scholarly journals EARLY STAGE RESPONSES OF INTENSIVE CARE UNITS DURING MAJOR DISASTERS: FROM THE EXPERIENCES OF THE GREAT EAST JAPAN EARTHQUAKE

2015 ◽  
Vol 61 (1) ◽  
pp. 32-37
Author(s):  
JIRO SHIMADA ◽  
CHOICHIRO TASE ◽  
YASUHIKO TSUKADA ◽  
ARIFUMI HASEGAWA ◽  
HIROSHI IIDA
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Early Stage ◽  
Great East Japan Earthquake

scholarly journals Assessment of Respiratory Bacterial Coinfections Among Severe Acute Respiratory Syndrome Coronavirus 2-Positive Patients Hospitalized in Intensive Care Units Using Conventional Culture and BioFire, FilmArray Pneumonia Panel Plus Assay

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Camille Kolenda ◽  
Anne-Gaëlle Ranc ◽  
Sandrine Boisset ◽  
Yvan Caspar ◽  
Anne Carricajo ◽  
...  
Keyword(s):  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Intensive Care Units ◽  
Bacterial Infections ◽  
Early Stage ◽  
Bacterial Load ◽  
Empiric Antibiotic Therapy ◽  
Molecular Diagnostic ◽  
Oral Flora ◽  
Conventional Culture

Abstract Background Approximately 15% of patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) present with severe forms of the disease and require hospitalization in intensive care units, which has been associated with high mortality rates. The prevalence of bacterial infections in these patients is not well established, and more data are needed to guide empiric antibiotic therapy and improve patient outcomes. Methods In this prospective multicenter study, we assessed bacterial coinfections identified in culture from 99 French patients infected by SARS-Cov-2 and hospitalized in intensive care units. We concomitantly evaluated an innovative molecular diagnostic technology technique, the BioFire, FilmArray Pneumonia Panel plus (FA-pneumo) assay, to identify these coinfections at an early stage, and its concordance with conventional culture. Results We showed that a bacterial coinfection was detected in 15% of patients based on conventional culture. Staphylococcus aureus and Haemophilus influenzae were the most prevalent pathogens. The sensitivity of FA-pneumo compared with culture was 100%. In contrast, the specificity varied between 88.4% and 100% according to the pathogen, and our results highlighted that 60.5% of bacterial targets reported using this assay were not recovered by culture; 76.9% of discordant results corresponded to bacteria belonging to commensal oral flora and/or reported with ≤105 copies/mL bacterial nucleic acids. Conclusions Based on its excellent sensitivity, the FA-pneumo assay is useful to rule out bacterial coinfections in the context of severe SARS-CoV-2 infection and avoid the inappropriate prescription of antibiotics. However, positive tests should be interpreted carefully, taking into consideration deoxyribonucleic acid bacterial load and all clinical and biological signs.

scholarly journals Basic Principles of Antibiotics Dosing in Patients with Sepsis and Acute Kidney Damage Treated with Continuous Venovenous Hemodiafiltration

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Aleksandra Nikolić ◽  
Sasa Jaćović ◽  
Željko Mijailović ◽  
Dejan Petrović
Keyword(s):  
Intensive Care ◽  
Renal Clearance ◽  
Intensive Care Units ◽  
Flow Rate ◽  
Early Stage ◽  
Target Therapy ◽  
Kidney Damage ◽  
Dialysis Dose ◽  
Continuous Venovenous Hemodiafiltration ◽  
The Impact

Abstract Sepsis is the leading cause of acute kidney damage in patients in intensive care units. Pathophysiological mechanisms of the development of acute kidney damage in patients with sepsis may be hemodynamic and non-hemodynamic. Patients with severe sepsis, septic shock and acute kidney damage are treated with continuous venovenous hemodiafiltration. Sepsis, acute kidney damage, and continuous venovenous hemodiafiltration have a significant effect on the pharmacokinetics and pharmacodynamics of antibiotics. The impact dose of antibiotics is increased due to the increased volume of distribution (increased administration of crystalloids, hypoalbuminemia, increased capillary permeability syndrome toproteins). The dose of antibiotic maintenance depends on renal, non-renal and extracorporeal clearance. In the early stage of sepsis, there is an increased renal clearance of antibiotics, caused by glomerular hyperfiltration, while in the late stage of sepsis, as the consequence of the development of acute renal damage, renal clearance of antibiotics is reduced. The extracorporeal clearance of antibiotics depends on the hydrosolubility and pharmacokinetic characteristics of the antibiotic, but also on the type of continuous dialysis modality, dialysis dose, membrane type, blood flow rate, dialysis flow rate, net filtration rate, and effluent flow rate. Early detection of sepsis and acute kidney damage, early target therapy, early administration of antibiotics at an appropriate dose, and early extracorporeal therapy for kidney replacement and removal of the inflammatory mediators can improve the outcome of patients with sepsis in intensive care units.

scholarly journals The effects of containment measures in the Italian outbreak of COVID-19

2020 ◽  
Author(s):  
M. Supino ◽  
A. d’Onofrio ◽  
F. Luongo ◽  
G. Occhipinti ◽  
A. Dal Co
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Early Stage ◽  
Northern Italy ◽  
Virus Spread ◽  
Intensive Care Patients ◽  
Rapid Spread ◽  
Containment Measures ◽  
Containment Measure

