scholarly journals Prevention and management of delirium in critically Ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines

2019 ◽  
Vol 34 (2) ◽  
pp. 117-125 ◽  
Author(s):  
Seung Yong Park ◽  
Heung Bum Lee
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Adult Patients

scholarly journals Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

2013 ◽  
pp. 184-188 ◽  
Author(s):  
Alvaro Sanabria ◽  
Ximena Gomez ◽  
Valentin Vega ◽  
Luis Carlos Dominguez ◽  
Camilo Osorio
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Medical Condition ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

A Non-Hybrid Model of Transitioning Pediatric to Adult Critical Care during the Coronavirus Disease 2019 Surge: A Single Unit Experience

2021 ◽  
Author(s):  
Kathryn Holliday ◽  
Rebecca Horner ◽  
Pavanasam Ramesh ◽  
Mark B. Bebbington ◽  
Constantinos Kanaris
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Early Stage ◽  
Case Fatality ◽  
Pediatric Intensive Care ◽  
Adult Patients ◽  
Clinical Role ◽  
Adult Intensive Care Unit

AbstractTo accommodate the unprecedented demand for critical care beds during the first surge of the coronavirus disease 2019 (COVID-19) pandemic in the United Kingdom, hospitals had to adapt, restructure, and collaborate to provide the best possible care for the pediatric and adult populations. This single-center experience outlines the considerations our hospital took into account when planning for this restructure and the steps taken to ensure a successful execution of the task. Cross-specialty collaboration between the pediatric and adult critical care teams adopted a unique approach to care for only critically ill COVID-19 positive adult patients in the pediatric intensive care unit (PICU), transferring out critically unwell children at an early stage before the adult intensive care unit (AICU) became overwhelmed (nonhybrid model). This was designed to be in a staggered fashion, before allowing the AICU to overflow. This approach enabled the adult critical care team to support pediatric colleagues in learning the nuances of looking after critically ill adults prior to the service being saturated by the predicted supersurge. The success of the operation hinged on two things. First, PICU staff continuing to work in a familiar environment with their usual clinical team and second, the gradual and controlled admission of adult patients into PICU before the peak in demand for critical care beds. This design helped protect staff morale and build confidence in their new clinical role. The overall case fatality of invasively ventilated patients with COVID-19 in our hospital during the first surge was 32%, which is lower than the global average of 45%. This serves as evidence that this nonhybrid model is safe and sustainable.

scholarly journals Association between Conventional Oxygen Therapy and Characteristics and Outcomes of Adult Patients in a Surgical Intensive Care Unit

2021 ◽  
Author(s):  
Lubov Stroh ◽  
Dennis Nurjadi ◽  
Florian Uhle ◽  
Thomas Bruckner ◽  
Markus A. Weigand ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Critically Ill ◽  
Oxygen Therapy ◽  
Adult Patients ◽  
Arterial Oxygen ◽  
Secondary Outcome ◽  
Surgical Intensive Care Unit ◽  
Organ Dysfunctions

Abstract Background: Oxygen therapy is often used in emergency departments and intensive care units. The prevention of hypoxia with associated complications remains the main target, but a high-concentrated usual oxygen therapy seems not to be the best strategy. We hypothesize that physiological pressure of arterial oxygen (paO2) reduces mortality, onset of new infections and organ dysfunctions in critically ill patients compared with supraphysiological paO2.Methods: In this retrospective exploratory cohort study we included 112 critically ill adult patients treated in a surgical critical care unit. All patients were assigned to two groups defined a priori based on paO2 mean values measured in the first 24 hours of mechanical ventilation: first group paO2 75-100 mmHg (n=43), second group patients with paO2 > 100mmHg (n=69). Primary outcome was the cumulative survival, defined from the day of admission in the intensive care unit (ICU) until death or end of the hospital stay. Secondary outcome was the incidence of infections and new organ dysfunctions in both groups. Results: The baseline characteristics like age, body mass index (BMI), lactate and severity of disease scores were similar in both groups. A total of 27 of 69 patients (39,1%) in the group paO2 > 100mmHg and 12 of 43 patients (27,9%) in the group paO2 75-100mmHg died during their ICU stay or further hospital stay (p=0.54). There were no statistically significant differences in the incidence of new infections and new organ dysfunctions between the two groups. Positive end expiratory pressure (PEEP) and fraction of inspired oxygen (FiO2) were in the group of patients with paO2 > 100mmHg significantly lower 8,4 mbar vs. 9,5 mbar (p=0.03).Conclusions: There was no significant increase in overall mortality or new onset of infections and organ dysfunctions in critically ill adult ICU patients requiring oxygen therapy with supraphysiological paO2 (> 100 mmHg) compared to patients with physiological paO2 (75-100 mmHg). Further studies are needed to define the optimal paO2 parameter.

scholarly journals Effect of length of stay in intensive care unit on hospital and long-term mortality of critically ill adult patients

2010 ◽  
Vol 104 (4) ◽  
pp. 459-464 ◽  
Author(s):  
T.A. Williams ◽  
K.M. Ho ◽  
G.J. Dobb ◽  
J.C. Finn ◽  
M. Knuiman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Adult Patients ◽  
Long Term Mortality
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