcomes beyond surviving intensive care unit.

Maternal intensive care unit admission as an indicator of severe acute maternal morbidity: A population-based study

2020 ◽  
Author(s):  
Charlotte Godeberge ◽  
Catherine Deneux-Tharaux ◽  
Aurélien Séco ◽  
Mathias Rossignol ◽  
Anne Alice Chantry ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Odds Ratio ◽  
Maternal Morbidity ◽  
Adjusted Odds Ratio ◽  
Population Based ◽  
Population Based Study ◽  
Icu Admission ◽  
Severe Acute Maternal Morbidity

Abstract Background Severe acute maternal morbidity, accounting for any life-threatening complication during pregnancy or after delivery, is a major issue in maternal health. Measuring and monitoring it seems critical for assessing the quality of maternal health care. We explored the relevance of maternal ICU admission as an indicator of severe acute maternal morbidity by characterizing, among maternal ICU admissions, the profile of women with severe acute maternal morbidity and their ICU stay, according to the association with other criterion of severe acute maternal morbidity. Methods Secondary analysis of a multiregional prospective population-based study of 2,540 women with severe acute maternal morbidity according to a multicriteria definition based on national experts’ consensus and including ICU admission. Results 511 women were admitted to an ICU during or up to 42 days after pregnancy (2.8 per 1,000 deliveries; 20.1% of women with severe acute maternal morbidity); 15.5% had no other severe acute maternal morbidity criterion. Among women with severe acute maternal morbidity, on multivariable multinomial analysis and adjusting for cause, the odd of intensive care unit admission with another morbidity criterion was increased for migrant from outside of Europe or Africa (adjusted odds ratio = 2.1 [95% CI 1.3-3.4]), with multiple gestation (adjusted odds ratio =1.5 [1.0-2.2]), and intrapartum cesarean (adjusted odds ratio =1.5 [1.1-2.2]). The odd of intensive care unit admission with no other morbidity criterion was increased with pre-existing medical conditions (adjusted odds ratio =2.2 [1.2-4.0]) and cesarean before labor (adjusted odds ratio =3.0 [1.4-6.1]). Women admitted to an ICU with no other morbidity criterion had no interventions for organ support. Conclusions Among women with severe acute maternal morbidity, one in five is admitted to an ICU; 15.5% of these have no other severe acute maternal morbidity criterion and their admission appears mostly indicated for continuous monitoring. The use of ICU admission alone as a single criterion morbidity is misleading to define severe acute maternal morbidity; this criterion needs to be refined to be included in the definition of severe acute maternal morbidity. These results also challenge the current organization of acute care for women with severe maternal morbidity.

Abstract 339: Relationship Between Post-arrest Care Hemodynamics and Cerebral Oxygen Saturation in Comatose Survivors of Out-of-hospital Cardiac Arrest: Insights From the CAPITAL-RETURN Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Juan J Russo ◽  
Paul Boland ◽  
Simon Parlow ◽  
Jordan Bernick ◽  
Rebecca Mathew ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Oxygen Delivery ◽  
Cerebral Oxygen ◽  
Shockable Rhythm ◽  
The Mean ◽  
The Relationship ◽  
Capital Return

Introduction: Comatose survivors of OHCA develop a post cardiac arrest syndrome (PCAS) characterized by myocardial dysfunction and cerebrovascular dysregulation. Hemodynamic derangements related to PCAS can jeopardize cerebral oxygen delivery and therefore impair neurologic recovery. However, optimal hemodynamic targets to ensure adequate cerebral oxygen delivery following OHCA remain undefined. Accordingly, we examined the relationship between cardiac index (CI), mean arterial pressure (MAP), and regional cerebral oxygen saturation (rO 2 %) following OHCA. Methods: CAPITAL-RETURN was a prospective, single-center observational study examining hemodynamics in comatose survivors of OHCA undergoing targeted temperature management after an initial shockable rhythm. Between August 2016 and December 2017, comatose survivors of OHCA underwent continuous, blinded, non-invasive monitoring of CI and rO 2 % using bioimpedance (Cheetah Medical, Portland, OR, USA) and near-infrared spectroscopy (Covidien, Boulder, CO, USA), respectively, for 96 hours after intensive care unit admission. In the present study, we examined the relationship between CI, MAP, and rO 2 % using multivariable linear regression. Results: In 56 patients in this analysis, the mean CI and MAP during the first 96 hours of intensive care unit admission were 3.2±0.5 L/min/m 2 and 76±6 mmHg, respectively (Figure). The mean rO 2 % was 63±9% and increased over time (+0.1% per hour; p<0.001). Higher CI was associated with improved rO 2 % (+3.2% per L/min/m2 increase in CI; p<0.0001). There was no association between MAP and rO 2 % (p=0.42). After adjustment for MAP, the association between CI and rO 2 % remained significant (+3.1% per L/min/m2 increase in CI; p<0.0001). Conclusion: In comatose survivors of OHCA with an initial shockable rhythm, a higher CI is associated with improved rO 2 %. Further studies are needed to determine whether CI targets improve rO2% and neurologic outcomes following OHCA.

