Incidence and prognosis of dysnatraemia in critically ill patients: Analysis of a large prevalence study

Background: The objective of this study is to assess the impact of dysnatraemia on mortality among intensive care unit (ICU) patients in a large, international cohort. Material and methods: Analysis of the Extended Prevalence of Infection in Intensive Care (EPIC II) study, a 1-day (8 May 2007) worldwide multicenter, prospective point prevalence study. Hyponatraemia was categorized as mild (130-134 mM/L), moderate (125-129 mM/L) or severe ( 155 mM/L). Patients with normal serum sodium (135-145 mM/L) constituted the reference group. The main outcome was hospital mortality. Analysis was conducted separately for patients admitted on the study day (25·8%) and those already present on the ICU (74·2%). Results: Serum sodium was measured in 13 276 of the 13 796 patients (96·2%). A total of 3815 patients (28·7%) had dysnatraemia: 12·9% with hyponatraemia and 15·8% with hypernatraemia. The prevalence of dysnatraemia was significantly greater in patients already present on the ICU prior to the study day than for those just admitted (13·1% vs. 12·3% for hyponatraemia and 17·1% vs. 12·1% for hypernatraemia, both P < 0·001). Hospital mortality rates were higher in patients with dysnatraemia than in those with normal sodium levels and were directly related to the severity of hypo- and hypernatraemia. This association between dysnatraemia and mortality was similar in infected and noninfected patients (P = 0·061). Conclusions: Dysnatraemia is more frequent during the ICU stay than on the day of admission. Dysnatraemia in the ICU - even mild - is an independent predictor of increased hospital mortality

Significance of chronic opioid medication for dental treatment: A brief overview of the special features of dental treatment for patients with chronic opioid use

Die Zahl von Patientinnen und Patienten unter chronischer Opioid-Therapie hat in der Schweiz über die letzten Jahre permanent zugenommen. Ungeduld, Angst und Unterversorgung spielen bei der Betreuung eines Teils dieser Klientel eine wesentliche Rolle. Empfehlenswert ist die aktive Kontaktaufnahme mit den somatischen und psychiatrischen Mitbehandelnden der Patienten und Patientinnen, um eine bessere Koordination, z. B. durch aktive Begleitung durch eine Bezugs-person, zu erreichen. Wenig bekannt ist, dass eine chronische Opioid-Einnahme die An- schlagszeit von Lokalanästhetika verlängert und deren Wirkdauer auf die Hälfte verkürzt. Die Kenntnis und Beachtung der veränderten Kinetik der Lokalanästhesie führt zu erhöhter Zufrie- denheit bei den Betroffenen wie auch bei den Behandelnden. Die Wirksamkeit von Nicht- Opioid-Analgetika ist nicht beeinträchtigt.The number of patients undergoing chronic opioid therapy has steadily increased in Switzerland in recent years. Impatience, anxiety and inadequate care play a significant role in the care of some of these clients. It is advisable to actively liaise with the patient's somatic and psychiatric co-treaters in order to achieve better coordination, e.g. through active support from a caregiver. It is little known that chronic opioid use prolongs the onset time of local anaesthetics and reduces their duration of action by half. Knowledge of and attention to the altered kinetics of local anaesthesia leads to increased satisfaction among patients and practitioners alike. The efficacy of non-opioid analgesics is not impaired

Post-traumatic changes in energy expenditure and body composition in patients with acute spinal cord injury

Study design: Prospective cohort study. Objective: To investigate the changes in resting energy expenditure and body composition over time in a cohort of patients with spinal cord injury during acute treatment, rehabilitation, and 2 years after the end of rehabilitation. Methods: Adult patients admitted for acute treatment and rehabilitation after traumatic spinal cord injury were recruited. Measurements of resting energy expenditure and body composition were scheduled at 2, 6, 10 and 14 weeks after spinal cord injury, at the end of rehabilitation, and 2 years later. Results: Patients’ mean age was 38.8 years (standard deviation 14.0). Resting energy expenditure began to decrease up to the 10-week measurement (p = 0.02) and further decreased after the 130-week measurement (p < 0.001). Body weight was already decreased after the 6-week measurement (p < 0.01) and increased after the end of rehabilitation (p = 0.009). Percentage body fat mass showed similar changes. Conclusion: After an initial decrease in resting energy expenditure, body weight and percentage of body fat, these values levelled off during the rehabilitation period. After the end of the rehabilitation period, body weight and body fat mass increased again to the baseline levels, whereas resting energy expenditure decreased further. These results suggest that rehabilitation programmes should focus on adapting to these foreseeable changes

