The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients,...The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients, and when appropriate off-line is an important issue in the field of critical care medicine. Appropriate sedation can improve patient outcomes, but excessive sedation may lead to prolonged mechanical ventilation and increase the risk of complications. Elderly patients should be closely monitored and evaluated on an individual basis while offline, and the sedation regimen should be dynamically adjusted. This requires the healthcare team to consider the patient’s sedation needs, disease status, and pharmacodynamics and pharmacokinetics of the drug to arrive at the best strategy. Although the current research has provided valuable insights and strategies for sedation and off-line management, there are still many problems to be further explored and solved.展开更多
Background: Critically ill patients receiving prolonged mechanical ventilatory support are at risk for loss of muscle mass and muscle strength from immobility. Feasible, non-invasive methods are needed to accurately o...Background: Critically ill patients receiving prolonged mechanical ventilatory support are at risk for loss of muscle mass and muscle strength from immobility. Feasible, non-invasive methods are needed to accurately obtain data on markers of muscle mass to design effective interventions and monitor patient progress during recovery from critical illness. Bioelectric impedance has been used in other settings to obtain data on body composition and muscle mass. Purpose: The aims of this study were to determine the feasibility of bioelectric impedance as a marker of muscle mass in a sample of mechanically ventilated patients and to assess data trends in these obtained values. Methods: A descriptive design was used to obtain standard bioelectric impedance parameters (total body resistance, legs resistance, and percent lean body mass) over 4 days from eligible patients already enrolled in a randomized clinical trial. Results: Bioimpedance parameters were readily obtained over 4 days in a sample of 43 patients (age 59 + 15.7 years, 56% male) receiving prolonged ventilatory support (mean 9.4 + 10.4 days) due to respiratory failure. Reasons for not obtaining impedance measures included skin impairment, monitoring devices, or presence of implantable cardiac defibrillator or pacemaker. Average total body impedance was 464.3 + 117.1 ohms, while average impedance of legs was 479.1 + 146.4 ohms. Lean body mass was 68.4% (+10.8). Conclusions/Implications for Practice: With carefully trained staff and a standardized measurement protocol, bioimpedance is a feasible method to obtain body composition data reflective of muscle mass in mechanically ventilated patients. Further research will determine the utility of bioimpedance to monitor recovery and effectiveness of interventions to restore function after prolonged periods of ventilatory support and immobility in mechanically ventilated patients.展开更多
Background: Significant resource constraints and critical care training gaps are responsible for the limited development of intensive care units (ICUs) in resource limited settings. We describe the implementation of a...Background: Significant resource constraints and critical care training gaps are responsible for the limited development of intensive care units (ICUs) in resource limited settings. We describe the implementation of an ICU in Haiti and report the successes and difficulties encountered throughout the process. We present a consecutive case series investigating an anesthesiologist, emergency, and critical care physician implemented endotracheal intubation and mechanical ventilation protocol in an austere environment with the assistance of telemedicine. Methods: A consecutive case series of fifteen patients admitted to an ICU at St. Luc Hospital located in Portau-Prince, Haiti, between the months of February 2012 to April 2014 is reported. Causes of respiratory failure and the clinical course are presented. Patients were followed to either death or discharge. Results: Fifteen patients (eight women and seven men) were included in the study with an average age of 37.7 years. The mean duration of ventilation was three days. Of the fifteen patients intubated, five patients (33.3%) survived and were discharged from the ICU. Of the five surviving patients, two were intubated for status epilepticus, one for status asthmaticus and one for hyperosmolar coma associated with intracerebral hemorrhage. Of the patients dying on the ventilator, four patients died from pneumonia, two from renal failure, and one from tetanus. The remaining three died from strokes and cardiac arrests. Conclusions: Mortality of mechanically ventilated patients in a resource-limited country is significant. Focused training in core critical care skills aimed at increasing the endotracheal intubation and ventilatory management capacity of local medical staff should be a priority in order to continue to develop ICUs in these austere environments. Collaborative educational and training efforts directed by anesthesiologists, emergency, and critical care physicians, and aided by telemedicine can facilitate realizing this goal.展开更多
