scholarly journals On a Controlled Se(Is)(Ih)(Iicu)AR Epidemic Model with Output Controllability Issues to Satisfy Hospital Constraints on Hospitalized Patients

Algorithms ◽  
2020 ◽  
Vol 13 (12) ◽  
pp. 322
Author(s):  
Manuel De la Sen ◽  
Asier Ibeas
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Epidemic Model ◽  
Hospital Admissions ◽  
Transmission Rate ◽  
Worked Examples ◽  
Hospitalized Patients ◽  
Number Of Patients ◽  
Output Controllability ◽  
Joint Consideration

An epidemic model, the so-called SE(Is)(Ih)(Iicu)AR epidemic model, is proposed which splits the infectious subpopulation of the classical SEIR (Susceptible-Exposed-Infectious-Recovered) model into four subpopulations, namely asymptomatic infectious and three categories of symptomatic infectious, namely slight infectious, non-intensive care infectious, and intensive care hospitalized infectious. The exposed subpopulation has four different transitions to each one of the four kinds of infectious subpopulations governed under eventually different proportionality parameters. The performed research relies on the problem of satisfying prescribed hospitalization constraints related to the number of patients via control interventions. There are four potential available controls which can be manipulated, namely the vaccination of the susceptible individuals, the treatment of the non-intensive care unit hospitalized patients, the treatment of the hospitalized patients at the intensive care unit, and the transmission rate which can be eventually updated via public interventions such as isolation of the infectious, rules of groups meetings, use of face masks, decrees of partial or total quarantines, and others. The patients staying at the non-intensive care unit and those staying at the intensive care unit are eventually, but not necessarily, managed as two different hospitalized subpopulations. The controls are designed based on output controllability issues in the sense that the levels of hospital admissions are constrained via prescribed maximum levels and the measurable outputs are defined by the hospitalized patients either under a joint consideration of the sum of both subpopulations or separately. In this second case, it is possible to target any of the two hospitalized subpopulations only or both of them considered as two different components of the output. Different algorithms are given to design the controls which guarantee, if possible, that the prescribed hospitalization constraints hold. If this were not possible, because the levels of serious infection are too high according to the hospital availability means, then the constraints are revised and modified accordingly so that the amended ones could be satisfied by a set of controls. The algorithms are tested through numerically worked examples under disease parameterizations of COVID-19.

scholarly journals Causes and Outcomes of Finger Ischemia in Hospitalized Patients in the Intensive Care Unit

2017 ◽  
Vol 66 (3) ◽  
pp. e57
Author(s):  
Gregory Landry ◽  
Courtney Mostul ◽  
Bryan McLafferty ◽  
Daniel Ahn ◽  
Erica Mitchell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospitalized Patients

The Impact of Implementing a “Pain, Agitation, and Delirium Bundle” in a Pediatric Intensive Care Unit: Improved Delirium Diagnosis

2021 ◽  
Author(s):  
Lise D. Cloedt ◽  
Kenza Benbouzid ◽  
Annie Lavoie ◽  
Marie-Élaine Metras ◽  
Marie-Christine Lavoie ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Post Intervention ◽  
Number Of Patients ◽  
Implementation Period ◽  
Short And Long Term ◽  
The Impact

AbstractDelirium is associated with significant negative outcomes, yet it remains underdiagnosed in children. We describe the impact of implementing a pain, agitation, and delirium (PAD) bundle on the rate of delirium detection in a pediatric intensive care unit (PICU). This represents a single-center, pre-/post-intervention retrospective and prospective cohort study. The study was conducted at a PICU in a quaternary university-affiliated pediatric hospital. All patients consecutively admitted to the PICU in October and November 2017 and 2018. Purpose of the study was describe the impact of the implementation of a PAD bundle. The rate of delirium detection and the utilization of sedative and analgesics in the pre- and post-implementation phases were measured. A total of 176 and 138 patients were admitted during the pre- and post-implementation phases, respectively. Of them, 7 (4%) and 44 (31.9%) were diagnosed with delirium (p < 0.001). Delirium was diagnosed in the first 48 hours of PICU admission and lasted for a median of 2 days (interquartile range [IQR]: 2–4). Delirium diagnosis was higher in patients receiving invasive ventilation (p < 0.001). Compliance with the PAD bundle scoring was 79% for the delirium scale. Score results were discussed during medical rounds for 68% of the patients in the post-implementation period. The number of patients who received opioids and benzodiazepines and the cumulative doses were not statistically different between the two cohorts. More patients received dexmedetomidine and the cumulative daily dose was higher in the post-implementation period (p < 0.001). The implementation of a PAD bundle in a PICU was associated with an increased recognition of delirium diagnosis. Further studies are needed to evaluate the impact of this increased diagnostic rate on short- and long-term outcomes.

