HOW CLOSELY IS PROTEIN CARBONYL (PCO) LEVEL CORRELATED WITH SEPSIS-RELATED ORGAN FUNCTION ASSESSMENT (SOFA) SCORE?

Objective: Sepsis remains an unsolved problem in hospitals since its mortality rate is not significantly reduced despite considerable therapy efforts. The most used prognostic tool is the Sepsis-related Organ Function (SOFA) score, which requires several clinical and laboratory examinations; our recent studies also showed that the protein carbonyl level (PCO) has prognostic value in predicting sepsis mortality. Methods: This prospective study was designed to assess the correlation between PCO values and the SOFA score following ethical approval. Adult patients aged>18 y who met the Sepsis-3 definition were included. Exclusion criteria were patients not admitted to the intensive care unit. Dropout criteria included mortality within the 1h bundle protocol. Baseline demographic data and blood collection were measured for all subjects. Subjects were treated with the 1h bundle protocol and observed for 28 d. Results: Fifty-nine subjects were included, with no significant differences in age, sex, diagnosis, microbiology or Charlson’s Comorbidity score between survivors and non-survivors. The SOFA score was higher in non-survivors (10.90±3.38 vs 8.11±3.07; p=0.003), as was the PCO value (24.5 [14.67-81] vs 18 [15-21.33]; p<0.001). However, the correlation between PCO and SOFA score is very weak (r=0.101; p=0.45). Conclusion: Both the PCO level and SOFA scores were higher in non-survivor septic patients. However, they have a very weak correlation and cannot be used interchangeably

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

Comparison of the Success Rate of Radial Arterial Cannulation with Palpation Techniques and Ultrasound Guidance in Patients Undergoing Major Surgery with General Anesthesia

Background: Ultrasound-guided arterial cannulation has the potential to increase the total success rate and first attempt and reduce complications compared to conventional landmark palpation methods. This study aims to compare the success rate of radial artery cannula with palpation techniques and ultrasound guidance in patients undergoing major surgery under general anesthesia. Methods: This study is a randomized controlled trial singly. The inclusion criteria for this study were patients who underwent both emergency and elective surgery under general anesthesia, aged >18 years, with ASA I and II physical status. The study sample (60 people) was randomized by computer and divided into two groups (ultrasound guidance and palpation technique). The study will assess the success of the first insertion of the radial artery cannula in both groups. Data analysis was performed with SPSS 25 univariate and bivariate. Results: There is a significant relationship with the success of the first attempt at an ultrasound-guided cannula trial with a p-value of 0.045 with an odds ratio of 3.33 with a 95% confidence interval (0.998 – 11.139). Conclusion: Ultrasound-guided arterial cannulation has a better success rate and fewer complications than conventional palpation techniques.&nbsp

Comorbidities and COVID-19 status influence the survival rate of geriatric patients in intensive care units: a prospective cohort study from the Indonesian Society of Anaesthesiology and Intensive Therapy

Background: With the more advanced science in the field of medicine and disease management, the population of geriatric intensive care patients is increasing. The COVID-19 pandemic has impacted healthcare management around the globe, especially on critically-ill elderly patients. We aim to analyse the relationship between underlying illnesses, including COVID-19, and the survival rate of elderly patients who are treated in the intensive care setting. Methods: We conducted a prospective cohort study at 14 teaching hospitals for Anaesthesiology and Intensive Therapy Education in Indonesia. We selected all subjects with 60 years of age or older in the period between February to May 2021. Variables recorded included subject characteristics, comorbidities, and COVID-19 status. Subjects were followed for 30-day mortality as an outcome. We analysed the data using Kaplan-Meier survival analysis. Results: We recruited 982 elderly patients, and 728 subjects were in the final analysis (60.7% male; 68.0 ± 6.6 years old). The 30-day mortality was 38.6%. The top five comorbidities are hypertension (21.1%), diabetes (16.2%), moderate or severe renal disease (10.6%), congestive heart failure (9.2%), and cerebrovascular disease (9.1%). Subjects with Charlson’s Comorbidity Index Score > 5 experienced 66% death. Subjects with COVID-19 who died were 57.4%. Subjects with comorbidities and COVID-19 had lower survival time than subjects without those conditions (p < 0.005). Based on linear correlation analysis, the more comorbidities the geriatric patients in the ICU had, the higher chance of mortality in 30 days (p < 0.005, R coefficient 0.22). Conclusion: Approximately one in four elderly intensive care patients die, and the number is increasing with comorbidities and COVID-19 status

