scholarly journals Simplified Diagnosis of Critical Illness Polyneuropathy in Patients with Prolonged Mechanical Ventilation: A Prospective Observational Cohort Study

2020 ◽  
Vol 9 (12) ◽  
pp. 4029
Author(s):  
Chul Jung ◽  
Nak-Jun Choi ◽  
Won Jun Kim ◽  
Yoon Mok Chun ◽  
Hak-Jae Lee ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Illness ◽  
Clinical Outcomes ◽  
Diagnostic Criteria ◽  
Early Identification ◽  
Prolonged Mechanical Ventilation ◽  
Critical Illness Polyneuropathy ◽  
Single Center Study ◽  
Sum Score ◽  
Observational Cohort

Background: Although early identification of critical illness polyneuropathy (CIP) is necessary, the established diagnostic criteria have several limitations in the intensive care unit (ICU) setting. The purpose of this study was to define simplified diagnostic criteria of CIP that best predict clinical outcomes. Methods: This prospective, single-center study included 41 ICU patients with prolonged mechanical ventilation (≥21 days). We applied three different sets of diagnostic criteria (combining the results of the Medical Research Council (MRC) sum score and nerve conduction studies (NCS)) for CIP in order to identify the criteria with the best predictive power for clinical outcomes. Results: The simplified diagnosis of CIP meeting the criteria, i.e., that the MRC sum score < 48 and amplitudes of the tibial and sural nerve < 80% of the lower limit of normal, showed the strongest association with 0 ventilator-free days at day 60 (odds ratio, 6.222; p = 0.029). Conclusions: The diagnostic criteria combining the MRC sum score and the tibial and the sural NCS were identified as the simplified criteria of CIP that best predicted the clinical outcomes. The implementation of these simplified criteria may allow for early identification of CIP in the ICU, thereby contributing to prompt interventions for patients with a poor prognosis.

The Association between D-dimer Levels and Thromboembolism, Worsening Severity, and Mortality among Hospitalized Adults with COVID-19

2021 ◽  
Author(s):  
Patricia Pauline M. Remalante-Rayco ◽  
Evelyn O. Salido ◽  
Joey A. Tabula ◽  
Maria Teresa S. Tolosa
Keyword(s):  
Mechanical Ventilation ◽  
Critical Illness ◽  
Open Access ◽  
Clinical Outcomes ◽  
Observational Studies ◽  
Prognostic Indicator ◽  
Cochrane Library ◽  
Increased Risk ◽  
D Dimer

Objective. To assess the association between D-dimer and clinical outcomes in adults with COVID-19. Methods. We reviewed published articles and preprints from MEDLINE, Cochrane Library, Cornell Open Access Publication (COAP), MedRxiv, and BioRxiv databases. We included cohort studies on the association between D-dimer and the outcomes of thromboembolism, mortality, and worsening severity among hospitalized adults with COVID-19. Results. We found 25 observational studies on the association between D-dimer and the outcomes of thromboembolism, mortality, or worsening severity. There was an increased risk of thromboembolism (OR 5.61 [95% CI 3.97, 7.94]) with higher D-dimer levels across different COVID-19 severities. D-dimer levels are associated with higher in-hospital mortality (OR 5.57 [95% CI 2.74, 11.31]) and worsening severity manifesting as critical illness (OR 1.91 [95% CI 1.05, 3.48] to 2.58 [95% CI 1.57, 4.24]), disease progression (HR 2.846 [95% CI 2.10, 3.85]), or need for mechanical ventilation (HR 3.28 [95% CI 1.07, 10.10]). However, some methodological flaws, such as incomplete laboratory or follow-up data and concern on varied D-dimer cut-offs and definitions of worsening disease, raise some uncertainty in the widespread use of D-dimer as a prognostic marker. Conclusion. A higher D-dimer value is associated with worse clinical outcomes among hospitalized adults with COVID-19 and may be a useful prognostic indicator.

