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Silva AR, Hoffmann NG, Fernandez-Llimos F, Lima EC. Data quality review of the Brazilian nosocomial infections surveillance system. J Infect Public Health 2024; 17:687-695. [PMID: 38471259 DOI: 10.1016/j.jiph.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/29/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Surveillance of healthcare-associated infections (HAIs) is an essential component of hospital infection prevention and control systems. We aimed to assess the quality of the data compiled by the Brazilian HAI Surveillance System from pediatric (PICUs) and neonatal intensive care units (NICUs), between 2012 and 2021. METHODS Data Quality Review, including adherence, completeness, internal consistency, consistency over time, and consistency of population trend, were computed at both national and state levels based on quality metrics from World Health Organization Toolkit. Incidence rates (or incidence density) of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) were obtained from the Brazilian National Nosocomial Infections Surveillance (NNIS) system. Data on sepsis-related mortality, spanning the period from 2012 to 2021, were extracted from the Brazilian National Health Service database (DATASUS). Additionally, correlations between sepsis-related mortality and incidence rates of VAP or CLABSI were calculated. RESULTS Throughout the majority of the study period, adherence to VAP reporting remained below 75%, exhibiting a positive trend post-2016. Widespread outliers, as well as inconsistencies over time and in population trends, were evident across all 27 states. Only four states maintained consistent adherence levels above 75% for more than 8 years regarding HAI incidence rates. Notably, CLABSI in NICUs boasted the highest reporting adherence among all HAIs, with 148 periods out of 270 (54.8%) exhibiting reporting adherence surpassing 75%. Three states achieved commendable metrics for CLABSI in PICUs, while five states demonstrated favorable results for CLABSI in NICUs. CONCLUSIONS While adherence to HAI report is improving among Brazilian states, an important room for improvement in the Brazilian NNIS exists. Additional efforts should be made by the Brazilian government to improve the reliability of HAI data, which could serve as valuable guidance for hospital infection prevention and control policies.
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Affiliation(s)
- Alice Ramos Silva
- Pharmacy School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Fernando Fernandez-Llimos
- Applied Molecular Biosciences Unit (UCIBIO), Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto, Porto, Portugal.
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Zirpe KG, Tiwari AM, Kulkarni AP, Vaidya HS, Gurav SK, Deshmukh AM, Suryawanshi PB, Kapse US, Bhoyar AP, Dhawad PA, Mukherjee S. The Evolution of Central Venous-to-arterial Carbon Dioxide Difference (PCO 2 Gap) during Resuscitation Affects ICU Outcomes: A Prospective Observational Study. Indian J Crit Care Med 2024; 28:349-354. [PMID: 38585325 PMCID: PMC10998525 DOI: 10.5005/jp-journals-10071-24680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/19/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction The usual methods of perfusion assessment in patients with shock, such as capillary refill time, skin mottling, and serial serum lactate measurements have many limitations. Veno-arterial difference in the partial pressure of carbon dioxide (PCO2 gap) is advocated being more reliable. We evaluated serial change in PCO2 gap during resuscitation in circulatory shock and its effect on ICU outcomes. Materials and methods This prospective observational study included 110 adults with circulatory shock. Patients were resuscitated as per current standards of care. We recorded invasive arterial pressure, urine output, cardiac index (CI), PCO2 gap at ICU admission at 6, 12, and 24 hours, and various patient outcomes. Results Significant decrease in PCO2 gap was observed at 6 h and was accompanied by improvement in serum lactate, mean arterial pressure, CI and urine output in (n = 61). We compared these patients with those in whom this decrease did not occur (n = 49). Mortality and ICU LOS was significantly lower in patients with low PCO2 gap, while more patients with high PCO2 gap required RRT. Conclusion We found that a persistently high PCO2 gap at 6 and 12 h following resuscitation in patients with shock of various etiologies, was associated with increased mortality, need for RRT and increased ICU LOS. High PCO2 gap had a moderate discriminative ability to predict mortality. How to cite this article Zirpe KG, Tiwari AM, Kulkarni AP, Vaidya HS, Gurav SK, Deshmukh AM, et al. The Evolution of Central Venous-to-arterial Carbon Dioxide Difference (PCO2 Gap) during Resuscitation Affects ICU Outcomes: A Prospective Observational Study. Indian J Crit Care Med 2024;28(4):349-354.