Increased mortality in critically ill patients with mild or moderate hyperbilirubinemia

Purpose Increased bilirubin concentrations may be related to outcome, but this has not been well studied. We evaluated the relationship between total serum bilirubin levels and outcome in critically ill patients. Materials and methods Data were analyzed from adult critically ill patients included in a 1-day international prevalence study after excluding those with an obvious underlying cause of hyperbilirubinemia. Results Serum bilirubin concentrations were >1 mg/dL in 2803 (31%) of 8973 patients, and these patients had higher mortality rates than patients with lower bilirubin concentrations (30% vs 21%, P 6 mg/dL. A serum bilirubin concentration >1 mg/dL was an independent risk factor for mortality in multilevel analysis. Conclusions Hyperbilirubinemia without a recognized cause was common and independently associated with increased mortality. There was a linear correlation of mortality with bilirubin concentration for values between 1 and 6 mg/dL but not for higher values.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Incidence and prognosis of dysnatraemia in critically ill patients: analysis of a large prevalence study.

The objective of this study is to assess the impact of dysnatraemia on mortality among intensive care unit (ICU) patients in a large, international cohort.Journal ArticleFLWINSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study

BACKGROUND: Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis. AIMS: We used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II 1-day point-prevalence study to better define the characteristics of infection in these patients. METHODS: We compared characteristics, including occurrence and types of infections in non-cirrhotic and cirrhotic patients who had not undergone liver transplantation. RESULTS: The EPIC II database includes 13,796 adult patients from 1265 ICUs: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non-cirrhotic patients (59 vs. 51%, P < 0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non-cirrhotic patients (30 vs. 19%, P < 0.01). Infected cirrhotic patients more often had Gram-positive (56 vs. 47%, P < 0.05) isolates than did infected non-cirrhotic patients. Methicillin-resistant Staphylococcus aureus (MRSA) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42%, compared to 24% in the non-cirrhotic population (P < 0.001). Severe sepsis and septic shock were associated with higher in-hospital mortality rates in cirrhotic than in non-cirrhotic patients (41% and 71% vs. 30% and 49%, respectively, P < 0.05). CONCLUSIONS: Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly caused by Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients

Increased mortality associated with meticillin-resistant Staphylococcus aureus (MRSA) infection in the Intensive Care Unit: Results from the EPIC II study

Controversy continues regarding whether the presence of meticillin resistance increases mortality risk in Staphylococcus aureus infections. In this study, we assessed the role of meticillin resistance in survival of patients with S. aureus infection included in the EPIC II point-prevalence study of infection in critically ill patients performed on 8 May 2007. Demographic, physiological, bacteriological and therapeutic data were collected for 13 796 adult patients in 1265 participating Intensive Care Units (ICUs) from 75 countries on the study day. ICU and hospital outcomes were recorded. Characteristics of patients with meticillin-sensitive S. aureus (MSSA) and meticillin-resistant S. aureus (MRSA) infections were compared. Co-morbidities, age, Simplified Acute Physiology Score (SAPS) II, site of infection, geographical region and MRSA/MSSA were entered into a multivariate model, and adjusted odds ratios (ORs) [95% confidence interval (CI)] for ICU and hospital mortality rates were calculated. On the study day, 7087 (51%) of the 13 796 patients were classified as infected. There were 494 patients with MRSA infections and 505 patients with MSSA infections. There were no significant differences between the two groups in use of mechanical ventilation or haemofiltration/haemodialysis. Cancer and chronic renal failure were more prevalent in MRSA than in MSSA patients. ICU mortality rates were 29.1% and 20.5%, respectively (P < 0.01) and corresponding hospital mortality rates were 36.4% and 27.0% (P < 0.01). Multivariate analysis of hospital mortality for MRSA infection showed an adjusted OR of 1.46 (95% CI 1.03-2.06) (P = 0.03). In ICU patients, MRSA infection is therefore independently associated with an almost 50% higher likelihood of hospital death compared with MSSA infection. (C) 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved