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

Investigation for the Effects of Omega 3 Fatty Acid and Glutamine- L-Alanine on Morbidity and Mortality in the Critically ILL Patients after Major Abdominal Surgery

Background & Objectives: This study investigated the effects for the addition of omega 3 fatty acids and glutamine-L-alanine to the standard enteral and/or parenteral nutrition regimen on infection and mortality in the critically ill patients after major abdominal surgery. Methods: This is a prospective, randomized, single center study. A total of 43 patients (age range: 18-85 years), who were in the critical care unit after major abdominal surgery, were included. Patients were divided into two groups according to simple randomized selection [Control group, n=20; Study Group, n=23 (omega3 fatty acids and glutamine-L-alanine)] and were monitored for 21 days. Patients were examined for the assessment of APACHE II Score and existence of ALI (acute lung injury)/ARDS (acute respiratory distress syndrome) requiring mechanical ventilation. In addition to standard enteral or parenteral nutrition, patients in the study group were given parenteral pharmaconutrition products for 10 days postoperatively. Groups were compared for the duration of mechanical ventilation, duration of stay in the intensive care unit and hospitalization, and mortality. Laboratory parameters including CRP, TNF, IL6, IL8, nitrogen balance, albumin, and total lymphocyte count were recorded. Results:Although the mean APACHE score was higher in study group in which patients received omega-3 fatty acids and glutamine-L-alanine support, the clinical infection rate seemed to decrease insignificantly. Conclusions: A clinically decreased rate of infection was observed in patients with a high APACHE II score, or who received omega-3 fatty acids, glutamine-L-alanine, are required to be administered more selectively and in larger patient groups in different doses and in combination protocols in accordance with the current pharmaconutritional support and in different timing combinations, including preoperative perio

Investigation for the Effects of Omega Fatty Acid and Glutamine-L-Alanine on Morbidity and Mortality in the Critically ILL Patients after Major Abdominal Surgery

Background & Objectives: This study investigated the effects for the addition of omega 3 fatty acids and glutamine-L-alanine to the standard enteral and/or parenteral nutrition regimen on infection and mortality in the critically ill patients after major abdominal surgery. Methods: This is a prospective, randomized, single center study. A total of 43 patients (age range: 18-85 years), who were in the critical care unit after major abdominal surgery, were included. Patients were divided into two groups according to simple randomized selection [Control group, n=20; Study Group, n=23 (omega3 fatty acids and glutamine-L-alanine)] and were monitored for 21 days. Patients were examined for the assessment of APACHE II Score and existence of ALI (acute lung injury)/ARDS (acute respiratory distress syndrome) requiring mechanical ventilation. In addition to standard enteral or parenteral nutrition, patients in the study group were given parenteral pharmaconutrition products for 10 days postoperatively. Groups were compared for the duration of mechanical ventilation, duration of stay in the intensive care unit and hospitalization, and mortality. Laboratory parameters including CRP, TNF, IL6, IL8, nitrogen balance, albumin, and total lymphocyte count were recorded. Results:Although the mean APACHE score was higher in study group in which patients received omega-3 fatty acids and glutamine-L-alanine support, the clinical infection rate seemed to decrease insignificantly. Conclusions: A clinically decreased rate of infection was observed in patients with a high APACHE II score, or who received omega-3 fatty acids, glutamine-L-alanine, are required to be administered more selectively and in larger patient groups in different doses and in combination protocols in accordance with the current pharmaconutritional support and in different timing combinations, including preoperative perio

Non-invasive mechanical ventilation after the successful weaning: a comparison with the venturi mask

Abstract Background and objectives: This study compared the rates of acute respiratory failure, reintubation, length of intensive care stay and mortality in patients in whom the non-invasive mechanical ventilation (NIMV) was applied instead of the routine venturi face mask (VM) application after a successful weaning. Methods: Following the approval of the hospital ethics committee, 62 patients who were under mechanical ventilation for at least 48 hours were scheduled for this study. 12 patients were excluded because of the weaning failure during T-tube trial. The patients who had optimum weaning criteria after the T-tube trial of 30 minutes were extubated. The patients were kept on VM for 1 hour to observe the hemodynamic and respiratory stability. The group of 50 patients who were successful to wean randomly allocated to have either VM (n = 25), or NIV (n = 25). Systolic arterial pressure (SAP), heart rate (HR), respiratory rate (RR), PaO2, PCO2, and pH values were recorded. Results: The number of patients who developed respiratory failure in the NIV group was significantly less than VM group of patients (3 reintubation vs. 14 NIV + 5 reintubation in the VM group). The length of stay in the ICU was also significantly shorter in NIV group (5.2 ± 4.9 vs. 16.7 ± 7.7 days). Conclusions: The ratio of the respiratory failure and the length of stay in the ICU were lower when non-invasive mechanical ventilation was used after extubation even if the patient is regarded as ‘successfully weaned’. We recommend the use of NIMV in such patients to avoid unexpected ventilator failure