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Affiliation(s)
- Kapil G Zirpe
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Anand M Tiwari
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Atul P Kulkarni
- Department of Anaesthesia and Critical Care, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | | | - Sushma K Gurav
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Abhijit M Deshmukh
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | | | | | - Abhaya P Bhoyar
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Piyush A Dhawad
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Shameek Mukherjee
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
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Jingyi S, Cunliang G, Biao C, Yingguang X, Jinluan M, Xiaohua C, Wenqiang L. Vascular Reactivity Index as an Effective Predictor of Mortality in Patients With Septic Shock: A Retrospective Study. J Intensive Care Med 2024:8850666241233183. [PMID: 38465637 DOI: 10.1177/08850666241233183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND Sepsis is a serious complication that occurs after trauma, burns, and infections, and it is an important cause of death in intensive care unit (ICU) patients. Despite many new measures being proposed for sepsis treatment, its mortality rate remains high; sepsis has become a serious threat to human health, and there is an urgent need to carry out in-depth clinical research related to sepsis. In recent years, it has been found that septic shock-induced vasoplegia is a result of vascular hyporesponsiveness to vasopressors. Therefore, this study intended to establish an objective formula related to vasoplegia that can be used to assess the prognosis of patients and guide clinical treatment. MATERIALS AND METHODS A retrospective cohort study was conducted using data from 106 septic shock patients admitted to the ICU of Jining No. 1 People's Hospital from January 2020 to December 2022. The patients were divided into mortality and survival groups based on 28-day survival, and hemodynamics were monitored by the pulse index continuous cardiac output system. The dose and duration of vasopressors, major hemodynamic parameters, lactic acid (Lac) levels, and Sequential Organ Failure Assessment scores were recorded within 48 h of hospital admission. Multifactorial logistic regression was used to analyze the independent risk factors affecting the prognosis of patients, and the predictive value of the vascular response index (VRI) was analyzed by the receiver operating characteristic (ROC) curve. RESULTS The differences between the survival and mortality groups in terms of age, sex ratio, body weight, ICU length of stay, distribution of infection sites, underlying disease conditions, baseline Lac levels, and some hemodynamic parameters were not statistically significant (P > .05). The results of multifactorial logistic regression showed that the admission Acute Physiology and Chronic Health Evaluation II score, Lac level at 24 h of treatment, maximal vasoactive inotropic score at 24 h (VISmax24), maximal vasoactive inotropic score at 48 h (VISmax48), and VRI were independent risk factors affecting 28-day mortality. Within 48 h of receiving vasopressor therapy, the VRI was lower in the mortality group than in the survival group. The area under the ROC curve for the VRI was 0.86, and the best cutoff value of the VRI for predicting 28-day mortality was 32.50 (YI = 0.80), with a sensitivity of 0.90, a specificity of 0.90, and a better prediction of mortality than the other indicators. CONCLUSIONS The VRI is a good predictor of mortality in patients with septic shock, and a lower VRI indicates more severe vasoplegia, poorer prognosis, and higher mortality in patients with septic shock.
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Affiliation(s)
- Sun Jingyi
- Department of Clinical Medicine, Jining Medical University Clinical Medical College, Jining, Shandong, China
| | - Gao Cunliang
- Intensive Care Unit, Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Chen Biao
- Central Laboratory, Jining No.1 People's Hospital, Jining, Shandong, China
| | - Xie Yingguang
- Intensive Care Unit, Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Ma Jinluan
- Intensive Care Unit, Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Cao Xiaohua
- Intensive Care Unit, Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Li Wenqiang
- Intensive Care Unit, Jining No. 1 People's Hospital, Jining, Shandong, China
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Shrestha K, Vaidya SR, Shrestha K, Shrestha SM, Rawal P, Dangol S. Sepsis among Adults Admitted to Intensive Care Unit of a Tertiary Care Centre. JNMA J Nepal Med Assoc 2024; 62:85-88. [PMID: 38409979 PMCID: PMC10924509 DOI: 10.31729/jnma.8439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Sepsis is a syndrome that starts with an infection, causes organ dysfunction, and leads to death is a global health issue in critically ill patients. While its epidemiology is well-known in high-income countries, it is poorly understood in low- and middle-income countries, including Nepal. This study aimed to find out the prevalence of sepsis among adults admitted to the intensive care unit of a tertiary care centre. Methods This descriptive cross-sectional study was conducted among adults admitted to the intensive care unit after obtaining ethical approval from the Ethical Review Board. Data was collected from 11 January 2022 and 29 December 2022 from hospital records. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results Among 195 patients, the prevalence of sepsis was seen in 74 (37.95%) (31.14-44.76, 95% Confidence Interval). Septic patients had a median age of 44 (interquartile range: 33.75±60.25) years. A total of 40 (54.05%) were male. A total of 28 (37.84%) septic patients were identified with ≥2 diagnoses, while 9 (12.16%) had ≥2 comorbidities. Conclusions The prevalence of sepsis among adult patients admitted to the intensive care unit was higher as compared to other studies done in other international studies. Keywords intensive care units; prevalence; sepsis.