Prolonged mechanical ventilation in patients with terminated status epilepticus and outcome: An observational cohort study

Epilepsia ◽  
2021 ◽  
Author(s):  
Sira M. Baumann ◽  
Saskia Semmlack ◽  
Anja Rybitschka ◽  
Paulina S. C. Kliem ◽  
Gian Marco De Marchis ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Status Epilepticus ◽  
Prolonged Mechanical Ventilation ◽  
Observational Cohort Study ◽  
Observational Cohort

scholarly journals Clinical Outcomes of Hospitalized Patients with COVID-19 on Therapeutic Anticoagulants

2020 ◽  
Author(s):  
Niti G Patel ◽  
Ajay Bhasin ◽  
Joseph M Feinglass ◽  
Steven M Belknap ◽  
Michael P Angarone ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Illness ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Antiplatelet Agents ◽  
World Health ◽  
Ordinal Scale ◽  
Therapeutic Anticoagulation ◽  
Health Organization ◽  
Prophylactic Anticoagulation

Background: COVID-19 is associated with hypercoagulability and an increased incidence of thrombosis. We evaluated the clinical outcomes of adults hospitalized with COVID-19 who either continued therapeutic anticoagulants previously prescribed or who were newly started on anticoagulants during hospitalization. Methods: We performed an observational study of adult inpatients with COVID-19 at 10 hospitals affiliated with Northwestern Medicine in the Chicagoland area from March 9 to June 26, 2020. We evaluated clinical outcomes of subjects with COVID-19 who were continued on their outpatient therapeutic anticoagulation during hospitalization and those who were newly started on these medications compared to those who were on prophylactic doses of these medications based on the World Health Organization (WHO) Ordinal Scale for Clinical Improvement. The primary outcome was overall death while secondary outcomes were critical illness (WHO score >5), need for mechanical ventilation, and death among those subjects who first had critical illness adjusted for age, sex, race, body mass index (BMI), Charlson score, glucose on admission, and use of antiplatelet agents. Results: 1,716 subjects with COVID-19 were included in the analysis. 171 subjects (10.0%) were continued on their outpatient therapeutic anticoagulation and 201(11.7%) were started on new therapeutic anticoagulation during hospitalization. In subjects continued on home therapeutic anticoagulation, there were no differences in overall death, critical illness, mechanical ventilation, or death among subjects with critical illness compared to subjects on prophylactic anticoagulation. Subjects receiving new therapeutic anticoagulation for COVID-19 were more likely to die (OR 5.93; 95% CI 3.71-9.47), have critical illness (OR 14.51; 95% CI 7.43-28.31), need mechanical ventilation (OR 11.22; 95% CI 6.67-18.86), and die after first having critical illness. (OR 5.51; 95% CI 2.80 -10.87). Conclusions: Continuation of outpatient prescribed anticoagulant was not associated with improved clinical outcomes. Therapeutic anticoagulation for COVID-19 in absence of other indications was associated with worse clinical outcomes.

scholarly journals Review of Critical Illness Myopathy and Neuropathy

2016 ◽  
Vol 7 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Starane Shepherd ◽  
Ayush Batra ◽  
David P. Lerner
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Care Setting ◽  
Early Recognition ◽  
Prolonged Mechanical Ventilation ◽  
Critical Illness Polyneuropathy ◽  
Critical Illness Myopathy ◽  
Biopsy Specimens ◽  
Electrophysiological Studies ◽  
Review Current

Critical illness myopathy (CIM) and neuropathy are underdiagnosed conditions within the intensive care setting and contribute to prolonged mechanical ventilation and ventilator wean failure and ultimately lead to significant morbidity and mortality. These conditions are often further subdivided into CIM, critical illness polyneuropathy (CIP), or the combination—critical illness polyneuromyopathy (CIPNM). In this review, we discuss the epidemiology and pathophysiology of CIM, CIP, and CIPNM, along with diagnostic considerations such as detailed clinical examination, electrophysiological studies, and histopathological review of muscle biopsy specimens. We also review current available treatments and prognosis. Increased awareness and early recognition of CIM, CIP, and CIPNM in the intensive care unit setting may lead to earlier treatments and rehabilitation, improving patient outcomes.

