medRxiv - Intensive Care and Critical Care Medicine最新文献

{"title":"Association of sepsis and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage","authors":"Franz-Simon Centner, Holger Wenz, Mariella Eliana Oster, Franz-Joseph Dally, Johannes Sauter-Servaes, Tanja Pelzer, Jochen Johannes Schoettler, Bianka Hahn, Amr Abdulazim, Katharina A.M. Hackenberg, Christoph Groden, Joerg Krebs, Manfred Thiel, Nima Etminan, Mate E. Maros","doi":"10.1101/2024.01.27.24301874","DOIUrl":"https://doi.org/10.1101/2024.01.27.24301874","url":null,"abstract":"Background: Although sepsis and delayed cerebral ischemia (DCI) are severe complications in patients with aneurysmal subarachnoid hemorrhage (aSAH) and share pathophysiological features, their interrelation and additive effect on functional outcome is uncertain. We investigated the association of sepsis with DCI and their cumulative effect on functional outcome in patients with aSAH using current sepsis-3 definition.\u0000Methods: Patients admitted to our hospital between 11/2014-11/2018 for aSAH were retrospectively analyzed. The main explanatory variable was sepsis, diagnosed using sepsis-3 criteria. Endpoints were DCI and functional outcome at hospital discharge (modified Rankin Scale (mRS) 0-3 vs. 4-6). Propensity score matching (PSM) and multivariable logistic regressions were performed.\u0000Results: Of 238 patients with aSAH, 55 (23%) developed sepsis and 74 (31%) DCI. After PSM, aSAH patients with sepsis displayed significantly worse functional outcome (p<0.01) and longer ICU stay (p=0.046). Sepsis was independently associated with DCI (OR=2.46, 95%CI: 1.28-4.72, p<0.01). However, after exclusion of patients who developed sepsis before (OR=1.59, 95%CI: 0.78-3.24, p=0.21) or after DCI (OR=0.85, 95%CI: 0.37-1.95, p=0.70) this statistical association did not remain. Good functional outcome gradually decreased from 56% (76/135) in patients with neither sepsis nor DCI, to 43% (21/48) in those with no sepsis but DCI, to 34% (10/29) with sepsis but no DCI and to 8% (2/26) in patients with both sepsis and DCI.\u0000Conclusions: Our study demonstrates a strong association between sepsis, DCI and functional outcome in patients with aSAH and suggests a complex interplay resulting in a cumulative effect towards poor functional outcome, which warrants further studies.","PeriodicalId":501249,"journal":{"name":"medRxiv - Intensive Care and Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139590649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Person-Centred Care: Lessons from a service evaluation","authors":"Stephen Pearson, Anna Petsas, Janet Balabanovic, Manoj Juj, Wendy Harris, Timothy Bonnici","doi":"10.1101/2024.01.26.24301616","DOIUrl":"https://doi.org/10.1101/2024.01.26.24301616","url":null,"abstract":"Context: Critical care encompasses intensive care, intensive therapy and high dependency care and is operationalised when patients require specialised monitoring and intervention following complex surgery, or a life-threatening illness or injury. Background: During the pandemic, the Critical Care Department at UCLH formed a family liaison team to bridge the connection gap between patients, families, and clinical teams. This evolved into the Patient & Family Team (PFT), which organised several engagement events to understand patient and family experiences in critical care. Methods: Focus group discussions were conducted online and in-person with patients and bereaved families exploring their experience of the service. Discussions revolved around pivotal moments in the critical care journey. Feedback was analysed thematically and validated with the participants.\u0000Findings: Patients described their journey through four stages: Admission, Period of Disorientation, Re-Awakening, and Recovery. Bereaved families categorised their experiences into seven stages from 'The Phone Call' to 'Bereavement.' The need for effective and compassionate communication and support was evident for both groups. Discussion: Feedback revealed the emotional journeys of patients and families in critical care. While many experiences align with the existing literature, they also highlight areas for improvement, emphasising the value of human connection in healthcare. This study also demonstrated the need for continuous service evaluation and strategies for understanding underserved populations.","PeriodicalId":501249,"journal":{"name":"medRxiv - Intensive Care and Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139587602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comprehensive ML-based Respiratory Monitoring System for Physiological Monitoring & Resource Planning in the ICU","authors":"Matthias Hüser, Xinrui Lyu, Martin Faltys, Alizée Pace, Marine Hoche, Stephanie L. Hyland, Hugo Yèche, Manuel Burger, Tobias M. Merz, Gunnar Rätsch","doi":"10.1101/2024.01.23.24301516","DOIUrl":"https://doi.org/10.1101/2024.01.23.24301516","url":null,"abstract":"Respiratory failure (RF) is a frequent occurrence in critically ill patients and is associated with significant morbidity and mortality as well as resource use. To improve the monitoring and management of RF in intensive care unit (ICU) patients, we used machine learning to develop a monitoring system covering the entire management cycle of RF, from early detection and monitoring, to assessment of readiness for extubation and prediction of extubation failure risk. For patients in the ICU in the study cohort, the system predicts 80% of RF events at a precision of 45% with 65% identified 10h before the onset of an RF event. This significantly improves upon a standard clinical baseline based on the SpO2/FiO2 ratio. After