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Affiliation(s)
- Kundu Shrestha
- Department of Anesthesiology and Critical Care, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal
| | - Sagun Ram Vaidya
- Department of Anesthesiology and Critical Care, Nepal Medical College, Jorpati, Kathmandu, Nepal
| | - Keny Shrestha
- Department of General Practice, Royal Cornwall Hospital, NHS Trust, Treliske, UK
| | - Surendra Man Shrestha
- Department of Anesthesiology and Critical Care, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal
| | - Prabhat Rawal
- Department of Anesthesiology and Critical Care, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal
| | - Shova Dangol
- Department of Anesthesiology and Critical Care, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal
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Kiya GT, Mekonnen Z, Melaku T, Tegene E, Gudina EK, Cools P, Abebe G. Prevalence and mortality rate of sepsis among adults admitted to hospitals in sub-Saharan Africa: a systematic review and meta-analysis. J Hosp Infect 2024; 144:1-13. [PMID: 38072089 DOI: 10.1016/j.jhin.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 12/25/2023]
Abstract
Due to abundant pathogen diversity and mounting antimicrobial resistance, sepsis is more common in sub-Saharan Africa (sSA). However, there is a lack of consistent reports regarding the prevalence of adult sepsis in the region. Therefore, this study aimed to determine pooled estimates of sepsis prevalence and associated mortality among adults admitted to hospitals in sSA. Medline (through PubMed), Scopus, Embase, and Web of Science were systematically searched for studies of sepsis in sSA published before 13th February 2023. A random-effects meta-analysis of hospital-wide and intensive care unit (ICU)-based sepsis prevalence was performed with a 95% confidence interval (CI). Subgroup analysis was conducted considering geographic region and sepsis diagnostic criteria. Funnel plots and Egger's test were used to assess publication bias. The protocol was submitted to the Prospective Register for Systematic Reviews (PROSPERO) with an identifier (CRD42023396719). Overall, 14 observational studies, published between 2009 and 2022, from eight different sSA countries comprising 31,653 adult patients (5723 with sepsis) were included in the review. Nine studies that were conducted in a hospital-wide setting showed a pooled prevalence and mortality of 17% (95% CI: 12-21%) and 15% (95% CI: 17-35%), respectively. Five studies in the ICUs presented a pooled prevalence and mortality of 31% (95% CI: 24-38%) and 46% (95% CI: 39-54%), respectively. Based on the sub-group analysis, the pooled hospital-wide prevalence of sepsis in East and Southern Africa was 18% (95% CI: 11-25%), and 20% (95% CI: 2-42%), respectively. The pooled prevalence in the ICU was 14% (95% CI: 4-23%) and 13% (95% CI: 5-20%) for East and Southern Africa, respectively. The hospital-wide and ICU-based sepsis prevalence and mortality are high in sSA. Addressing the burden of adult sepsis should be a priority for healthcare systems in sub-Saharan Africa.
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Affiliation(s)
- G T Kiya
- School of Medical Laboratory Science, Jimma University, Ethiopia.
| | - Z Mekonnen
- School of Medical Laboratory Science, Jimma University, Ethiopia
| | - T Melaku
- School of Pharmacy, Jimma University, Ethiopia
| | - E Tegene
- Department of Internal Medicine, Jimma University, Ethiopia
| | - E K Gudina
- Department of Internal Medicine, Jimma University, Ethiopia
| | - P Cools
- Department of Diagnostic Sciences, Ghent University, Belgium
| | - G Abebe
- School of Medical Laboratory Science, Jimma University, Ethiopia
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Guo DC, Zhuang HZ, Lin J, Zhi DY, Duan ML. Epidemiology of sepsis in Beijing from 2012 to 2018: analysis of hospital homepage databases derived from the Beijing Public Health System. BMC Public Health 2022; 22:2237. [PMID: 36451165 PMCID: PMC9713983 DOI: 10.1186/s12889-022-14725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND We aimed to evaluate the epidemiology of sepsis in secondary and tertiary hospitals in Beijing, China between 2012 and 2018 using information derived from the Beijing Public Health System. METHODS The Beijing Public Health System accessed hospital homepage databases and identify patients who diagnosed sepsis or associated condition according to the International Classification of Diseases, 10th Edition, Clinical Modification codes. There are 125 hospitals involved in this study, including 61 secondary hospitals, accounting for 49.2%, and 63 tertiary hospitals, accounting for 50.8%. Patients were stratified by age as minors (0-17 years old), adults (18-64 years old), seniors (65-84 years old), and the elderly (≥ 85 years old). Patient's demographic information, treatments, outcomes, and all-cause hospitalization cost were evaluated. RESULTS This study involved 8,597 patients. Patients treated in tertiary hospitals or received blood transfusion decreased with age, while patients who were male, received ventilation, or took Traditional Chinese Medicine, and in-hospital mortality and hospitalization cost, increased with age. There were 2,729 (31.7%) deaths in this study. A slight increase in in-hospital mortality occurred from 2012 to 2018. Median hospitalization cost for all patients was ¥29,453 (15,011, 65,237). Hospitalization cost showed no significant change from 2012 to 2016, but increased in 2017 and 2018. CONCLUSION Sepsis is associated with high mortality and cost. From 2012 to 2018, in-hospital mortality and hospitalization cost of sepsis in Beijing increased significantly with age, and slightly by year.