BACKGROUND Emergency sepsis is a common and serious infectious disease,and its prognosis is influenced by a number of factors.AIM To analyse the factors influencing the prognosis of patients with emergency sepsis in o...BACKGROUND Emergency sepsis is a common and serious infectious disease,and its prognosis is influenced by a number of factors.AIM To analyse the factors influencing the prognosis of patients with emergency sepsis in order to provide a basis for individualised patient treatment and care.By retrospectively analysing the clinical data collected,we conducted a comprehensive analysis of factors such as age,gender,underlying disease,etiology and site of infection,inflammatory indicators,multi-organ failure,cardiovascular function,therapeutic measures,immune status and severity of infection.METHODS Data collection:Clinical data were collected from patients diagnosed with acute sepsis,including basic information,laboratory findings,medical history and treatment options.Variable selection:Variables associated with prognosis were selected,including age,gender,underlying disease,etiology and site of infection,inflammatory indicators,multi-organ failure,cardiovascular function,treatment measures,immune status and severity of infection.Data analysis:The data collected are analysed using appropriate statistical methods such as multiple regression analysis and survival analysis.The impact of each factor on prognosis was assessed according to prognostic indicators,such as survival,length of stay and complication rates.RESULTS Descriptive statistics:Descriptive statistics were performed on the data collected from the patients,including their basic characteristics and clinical presentation.CONCLUSION Type 2 diabetes mellitus were independent factors affecting the prognosis of patients with sepsis.展开更多
Hospital-acquired infections (HAI) reflect as a major global safety concern for both patients and health-care professionals. These infections could be in the form of cross-infection, endogenous infection and environme...Hospital-acquired infections (HAI) reflect as a major global safety concern for both patients and health-care professionals. These infections could be in the form of cross-infection, endogenous infection and environmental Infection. Over 80% of these infections are related to devices’ utilization needed for patients’ life support. Methods show this is an observational and cross-sectional study, to identify the microorganism and determine the potential source of transmitting of hospital acquired infection by routine devices in adult ICU. The samples were collected using Amies transport media;three swabs were taken from the surfaces of indwelling urinary catheter, mechanical ventilation device and central venous catheter used from every twelve patients. The samples were cultured and analyzed by using microbiologic technique. Finally, all samples analyzed by MicroScan WalkAway 96 pulse. Results showing the most bacteria isolated are “Klebsiella pneumonia” (18.37%), “Acinetobacter baumannii” (11.48%), “Staphylococcus epidermidis” (4.59%), “Staphylococcus haemolyticus” (4.59%), “E. coli” (4.59%), “Serratia marcescens” (2.3%), “Pseudomonas luteola” (2.3%), “Kocurio kristinae” (2.3%) and “Photorhabdus luminscens” (2.3%). This study detects a high contamination of routine devices and resistant organisms. In the end it is recommended that effective infection control practices and effective strategies to control antibiotic-resistant bacteria should be applied.展开更多
BACKGROUND The exponential rise in Coronavirus disease 2019(COVID-19)cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy.With the limited availabil...BACKGROUND The exponential rise in Coronavirus disease 2019(COVID-19)cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy.With the limited availability of literature regarding the outcomes of COVID-19 patients with tracheostomy,we attempted to study the clinical characteristics and multiple parameters affecting the outcomes in these patients.AIM To determine all-cause mortality following tracheostomy and its association with various risk factors in COVID-19 patients.METHODS This retrospective study included 73 adult COVID-19 patients admitted to the ICU between 1 April,2020 and 30 September,2021 who underwent tracheostomy as a result of acute respiratory failure due to COVID-19.The data collected included demographics(age,sex),comorbidities,type of oxygen support at admission,severity of COVID-19,complications,and other parameters such as admission to tracheostomy,intubation to tracheostomy,ICU stay,hospital stay,and outcome.RESULTS This study included 73 adult patients with an average age of 52±16.67 years,of which 52%were men.The average time for admission to tracheostomy was 18.12±12.98 days while intubation to tracheostomy was 11.97±9 days.The mortality rate was 71.2%and 28.8%of patients were discharged alive.The mean duration of ICU and hospital stay was 25±11 days and 28.21±11.60 days,respectively.Greater age,severe COVID-19,mechanical ventilation,shock and acute kidney injury were associated with poor prognosis;however,early tracheostomy in intubated patients resulted in better outcomes.CONCLUSION Patients with severe COVID-19 requiring mechanical ventilation have a poor prognosis but patients with early tracheostomy may benefit with no added risk.We recommend that the timing of tracheostomy be decided on a case-by-case basis and a well-designed randomised controlled trial should be performed to elucidate the potential benefit of early tracheostomy in such patients.展开更多
文摘The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients, and when appropriate off-line is an important issue in the field of critical care medicine. Appropriate sedation can improve patient outcomes, but excessive sedation may lead to prolonged mechanical ventilation and increase the risk of complications. Elderly patients should be closely monitored and evaluated on an individual basis while offline, and the sedation regimen should be dynamically adjusted. This requires the healthcare team to consider the patient’s sedation needs, disease status, and pharmacodynamics and pharmacokinetics of the drug to arrive at the best strategy. Although the current research has provided valuable insights and strategies for sedation and off-line management, there are still many problems to be further explored and solved.