AbstractBackgroundThe COVID-19 pandemic is spreading worldwide. Italy emerged early on as the country with the largest outbreak outside Asia. The outbreak in Northern Italy demonstrates that it is fundamental to contain the virus’ spread at a very early stage of diffusion. At later stages, no containment measure, even if strict, can prevent the saturation of the hospitals and of the intensive care units in any country.Methods and ResultsHere we show that it is possible to predict when the intensive care units will saturate, within a few days from the first cases of COVID-19 intensive care patients. Using early counts of intensive care patients, we predict the saturation for Lombardy, Italy.ConclusionsGovernments should use the Italian outbreak as a precedent and implement appropriate containment measures to prevent the saturation of their intensive care units and protect their population, also, and above all, in anticipation of a possible second rapid spread of infections.

scholarly journals The effects of containment measures in the Italian outbreak of COVID-19

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
M. Supino ◽  
A. d’Onofrio ◽  
F. Luongo ◽  
G. Occhipinti ◽  
A. Dal Co
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Early Stage ◽  
Northern Italy ◽  
Virus Spread ◽  
Short Term ◽  
Intensive Care Patients ◽  
Containment Measures ◽  
Containment Measure

AbstractThe COVID-19 pandemic is spreading worldwide. Italy emerged early on as the country with the largest outbreak outside Asia. The outbreak in Northern Italy demonstrates that it is fundamental to contain the virus’ spread at a very early stage of diffusion. At later stages, no containment measure, even if strict, can prevent the saturation of the hospitals and of the intensive care units in any country. Here we show that it is possible to predict when the intensive care units will saturate, within a few days from the beginning of the exponential growth of COVID-19 intensive care patients. Using early counts of intensive care patients, we predict the saturation for Lombardy, Italy. We also assess short-term and long-term lockdown effects on intensive care units and number of deaths. Governments should use the Italian outbreak as a precedent and implement appropriate containment measures to prevent the saturation of their intensive care units and protect their population, also, and above all, in anticipation of a possible second exponential spread of infections.

scholarly journals The Polish Version of the Nursing Delirium Screening Scale (NuDESC PL)-Experience of Using in Nursing Practice in Cardiac Surgery Intensive Care Unit

2021 ◽  
Vol 18 (19) ◽  
pp. 10108
Author(s):  
Sabina Krupa ◽  
Ozga Dorota ◽  
Adriano Friganovic ◽  
Wioletta Mędrzycka-Dąbrowska ◽  
Krzysztof Jurek
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Early Stage ◽  
Statistical Significance ◽  
Night Shift ◽  
Common Diagnosis ◽  
Polish Version ◽  
Nursing Delirium Screening Scale ◽  
Screening Scale

Introduction: Delirium is a common complication of patients hospitalized in Intensive care units (ICU). The risk of delirium is estimated at approximately 80% in intensive care units. In the case of cardiac surgery ICU, the risk of delirium increases due to the type of procedures performed with the use of extracorporeal circulation. The aim of this study was to provide an official translation and evaluation of Nursing Delirium Screening Scale (NuDESC) into Polish. The NuDESC scale is a scale used by nurses around the world to detect delirium at an early stage in treatment. Methods: The method used in the study was the NuDESC tool, which was translated into Polish. The study was conducted by Cardiac ICU nurses during day shift (at 8 a.m.), night shift (at 8 p.m.) and in other situations where the patients showed delirium-like symptoms. Results: Statistically significant differences were observed between the first and second day in the studied group of patients in the case of illusions/hallucinations. Delirium occurred more frequently during the night, but statistical significance was demonstrated for both daytime and nighttime shifts. It was not demonstrated in relation to the NuDESC scale in the case of insomnia disorders. The diagnosis of delirium and disorientation was the most common diagnosis observed in patients on the first day of their stay in the ICU, followed by problems with communication. Delirium occurred on the first day, mainly at night. On the second day, delirium was much less frequent during the night; the biggest problem was disorientation and problems with communication. Conclusion: This study contributed to the development of the Polish version of the scale (NuDESC PL) which is now used as the Polish screening tool for delirium detection. The availability of an easy-to-use nurse-based delirium instrument is a prerequisite for widespread implementation.

scholarly journals Biological Risk Factors Predict Transfer to Intensive Care Units and Death in Covid-19 Patients

2020 ◽  
Author(s):  
Chloé Sauzay ◽  
Maïlys Le Guyader ◽  
Ophélie Evrard ◽  
Rémy Nyga ◽  
Alexis Caulier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Early Stage ◽  
Prognostic Score ◽  
University Hospital ◽  
World Health ◽  
Biological Parameters ◽  
Biological Risk ◽  
Cox Analysis

Abstract Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), causing the COVID-19, has been declared as pandemic by the World Health Organization. Epidemiological and clinical characteristics of patients with COVID-19 have been largely reported but biological risk factors have not yet been well described. In this retrospective and monocentric study, we explored 35 hematological and biochemical parameters, routinely measured at the Amiens University Hospital laboratory, between February 21, 2020 and March 30, 2020 for patients diagnosed with COVID-19. 154 patients were included in this study. We compared biological parameters collected at hospital admission between patients who survived or not after hospitalization. Non survivor patients displayed lower hemoglobin (p=0.02) and bicarbonate concentrations (p=0.03) and higher potassium concentration (p=0.03) compared to the survivors. We then compared these biological parameters between patients hospitalized in conventional care units and patients hospitalized in intensive care units (ICU). Numerous biological examinations had significant variations, including lymphocyte and neutrophil counts, bicarbonate, calcium and C Reactive Protein concentrations. In multivariate Cox analysis, risk factors for aggravation (defined as ICU admission or death) included low bicarbonate levels and hyponatremia. A significant worse overall survival was associated with hyponatremia, hyperkaliemia and prothrombin time > 16.8 seconds. We then proposed a prognostic score, to be validated in a future prospective study. Thus, these biological parameters, easily available, could help clinicians to identify high risk patients at an early stage of infection.

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