Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU

Introduction. We sought to identify possible risk factors associated with mortality in patients with high-risk pulmonary embolism (PE) after intensive care unit (ICU) admission. Patients and Methods. PE patients, diagnosed with computer tomography pulmonary angiography, were included from two ICUs and were categorized into groups: group 1 high-risk patients and group 2 intermediate/low-risk patients. Results. Fifty-six patients were included. Of them, 41 (73.2%) were group 1 and 15 (26.7%) were group 2. When compared to group 2, need for vasopressor therapy (0 vs 68.3%; p18 (OR 42.47 95% CI 1.50–1201.1), invasive mechanical ventilation (OR 30.10 95% CI 1.96–463.31), and thrombolytic therapy (OR 0.03 95% CI 0.01–0.98) were found as independent predictors of mortality. Conclusion. In high-risk PE, admission APACHE II score and need for invasive mechanical ventilation may predict death in ICU. Thrombolytic therapy seems to be beneficial in these patients

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Yoğun Bakımda Organizasyon, Yönetim ve Eğitim

Erişkin yoğun bakımlarda çocuk hasta takip ve tedavisi erişkin yoğun bakımcılar için rutin dışıözellikli bir konudur. Hem yoğun bakım doktorları, hemşireleri ve hem de aile için stresli bir süreçtir.Bu sürecin yönetiminde çocuğun yaşamsal bulgularının stabilizasyonu sağlanması, idame tedavileriningerektiğinde çocuk yoğun bakımcılar ile konsulte edilerek düzenlenmesi önemlidir. Bu açıdan çocuklarve yetişkinler arasındaki fizyolojik ve anatomik farklılıklar bilinmelidir. Bunlara göre çocukların fizyolojilerine uygun hedefler konmalı, vital bulgularının stabilizasyonları sağlanmalı, bu amaçla temel ve ileriyaşam desteği verilmelidir. Stabilizasyondan sonra yoğun bakım takibinde gerekli olan sedasyon, analjezi, sıvı, elektrolit ve beslenme idame tedavilerinin erken verilmesi zaman kaybını önleyip hayat kurtarıcı olacaktır.&nbsp;&nbsp;</p

PREVALENCE AND CLINICAL FEATURES OF CHRONIC CRITICAL ILLNESS IN THE ELDERLY POPULATION IN TURKEY

Objectives: The definition of chronic critical illness in the elderly has not yetbeen determined. The aim of the study is to determine the prevalence and clinicalfeatures of chronic critical illness in the elderly population in Turkey.Materials and Methods: Data from 16 intensive care units of public and privatehospitals in Turkey were evaluated. Patients staying in the intensive care units for atleast eight days between 2015 and 2017 and having at least one of the additionalcriteria were accepted as chronic critical illness and they were divided into twogroups by age, those 65 and older and those under 65.Results: The chronic critical illness patient rate in the intensive care units was10.7%. Of chronic critical illness patients in the intensive care units, 60.9% were 65years of age and older, and the mortality rate of patients 65 years and older was70%. The frequencies of ischemic stroke and sepsis, the number of patients withcomorbidities, and the mortality rate were higher in patients over 65 years ofage, while the frequency of traumatic brain injury, presence of a major wound,tracheostomy, length of hospital stay and cost of care were higher in patients under65 years of age.Conclusion: We determined that prolonged mechanical ventilation, traumaticbrain injury, tracheostomy and major wound presence in intensive care unitspatients 65 years and older increased hospital stay and costs. More work is neededto define chronic critical illness more clearly in elderly&nbsp;&nbsp;</p