a careful analysis of ICU differences, the RF alarm system was externally validated showing similar performance for patients in the external validation cohort. Our system also provides a risk score for extubation failure for patients who are clinically ready to extubate, and we illustrate how such a risk score could be used to extubate patients earlier in certain scenarios. Moreover, we demonstrate that our system, which closely monitors respiratory failure, ventilation need, and extubation readiness for individual patients can also be used for ICU-level ventilator resource planning. In particular, we predict ventilator use 8-16h into the future, corresponding to the next ICU shift, with a mean absolute error of 0.4 ventilators per 10 patients effective ICU capacity.","PeriodicalId":501249,"journal":{"name":"medRxiv - Intensive Care and Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139555528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial pressure-flow relationships in traumatic brain injury patients expose gaps in the tenets of models and pressure-oriented management","authors":"JN Stroh, Brandon Foreman, Tellen D Bennett, Jennifer K Briggs, Soojin Park, David J Albers","doi":"10.1101/2024.01.17.24301445","DOIUrl":"https://doi.org/10.1101/2024.01.17.24301445","url":null,"abstract":"<strong>Background</strong> The protocols and therapeutic guidance established for treating traumatic brain injuries (TBI) in neurointensive care focus on managing cerebral blood flow (CBF) and brain tissue oxygenation based on pressure signals. The decision support process relies on assumed relationships between cerebral perfusion pressure (CPP) and blood flow, pressure-flow relationships (PFRs), and shares this framework of assumptions with mathematical intracranial hemodynamic models. These foundational assumptions are difficult to verify, and their violation can impact clinical decision-making and model validity.","PeriodicalId":501249,"journal":{"name":"medRxiv - Intensive Care and Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139518726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a difference in the satisfaction levels between professionals who have participated and those who have not participated in the TeleUTIP telemedicine project regarding their engagement in tele-education activities?","authors":"Hilda M. R. Moleda Constant, Vanessa Cristina Jacovas, Maria Eulália Vinadé Chagas, Maria Cristina Cotta Matte, Emanuele König Klever, Luciane Cunha, João Ronaldo Mafalda Krauzer, Taís de Campos Moreira, Felipe Cezar Cabral","doi":"10.1101/2024.01.16.24301368","DOIUrl":"https://doi.org/10.1101/2024.01.16.24301368","url":null,"abstract":"<strong>Objective</strong> The aim of this study is to introduce a distance education program and assess the satisfaction of health professionals.","PeriodicalId":501249,"journal":{"name":"medRxiv - Intensive Care and Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139506485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare-associated Urinary tract infection and its determinants among Adult Patients Admitted to Intensive Care Units of Addis Ababa Public Governmental Hospital, Ethiopia; 2020","authors":"Wondimagegn Genaneh Shiferaw, Tigist Nega Alemu, Hindu Argeta Hailemariam, Silenat Gashaw Adibaru, Eyouel Shimeles Demissie","doi":"10.1101/2023.12.05.23299476","DOIUrl":"https://doi.org/10.1101/2023.12.05.23299476","url":null,"abstract":"Back ground Urinary tract infections are common bacterial infections that affect almost 150 million people internationally each year. A catheter-associated urinary tract infection arises when germs enter the urinary tract via a urinary catheter, leading to infection and have been linked with increased mortality, morbidity, healthcare costs in intensive care units. It is one of the highest prevalent health care-related infections, accounting for nearly 30% of intensive care unit (ICU) reports because of its association to urinary catheterization, but has great preventive potential. Method Institutional based cross-sectional study design applied to determine the prevalence and associated factors of Health care-associated urinary tract infections among adult 391 patients admitted to ICU from 2017 to 2019 GC at Addis Ababa Public Governmental Hospital, Addis Ababa, Ethiopia, June-December 2020.Data had manually checked and entered to Epi-data manager version 4.6 and statistical analyses have been performed using SPSS version 23 software program. Strength of association between dependent and independent variables is assessed using crude odds ratio (COR) and adjusted odds ratio (AOR) with confidence Interval (CI) of 95%. Variables that had a value of P &lt; 0.25 on bi-variate analysis were directly forward to be analyzed by multi variable analysis. Goodness of fit test had also computed for logistic regression using Hosmer and Lemeshow test resulted in (sig=0.073), finally having P-values &lt; 0.05 is considered as statistically significant. Result the study find that the prevalence of Healthcare Associated Urinary Tract Infection among ICU admitted patients was 91(23.3%) 95%CI ;(19.2- 27.4), While length of stay, Having tracheostomy, patients on Mechanical Ventilation and taking Proton pump inhibitor drugs were associated with HAUTI in the study area. Conclusion Healthcare-associated Urinary Tract infection is highly emerging clinical condition among ICU admitted patients in the study areas.","PeriodicalId":501249,"journal":{"name":"medRxiv - Intensive Care and Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term survival, psychiatric, physiological, and functional outcomes of critically ill patients requiring