Perioperative Factors Impact on Mortality and Survival Rate of Geriatric Patients Undergoing Surgery in the COVID-19 Pandemic: A Prospective Cohort Study in Indonesia

Background: The COVID-19 pandemic continues to have an impact on geriatric patients worldwide since geriatrics itself is an age group with a high risk due to declined physiological function and many comorbidities, especially for those who undergo surgery. In this study, we determine the association between perioperative factors with 30-day mortality and a survival rate of geriatric patients undergoing surgery during COVID-19 pandemic. Methods: A prospective cohort study was conducted at 14 central hospitals in Indonesia. The recorded variables were perioperative factors, 30-day mortality, and survival rate. Analyses of associations between variables and 30-day mortality were performed using univariate/multivariable logistic regression, and survival rates were determined with Kaplan–Meier survival analysis. Results: We analyzed 1621 elderly patients. The total number of patients who survived within 30 days of observation was 4.3%. Several perioperative factors were associated with 30-day mortality (p p = 0.04), CCI > 3 ( odds ratio [OR], 2.33; 95% confidence interval [CI], 1.03–5.26; p = 0.04), emergency surgery (OR, 3.70; 95% CI, 1.96–7.00; p ≤ 0.01), postoperative ICU care (OR, 2.70; 95% CI, 1.32–5.53; p = 0.01), and adverse events (AEs) in the ICU (OR, 3.43; 95% CI, 1.32–8.96; p = 0.01). Aligned with these findings, COVID-19, CCI > 3, and comorbidities have a log-rank p p p ≤ 0.01), cerebrovascular disease (log-rank p ≤ 0.01), diabetes with chronic complications (log-rank p = 0.03), metastatic solid tumor (log-rank p = 0.02), dementia (log-rank p ≤ 0.01), and rheumatology disease (log-rank p = 0.03). Conclusions: Having at least one of these conditions, such as COVID-19, comorbidities, emergency surgery, postoperative ICU care, or an AE in the ICU were associated with increased mortality in geriatric patients undergoing surgery during the COVID-19 pandemic

Obstetric anesthesia services profile in cesarean section in Indonesian population: A prospective, observational, multicenter study

Background: All obstetrics or pregnant patients potentially require anesthesia during their delivery, both planned and emergency. The rate of cesarean deliveries in Indonesia has also increased from 9.8% to 17.6%. This study was conducted to provide a profile of anesthesia services in obstetric patients in Indonesian population. Materials and Methods: This observational prospective multicenter study was conducted from March to June 2022 in 67 hospitals in Indonesia. A total of 1731 subjects were enrolled. The study population consisted of patients who received obstetric anesthesia services during cesarean section. Data collection was conducted via the REDCap application. Results: A total of 1731 subjects were included in this study. Most cases were emergency surgeries (66.44%), with an American Society of Anesthesiologists classification of ASA II with emergency situation (53.96%). Spinal anesthesia was the most frequent technique (96.42%), although 1.16% of subjects had a conversion of anesthesia technique. The most common complication during the surgery, in the recovery room, and in the ward was hypotension (8.55%, 1.50%, and 0.58%, respectively), and the maternal mortality rate was 0.29%, with some identified causes being prolonged shock. A total of 120 (6.93%) subjects experienced postoperative care in the intensive care unit, whereas the remaining 1511 (93.17%) subjects did not. Conclusion: Anesthesia services in this study showed proper and representative results for obstetrics services in Indonesia. Our study demonstrated that single shot spinal anesthesia is the most commonly preferred mode of anesthesia for both elective and emergency cesarean delivery cases. However, there is still room for improvement in the anesthesia field, which should be continuously evaluated

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

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