scholarly journals Effect of etomidate use on ICU patients with ventilator therapy: a study of 12,526 patients in an open database from a single-center

2020 ◽  
Author(s):  
Ha Yeon Park ◽  
Younsuk Lee ◽  
Chi-Yeon Lim ◽  
Mina Kim ◽  
Jieun Park ◽  
...  
Keyword(s):  
Single Center ◽  
Icu Patients ◽  
Ventilator Therapy

The Incidence of Heparin-Induced Thrombocytopenia (HIT) After Prophylactic Heparin Exposure in Pediatric Intensive Care and Congenital Cardiology Patients: A Single Center, Prospective and Phase-IV Study: Turkish Experience

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4365-4365
Author(s):  
Kaan Kavakli ◽  
Gabil Mursalov ◽  
Bulent Karapinar ◽  
Ruhi Ozyurek ◽  
Deniz Yilmaz Karapinar ◽  
...  
Keyword(s):  
Intensive Care ◽  
Venous Thromboembolism ◽  
Congenital Heart ◽  
Elisa Test ◽  
Short Exposure ◽  
Single Center ◽  
Icu Patients ◽  
Heparin Induced Thrombocytopenia ◽  
Heparin Exposure ◽  
Phase Iv

Abstract Abstract 4365 Heparin is the standard therapy for the prevention and the treatment of venous thromboembolism in children. Heparin-induced thrombocytopenia (HIT) is a well-known serious adverse effect related with heparin therapy or prophylaxis. HIT affects up to %5 of patients treated with unfractionated heparin (UFH). However, prospective studies are so rare in children for technical and ethical reasons. Aim of this study was to determine the incidence of HIT in UFH-exposed children for prohylaxis. Patients who used treatment doses of UFH were excluded. Only ICU and cardiology patients were included. We performed a prospective single center phase-IV study in Ege University Children's Hospital after approved by Ethics Commitee and Ministry of Health. Children who exposed to UFH for any time were eligible for study. Study group consists of intensive care (ICU) patients (n=28) and congenital heart disorders who will undergo catheter operation (n=25). Mean age was 52 mo (range:1–204). Thirty of patients were female and others were male. All ICU patients used diluted UFH for flushing to maintain patency of central lines. All cardiology cases received only one bolus dose of UFH (50 IU/kg) for prophylaxis. In all patients (n=53) blood samples were collected for platelet counts (CELL DYN 3700 counter, Abbott), anti-Heparin/PF4 antibody (ELISA)(Asserachrom HPIA-Ig G, Diagnostica Stago) and heparin-induced platelet agregation tests (APACT-4004, Tokra) prior to and after 10 days (median) (range: 7–15) of first UFH exposure. After 2 years of observation, we have not found any single patient diagnosed as HIT by clinical findings and confirmed by laboratory analysis. Significant dropping (>50%) of platelet count was observed in only 4 ICU patients. Only one patient had below <150.000/mm3. However, ELISA and agregation tests were negative for these patients. Reasons for thrombocytopenia were evaluated as underlying medical conditions (trauma, pneumonia and sepsis) not for HIT. In only one ICU case, ELISA test was found border-line positive (O.D: 1.374)(positive controls: 1.35±0.34). However, no thrombocytopenia and no activation in agregation related heparin studies were found. This result was evaluated as false-positivity for ELISA. However, mean OD values for ELISA test was found significantly elevated after heparin exposure (before heparin: 0.119±0.061 versus after heparin: 0.258±0.262)(Wilcoxon test; p<0.0001). Elevated heparin-induced agregation response (more than >20% after heparin exposure) was found only in three cardiology patients (diagnosed as ASD, VSD and PDA). However, there was no thrombocytopenia and ELISA seropositivity in these patients. This hyperactivity was evaluated as “non-specific” heparin-induced agregation. In literature, infants with congenital heart disease or children requiring admission to ICU are particularly at risk of venous thromboembolism and likely to be exposed to heparins for prevention and treatment. However, in this single center phase-IV study, we have not found prospectively any HIT patients among 53 risky patients. Reasons may be prophylaxis versus treatment doses, short exposure time versus long-term exposures and medical versus surgical interventions and lower count of patients for low incidence. However significant ELISA activity after heparin exposure was noted as interesting finding. This point might supported for mild heparin activity in patient group who has lower immunogenicity of heparin. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Prevalence and risk factors of hemodynamic instability associated with preload-dependence during continuous renal replacement therapy in a prospective observational cohort of critically ill patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Guillaume Chazot ◽  
Laurent Bitker ◽  
Mehdi Mezidi ◽  
Nader Chebib ◽  
Paul Chabert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Hemodynamic Instability ◽  
Single Center ◽  
Icu Patients ◽  
Fluid Removal ◽  
Observational Cohort

Abstract Background Hemodynamic instability is a frequent complication of continuous renal replacement therapy (CRRT). Postural tests (i.e., passive leg raising in the supine position or Trendelenburg maneuver in the prone position) combined with measurement of cardiac output are highly reliable to identify preload-dependence and may provide new insights into the mechanisms involved in hemodynamic instability related to CRRT (HIRRT). We aimed to assess the prevalence and risk factors of HIRRT associated with preload-dependence in ICU patients. We conducted a single-center prospective observational cohort study in ICU patients with acute kidney injury KDIGO 3, started on CRRT in the last 24 h, and monitored with a PiCCO® device. The primary endpoint was the rate of HIRRT episodes associated with preload-dependence during the first 7 days after inclusion. HIRRT was defined as the occurrence of a mean arterial pressure below 65 mmHg requiring therapeutic intervention. Preload-dependence was assessed by postural tests every 4 h, and during each HIRRT episode. Data are expressed in median [1st quartile–3rd quartile], unless stated otherwise. Results 42 patients (62% male, age 69 [59–77] year, SAPS-2 65 [49–76]) were included 6 [1–16] h after CRRT initiation and studied continuously for 121 [60–147] h. A median of 5 [3–8] HIRRT episodes occurred per patient, for a pooled total of 243 episodes. 131 episodes (54% [CI95% 48–60%]) were associated with preload-dependence, 108 (44%, [CI95% 38–51%]) without preload-dependence, and 4 were unclassified. Multivariate analysis (using variables collected prior to HIRRT) identified the following variables as risk factors for the occurrence of HIRRT associated with preload-dependence: preload-dependence before HIRRT [odds ratio (OR) = 3.82, p < 0.001], delay since last HIRRT episode > 8 h (OR = 0.56, p < 0.05), lactate (OR = 1.21 per 1-mmol L−1 increase, p < 0.05), cardiac index (OR = 0.47 per 1-L min−1 m−2 increase, p < 0.001) and SOFA at ICU admission (OR = 0.91 per 1-point increase, p < 0.001). None of the CRRT settings was identified as risk factor for HIRRT. Conclusions In this single-center study, HIRRT associated with preload-dependence was slightly more frequent than HIRRT without preload-dependence in ICU patients undergoing CRRT. Testing for preload-dependence could help avoiding unnecessary decrease of fluid removal in preload-independent HIRRT during CRRT.

scholarly journals Prevalence and Risk Factors of Hemodynamic Instability Associated with Preload-Dependence During Continuous Renal Replacement Therapy in a Prospective Observational Cohort of Critically Ill Patients

2020 ◽  
Author(s):  
Guillaume CHAZOT ◽  
Laurent BITKER ◽  
Mehdi MEZIDI ◽  
Nader CHEBIB ◽  
Paul CHABERT ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Hemodynamic Instability ◽  
Single Center ◽  
Icu Patients ◽  
Fluid Removal ◽  
Observational Cohort

Abstract BackgroundHemodynamic instability is a frequent complication of continuous renal replacement therapy (CRRT). Postural tests (i.e. passive leg raising in the supine position or Trendelenburg maneuver in the prone position) combined with measurement of cardiac output are highly reliable to identify preload-dependence and may provide new insights into the mechanisms involved in hemodynamic instability related to CRRT (HIRRT). We aimed to assess the prevalence and risk factors of HIRRT associated with preload-dependence in ICU patients.MethodsWe conducted a single-center prospective observational cohort study in ICU patients with acute kidney injury KDIGO 3, started on CRRT in the last 24 hours, and monitored with a PiCCO® device. The primary endpoint was the rate of HIRRT episodes associated with preload-dependence during the first 7 days after inclusion. HIRRT was defined as the occurrence of a mean arterial pressure below 65 mm Hg requiring therapeutic intervention. Preload-dependence was assessed by postural tests every 4 hours, and during each HIRRT episode. Data are expressed in median [1rst quartile-3rd quartile], unless stated otherwise.Results42 patients (62% male, age 69 [59–77] year, SAPS-2 65 [49–76]) were included 6 [1–16] hours after CRRT initiation and studied continuously for 121 [60–147] hours. A median of 5 [3–8] HIRRT episodes occurred per patient, for a pooled total of 243 episodes. 131 episodes (54% [CI95%: 48%-60%]) were associated with preload-dependence, 108 (44%, [CI95%: 38%-51%]) without preload-dependence, and 4 were unclassified. Multivariate analysis (using variables collected prior to HIRRT) identified the following variables as risk factors for the occurrence of HIRRT associated with preload-dependence: preload-dependence before HIRRT (odd ratio (OR) = 3.82, p < 0.001), delay since last HIRRT episode > 8 hours (OR = 0.56, p < 0.05), lactate (OR = 1.21 per 1-mmol.L− 1 increase, p < 0.05), cardiac index (OR = 0.47 per 1-L.min− 1.m− 2 increase, p < 0.001) and SOFA at ICU admission (OR = 0.91 per 1-point increase, p < 0.001). None of the CRRT settings was identified as risk factor for HIRRT.Conclusions:In this single center study, HIRRT associated with preload-dependence was slightly more frequent than HIRRT without preload-dependence in ICU patients undergoing CRRT. Testing for preload-dependence to adjust fluid removal by CRRT could help preventing HIRRT occurrence during CRRT.

scholarly journals Differences in Inflammatory Marker Kinetics between the First and Second Wave of COVID-19 Patients Admitted to the ICU: A Retrospective, Single-Center Study

2021 ◽  
Vol 10 (15) ◽  
pp. 3290
Author(s):  
Tamas Szakmany ◽  
William Tuckwell ◽  
Elsa Harte ◽  
Nick Wetherall ◽  
Saraswathi Ramachandran ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Inflammatory Marker ◽  
Management Strategies ◽  
Single Center ◽  
Icu Patients ◽  
Reactive Protein ◽  
Icu Stay ◽  
Results Management ◽  
Wbc Count ◽  
Second Wave

Background: We sought to determine if there was a difference in the longitudinal inflammatory response measured by white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), and ferritin levels between the first and the second COVID-19 wave of ICU patients. Methods: In a single-center retrospective observational study, ICU patients were enrolled during the first and second waves of the COVID-19 pandemic. Data were collected on patient demographics, comorbidities, laboratory results, management strategies, and complications during the ICU stay. The inflammatory response was evaluated using WBC count, CRP, PCT, and Ferritin levels on the day of admission until Day 28, respectively. Organ dysfunction was measured by the SOFA score. Results: 65 patients were admitted during the first and 113 patients during the second wave. WBC and ferritin levels were higher in the second wave. CRP and PCT showed markedly different longitudinal kinetics up until day 28 of ICU stay between the first and second wave, with significantly lower levels in the second wave. Steroid and immunomodulatory therapy use was significantly greater in the second wave. Mortality was similar in both waves. Conclusions: We found that there was a significantly reduced inflammatory response in the second wave, which is likely to be attributable to the more widespread use of immunomodulatory therapies.

scholarly journals Psychological distress and health-related quality of life in patients after hospitalization during the COVID-19 pandemic: A single-center, observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255774
Author(s):  
Johan Hendrik Vlake ◽  
Sanne Wesselius ◽  
Michel Egide van Genderen ◽  
Jasper van Bommel ◽  
Bianca Boxma-de Klerk ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Psychological Distress ◽  
Hospital Discharge ◽  
Well Being ◽  
Health Related Quality ◽  
Single Center ◽  
Icu Patients ◽  
Related Quality ◽  
Health Related

Introduction Illnesses requiring hospitalization are known to negatively impact psychological well-being and health-related quality of life (HRQoL) after discharge. The impact of hospitalization during the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic on psychological well-being and health-related quality of life is expected to be higher due to the exceptional circumstances within and outside the hospital during the pandemic surge. The objective of this study was to quantify psychological distress up to three months after discharge in patients hospitalized during the first coronavirus disease 2019 (COVID-19) pandemic wave. We also aimed to determine HRQoL, to explore predictors for psychological distress and HRQoL, and to examine whether psychological distress was higher in COVID-19 confirmed patients, and in those treated in Intensive Care Units (ICUs). Methods In this single-center, observational cohort study, adult patients hospitalized with symptoms suggestive of COVID-19 between March 16 and April 28, 2020, were enrolled. Patients were stratified in analyses based on SARS-CoV-2 PCR results and the necessity for ICU treatment. The primary outcome was psychological distress, expressed as symptoms of post-traumatic stress disorder (PTSD), anxiety, and depression, up to three months post-discharge. Health-related quality of life (HRQoL) was the secondary outcome. Exploratory outcomes comprised predictors for psychological distress and HRQoL. Results 294 of 622 eligible patients participated in this study (median age 64 years, 36% female). 16% and 13% of these patients reported probable PTSD, 29% and 20% probable anxiety, and 32% and 24% probabledepression at one and three months after hospital discharge, respectively. ICU patients reported less frequently probable depression, but no differences were found in PTSD, anxiety, or overall HRQoL. COVID-19 patients had a worse physical quality of life one month after discharge, and ICU patients reported a better mental quality of life three months after discharge. PTSD severity was predicted by time after discharge and being Caucasian. Severity of anxiety was predicted by time after discharge and being Caucasian. Depression severity was predicted by time after discharge and educational level. Conclusion COVID-19 suspected patients hospitalized during the pandemic frequently suffer from psychological distress and poor health-related quality of life after hospital discharge. Non-COVID-19 and non-ICU patients appear to be at least as affected as COVID-19 and ICU patients, underscoring that (post-)hospital pandemic care should not predominantly focus on COVID-19 infected patients.

1337: CLINICAL APPLICATION OF THE QSOFA IN ICU PATIENTS WITH BACTEREMIA: A SINGLE-CENTER STUDY IN KOREA

2016 ◽  
Vol 44 (12) ◽  
pp. 410-410
Author(s):  
Hae Jung Na ◽  
Kwangha Lee ◽  
Eun Suk Jeong ◽  
Insu Kim ◽  
Ki Uk Kim ◽  
...  
Keyword(s):  
Clinical Application ◽  
Single Center ◽  
Icu Patients ◽  
Single Center Study ◽  
Center Study

scholarly journals Effectiveness of lubratex and vitamin A on ocular surface disorders in ICU patients: A randomized clinical trial

2020 ◽  
pp. 175114372091269
Author(s):  
Mitra Badparva ◽  
Mohammad Veshagh ◽  
Farideh Khosravi ◽  
Abbas Mardani ◽  
Hossein Ebrahimi
Keyword(s):  
Clinical Trial ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Vitamin A ◽  
Randomized Clinical Trial ◽  
Ocular Surface ◽  
Corneal Ulcer ◽  
Single Center ◽  
Icu Patients ◽  
High Prevalence

Background High prevalence of ocular surface disorders includes eye dryness and corneal ulcer among intensive care unit patients remains an issue. This study aimed to compare the effectiveness of Lubratex ointment and vitamin A eye ointment in preventing ocular surface disorders in intensive care unit patients. Methods A single-center randomized clinical trial was conducted in critically ill patients of vitamin A eye ointment and Lubratex ointment in preventing ocular surface disorders. Forty-one eligible patients were randomly assigned to administered vitamin A eye ointment in one eye and Lubratex ointment in the other eye. After five days, using fluorescein and Schirmer's tests, an ophthalmologist examined patients and specified those with ocular surface disorders. Results The results showed a significant decrease in the incidence of dry eye ( p ≤ 0.001) and corneal ulcer ( p = 0.002) with the use of Lubratex ointment. Conclusions Although Lubratex ointment was more effective than vitamin A ointment in preventing ocular surface disorders, further research is needed to confirm the findings of the present study.

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