scholarly journals Clinical course and severity outcome indicators among COVID 19 hospitalized patients in relation to comorbidities distribution Mexican cohort

2020 ◽  
Author(s):  
Genny Carrillo ◽  
Nina Mendez Dominguez ◽  
Kassandra D Santos Zaldivar ◽  
Andrea Rochel Perez ◽  
Mario Azuela Morales ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Diseases ◽  
Risk Estimation ◽  
Clinical Manifestations ◽  
Case Fatality ◽  
Hospitalized Patients ◽  
Hospital Death ◽  
Outcome Indicators

Introduction: COVID-19 affected worldwide, causing to date, around 500,000 deaths. In Mexico, by April 29, the general case fatality was 6.52%, with 11.1% confirmed case mortality and hospital recovery rate around 72%. Once hospitalized, the odds for recovery and hospital death rates depend mainly on the patients' comorbidities and age. In Mexico, triage guidelines use algorithms and risk estimation tools for severity assessment and decision-making. The study's objective is to analyze the underlying conditions of patients hospitalized for COVID-19 in Mexico concerning four severity outcomes. Materials and Methods: Retrospective cohort based on registries of all laboratory-confirmed patients with the COVID-19 infection that required hospitalization in Mexico. Independent variables were comorbidities and clinical manifestations. Dependent variables were four possible severity outcomes: (a) pneumonia, (b) mechanical ventilation (c) intensive care unit, and (d) death; all of them were coded as binary Results: We included 69,334 hospitalizations of laboratory-confirmed and hospitalized patients to June 30, 2020. Patients were 55.29 years, and 62.61% were male. Hospital mortality among patients aged<15 was 9.11%, 51.99% of those aged >65 died. Male gender and increasing age predicted every severity outcome. Diabetes and hypertension predicted every severity outcome significantly. Obesity did not predict mortality, but CKD, respiratory diseases, cardiopathies were significant predictors. Conclusion: Obesity increased the risk for pneumonia, mechanical ventilation, and intensive care admittance, but it was not a predictor of in-hospital death. Patients with respiratory diseases were less prone to develop pneumonia, to receive mechanical ventilation and intensive care unit assistance, but they were at higher risk of in-hospital death.

scholarly journals Nutritional therapy of COVID-19 disease in Intensive care units

2021 ◽  
Vol 26 (83) ◽  
pp. 27-52
Author(s):  
Biljana Damnjanović ◽  
Đuro Šijan ◽  
Ivan Rović ◽  
Igor Lazić ◽  
Saša Knežević ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Negative Impact ◽  
Current Knowledge ◽  
Virus Disease ◽  
Nutritional Therapy ◽  
Hospital Treatment ◽  
Omega 3 ◽  
Corona Virus ◽  
Number Of Patients

Since the beginning of 2020, SARS-CoV 2 (Severe Acute Respiratory Syndrome - Corona Virus 2) has been in the focus of scientific circles and beyond. Finding the most efficient therapeutic protocol in prevention and treatment of the new and unknown COVID - 19 (Corona Virus Disease - 2019) disease has been indentified as especially important. SARS-CoV 2 uses various mechanisms to lead patients to malnutrition, which is detected by a higher frequency of admission to hospital treatment, especially on admission to the Intensive Care Unit (ICU). Malnutrition has a negative impact on the course and outcome of the disease. In the pandemic, the number of patients on various types of oxygen therapy and mechanical ventilation increased, and in correlation with that, there has been a greater need for knowledge and education of staff to use different diagnostic and therapeutic modalities and different approaches in feeding critically ill patients. Nutritional therapy is the basis for maintaining body weight, supporting respiratory function, as well as helping in the overall recovery of patients. Omega 3 fatty acids, vitamins C and D have shown potentially beneficial effects against COVID-19 diseases. The aim of this paper is to consolidate the current knowledge and recommendations in the field of nutritional therapy in patients with COVID-19 treated in the Intensive Care Unit.

scholarly journals Respiratory Rate Variability as a Prognostic Factor in Hospitalized Patients Transferred to the Intensive Care Unit

Cureus ◽  
2018 ◽  
Author(s):  
Daniel Garrido ◽  
Justin J Assioun ◽  
Anahit Keshishyan ◽  
Marcos A Sanchez-Gonzalez ◽  
Bishoy Goubran
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prognostic Factor ◽  
Respiratory Rate ◽  
Hospitalized Patients ◽  
Respiratory Rate Variability

scholarly journals Association between early mobilization or rehabilitation and intensive care unit acquired weakness: A systematic review and meta-analysis of randomized controlled trials.