prolonged mechanical ventilation: a systematic review","authors":"Jarryd Ludski, Conor Honeywill","doi":"10.1101/2023.11.27.23299077","DOIUrl":"https://doi.org/10.1101/2023.11.27.23299077","url":null,"abstract":"<strong>Purpose</strong> Invasive mechanical ventilation is utilized in over 50% of Australian Intensive Care Unit patients, with rates increasing world-wide. Prolonged mechanical ventilation is associated with increased length of hospital stay and in-hospital mortality compared with patients ventilated under the time threshold. Previous studies have highlighted mortality rates, but much remains unknown regarding the long-term physiological, functional, and psychiatric effects of prolonged mechanical ventilation. With a greater understanding of these outcomes, models of care can be formulated to reduce long-term morbidity.","PeriodicalId":501249,"journal":{"name":"medRxiv - Intensive Care and Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomised, controlled, feasibility trial comparing vasopressor infusion administered via peripheral cannula versus central venous catheter for critically ill adults: a study protocol","authors":"Stacey Watts, Yogesh Apte, Thomas Holland, April Hatt, Alison Craswell, Frances Lin, Alexis Tabah, Robert S Ware, Joshua Byrnes, Christopher Anstey, Gerben Keijzers, Mahesh Ramanan","doi":"10.1101/2023.11.21.23298856","DOIUrl":"https://doi.org/10.1101/2023.11.21.23298856","url":null,"abstract":"<strong>Background</strong> When clinicians need to administer a vasopressor infusion, they are faced with the choice of administration via either peripheral intravenous catheter (PIVC) or central venous catheter (CVC). Vasopressor infusions have traditionally been administered via central venous catheters (CVC) rather than Peripheral Intra Venous Catheters (PIVC), primarily due to concerns of extravasation and resultant tissue injury. This practice is not guided by contemporary RCT evidence. Observational data suggests safety of vasopressor infusion via PIVC. To address this evidence gap, we have designed the “Vasopressors Infused via Peripheral or Central Access” (VIPCA) randomised controlled trial (RCT).","PeriodicalId":501249,"journal":{"name":"medRxiv - Intensive Care and Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Laboratory Biomarkers in ICU-admitted Septic Patients with and without Bacteremia: A Predictive Analysis","authors":"Sangwon Baek, Seungjun Lee","doi":"10.1101/2023.11.16.23298625","DOIUrl":"https://doi.org/10.1101/2023.11.16.23298625","url":null,"abstract":"Background: Few studies have investigated the diagnostic utilities of biomarkers for predicting bacteremia among septic patients admitted to intensive care units (ICU). Therefore, this study evaluated the prediction power of laboratory biomarkers to utilize those markers with high performance to optimize the predictive model for bacteremia. Methods: A retrospective cross-sectional study was conducted at the ICU department of Gyeongsang National University Changwon Hospital in 2019. Adult patients qualifying SEPSIS—3 (increase in sequential organ failure score ≥ 2) criteria with at least two sets of blood culture were selected. Collected data was initially analyzed independently to identify the significant predictors, which was then used to build the multivariable logistic regression (MLR) model.\u0000Results: A total of 218 patients with 48 cases of true bacteremia were analyzed in this research. Both CRP and PCT showed a substantial area under the curve (AUC) value for discriminating bacteremia among septic patients (0.757 and 0.845, respectively). To further enhance the predictive accuracy, we combined PCT, bilirubin, neutrophil—lymphocyte ratio (NLR), platelets, lactic acid, erythrocyte sedimentation rate (ESR), and Glasgow Coma Scale (GCS) score to build the predictive model with an AUC of 0.907 [0.843–0.956]. In addition, a high association between bacteremia and mortality rate was discovered through the survival analysis (P=0.004).\u0000Conclusions: While PCT is certainly a useful index for distinguishing patients with and without bacteremia by itself, our MLR model indicates that the accuracy of bacteremia prediction substantially improves by the combined use of PCT, bilirubin, NLR, platelets, lactic acid, ESR, and GCS score.","PeriodicalId":501249,"journal":{"name":"medRxiv - Intensive Care and Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Beta Blocker and Clinical Outcome in Adult Patients with Sepsis or Septic Shock: Protocol of a Systematic Review and Meta- Analysis of Randomized Controlled Trials","authors":"Sulagna Bhattacharjee, Emmanuel Easterson Ernest, Souvik Maitra","doi":"10.1101/2023.11.14.23298548","DOIUrl":"https://doi.org/10.1101/2023.11.14.23298548","url":null,"abstract":"Use of beta-blockers as a part of heart rate control strategy is sepsis and septic shock patients is of great debate. Despite of early encouraging results, no large trial was performed and several subsequent small studies reported conflicting results. This meta-analysis and systematic review will be conducted and published as per PRISMA guidelines. In this review, randomized controlled trials comparing short-acting beta-blockers with standard of care in adult patients with sepsis and septic shock will be included. Primary outcome will be 28- day mortality and secondary outcomes will be duration of intensive care unit stay, duration of hospital stay, ICU mortality, hospital mortality and reported adverse events. A random effect model will be used for all analysis.","PeriodicalId":501249,"journal":{"name":"medRxiv - Intensive Care and Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}