Lower extremity vascular disease

Purpose: We performed a systematic review to assess (1) to what extent Incident Reporting Systems (IRS) on the adult ICU meet the criteria of the WHO Draft Guidelines for Adverse Event Reporting and Learning Systems, (2) to what extent the IRSs comply with the four aspects of the iterative quality loop and (3) whether IRSs have led to improvement measures in clinical practice. Data sources: The authors searched multiple electronic databases from 1966 until June 26th 2014. Study Selection: Studies were included if they reported incident reporting systems on the adult ICU. Data Extraction: Data on study design, characteristics of the incident reporting system, implementation, feedback and improvement measures were collected using structured data extraction forms. Results of data synthesis: A total of 2098 studies were identified and 36 studies reported IRSs on the adult ICU. Studies were divided into: ICU specific IRSs and general IRSs. Items of the WHO checklist were assessed and categorized into the four phases of the iterative quality loop. Conclusion: None of the IRSs completely fulfilled the WHO checklist criteria. With respect to the iterative loop, data input and data collection are well established but not much attention was given to analyzing incidents and to give feedback. This resulted in an administrative report system, rather than the much desired instrument for change of practice and increase of quality as an IRS can only effectively contribute to improve patient safety and quality of care if more attention is given to analyzing incidents and feedback.Perioperative Medicine: Efficacy, Safety and Outcom

Welke waarheid mag door?

Oratie uitgesproken door Prof. dr. Sesmu M. Arbous bij de aanvaarding van het ambt van hoogleraar Intensive Care Geneeskunde, in het bijzonder de integratie van technologie in de patiëntenzorg aan de Universiteit Leiden op vrijdag 4 juli 2025LUMC / Geneeskund

The Microcirculation in the First Days of ICU Admission in Critically Ill COVID-19 Patients is Influenced by Severity of Disease

The objective of this study was to investigate the relationship between sublingual microcirculatory parameters and the severity of the disease in critically ill coronavirus disease 2019 (COVID-19) patients in the initial period of Intensive Care Unit (ICU) admission in a phase of the COVID-19 pandemic where patients were being treated with anti-inflammatory medication. In total, 35 critically ill COVID-19 patients were included. Twenty-one critically ill COVID-19 patients with a Sequential Organ Failure Assessment (SOFA) score below or equal to 7 were compared to 14 critically ill COVID-19 patients with a SOFA score exceeding 7. All patients received dexamethasone and tocilizumab at ICU admission. Microcirculatory measurements were performed within the first five days of ICU admission, preferably as soon as possible after admission. An increase in diffusive capacity of the microcirculation (total vessel density, functional capillary density, capillary hematocrit) and increased perfusion of the tissues by red blood cells was found in the critically ill COVID-19 patients with a SOFA score of 7–9 compared to the critically ill COVID-19 patients with a SOFA score ≤ 7. No such effects were found in the convective component of the microcirculation. These effects occurred in the presence of administration of anti-inflammatory medication

Risk factors and outcomes after unplanned extubations on the ICU: a case-control study

Diabetes mellitus: pathophysiological changes and therap

Low postoperative mitochondrial oxygen tension is an early marker of acute kidney injury after cardiac surgery:A prospective observational study

Background: Dissociation between the micro- and macrocirculation as well as the lack of specificity of current markers to signal impaired tissue oxygenation complicate the timely diagnosis and treatment of tissue hypoperfusion to prevent acute kidney injury (AKI) after cardiac surgery. The newly developed non-invasive technique to measure the mitochondrial oxygenation (mitoPO2) is currently the most downstream bedside marker of tissue oxygenation. The aim was to investigate mitoPO2 as an early marker of postoperative development of AKI. Methods: In a prospective observational study, postoperative mitochondrial oxygen tension was measured to detect AKI (defined by KDIGO) in patients undergoing cardiac surgery. Results: Of 50 included patients, 44 patients had analyzable mitoPO2 signal. 5 patients developed AKI. MitoPO2 at ICU admission was 16(13.8–24.6)mmHg in patients who developed AKI vs 63.4(37.5–77.9) mmHg in patients without AKI (p &lt; 0.001). MitoPO2 predicted AKI (ROC 0.95 (0.89–1.0) with an optimal cut-off value of 30 mmHg (OR 4.4, CI 2.8–6.0, p &lt; 0.001). Also, longer period of time under the mitoPO2 threshold predicted AKI with an AUROC of 0.91(0.80–1.00). In all patients, a decreased mitoPO2 occurred 4 h earlier than an clinically relevant increase in serum lactate. Other markers of tissue hypoperfusion, did not differ between patients with and without AKI. Conclusions: A mitoPO2 value below 30 mmHg at ICU admission as well as the duration below this threshold indicate the development of AKI in cardiac surgery patients, occurring earlier than an increase in lactate above the normal range.</p

Study protocol and pilot results of an observational cohort study evaluating effect of red blood cell transfusion on oxygenation and mitochondrial oxygen tension in critically ill patients with anaemia: the INsufficient Oxygenation in the Intensive Care Unit (INOX ICU-2) study

INTRODUCTION: The recently developed protoporphyrin IX-triple state lifetime technique measures mitochondrial oxygenation tension (mitoPO2) in vivo at the bedside. MitoPO2might be an early indicator of oxygen disbalance in cells of critically ill patients and therefore m

Association between first-week propofol administration and long-term outcomes of critically ill mechanically ventilated patients: a retrospective cohort study

Background & aim: Propofol is commonly used in ICUs, but its long-term effects have not been thoroughly studied. In vitro studies suggest it may harm mitochondrial function, potentially affecting clinical outcomes. This study aimed to investigate the association between substantial propofol sedation and clinical outcomes in critically ill patients.Methods: We conducted a single-centre cohort study of critically ill, mechanically ventilated (>= 7 days) adults to compare patients who received a substantial dose of propofol (cumulative >500 mg) during the first week of ICU admission with those who did not. The primary outcome was the association between substantial propofol administration and 6-month mortality, adjusted for relevant covariates. Subanalyses were performed for administration in the early (day 1-3) and late (day 4-7) acute phases of critical illness due to the metabolic changes in this period. Secondary outcomes included tracheostomy need and duration, length of ICU and hospital stay (LOS), discharge destinations, ICU, hospital, and 3-month mortality.Results: A total of 839 patients were enrolled, with 73.7 % receiving substantial propofol administration (substantial propofol dose group). Six-month all-cause mortality was 32.4 %. After adjusting for relevant variables, we found no statistically significant difference in 6-month mortality between both groups. There were also no significant differences in secondary outcomes.Conclusion: Our study suggests that substantial propofol administration during the first week of ICU stay in the least sick critically ill, mechanically ventilated adult patients is safe, with no significant associations found with 6-month mortality, ICU or hospital LOS, differences in discharge destinations or need for tracheostomy.(c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Experimentele farmacotherapi

Hydrocortisone-associated death and hospital length of stay in patients with sepsis:A retrospective cohort of large-scale clinical care data

PURPOSE: Sepsis is one of the leading causes of morbidity and mortality worldwide with approximately 50 million annual cases. There is ongoing debate on the clinical benefit of hydrocortisone in the prevention of death in septic patients. Here we evaluated the association between hydrocortisone treatment and mortality in patients diagnosed with sepsis in a large-scale clinical dataset.METHODS: Data from patients between 2008 and 2019 were extracted from the retrospective Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients who received hydrocortisone after diagnosis were matched using propensity-score matching with patients who did not, to balance confounding (by indication and contraindication) factors between the groups. 90-day mortality and survivors' length of hospital stay was compared between patients who did or did not receive hydrocortisone.RESULTS: A total of 31,749 septic patients were included in the study (mean age: 67, men: 57.3%, in-hospital mortality: 15.6%). 90-day mortality was higher among the 1802 patients receiving hydrocortisone when compared with the 6348 matched non-users (hazard ratio: 1.35, 95% CI: 1.24-1.47). Hydrocortisone treatment was also associated with increased in-hospital mortality (40.9% vs. 27.6%, p &lt; 0.0001) and prolonged hospital stay in those who survived until discharge (median 12.6 days vs. 10.8 days, p &lt; 0.0001). Stratification for age, gender, ethnicity, occurrence of septic shock, and the need for vasopressor drug administration such as (nor)epinephrine did not reveal sub-population(s) benefiting of hydrocortisone use.CONCLUSION: Hydrocortisone treatment is associated with increased risk of death as well as prolonged hospital stay in septic patients. Although residual confounding (by indication) cannot be ruled out completely due to the observational nature of the study, the present study suggests clinical implication of hydrocortisone use in patients with sepsis.</p