scholarly journals HIV treatment non-adherence is associated with ICU mortality in HIV-positive critically ill patients

2020 ◽  
pp. 175114371989897 ◽  
Author(s):  
Nelson BF Neto ◽  
Luiz G Marin ◽  
Bruna G de Souza ◽  
Ana LD Moro ◽  
Wagner L Nedel
Keyword(s):  
Intensive Care Unit ◽  
Human Immunodeficiency Virus ◽  
Intensive Care ◽  
Antiretroviral Therapy ◽  
Intensive Care Unit Admission ◽  
Hospital Mortality ◽  
Intensive Care Units ◽  
Therapy Adherence ◽  
Antiretroviral Therapy Adherence ◽  
Immunodeficiency Virus

Introduction Combined antiretroviral therapy has led to significant decreases in morbidity and mortality in acquired immunodeficiency syndrome patients. Survival among these patients admitted to intensive care units has also improved in the last years. However, the prognostic predictors of human immunodeficiency vírus patients in intensive care units have not been adequately studied. The main objective of this study was to evaluate if non-adherence to antiretroviral therapy is a predictor of hospital mortality. Methods A unicentric, retrospective, cohort study composed of patients admitted to a 59-bed mixed intensive care unit including all patients with human immunodeficiency vírus infection. Patients were excluded if exclusive palliative care was established before completing 48 h of intensive care unit admission. Clinical and treatment data were obtained, including demographic records, underlying diseases, Simplified Acute Physiology III score at the time of intensive care unit admission, CD4 lymphocyte count, antiretroviral therapy adherence, admission diagnosis, human immunodeficiency vírus-related diseases, sepsis and use of mechanical ventilation and hemodialysis. The outcome analyzed was hospital mortality. Results Overall, 167 patients were included in the study, and intensive care unit mortality was 34.7%. Multivariate analysis indicated that antiretroviral therapy adherence and the Simplified Acute Physiology 3 score were independently related to hospital mortality. antiretroviral therapy adherence was a protective factor (OR 0.2; 95% CI 0.05–0.71; P = 0.01), and Simplified Acute Physiology 3 (OR 1.04; 95% CI 1.01–1.08; P < 0.01) was associated with increased hospital mortality. Conclusion Non-adherence to antiretroviral therapy is associated with hospital mortality in this population. Highly active antiretroviral therapy non-adherence may be associated with other comorbidities that may be associated with a worst prognosis in this scenario.

scholarly journals When should a diagnosis of influenza be considered in adults requiring intensive care unit admission? Results of population-based active surveillance in Toronto

Critical Care ◽  
2011 ◽  
Vol 15 (4) ◽  
pp. R182 ◽  
Author(s):  
Stefan P Kuster ◽  
Kevin C Katz ◽  
Joanne Blair ◽  
James Downey ◽  
Steven J Drews ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Active Surveillance ◽  
Population Based

scholarly journals Clinical Utility of Rapid Pathogen Identification for Detecting the Causative Organisms in Sepsis: A Single-Center Study in Korea

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Won-Young Kim ◽  
Eun Suk Jeong ◽  
Insu Kim ◽  
Kwangha Lee
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Confidence Interval ◽  
Intensive Care Unit Admission ◽  
Antimicrobial Therapy ◽  
Odds Ratio ◽  
Pathogen Identification ◽  
Maldi Tof Ms ◽  
Maldi Tof ◽  
Tof Ms

Purpose. The aim of this pre- and postintervention cohort study was evaluating how effectively rapid pathogen identification with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) detected the causative organisms in sepsis.Methods. All consecutive adult patients who had bacteremia within 72 h of intensive care unit admission and met ≥2 quick Sequential Organ Failure Assessment criteria at intensive care unit admission were analyzed. The patients whose microorganisms were identified via MALDI-TOF MS between March 2014 and February 2016 formed the postintervention group. The patients whose microorganisms were identified by using conventional methods between March 2011 and February 2013 formed the preintervention group.Results. The postintervention group (n=58) had a shorter mean time from blood draw to receiving the antimicrobial susceptibility results than the preintervention group (n=40) (90.2 ± 32.1 vs. 108.7 ± 43.1 h;p=0.02). The postintervention group was also more likely to have received active antimicrobial therapy by the time the susceptibility report became available (77% vs. 47%;p=0.005). Its 28-day mortality was also lower (40% vs. 70%;p=0.003). Univariate analysis showed that identification via MALDI-TOF MS (odds ratio, 0.28; 95% confidence interval, 0.12–0.66;p=0.004) and active therapy (odds ratio, 0.38; 95% confidence interval, 0.16–0.95;p=0.04) were associated with lower 28-day mortality.Conclusion. Rapid microorganism identification via MALDI-TOF MS followed by appropriate antimicrobial therapy may improve the clinical outcomes of patients with sepsis.

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