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López J, Pons-Òdena M, Medina A, Molinos-Norniella C, Palanca-Arias D, Demirkol D, León-González JS, López-Fernández YM, Perez-Baena L, López-Herce J. Early factors related to mortality in children treated with bi-level noninvasive ventilation and CPAP. Pediatr Pulmonol 2021; 56:1237-1244. [PMID: 33382190 DOI: 10.1002/ppul.25246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/26/2020] [Accepted: 12/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe and analyze the characteristics and the early risk factors for mortality of noninvasive ventilation (NIV) in critically ill children. STUDY DESIGN A multicenter, prospective, observational 2-year study carried out with critically ill patients (1 month - 18 years of age) who needed NIV. Clinical data and NIV parameters during the first 12 h of admission were collected. A multilevel mixed-effects logistic regression was performed to identify mortality risk factors. RESULTS A total of 781 patients (44.2 ± 57.7 months) were studied (57.8% male). Of them, 53.7% had an underlying condition, and 47.1% needed NIV for lower airway respiratory pathologies. Bi-level NIV was the initial support in 78.2% of the patients. Continuous positive airway pressure (CPAP) was used more in younger patients (33.7%) than in older ones (9.7%; p < .001). About 16.7% had to be intubated and 6.2% died. The risk factors for mortality were immunodeficiency (odds ratio [OR] = 11.79; 95% confidence interval [CI] = 2.95-47.13); cerebral palsy (OR = 5.86; 95% CI = 1.94-17.65); presence of apneas on admission (OR = 5.57; 95% CI = 2.13-14.58); tachypnea 6 h after NIV onset (OR = 2.59; 95% CI = 1.30-6.94); and NIV failure (OR = 6.54; 95% CI = 2.79-15.34). CONCLUSION NIV is used with great variability in types of support. Younger children receive CPAP more frequently than older children. Immunodeficiency, cerebral palsy, apneas on admission, tachypnea 6 h after NIV onset, and NIV failure are the early factors associated with mortality.
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Affiliation(s)
- Jorge López
- Department of Pediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain.,Mother-Child Health and Development Network (RedSAMID) of Carlos III Health Institute, Madrid, Spain
| | - Martí Pons-Òdena
- Department of Pediatric Intensive and Intermediate Care, Sant Joan de Déu University Hospital, Universitat de Barcelona, Esplugues de Llobregat, Spain.,Critical Care Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Alberto Medina
- Pediatric Intensive Care Unit, CIBERes, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Daniel Palanca-Arias
- Pediatric Intensive Care Unit, Miguel Servet University Hospital, Zaragoza, Spain
| | - Demet Demirkol
- Pediatric Intensive Care Unit, Koç University School of Medicine, Istanbul, Turkey
| | - José S León-González
- Pediatric Intensive Care Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Luis Perez-Baena
- Pediatric Intensive Care Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Jesús López-Herce
- Department of Pediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain.,Mother-Child Health and Development Network (RedSAMID) of Carlos III Health Institute, Madrid, Spain
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Sprooten RTM, Rohde GGU, Janssen MTHF, Cobben NAM, Wouters EFM, Franssen FME. Predictors for long-term mortality in COPD patients requiring non-invasive positive pressure ventilation for the treatment of acute respiratory failure. THE CLINICAL RESPIRATORY JOURNAL 2020; 14:1144-1152. [PMID: 32780940 PMCID: PMC7756413 DOI: 10.1111/crj.13251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/31/2020] [Accepted: 08/05/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The effectiveness of non-invasive mechanical ventilation (NIV) in the management of COPD patients suffering from acute respiratory failure (ARF) as a consequence of exacerbation of the disease, is well established. However, data on long-term outcomes and their predictors, including the individual response to NIV, are scarce. OBJECTIVES To investigate predictors for short- and long-term mortality in this study population. METHODS A retrospective cohort study was performed including all patients admitted to the Medium Respiratory Care Unit of Maastricht University Medical Center in Maastricht, the Netherlands, with hospitalized exacerbation of COPD (H-ECOPD) with ARF requiring NIV for the first time between January 2009 and December 2011. An extensive number of potential predictors of outcomes, including the response to NIV, were determined on admission and during hospitalization. Univariate and multivariate logistic regression was used for statistical analysis. RESULTS Seventy-eight consecutive patients with moderate to severe COPD (mean age 71.0 ± 10.7 years; 48.7% males) were included; In-hospital, 1-year and 2-year mortality rates were 14.1%, 43.6% and 56.4%, respectively. Independent risk factors for 2-year mortality were: advanced age (odds ratio(OR) 1.025; confidence interval (CI) 1.002-1.049; P = 0.037), prolonged NIV use more than 8 days (OR:1.054;CI:1.006-1.104; P = 0.027) and no successful response to NIV (OR:2.392;CI:1.297-4.413; P = 0.005). CONCLUSION Patients with an H-ECOPD requiring NIV for the first time, constitute a severely ill patient group with high in-hospital and 2-year mortality. This study identified advanced age, NIV use more than 8 days and unsuccessful response to NIV as clinical important independent predictors for long-term mortality.