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Affiliation(s)
- Dong-chen Guo
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, 100050 Beijing, China
| | - Hai-zhou Zhuang
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, 100050 Beijing, China
| | - Jin Lin
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, 100050 Beijing, China
| | - De-yuan Zhi
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, 100050 Beijing, China
| | - Mei-li Duan
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, 100050 Beijing, China
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Scope and mortality of adult medical ICU patients in an Eastern Cape tertiary hospital. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2022; 38:10.7196/SAJCC.2022.v38i3.546. [PMID: 36704425 PMCID: PMC9869489 DOI: 10.7196/sajcc.2022.v38i3.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background The characteristics and mortality outcomes of patients admitted to South African intensive care units (ICUs) owing to medical conditions are unknown. Available literature is derived from studies based on data from high-income countries. Objectives To determine ICU utilisation by medical patients and evaluate the scope of admissions and clinical associations with hospital mortality in ICU patients 12 years and older admitted to an Eastern Cape tertiary ICU, particularly in the subset with HIV disease. Methods A retrospective descriptive one-year cohort study. Data were obtained from the LivAKI study database and demographic data, comorbidities, diagnosis, and mortality outcomes and associations were determined. Results There were 261 (29.8%) medical ICU admissions. The mean age of the cohort was 40.2 years; 51.7% were female. When compared with the surgical emergencies, the medical subgroup had higher sequential organ failure assessment (SOFA) scores (median score 5 v. 4, respectively) and simplified acute physiology score III (SAPS 3) scores (median 52.7 v. 48.5), a higher incidence of acute respiratory distress syndrome (ARDS) (7.7% v. 2.9%) and required more frequent dialysis (20.3% v. 5.5%). Of the medical admissions, sepsis accounted for 32.4% of admission diagnoses. The HIV seroprevalence rate was 34.0%, of whom 57.4% were on antiretroviral therapy. ICU and hospital mortality rates were 11.1% and 21.5% respectively, while only acute kidney injury (AKI) and sepsis were independently associated with mortality. The HIV-positive subgroup had a higher burden of tuberculosis (TB), higher admission SOFA and SAPS 3 scores and required more organ support. Conclusion Among medical patients admitted to ICU, there was a high HIV seroprevalence with low uptake of antiretroviral therapy. Sepsis was the most frequently identified ICU admission diagnosis. Sepsis and AKI (not HIV) were independent predictors of mortality. Co-infection with HIV and TB was associated with increased mortality. Contributions of the study The epidemiology and outcomes of adults who are critically ill from medical conditions in South African intensive care units was previously unknown but has been described in this study. The association of sepsis, TB, HIV and acute kidney injury with mortality is discussed.
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Lei S, Li X, Zhao H, Xie Y, Li J. Prevalence of sepsis among adults in China: A systematic review and meta-analysis. Front Public Health 2022; 10:977094. [PMID: 36304237 PMCID: PMC9596150 DOI: 10.3389/fpubh.2022.977094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/16/2022] [Indexed: 01/25/2023] Open
Abstract
Background Sepsis is a major public health problem that cannot be ignored in China and even in the world. However, the prevalence of sepsis in Chinese adults varies among different studies. Objective To evaluate the prevalence of hospital-wide sepsis and intensive care unit (ICU) sepsis in Chinese adults. Methods PubMed, EMBASE, Cochrane Library, Web of science, China National Knowledge Infrastructure, Chinese biomedical literature service system, Wanfang Database, and VIP databases were systematically searched for studies on sepsis in China published before March 2, 2022. Random effects model was used to calculate pooled prevalence estimates with 95% confidence interval. Subgroup and sensitivity analyses were performed to address heterogeneity. Funnel plots and Egger's test were used to assess the publication bias. Results Overall, nine observational studies involving 324,020 Chinese patients (9,587 patients with sepsis) were analyzed. Four hospital-wide studies involving 301,272 patients showed pooled prevalence and mortality of 3.8% (95% CI: 2.9-4.7%, I 2 = 99.9%) and 26% (95% CI: 16-36%, I 2 = 98.0%), respectively. Five studies of ICU sepsis involving 22,748 patients presented pooled prevalence and mortality of 25.5% (95% CI: 13.9-37.0%, I 2 = 99.8%) and 40% (95%CI: 34-47%, I 2 = 95.9%), respectively. Subgroup analysis of sepsis in ICUs revealed that the pooled prevalence was higher among males [17% (95% CI 9-24%, I 2 = 99.6%)], in lung infections [66% (95%CI: 54-77%, I 2 = 98.7%)], and Gram-negative bacteria infections [37% (95%CI: 26-47%, I 2 = 98.3%)]. The pooled prevalence of sepsis, severe sepsis and septic shock was 25.5% (95%CI: 13.9-37.0%, I 2 = 99.8%), 19% (95%CI: 9-28%, I 2 = 99.6%), and 13% (95%CI: 7-19%, I 2 = 99.2%), respectively. Conclusions Sepsis is prevalent in 25.5% of ICU patients in China, and sex, sepsis severity, infection site, causative microorganism, and infection type are significant influencing factors. Larger trials are needed to evaluate the prevalence of sepsis in China, which may help the development of global strategies for sepsis management. Systematic review registration PROSPERO, identifier: CRD42022314274.