文摘Background: Critically ill patients receiving prolonged mechanical ventilatory support are at risk for loss of muscle mass and muscle strength from immobility. Feasible, non-invasive methods are needed to accurately obtain data on markers of muscle mass to design effective interventions and monitor patient progress during recovery from critical illness. Bioelectric impedance has been used in other settings to obtain data on body composition and muscle mass. Purpose: The aims of this study were to determine the feasibility of bioelectric impedance as a marker of muscle mass in a sample of mechanically ventilated patients and to assess data trends in these obtained values. Methods: A descriptive design was used to obtain standard bioelectric impedance parameters (total body resistance, legs resistance, and percent lean body mass) over 4 days from eligible patients already enrolled in a randomized clinical trial. Results: Bioimpedance parameters were readily obtained over 4 days in a sample of 43 patients (age 59 + 15.7 years, 56% male) receiving prolonged ventilatory support (mean 9.4 + 10.4 days) due to respiratory failure. Reasons for not obtaining impedance measures included skin impairment, monitoring devices, or presence of implantable cardiac defibrillator or pacemaker. Average total body impedance was 464.3 + 117.1 ohms, while average impedance of legs was 479.1 + 146.4 ohms. Lean body mass was 68.4% (+10.8). Conclusions/Implications for Practice: With carefully trained staff and a standardized measurement protocol, bioimpedance is a feasible method to obtain body composition data reflective of muscle mass in mechanically ventilated patients. Further research will determine the utility of bioimpedance to monitor recovery and effectiveness of interventions to restore function after prolonged periods of ventilatory support and immobility in mechanically ventilated patients.
文摘Background: Significant resource constraints and critical care training gaps are responsible for the limited development of intensive care units (ICUs) in resource limited settings. We describe the implementation of an ICU in Haiti and report the successes and difficulties encountered throughout the process. We present a consecutive case series investigating an anesthesiologist, emergency, and critical care physician implemented endotracheal intubation and mechanical ventilation protocol in an austere environment with the assistance of telemedicine. Methods: A consecutive case series of fifteen patients admitted to an ICU at St. Luc Hospital located in Portau-Prince, Haiti, between the months of February 2012 to April 2014 is reported. Causes of respiratory failure and the clinical course are presented. Patients were followed to either death or discharge. Results: Fifteen patients (eight women and seven men) were included in the study with an average age of 37.7 years. The mean duration of ventilation was three days. Of the fifteen patients intubated, five patients (33.3%) survived and were discharged from the ICU. Of the five surviving patients, two were intubated for status epilepticus, one for status asthmaticus and one for hyperosmolar coma associated with intracerebral hemorrhage. Of the patients dying on the ventilator, four patients died from pneumonia, two from renal failure, and one from tetanus. The remaining three died from strokes and cardiac arrests. Conclusions: Mortality of mechanically ventilated patients in a resource-limited country is significant. Focused training in core critical care skills aimed at increasing the endotracheal intubation and ventilatory management capacity of local medical staff should be a priority in order to continue to develop ICUs in these austere environments. Collaborative educational and training efforts directed by anesthesiologists, emergency, and critical care physicians, and aided by telemedicine can facilitate realizing this goal.