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Affiliation(s)
- Roy T. M. Sprooten
- Department of Respiratory MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
- NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Gernot G. U. Rohde
- Department of Respiratory Medicine, Medical Clinic 1University HospitalFrankfurtGermany
| | - Marlou T. H. F. Janssen
- Department of Respiratory MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Nicolle A. M. Cobben
- Department of Respiratory MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Emiel F. M. Wouters
- Department of Respiratory MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
- NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
- CIROHornThe Netherlands
| | - Frits M. E. Franssen
- Department of Respiratory MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
- NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
- CIROHornThe Netherlands
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Quigley D, Jones S, Piccolo F, Huseini T, Manners D. Midland non‐invasive ventilation score: a tool to predict non‐invasive ventilation failure in people with acute hypercapnic respiratory failure. Intern Med J 2020; 50:1412-1415. [DOI: 10.1111/imj.15058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
Affiliation(s)
- David Quigley
- Respiratory Department St John of God Midland Public and Private Hospital (SJGMPPH) Perth Western Australia Australia
| | - Simon Jones
- Respiratory Department St John of God Midland Public and Private Hospital (SJGMPPH) Perth Western Australia Australia
| | - Francesco Piccolo
- Respiratory Department St John of God Midland Public and Private Hospital (SJGMPPH) Perth Western Australia Australia
| | - Taha Huseini
- Respiratory Department St John of God Midland Public and Private Hospital (SJGMPPH) Perth Western Australia Australia
| | - David Manners
- Respiratory Department St John of God Midland Public and Private Hospital (SJGMPPH) Perth Western Australia Australia
- Curtin Medical School Curtin University Perth Western Australia Australia
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Duan J, Mina B, Esquinas AM. SAPS3-CNIV score to predict hospital mortality following noninvasive ventilation: methodology insights. ERJ Open Res 2019; 5:00143-2019. [PMID: 31886160 PMCID: PMC6926366 DOI: 10.1183/23120541.00143-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 11/25/2022] Open
Abstract
We have read with great interest and congratulate Huseiniet al. [1] on the external validation of the SAPS3-CNIV score (Simplified Acute Physiology Score 3 customised for noninvasive ventilation) to predict hospital mortality. Huseiniet al. [1] concluded that SAPS3-CNIV did not improve prediction of mortality in patients over SAPS3. This scoring system included the SAPS3, haemoglobin, carbon dioxide tension, lactate, do not resuscitate (DNR) orders and aetiology of respiratory failure. However, we consider that there are some key aspects that need to be taken into account for a proper clinical extrapolation. Further work towards the development of scores to predict hospital mortality is warranted, to overcome the methodological limitations of the SAPS3-CNIVhttp://bit.ly/2QE1LoB
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Affiliation(s)
- Jun Duan
- Dept of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bushra Mina
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Antonio M Esquinas
- Intensive Care and Non-invasive Ventilatory Unit, Hospital Morales Meseguer, Murcia, Spain
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Molmy P, Vangrunderbeeck N, Nigeon O, Lemyze M, Thevenin D, Mallat J. Patients with limitation or withdrawal of life supporting care admitted in a medico-surgical intermediate care unit: Prevalence, description and outcome over a six-month period. PLoS One 2019; 14:e0225303. [PMID: 31756229 PMCID: PMC6874297 DOI: 10.1371/journal.pone.0225303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 10/21/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose There have been few studies on the limitation of Life Supporting Care (LSC) and Withdrawal of LSC in Intermediate Care Units (IMCUs). We report the prevalence of LSC limited patients in a medico-surgical IMCU over a six-month period, examining the description, outcomes, and patterns of LSC Limitations and Withdrawal of LSC. Methods Single center, retrospective observational study in an IMCU of a 500-bed general hospital. Results Our study of 404 patients, reported 79 (19.5%, 95%CI: [16.0–23.7]%) being admitted with LSC limitations in the IMCU. This group of LSC limited patients presented with higher chronic and acute severity scores. The most common admission diagnosis of LSC limited patients was acute respiratory failure (51%). Non-invasive ventilation (NIV) was frequently used within this population (39%). Hospital mortality for LSC limited patients was high (53%) and associated with age (OR = 1.07, 95%CI: [1.01–1.13)]), SOFA score (OR 1.29, 95%CI: [1.01–1.64]), and hypoxemic respiratory failure (OR 7.2, 95%CI: [1.27–40.9]). Withdrawal of LSC occurred in 19.5% of cases, often accompanied with terminal sedation with or without NIV removal (43.8%). Conclusions Patients with limitation of LSC are frequently admitted into IMCU. Hospital mortality rate was high and associated with age, acute organ failures, and hypoxemic respiratory failure. Life support withdrawal includes palliative sedation with or without NIV discontinuation.