Mortality after Critical Illness

2014 ◽  
Author(s):  
Matthew Baldwin ◽  
Hannah Wunsch
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Prolonged Mechanical Ventilation ◽  
Risk Of Death ◽  
Increased Risk ◽  
Poor Nutrition ◽  
Long Term Mortality

Many critically ill patients now survive what were previously fatal illnesses, but long-term mortality after critical illness remains high. While study populations vary by country, age, intervention, or specific diagnosis, investigations demonstrate that the majority of additional deaths occur in the first 6 to 12 months after hospital discharge. Patients with diagnoses of cancer, respiratory failure, and neurological disorders leading to the need for intensive care have the highest long-term mortality, while those with trauma and cardiovascular diseases have much lower long-term mortality. Use of mechanical ventilation, older age, and a need for care in a facility after the acute hospitalization are associated with particularly high 1-year mortality among survivors of critical illnesses. Due to challenges of follow-up, less is known about causes of delayed mortality following critical illness. Longitudinal studies of survivors of pneumonia, stroke, and patients who require prolonged mechanical ventilation suggest that most debilitated survivors die from recurrent infections and sepsis. Potential biologic mechanisms for increased risk of death after a critical illness include sepsis-induced immunoparalysis, intensive care unit-acquired weakness, neuroendocrine changes, poor nutrition, and genetic variance. Studies are needed to fully understand how the severity of the acute critical illness interacts with comorbid disease, pre-illness disability, and pre-existing and acquired frailty to affect long-term mortality. Such studies will be fundamental to improve targeting of rehabilitative, therapeutic, and palliative interventions to improve both survival and quality of life after critical illness.

Can Creatinine Height Index Predict Weaning and Survival Outcomes in Patients on Prolonged Mechanical Ventilation After Critical Illness?

2016 ◽  
Vol 33 (2) ◽  
pp. 104-110 ◽  
Author(s):  
Debapriya Datta ◽  
Raymond Foley ◽  
Rong Wu ◽  
James Grady ◽  
Paul Scalise
Keyword(s):  
Mechanical Ventilation ◽  
Critical Illness ◽  
Total Protein ◽  
Prolonged Mechanical Ventilation ◽  
Strong Predictor ◽  
Multivariate Logistic Regression Analysis ◽  
Ideal Body Weight ◽  
Dichotomous Outcome ◽  
Successful Weaning ◽  
The Impact

Objective: Malnutrition is common in chronic critically ill patients on prolonged mechanical ventilation (PMV) and may affect weaning. The creatinine height index (CHI), which reflects lean muscle mass, is regarded as the most accurate indicator of malnutrition. The objective of this study was to determine the impact of CHI in comparison with other traditional nutritional indices on successful weaning and survival in patients on PMV after critical illness. Methods: Records of 167 patients on PMV following critical illness, admitted for weaning, were reviewed. Parameters studied included age, gender, body mass index (BMI), percentage ideal body weight (%IBW), total protein, albumin, prealbumin, hemoglobin (Hb), and cause of respiratory failure. Number successfully weaned and number discharged alive and time to wean and time to discharge alive were determined from records. The CHI was calculated from 24-hour urine creatinine using a standard formula. Unpaired 2-sample t test was performed to determine the association between the studied nutritional parameters and outcomes. Predictive value of studied parameters for successful weaning and survival was determined by multivariate logistic regression analysis to model dichotomous outcome of successful weaning and survival. Results: Mean age was 68 ± 14 years, 49% were males, 64% were successfully weaned, and 65.8% survived. Total protein, Hb, and CHI had a significant impact on successful weaning. Weight, %IBW, BMI, and CHI had a significant effect on survival. Of all parameters, CHI was most strongly predictive of successful weaning and survival. Conclusions: The CHI is a strong predictor of successful weaning and survival in patients on PMV.

Sign in / Sign up

Export Citation Format

Share Document