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Affiliation(s)
- Siyuan Lei
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Xuanlin Li
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China,College of Basic Medical Science, Institute of Basic Research in Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hulei Zhao
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Yang Xie
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jiansheng Li
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China,Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China,*Correspondence: Jiansheng Li
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Protus M, Uchytilova E, Indrova V, Lelito J, Viklicky O, Hruba P, Kieslichova E. Sepsis affects kidney graft function and one-year mortality of the recipients in contrast with systemic inflammatory response. Front Med (Lausanne) 2022; 9:923524. [PMID: 35966839 PMCID: PMC9372308 DOI: 10.3389/fmed.2022.923524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Infections remain a major cause of morbidity and mortality after kidney transplantation. The aim of our study was to determine the effect of sepsis on kidney graft function and recipient mortality. Methods A prospective, observational, single-center study was performed. Selected clinical and biochemical parameters were recorded and compared between an experimental group (with sepsis, n = 34) and a control group (with systemic inflammatory response syndrome, n = 31) comprising kidney allograft recipients. Results Sepsis worsened both patient (HR = 14.77, p = 0.007) and graft survival (HR = 15.07, p = 0.007). Overall one-year mortality was associated with age (HR = 1.08, p = 0.048), APACHE II score (HR = 1.13, p = 0.035), and combination immunosuppression therapy (HR = 0.1, p = 0.006), while graft survival was associated with APACHE II (HR = 1.25, p = 0.004) and immunosuppression. In sepsis patients, mortality correlated with the maximal dose of noradrenalin (HR = 100.96, p = 0.008), fungal infection (HR = 5.64, p = 0.024), SAPS II score (HR = 1.06, p = 0.033), and mechanical ventilation (HR = 5.97, p = 0.033), while graft survival was influenced by renal replacement therapy (HR = 21.16, p = 0.005), APACHE II (HR = 1.19, p = 0.035), and duration of mechanical ventilation (HR = 1.01, p = 0.015). Conclusion In contrast with systemic inflammatory response syndrome, septic kidney allograft injury is associated with early graft loss and may represent a significant risk of mortality.
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Affiliation(s)
- Marek Protus
- Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czechia
- First Faculty of Medicine, Charles University, Prague, Czechia
| | - Eva Uchytilova
- Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czechia
- First Faculty of Medicine, Charles University, Prague, Czechia
| | - Veronika Indrova
- Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Jan Lelito
- Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Ondrej Viklicky
- First Faculty of Medicine, Charles University, Prague, Czechia
- Department of Nephrology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Petra Hruba
- Transplantation Laboratory, Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Eva Kieslichova
- Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czechia
- First Faculty of Medicine, Charles University, Prague, Czechia
- *Correspondence: Eva Kieslichova,
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Wang J, Feng Q, Wu Y, Wang H. Involvement of blood lncRNA UCA1 in sepsis development and prognosis, and its correlation with multiple inflammatory cytokines. J Clin Lab Anal 2022; 36:e24392. [PMID: 35441408 PMCID: PMC9169193 DOI: 10.1002/jcla.24392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Sepsis is a highly life-threatening disease. Long non-coding RNA urothelial carcinoma associated 1 (lncRNA UCA1) participates in the processes of inflammation and organ injury in several diseases, whereas its role in sepsis patients is still unclear. The aim was to explore the clinical value of lncRNA UCA1 in sepsis patients. METHODS One hundred seventy-four sepsis patients and 100 age and gender-matched controls were enrolled. LncRNA UCA1 in peripheral blood mononuclear cell samples was examined, and the level of inflammatory cytokines in serum samples was assessed. RESULTS LncRNA UCA1 was highly expressed in sepsis patients compared with controls. LncRNA UCA1 was positively correlated with tumor necrosis factor-α, interleukin (IL)-6, IL-17, intercellular adhesion molecule 1, and vascular cell adhesion molecule 1 in sepsis patients, while it was not correlated with these inflammatory cytokines in controls. lncRNA UCA1 upregulation was related to raised APACHE II score and SOFA score in sepsis patients. Moreover, lncRNA UCA1 was increased in sepsis deaths compared with sepsis survivors and was independently correlated with increased 28-day sepsis mortality risk. Further receiver operating characteristic curves presented that lncRNA UCA1 had a good value to predict 28-motality risk, while its combination with other independent factors (including age, history of chronic kidney disease, G+ bacterial infection, Fungus infection, C-reactive protein, and APACHE II score) exerted a great predictive value for 28-day mortality risk. CONCLUSION LncRNA UCA1 is upregulated and correlates with multiple pro-inflammatory cytokines, terrible disease severity, and poor prognosis in sepsis patients.
