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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: intensive care unit (Page 1 of 3)

The impact of early percutaneous tracheotomy on reduction of the incidence of ventilator associated pneumonia and the course and outcome of ICU patients

Abstract

The aim of the study. The primary objective of this study was to determine the differences in the incidence of respiratory infections and septic episodes in patients who underwent early percutaneous tracheotomy (ET) and in patients who underwent translaryngeal intubation i.e late tracheotomy (LT). Secondary objectives were to determine the differences in the early mortality of patients, duration of mechanical ventilation and length of Intensive care unit (ICU) stay.

Materials and methods. The study included 72 surgical and trauma patients older than 18 years of age, treated at the ICU of the University Clinical Hospital Mostar who had undergone translaryngeal intubation and were mechanically ventilated for at least 48 hours. The basic criterion for inclusion in the study was expected duration of mechanical ventilation of at least 14 days. Forty-eight hours after enrollment, patients were randomly divided into two groups. The first group of patients underwent ET after 2-4 days of mechanical ventilation; the second group underwent LT if they exhibited longer episodes of hypoxemia after 15 days.

Results. The ET group of patients spent less time in mechanical ventilation and ICU. The ET group had a lower rate of VAS pneumonia (p=0.137), sepsis episodes (p=0.029) and mortality rate (p=0.056).

Conclusion. The results of our study support ET being performed 2–4 days from the start of mechanical ventilation. Despite a lack of power, we found significant benefits of ET regarding the incidence of pneumonia, sepsis, hospital mortality, duration of mechanical ventilation and length of ICU stay

Key words: tracheotomy, mechanical ventilation, intensive care unit, ventilator-associated pneumonia, treatment outcome, complications

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Clinical characteristics and mortality of patients in the intensive care unit with and without new-onset arrhythmias

Abstract

Objective. The aims of this study were to analyze the risk factors for and types of new-onset arrhythmias in ICU (Intensive care unit), and to evaluate their impact on patient outcomes.

Methods. We studied 1051 patients who were admitted to the two general ICUs between December 2013 and February 2016. These patients were divided into two groups: patients with new-onset arrhythmias and patients without new-onset arrhythmias. We compared the risk factors, types and prognoses of new-onset arrhythmias between these two groups.

Results. New-onset arrhythmias were observed in 20.84% (n=219) of 1051 patients. The main risk factors leading to arrhythmias included age, emergency operation, past cardiovascular disease, patients with multiple systemic diseases, acute respiratory distress syndrome, severe sepsis/septic shock, acute renal dysfunction, cardiovascular disease, electrolyte disturbance, patients on ventilators, patients on vasopressors and higher Acute Physiology and Chronic Health Evaluation II scores (APACHE II score) on ICU admission. Multivariate logistic regression revealed that age, emergency operation, severe sepsis/septic shock, cardiovascular disease, electrolyte disturbance, patients on ventilators and those with higher APACHE II scores on ICU admission, were all significantly associated with new-onset arrhythmias. Arial fibrillation was the most frequent arrhythmia. ICU mortality in patients with new-onset arrhythmias was 22.37% (49 out of 219) compared with 3.61% (30 out of 832) in patients without new-onset arrhythmias (p<0.001). Among surviving patients, ICU stay for those with new-onset arrhythmias was longer than those without new-onset arrhythmias (median stay of 10 days versus 5 days, p<0.001).

Conclusion. We found a high prevalence of new-onset arrhythmias in ICU patients. Arrhythmia, especially atrial fibrillation, was a common complication in ICU patients and was associated with increasing length of ICU stay and higher mortality.

Key words: arrhythmia, intensive care unit, critical illness, mortality

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Geriatric patients in the ICU

Abstract

The proportion of patients older than 80 years admitted to the ICU is constantly increasing. Despite well-known admission criteria, older patients are frequently not referred and are admitted to the ICU. The emergency ward and ICU management of acute medical conditions should not depend on age only, but should be tailored to the individual patient in line with standards of care. After the successful treatment of acute illness, elderly people should receive complex and prolonged physical, social and psychological rehabilitation. Nevertheless, we must be able to recognize the point of futile treatment and provide proper palliative care. Less traumatised procedures that are better tolerated are preferred in the management of specific medical conditions in geriatric patients. General preventive programs promoting healthy lifestyles have been developed, but these must be implemented by a majority of older people. Medical science should promote adequate education of all professionals who are involved in the treatment of geriatric patients; societies should provide equal access to health-care in developed countries and countries in transition.

Key words: intensive care unit, outcome, survival, elderly, treatment intensity

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Bronchoscopy during non-invasive ventilation in a patient with acute respiratory distress syndrome

Abstract

A 72-year-old man was transferred to our hospital for refractory severe acute respiratory syndrome. On arrival, he was intubated and mechanically ventilated. Furthermore, he required veno-venous extracorporeal membrane oxygenation. Two days later, he was extubated and supported with periods of non-invasive ventilation (NIV), with a new mask. Because of large amounts of bronchial secretions that he was not able to expectorate, flexible fiberoptic bronchoscopy (FFB) was performed to remove the secretions, without interrupting NIV support. During the procedure, the patient remained hemodynamically stable, breathing spontaneously and with just a mild reduction in oxygen saturation (SpO2) (97.9% vs. 96.8%). This case report highlights the possibility of performing upper endoscopic procedures, such as FFB, during non-invasive ventilation in patients in whom this respiratory support is required and its interruption may be harmful.

Key words: non-invasive ventilation, acute respiratory distress syndrome, flexible fiberoptic bronchoscopy, intensive care unit

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Current practice of hemodynamic monitoring with PiCCO in a single general surgical ICU in a university hospital – a short report

Abstract

Background: In recent years, there has been an overall trend toward using less invasive hemodynamic monitoring in surgical intensive care units. The pulse contour cardiac output monitor (PiCCO) is one of them.

Objectives: The aim of this study was to evaluate our practice of hemodynamic monitoring with PiCCO in the perioperative period.

Methods: A retrospective descriptive analysis was performed in a single general surgical intensive care unit (ICU) run by anesthesiologists for the years 2013-2016. We collected information about patients, ICU quality parameters and monitoring equipment available in the ICU. The primary endpoint was the incidence of PiCCO use.

Results: Out of 2972 patients admitted to the general surgical ICU in a 4-year period, besides basic monitoring with electrocardiography (ECG), pulse oximetry and blood pressure monitoring, more than half of the patients received central venous catheterization (55.1%), less than the half invasive arterial catheterization (44.1 %) and only a small proportion PiCCO (0.91%). No patient received a pulmonary arterial catheter. Mortality rate was 7.47 %.

Conclusion: The use of PiCCO in our ICU is far below reported in literature. In the majority of cases, our anesthesiologists make clinical decisions based on measurement of central venous and invasive arterial pressure.

Key words: hemodynamic monitoring, intensive care unit, general surgery

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