2020 ◽  
Author(s):  
Minghang Li ◽  
Mingyue Ding ◽  
Huanzhang Shao ◽  
Bingyu Qin ◽  
Xingwei Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Meta Analysis ◽  
Early Mobilization ◽  
Standard Of Care ◽  
Cochrane Library ◽  
Care Group ◽  
China National Knowledge Infrastructure ◽  
Number Of Patients ◽  
Icu Discharge

Abstract Background The prognosis of intensive care unit acquired weakness (ICUAW) is poor and the treatment effect is not ideal. At present, some effective and safe early prevention means are urgently needed to reduce its incidence.This study evaluated the effectiveness and safety of early activities or rehabilitation in the prevention of ICUAW. Methods We searched for articles in five electronic databases, including PubMed, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure (CNKI) and Wanfang Med Online. All publications until June, 2020 were searched. We have selected trials investigating early mobilization or rehabilitation as compared to standard of care in critically ill adults.The extracted data included adverse events, the number of patients with ICUAW, the length of stay in the ICU (ICU-LOS) the length of mechanical ventilation (MV) etc. Results The final results showed that compared with the usual care group, early mobilization or rehabilitation reduced the prevalence of ICUAW (RR, 0.73; [0.61, 0.87]; I2 = 44%; P = 0.0006), ICU-LOS (MD, − 1.47;[2.83, 0.10]; I2 = 56%; P = 0.04), length of MV (MD, − 1.96; [2.41, 1.51]; I2 = 0%; P = 0.00001), but the mortality (RR, 0.90; [0.62, 1.32]; I2 = 3%; P = 0.60) at ICU discharge was not associated. The subgroup analysis of ICUAW prevalence and ICU-LOS based on the intervention methods showed that early combined rehabilitation could reduce the prevalence of ICUAW (RR, 0.56; [0.43, 0.74]; I2 = 34%; P = 0.0001) and shorten the ICU-LOS (MD, − 2.21; [3.28, 0.97]; I2 = 23%; P = 0.0003). EGDM was not associated with a decrease in ICUAW prevalence (RR, 0.85; [0.65, 1.09]; I2 = 26%; P = 0.20), but it reduced the ICU-LOS (MD, − 2.27; [3.86, 0.68]; I2 = 0%; P = 0.005).Early in-bed cycling was not associated with reduced ICUAW prevalence(RR, 1.25; [0.73, 2.13]; I2 = 0%; P = 0.41) and ICU-LOS(MD, 2.27; [0.27, 4.80]; I2 = 0%; P = 0.08) . Conclusions Early mobilization or rehabilitation was associated with a shorter length of MV and ICU-LOS, but not mortality. Of course, not all early activities or forms of rehabilitation are effective. The early combined rehabilitation model is effective for the prevention of ICUAW. However, EGDM and early in-bed cycling were not effective in preventing ICUAW.

scholarly journals The efficacy and safety of rifaximin-α: a 2-year observational study of overt hepatic encephalopathy

2019 ◽  
Vol 12 ◽  
pp. 175628481985825 ◽  
Author(s):  
Rosalie C. Oey ◽  
Lennart E.M. Buck ◽  
Nicole S. Erler ◽  
Henk R. van Buuren ◽  
Robert A. de Man
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hepatic Encephalopathy ◽  
Adverse Events ◽  
Bacterial Infections ◽  
Hospital Admissions ◽  
Emergency Department Visits ◽  
Interquartile Range ◽  
Overt Hepatic Encephalopathy ◽  
Bed Days

Background: After 5  years since the registration of rifaximin-α as a secondary prophylaxis for overt hepatic encephalopathy (HE) in the Netherlands, we aimed to evaluate the use of hospital resources and safety of rifaximin-α treatment in a real-world setting. Methods: We carried out prospective identification of all patients using rifaximin-α for overt HE. We assessed hospital resource use, bacterial infections, and adverse events during 6-month episodes before and after rifaximin-α initiation. Results: During 26 months we included 127 patients [71.7% male; median age 60.8 years (interquartile range: 56.2–66.1); median model for end-stage liver disease (MELD) score 15.0 (interquartile range: 12.1–20.4); 98% using lactulose treatment]. When comparing the first 6 months after rifaximin-α initiation with the prior 6 months, HE-related hospital admissions decreased (0.86 to 0.41 admissions/patient; p < 0.001), as well as the mean length of stay (8.85 to 3.79 bed days/admission; p < 0.001). No significant differences were found regarding HE-related intensive care unit admissions (0.09 to 0.06 admission/patient; p = 0.253), stay on the intensive care unit (0.43 to 0.57 bed days/admission; p = 0.661), emergency department visits (0.66 to 0.51 visits/patient; p = 0.220), outpatient clinic visits (2.49 to 3.30 bed visits/patient; p = 0.240), or bacterial infections (0.41 to 0.35 infections/patient; p = 0.523). Adverse events were recorded in 2.4% of patients. Conclusions: The addition of rifaximin-α to lactulose treatment was associated with a significant reduction in the number and length of HE-related hospitalizations for overt HE. Rifaximin-α treatment was well tolerated.

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