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Affiliation(s)
- Jingmei Wang
- Department of Critical Care MedicineHanDan Central HospitalHandanChina
| | - Qiang Feng
- Department of CardiologyHanDan Central HospitalHandanChina
| | - Yiping Wu
- Department of NeurologyHanDan Central HospitalHandanChina
| | - Haiyan Wang
- Department of Critical Care MedicineHanDan Central HospitalHandanChina
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Vélez JW, Aragon DC, Donadi EA, Carlotti APCP. Risk factors for mortality from sepsis in an intensive care unit in Ecuador: A prospective study. Medicine (Baltimore) 2022; 101:e29096. [PMID: 35356943 PMCID: PMC10684228 DOI: 10.1097/md.0000000000029096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/21/2022] [Indexed: 12/16/2022] Open
Abstract
ABSTRACT To investigate risk factors for mortality from sepsis in an intensive care unit (ICU) in Quito-Ecuador and their association to adherence to Surviving Sepsis Campaign recommendations.Prospective cohort study of patients with severe sepsis/septic shock admitted to the ICU of a public Ecuadorian hospital from March, 2018 to March, 2019. Demographic, clinical, treatment, and outcome data were collected from patients' health records. Patients were divided into 2 groups according to ICU survival or death. Log-binomial regression models were used to identify risk factors for mortality.In total, 154 patients were included. Patients who died in the ICU (n = 42; 27.3%) had higher sequential organ failure assessment score (median 11.5 vs 9; P<.01), more organ dysfunction (median 4 vs 3; P<.0001), and received greater volumes of fluid resuscitation in the first 6 hours (median 800 vs 600 mL; P = .01). Dysfunction of > 2 organs was a risk factor for mortality (relative risks [RR] 3.80, 95% CI 1.33-10.86), while successful early resuscitation (RR 0.32, 95% CI 0.15-0.70), successful empirical antibiotic treatment (RR 0.38, 95%CI 0.18-0.82), and antibiotic de-escalation (RR 0.28, 95%CI 0.13-0.61) were protective factors.Dysfunction of >2 organs was a risk factor for mortality from sepsis while successful early resuscitation and appropriate antibiotic treatment were protective.
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Affiliation(s)
- Jorge W Vélez
- Division of Education and Research, Hospital de Especialidades Eugenio Espejo,Universidad Central del Ecuador, Quito, Ecuador,Division of Pediatric Critical Care, Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil,Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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12
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Kalın BS, Özçaylak S, Solmaz İ, Kılıç J. Assessment of Risk Factors for Mortality in Patients in Medical Intensive Care Unit of a Tertiary Hospital. Indian J Crit Care Med 2022; 26:49-52. [PMID: 35110844 PMCID: PMC8783230 DOI: 10.5005/jp-journals-10071-24092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Knowing the risk factors for patients in intensive care units (ICUs) facilitates patient's management. The goal of this study was to determine the risk agents that influence our medical ICU mortality. Patients and methods This 11-month retrospective trial was managed in the medical ICU. In this study, 340 patients who were followed up for at least 24 hours in ICUs were accepted. The clinical data on patients were recorded retrospectively, and the mortality-related factors were analyzed. A regression analysis was also performed to determine the independent risk factors for ICU mortality. Results The median age was 73 (53–82) years. The death rate was 23.8%. Length of stay (LOS) in ICU was 3 (2–5) days, and APACHE-II (acute physiologic and chronic health evaluation) score was 19 (13–25). The prevalence of chronic diseases was not dissimilar except acute and chronic renal failures among survivors and deceased patients (p >0.05). Acute and chronic renal failures were higher in deceased patients than in survivors and were statistically important [107 (41.3%) vs 47 (58%), p = 0.008] and 38 (14.7%) vs 22 (27.2%), p = 0.01], respectively. In the binary logistic regression analysis, age, APACHE II score, need for invasive mechanical ventilation (IMV), decreased serum albumin levels, and increased creatinine levels were established to be independent risk factors for death [(OR (odds ratio): 1.045 (1.009–1.081), p = 0.013, OR: 1.076 (21.008–1.150), p = 0.029, OR: 19.655 (6.337–60.963), p = 0.001), OR: 2.673 (1.191–6.024), p = 0.017, OR: 1.422 (1.106–1.831), p = 0.006)], respectively. Conclusion The most significant risk agents of death were determined through high APACHE II score, decreased serum albumin levels, and increased creatinine levels. How to cite this article Kalın BS, Özçaylak S, Solmaz İ, Kılıç J. Assessment of Risk Factors for Mortality in Patients in Medical Intensive Care Unit of a Tertiary Hospital. Indian J Crit Care Med 2022;26(1):49–52.