文摘BACKGROUND Emergency sepsis is a common and serious infectious disease,and its prognosis is influenced by a number of factors.AIM To analyse the factors influencing the prognosis of patients with emergency sepsis in order to provide a basis for individualised patient treatment and care.By retrospectively analysing the clinical data collected,we conducted a comprehensive analysis of factors such as age,gender,underlying disease,etiology and site of infection,inflammatory indicators,multi-organ failure,cardiovascular function,therapeutic measures,immune status and severity of infection.METHODS Data collection:Clinical data were collected from patients diagnosed with acute sepsis,including basic information,laboratory findings,medical history and treatment options.Variable selection:Variables associated with prognosis were selected,including age,gender,underlying disease,etiology and site of infection,inflammatory indicators,multi-organ failure,cardiovascular function,treatment measures,immune status and severity of infection.Data analysis:The data collected are analysed using appropriate statistical methods such as multiple regression analysis and survival analysis.The impact of each factor on prognosis was assessed according to prognostic indicators,such as survival,length of stay and complication rates.RESULTS Descriptive statistics:Descriptive statistics were performed on the data collected from the patients,including their basic characteristics and clinical presentation.CONCLUSION Type 2 diabetes mellitus were independent factors affecting the prognosis of patients with sepsis.
文摘Hospital-acquired infections (HAI) reflect as a major global safety concern for both patients and health-care professionals. These infections could be in the form of cross-infection, endogenous infection and environmental Infection. Over 80% of these infections are related to devices’ utilization needed for patients’ life support. Methods show this is an observational and cross-sectional study, to identify the microorganism and determine the potential source of transmitting of hospital acquired infection by routine devices in adult ICU. The samples were collected using Amies transport media;three swabs were taken from the surfaces of indwelling urinary catheter, mechanical ventilation device and central venous catheter used from every twelve patients. The samples were cultured and analyzed by using microbiologic technique. Finally, all samples analyzed by MicroScan WalkAway 96 pulse. Results showing the most bacteria isolated are “Klebsiella pneumonia” (18.37%), “Acinetobacter baumannii” (11.48%), “Staphylococcus epidermidis” (4.59%), “Staphylococcus haemolyticus” (4.59%), “E. coli” (4.59%), “Serratia marcescens” (2.3%), “Pseudomonas luteola” (2.3%), “Kocurio kristinae” (2.3%) and “Photorhabdus luminscens” (2.3%). This study detects a high contamination of routine devices and resistant organisms. In the end it is recommended that effective infection control practices and effective strategies to control antibiotic-resistant bacteria should be applied.
文摘BACKGROUND The exponential rise in Coronavirus disease 2019(COVID-19)cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy.With the limited availability of literature regarding the outcomes of COVID-19 patients with tracheostomy,we attempted to study the clinical characteristics and multiple parameters affecting the outcomes in these patients.AIM To determine all-cause mortality following tracheostomy and its association with various risk factors in COVID-19 patients.METHODS This retrospective study included 73 adult COVID-19 patients admitted to the ICU between 1 April,2020 and 30 September,2021 who underwent tracheostomy as a result of acute respiratory failure due to COVID-19.The data collected included demographics(age,sex),comorbidities,type of oxygen support at admission,severity of COVID-19,complications,and other parameters such as admission to tracheostomy,intubation to tracheostomy,ICU stay,hospital stay,and outcome.RESULTS This study included 73 adult patients with an average age of 52±16.67 years,of which 52%were men.The average time for admission to tracheostomy was 18.12±12.98 days while intubation to tracheostomy was 11.97±9 days.The mortality rate was 71.2%and 28.8%of patients were discharged alive.The mean duration of ICU and hospital stay was 25±11 days and 28.21±11.60 days,respectively.Greater age,severe COVID-19,mechanical ventilation,shock and acute kidney injury were associated with poor prognosis;however,early tracheostomy in intubated patients resulted in better outcomes.CONCLUSION Patients with severe COVID-19 requiring mechanical ventilation have a poor prognosis but patients with early tracheostomy may benefit with no added risk.We recommend that the timing of tracheostomy be decided on a case-by-case basis and a well-designed randomised controlled trial should be performed to elucidate the potential benefit of early tracheostomy in such patients.