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Affiliation(s)
- Perrine Molmy
- Intermediate Care Unit, Centre Hospitalier de Lens, Lens, France
- Intensive Care Unit, Centre Hospitalier de Lens, Lens, France
| | - Nicolas Vangrunderbeeck
- Intermediate Care Unit, Centre Hospitalier de Lens, Lens, France
- Respiratory & Infectious Diseases Unit, Centre Hospitalier de Lens, Lens, France
- * E-mail: (NVG); (JM)
| | - Olivier Nigeon
- Intermediate Care Unit, Centre Hospitalier de Lens, Lens, France
| | - Malcolm Lemyze
- Intensive Care Unit, Centre Hospitalier de Lens, Lens, France
| | - Didier Thevenin
- Intensive Care Unit, Centre Hospitalier de Lens, Lens, France
| | - Jihad Mallat
- Intermediate Care Unit, Centre Hospitalier de Lens, Lens, France
- Intensive Care Unit, Centre Hospitalier de Lens, Lens, France
- Department of Critical Care Medicine, Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
- * E-mail: (NVG); (JM)
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6
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Heili-Frades S, Carballosa de Miguel MDP, Naya Prieto A, Galdeano Lozano M, Mate García X, Mahillo Fernández I, Fernández Ormaechea I, Álvarez Suárez L, Ezzine de Blas F, Checa Venegas MJ, González Mangado N, Peces Barba G. Cost and Mortality Analysis of an Intermediate Respiratory Care Unit. Is It Really Efficient and Safe? Arch Bronconeumol 2019; 55:634-641. [PMID: 31587917 DOI: 10.1016/j.arbres.2019.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Historically, it has been assumed that Intermediate Respiratory Care Units (IRCU) were efficient, because they saved costs by reducing the number of admissions to intensive care units (ICU), and effective, because they specialized in respiratory diseases. METHODS The number of IRCU admissions and mortality rate, historically and in 2016, were evaluated. For 2016, the grouped Related Diagnostic Groups (DRGs) were also described, and the savings achieved under all budgetary headings by avoiding UCI stays were calculated. A multivariate analysis was performed to associate costs with mean weights and complexity, and multiple logistic regression was performed on all patients admitted from 2004 to 2017 to describe the variables associated with mortality in our unit. RESULTS An IRCU generates savings of €500,000/year by reducing length of ICU stay. Analysis of the 2016 cohort shows that costs correlate with mean weight and mortality, and consequently complexity. The multivariate logistic regression analysis of the 2004-2017 cohort found respiratory frequency, leukopenia, anemia, hyperkalemia, and acidosis to be the variables best associated with mortality. The area under the curve for the logistic model was 0.75. CONCLUSION The IRCU analyzed in our study was efficient in terms of 'avoided costs' and savings associated with complexity. Our results suggest that IRCUs have a lower mortality rate than other similar units, and are therefore a safe environment for patients.
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Affiliation(s)
- Sarah Heili-Frades
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España.
| | - María Del Pilar Carballosa de Miguel
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Alba Naya Prieto
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Marina Galdeano Lozano
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, Hospital Universitario Sagrat Cor, Grupo Quirón Salud. Universitat de Barcelona, REVA (Réseau Européen de Ventilation Artificielle), Barcelona, España
| | - Xavier Mate García
- Dirección General y Gerencia, Hospital Universitario Sagrat Cor, Grupo Quirón Salud, Barcelona, España
| | | | - Itziar Fernández Ormaechea
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Laura Álvarez Suárez
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Farah Ezzine de Blas
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - María José Checa Venegas
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Nicolás González Mangado
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Germán Peces Barba
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
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Jahn M, Rekowski J, Gerken G, Kribben A, Canbay A, Katsounas A. The predictive performance of SAPS 2 and SAPS 3 in an intermediate care unit for internal medicine at a German university transplant center; A retrospective analysis. PLoS One 2019; 14:e0222164. [PMID: 31553738 PMCID: PMC6760764 DOI: 10.1371/journal.pone.0222164] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/16/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To analyze and compare the performance of the Simplified-Acute-Physiology-Score (SAPS) 2 and SAPS 3 among intermediate care patients with internal disorders. MATERIALS AND METHODS We conducted a retrospective single-center analysis in patients (n = 305) admitted to an intermediate-care-unit (ImCU) for internal medicine at the University Hospital Essen, Germany. We employed and compared the SAPS 2 vs. the SAPS 3 scoring system for the assessment of disease severity and prediction of mortality rates among patients admitted to the ImCU within an 18-month period. Both scores, which utilize parameters recorded at admission to the intensive-care-unit (ICU), represent the most widely applied scoring systems in European intensive care medicine. The area-under-the-receiver-operating-characteristic-curve (AUROC) was used to evaluate the SAPS 2 and SAPS 3 discrimination performance. Ultimately, standardized-mortality-ratios (SMRs) were calculated alongside their respective 95%-confidence-intervals (95% CI) in order to determine the observed-to-expected death ratio and calibration belt plots were generated to evaluate the SAPS 2 and SAPS 3 calibration performance. RESULTS Both scores provided acceptable discrimination performance, i.e., the AUROC was 0.71 (95% CI, 0.65-0.77) for SAPS 2 and 0.77 (95% CI, 0.72-0.82) for SAPS 3. Against the observed in-hospital mortality of 30.2%, SAPS 2 showed a weak performance with a predicted mortality of 17.4% and a SMR of 1.74 (95% CI, 1.38-2.09), especially in association with liver diseases and/or sepsis. SAPS 3 performed accurately, resulting in a predicted mortality of 29.9% and a SMR of 1.01 (95% CI, 0.8-1.21). Based on Calibration belt plots, SAPS 2 showed a poor calibration-performance especially in patients with low mortality risk (P<0.001), while SAPS 3 exhibited a highly accurate calibration performance (P = 0.906) across all risk levels. CONCLUSIONS In our study, the SAPS 3 exhibited high accuracy in prediction of mortality in ImCU patients with internal disorders. In contrast, the SAPS 2 underestimated mortality particularly in patients with liver diseases and sepsis.
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Affiliation(s)
- Michael Jahn
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jan Rekowski
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ali Canbay
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Antonios Katsounas
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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Huseini T, Manners D, Jones S, Piccolo F. External validation of the SAPS3-CNIV score to predict hospital mortality following noninvasive ventilation: a retrospective single-centre study. ERJ Open Res 2019; 5:00232-2018. [PMID: 30972348 PMCID: PMC6452042 DOI: 10.1183/23120541.00232-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/11/2019] [Indexed: 11/11/2022] Open
Abstract
Prognostication tools are developed to assist clinical decision making and provide valid diagnostic and prognostic outcomes including mortality. Given significant disease and demographic heterogeneity, these tools have to be generally applicable to different patient populations. Therefore, once a model is developed it is internally and externally validated with subsequent clinical impact analyses after which its performance is evaluated and that particular model is then established. A retrospective single-centre study suggesting that patients with higher SAPS3-CNIV scores may be monitored in an ICU setting in order to reduce adverse patient events and optimal utilisation of resourceshttp://ow.ly/F5qp30o2OT7
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Affiliation(s)
- Taha Huseini
- Dept of Respiratory Medicine, St. John Of God Midland Public and Private Hospital, Perth, Australia
| | - David Manners
- Dept of Respiratory Medicine, St. John Of God Midland Public and Private Hospital, Perth, Australia.,Curtin Medical School, Curtin University, Bentley, Australia
| | - Simon Jones
- Dept of Respiratory Medicine, St. John Of God Midland Public and Private Hospital, Perth, Australia
| | - Francesco Piccolo
- Dept of Respiratory Medicine, St. John Of God Midland Public and Private Hospital, Perth, Australia
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A Proposal for an Intermediate Care Unit-Quality Measurement Framework. Crit Care Res Pract 2018; 2018:4560718. [PMID: 30151281 PMCID: PMC6087599 DOI: 10.1155/2018/4560718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/01/2018] [Accepted: 06/24/2018] [Indexed: 01/09/2023] Open
Abstract
Rationale, Aims, and Objectives. The Intermediate Care Unit (IMCU) is a hospital unit which is logistically situated between the hospital ward and the Intensive Care Unit (ICU). There is debate regarding the value of the IMCU. Understanding its value is compromised by the lack of adequate quality indicators. Therefore, this study identifies currently used IMCU indicators and evaluates their usefulness. Methods. Through a systematic literature search, currently used quality indicators were identified and evaluated for their importance using a proposed IMCU-specific quality measurement framework. Results. From 4034 titles and abstracts, 168 articles were selected for full-text review. Of these, 22 articles were included, which reported IMCU quality at the level of the IMCU (n = 12), the ICU (n = 5), both IMCU and ICU (n = 3) or hospital level (n = 2). At the IMCU, the IMCU mortality (n = 16), discharge-to-ICU rate (n = 7), in-hospital IMCU mortality (n = 7), and length of stay (n = 6) were most frequently reported. Three studies compared the effect of different structures of the IMCU on its utilization or hospital outcome. Conclusions. Current focus in IMCU quality research is towards measuring quality at the IMCU itself. Since the influence of the structure of IMCUs on its utilization and its effects on hospital outcome are only rarely investigated, attention should shift towards these important issues in further research. The proposed IMCU quality measurement framework can thereby serve as a helpful tool.
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Utilisation of Intermediate Care Units: A Systematic Review. Crit Care Res Pract 2017; 2017:8038460. [PMID: 28775898 PMCID: PMC5523340 DOI: 10.1155/2017/8038460] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/22/2017] [Indexed: 02/03/2023] Open
Abstract
Background. The diversity in formats of Intermediate Care Units (IMCUs) makes it difficult to compare data from different settings. The purpose of this article was to describe and quantify these different formations and utilisation. Methods. We performed a systematic review extracting geographic location, nomenclature used, admitting specialties, open (admitting specialist in charge) or closed (intensivist/generalist in charge) management format, location in hospital, number of beds, nursing workload, medical staff to patient ratios, and modalities—possibilities and limitations—implemented. Results. Nomenclature used was High Dependency Unit (56.8%) or Intermediate Care Unit (24.3%), with the latter one increasingly being used recently. The median number of beds was 6 (IQR 4–10). Location (p < 0.001) and admitting specialties (p = 0.03) were related to the management format. IMCUs integrated or adjacent to Intensive Care Units were more often capable of using single vasoactive medication (p = 0.025). The mean nurse to patient ratio was 1 to 2.5. Conclusions. IMCUs often have a specific task in a hospital, which is reflected in location, format, and utilisation. The management format depends on location and admitting specialist while incorporated supportive treatment modules reflect its function. Common IMCU denominators are continuous monitoring and respiratory support, without mechanical ventilation and multiple vasoactive medications.
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Efficiency of an electronic device in controlling tracheal cuff pressure in critically ill patients: a randomized controlled crossover study. Ann Intensive Care 2016; 6:93. [PMID: 27704488 PMCID: PMC5050178 DOI: 10.1186/s13613-016-0200-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/29/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Despite intermittent control of tracheal cuff pressure (P cuff) using a manual manometer, cuff underinflation (<20 cmH2O) and overinflation (>30 cmH2O) frequently occur in intubated critically ill patients, resulting in increased risk of microaspiration and tracheal ischemic lesions. The primary objective of our study was to determine the efficiency of an electronic device in continuously controlling P cuff. The secondary objective was to determine the impact of this device on the occurrence of microaspiration of gastric or oropharyngeal secretions. METHODS Eighteen patients requiring mechanical ventilation were included in this prospective randomized controlled crossover study. They randomly received either continuous control of P cuff with Mallinckrodt® device for 24 h, followed by discontinuous control with a manual manometer for 24 h, or the reverse sequence. During the 48 h after randomization, P cuff was continuously recorded, and pepsin and alpha amylase were quantitatively measured in tracheal aspirates. P cuff target was 25 cmH2O. RESULTS Clinical characteristics were similar during the two study periods, as well as mean airway pressure. Percentage of time spent with cuff overinflation or underinflation was significantly lower during continuous control compared with routine care period [median (IQR) 0.8 (0.1, 2) vs 20.9 (3.1, 40.1), p = 0.0009]. No significant difference was found in pepsin [median (IQR) 230 (151, 300) vs 259 (134, 368), p = 0.95] or in alpha amylase level [median (IQR) 1475 (528, 10,333) vs 2400 (1342, 15,391), p = 0.19] between continuous control and routine care periods, respectively. CONCLUSIONS The electronic device is efficient in controlling P cuff, compared with routine care using a manometer. Further studies are needed to evaluate the impact of this device on intubation-related complications. Trial registration ClinicalTrials.gov Identifier: NCT01965821.
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