Non-invasive mechanical ventilation after the successful weaning: a comparison with the venturi mask

Abstract Background and objectives: This study compared the rates of acute respiratory failure, reintubation, length of intensive care stay and mortality in patients in whom the non-invasive mechanical ventilation (NIMV) was applied instead of the routine venturi face mask (VM) application after a successful weaning. Methods: Following the approval of the hospital ethics committee, 62 patients who were under mechanical ventilation for at least 48 hours were scheduled for this study. 12 patients were excluded because of the weaning failure during T-tube trial. The patients who had optimum weaning criteria after the T-tube trial of 30 minutes were extubated. The patients were kept on VM for 1 hour to observe the hemodynamic and respiratory stability. The group of 50 patients who were successful to wean randomly allocated to have either VM (n = 25), or NIV (n = 25). Systolic arterial pressure (SAP), heart rate (HR), respiratory rate (RR), PaO2, PCO2, and pH values were recorded. Results: The number of patients who developed respiratory failure in the NIV group was significantly less than VM group of patients (3 reintubation vs. 14 NIV + 5 reintubation in the VM group). The length of stay in the ICU was also significantly shorter in NIV group (5.2 ± 4.9 vs. 16.7 ± 7.7 days). Conclusions: The ratio of the respiratory failure and the length of stay in the ICU were lower when non-invasive mechanical ventilation was used after extubation even if the patient is regarded as ‘successfully weaned’. We recommend the use of NIMV in such patients to avoid unexpected ventilator failure

Incidence, Etiology and Risk Factors Associated with Mortality of Nosocomial Candidemia in a Tertiary Care Hospital in Istanbul, Turkey

Objective: The aim of this study was to determine the incidence, etiology and risk factors for mortality of patients with nosocomial candidemia. Subjects and Methods: This observational study was performed at Haydarpasa Numune Training and Research Hospital, a tertiary care hospital with 750 beds, between the years 2004 and 2007. Fifty defined cases with a nosocomial bloodstream infection caused by Candida species were included in the study. All demographic, microbiological and clinical records for each patient were collected using a standardized form. Blood culture was performed by automated blood culture system, and those samples positive for yeast were subcultured on Sabouraud agar. Results: The mean incidence density of nosocomial candidemia was 0.58/10,000 patient-days/year (range 0.17-1.4). Candidemia episodes increased from 0.17/10,000 to 1.4/10,000 patient-days/year (p < 0.0001). Candida albicans and non-albicans Candida accounted for 15 (30%) and 35 (70%) cases, respectively. The overall mortality was 56% and was significantly associated with staying in the intensive care unit (odds ratio: 3.667, 95% confidence interval: 1.07-12.54, p = 0.034). Conclusion: This study showed that there was a significantly increased trend in the incidence of candidemia with high mortality during the study period. Copyright (C) 2010 S. Karger AG, Base

Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infections in Intensive Care Units: A Multicentre Case-Control Study with a Competing-Risks Analysis: Risk factors for CRKP infections

Aim: This study investigated the risk factors for the development of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in adult patients in intensive care units (ICUs). Methods: A multicentre case-control study was conducted in ICUs in three tertiary hospitals in Turkey. The cases were patients culture-confirmed CRKP and a condition associated with healthcare-associated infections. Two controls were randomly selected for each case from among all other patients with an ICU stay at least as long as that of the corresponding case patient. A proportional semiparametric subdistribution hazards regression model was used to assess risk factors for CRKP infection. ICU discharge and non-CRKP-related deaths were treated as competing risks. Results: A total of 120 patients, 44 cases, and 76 controls were included in the analysis. Of the controls, 32 were discharged from the ICU and 44 died without acquiring CRKP infection. Endotracheal intubation (hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.00–3.868) and type 2 diabetes mellitus (HR: 1.57, 95% CI: 0.888–2.806) were associated with an increased risk of CRKP infection, whereas carbapenem exposure (HR: 0.47, 95% CI: 0.190–1.1175) and the presence of a nasogastric tube (HR: 0.49, 95% CI: 0.277–0.884) were associated with a decreased risk of CRKP infection. Conclusions: Enteral nutrition support via a nasogastric tube may be associated with a reduced risk of CRKP-resistant infections in ICU patients. This hypothesis should be tested with a well-designed study