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Affiliation(s)
- Burhan Sami Kalın
- Gazi Yaşargil Training and Research Hospital, Department of Internal Medicine, Division of Critical Care, Diyarbakır, Turkey
- Burhan Sami Kalın, Gazi Yaşargil Training and Research Hospital, Department of Internal Medicine, Division of Critical Care, Diyarbakır, Turkey, Phone: +90 538 9787180, e-mail:
| | - Süleyman Özçaylak
- Gazi Yaşargil Training and Research Hospital, Department of Internal Medicine, Diyarbakır, Turkey
| | - İhsan Solmaz
- Gazi Yaşargil Training and Research Hospital, Department of Internal Medicine, Diyarbakır, Turkey
| | - Jehat Kılıç
- Gazi Yaşargil Training and Research Hospital, Department of Internal Medicine, Diyarbakır, Turkey
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Chen C, Chen X, Chen J, Xing J, Hei Z, Zhang Q, Liu Z, Zhou S. Association between Preoperative hs-crp/Albumin Ratio and Postoperative sirs in Elderly Patients: A Retrospective Observational Cohort Study. J Nutr Health Aging 2022; 26:352-359. [PMID: 35450991 DOI: 10.1007/s12603-022-1761-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Systemic inflammatory response syndrome (SIRS) is one of the severe postoperative complications in elderly patients and seriously affects their prognosis and survival rate. Heretofore, there have been no reliable and accurate methods to predict postoperative SIRS in elderly patients. The aim of this study was to determine whether increased preoperative hs-CRP/albumin ratio (CAR) was associated with postoperative SIRS in elderly population. METHODS The data of patients aged ≥ 65 years who underwent general anesthesia in two centers of Third Affiliated Hospital of Sun Yat-sen University between January 2015 and September 2020 were retrieved and analyzed. Based on the perioperative dataset, we used the targeted maximum likelihood estimation (TMLE) to estimate the association between preoperative CAR and postoperative SIRS in elderly population. Patients' CAR was calculated and divided into two groups (< 0.278 and ≥ 0.278) according to its normal range in our hospital. Adjusted odd ratios (aORs) and 95% confidence intervals (CIs) were calculated respectively. Further sensitivity analyses were conducted to evaluate the robustness of the results. RESULTS A total of 16141 elderly patients were accessed and 7009 of them were enrolled in the final analysis, and 1674 (23.9%) patients developed SIRS within 3 days after surgery. Compared with non-SIRS patients, patients with SIRS had a significantly longer postoperative hospitalization, higher cost and higher risk of in-hospital mortality. Compared with patients with preoperative CAR < 0.278, we found that CAR ≥ 0.278 had a significantly higher risk for the development of postoperative SIRS after multivariable adjustment [aOR = 1.27; 95% CI (1.21, 1.33)]. The interaction effect of preoperative CAR ≥ 0.278 and SIRS was stronger among patients with the following characteristics: aged ≥ 75 years, male, comorbid with diabetes mellitus and admitted to ICU after surgery, duration of surgery < 120 minutes, underwent cerebral surgery or skin, spine and joint surgery (all P < 0.001). The above results remained robust in the sensitivity analysis. CONCLUSIONS Preoperative CAR ≥ 0.278 was significantly associated with increased risk of postoperative SIRS in elderly patients. Special attention should be paid to elderly patients with a preoperative CAR ≥ 0.278 so as to reduce the incidence of postoperative SIRS.
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Affiliation(s)
- C Chen
- Shaoli Zhou, M.D., Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, China,
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Wang Y, Zhang L, Xi X, Zhou JX. The Association Between Etiologies and Mortality in Acute Respiratory Distress Syndrome: A Multicenter Observational Cohort Study. Front Med (Lausanne) 2021; 8:739596. [PMID: 34733862 PMCID: PMC8558376 DOI: 10.3389/fmed.2021.739596] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/25/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Lung-protective ventilation (LPV) strategies have been beneficial in patients with acute respiratory distress syndrome (ARDS). As a vital part of LPV, positive end-expiratory pressure (PEEP) can enhance oxygenation. However, randomized clinical trials of different PEEP strategies seem to show no advantages in clinical outcomes in patients with ARDS. A potential reason is that diverse etiologies and phenotypes in patients with ARDS may account for different PEEP responses, resulting in variations in mortality. We consider hospital mortality to be associated with a more specific classification of ARDS, such as sepsis induced or not, and pulmonary or extrapulmonary one. Our study aimed to compare clinical outcomes in various patients with ARDS by etiologies using the China Critical Care Sepsis Trial (CCCST) database. This was a retrospective analysis of a prospective cohort of 2,138 patients with ARDS in the CCCST database. According to ARDS induced by sepsis or not and medical history, patients were stratified into different four groups. Differences among groups were assessed in hospital mortality, ventilation-free days, and other clinical features. Results: A total of 2,138 patients with ARDS were identified in the database, including 647 patients with sepsis-induced pulmonary ARDS (30.3%), 396 patients with sepsis-induced extrapulmonary ARDS (18.5%), 536 patients with non-sepsis pulmonary ARDS (25.1%), and 559 patients with non-sepsis extrapulmonary ARDS (26.1%). The pulmonary ARDS group had higher mortality compared with the extrapulmonary group (45.9 vs. 23.0%, p < 0.01), longer intensive care unit (ICU) and hospital stays (9 vs. 6 days, p < 0.01, 20 vs. 18 days, p = 0.01, respectively), and fewer ventilation-free days (5 vs. 9 days) in the presence of sepsis. However, the mortality in ARDS without sepsis was inverted compared with extrapulmonary ARDS (pulmonary 23.5% vs. extrapulmonary 29.2%, p = 0.04). After adjusting for the Acute Physiology and Chronic Health Evaluation II and sequential organ failure assessment scores and other clinical features, the sepsis-induced pulmonary condition was still a risk factor for death in patients with ARDS (hazard ratio 0.66, 95% CI, 0.54–0.82, p < 0.01) compared with sepsis-induced extrapulmonary ARDS and other subphenotypes. Conclusions: In the presence of sepsis, hospital mortality in pulmonary ARDS is higher compared with extrapulmonary ARDS; however, mortality is inverted in ARDS without sepsis. Sepsis-induced pulmonary ARDS should attract more attention from ICU physicians and be cautiously treated. Trial registration: ChiCTR-ECH-13003934. Registered August 3, 2013, http://www.chictr.org.cn.
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Affiliation(s)
- Yan Wang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linlin Zhang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiuming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Jian-Xin Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Prediction of 90-Day Mortality among Sepsis Patients Based on a Nomogram Integrating Diverse Clinical Indices. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1023513. [PMID: 34722755 PMCID: PMC8550845 DOI: 10.1155/2021/1023513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022]
Abstract
Background Sepsis is prevalent among intensive care units and is a frequent cause of death. Several studies have identified individual risk factors or potential predictors of sepsis-associated mortality, without defining an integrated predictive model. The present work was aimed at defining a nomogram for reliably predicting mortality. Methods We carried out a retrospective, single-center study based on 231 patients with sepsis who were admitted to our intensive care unit between May 2018 and October 2020. Patients were randomly split into training and validation cohorts. In the training cohort, multivariate logistic regression and a stepwise algorithm were performed to identify risk factors, which were then integrated into a predictive nomogram. Nomogram performance was assessed against the training and validation cohorts based on the area under receiver operating characteristic curves (AUC), calibration plots, and decision curve analysis. Results Among the 161 patients in the training cohort and 70 patients in the validation cohort, 90-day mortality was 31.6%. Older age and higher values for the international normalized ratio, lactate level, and thrombomodulin level were associated with greater risk of 90-day mortality. The nomogram showed an AUC of 0.810 (95% CI 0.739 to 0.881) in the training cohort and 0.813 (95% CI 0.708 to 0.917) in the validation cohort. The nomogram also performed well based on the calibration curve and decision curve analysis. Conclusion This nomogram may help identify sepsis patients at elevated risk of 90-day mortality, which may help clinicians allocate resources appropriately to improve patient outcomes.
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Peng Y, Yuan X, Zhang Y, Wang L. Conservative oxygen supplementation versus usual oxygen supplementation among septic medical intensive care units patients: A before-after investigation. Sci Prog 2021; 104:368504211016953. [PMID: 34121519 PMCID: PMC10395172 DOI: 10.1177/00368504211016953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients admitted in the intensive care unit (ICU) are always managed with excessive high fraction of inspired oxygen and have hyperoxia for a significant period of time, which has potential harms. The guidelines for the management of patients in ICUs do not provide the target values for partial pressure of oxygen or arterial oxyhemoglobin saturations. The study was a before-after investigation comparing two time periods in which different oxygenation strategies were applied. Data of oxygen control, outcome measures, and mortality of a total of 273 patients (>18 years) admitted at least for 2 days in ICUs and received treatment for the sepsis were retrospectively collected and analyzed. Patients were received usual oxygen supplementation (targeted partial pressure of oxygen: 150 mmHg; a high fraction of inspired oxygen: 0.4; UOS cohort; n = 142) or conservative oxygen supplementation (targeted partial pressure of oxygen: 70-100 mmHg; a high fraction of inspired oxygen as low as possible; COS cohort; n = 131). Mechanical ventilation-free hours were significantly higher for patients of COS cohort than those of UOS cohort (77.99 ± 21.26 h/patient vs 70.01 ± 23.57 h/patient, p = 0.016). ICUs length of stays of patients of COS cohort was fewer than those of UOS cohort (7.05 ± 2.13 days/patient vs 7.69 ± 2.43 days/patients, p = 0.016). The probability of survival of patients was higher among patients of COS cohort than those of UOS cohort (p = 0.049). A higher number of patients from UOS cohort needed vasopressors than those from COS cohort (55 vs 35, p = 0.039). Conservative oxygen supplementation to maintain partial pressure of oxygen was improved outcome measures and decreases mortality as compared to that of usual oxygen supplementation.Level of Evidence: III.Technical Efficacy Stage: 4.
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Affiliation(s)
- Ying Peng
- Department of Burn Rectification, The Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, China
| | - Xiaoyan Yuan
- Department of Emergency Medicine, Gongli Hospital, Pudong New Area, Shanghai, China
| | - Yi Zhang
- Department of Burn Rectification, The Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, China
| | - Lei Wang
- Department of Emergency Medicine, Gongli Hospital, Pudong New Area, Shanghai, China
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