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

Amitriptyline Cardiac Toxicity Treated with Hemoperfusion

Tricyclic antidepressant intoxication is frequently encountered among children and adults due to widespread use of the drugs. Amitriptyline is among the major tricyclic antidepressants. It affects the cardiovascular, respiratory and central nervous system. In the treatment of amitriptyline intoxication, various treatments such as gastric lavage, activated charcoal, bicarbonate infusion, antiarrhythmic, and anticonvulsant drug usage were applied. Here, we reported a patient with severe amitriptyline intoxication who did not respond to these treatments but dramatically improved with hemoperfusion. A 33 year-old woman applied to the emergency service half an hour later ingesting 2000 mg of amitriptyline as a suicide attempt. On admission, her Glasgow coma scale (GCS) was 10, blood pressure was 100/60 mmHg, heart rate was 160 beats/min. Wide QRS and ventricular tachycardia was seen in the Electrocardiography (ECG) results. Having her GCS regressed to 7, she was intubated and admitted to intensive care unit after the initial treatments. Hemoperfusion was commenced within half an hour. While hemoperfusion was continuing, her ECG was seen to turn to sinus tachycardia. Her cardiovascular and neurological status returned to normal on the 2nd day and she was discharged from the intensive care unit on the 4th day. Besides hemoperfusion is not recommended due to high protein binding and large volume of distribution in classical treatment of amitriptyline overdose, current reports representing efficacy of hemoperfusion are also accumulating. After ingestion, tricyclic antidepressants are absorbed rapidly and reach to their effective concentration in the tissues, especially by the lung, the brain and the heart. Hence, hemoperfusion performed in early stage of ingestion is an effective treatment and in cases that do not respond to conventional therapies, it should be considered that this method can be used in the early period

Assessment of the Relationship Between Vitamin D Level and Non-specific Musculoskeletal System Pain: A Multicenter Retrospective Study (Stroke Study Group)

Objective: In this study, it was aimed to evaluate the relationship between vitamin D level and pain severity, localization and duration in patients with non-specific musculoskeletal pain. Materials and Methods: Patients who applied to physical medicine and rehabilitation outpatient clinics due to non-specific muscle pain in 19 centers in Turkey were retrospectively screened. Three thousand four hundred fourpatients were included in the study, whose pain level was determined by visual analog scale (VAS) and the painful region, duration of pain and vitamin D level were reached. D group was found to be D deficient (group 1) when 25 (OH)D level was 20 ng/mL or less and group D 2 (vitamin D deficiency) was higher than 30 ng/mL (group 3). The groups were compared in terms of pain duration, localization and severity. In addition, the correlations of pain localization, severity and duration with vitamin D levels were examined. Results: D vitamin deficiency was detected in 2202 (70.9%) of 3 thousand four hundred and four registered patients, and it was found that vitamin D deficiency in 516 (16.6%) and normal vitamin D in 386 (12.4%). The groups were similar in terms of age, body mass index, income level, duration of complaint, education level, family type and working status (p>0.05). There was no statistically significant difference between groups in terms of VAS, pain localization and duration scores (p>0.05). Conclusion: Our study shows that vitamin D deficiency in patients with nonspecific musculoskeletal pain is not associated with the severity and duration of pain

Cultural Encounters in The Ottoman World and Their Artistic Reflections:in Honor of Prof. Dr. Filiz Yenişehirlioğlu

Prof. Dr. Filiz Yenişehirlioğlu kurucu dekan olarak görev aldığı Başkent Üniversitesi Güzel Sanatlar Tasarım ve Mimarlık Fakültesi'ni üniversitenin rektörü Prof. Dr. Mehmet Haberal'm desteği ile üniversitenin 10. yılma rastlayan 2006'da kurar. Görsel Sanatlar ve Tasarım Bölümü'nün kuruluşunu takiben Iç Mimarlık ve Çevre Tasarımı bölümleri ardından da Sanat Tarihi ve Müzecilik Bölümü 2006'da akademik faaliyetlerine başlar. Ayrıca Müzik Bölümü ve üniversite öğrencilerinin geneline açık kültür ve sanatla ilgili farklı içerikli dersler sunan Güzel Sanatlar Birimi oluşturulur. Prof. Dr. Yenişehirlioğlu, Kültür ve Sanat Araştırmaları Merkezi adı altında farklı alanlarda projelerin yürütüldüğü bir merkezi de faaliyete geçirir. Yenişehirlioğlu'nun kurduğu fakültenin vizyonu çağdaş eğitimin vazgeçilmezi tasarımın, kültür ve toplumun yaşanılan mekân ile bütünleşik olduğu görüşüyle disiplinler arası bir programla öğrenciyi mezun etmeyi hedefler. Bu bağlamda Yenişehirlioğlu estetik, yaratıcı drama ve görsel kültürün değişik uygulamalarının yer aldığı bir program oluşturmayı amaçlar. Farklı ülkelerden çalıştaylar yapmaya gelen bilim insanlarının katılımlarıyla dolup taşan derslikler geç saatlere dek süren akademik çalışmalar, Güzel Sanatlar Birimi'nin sıklıkla düzenlediği kaliteli sergiler Yenişehirlioğlu'nun kurucu dekanlığı döneminde hız kazanır. Farklı disiplinlerden gelen bilim insanlarının birlikte olduğu Güzel Sanatlar Tasarım ve Mimarlık Fakültesi bünyesine öğretim üyesi kimliğimle 2005 yılında katılma fırsatını yakaladım. Bu süreçte yakından tanıma şansına sahip olduğum Filiz Yenişehirlioğlu hocam bitmez tükenmez enerjisi ve bilime çağdaş bakış açısı ile kendisinden çok şey öğrendiğim bir bilim insanıdır. Yenişehirlioğlu ile ortak paydada buluştuğum en önemli konu, tek bir alanda uzmanlaşan ve yaşamını bu alanda sürdüren, farklı alanların örtüştüğü bilgileri kullanamayan bireyler yetiştirmeye olan itirazımdı. Bunun yerine, üniversite kavramıyla asıl içinin doldurulması gerekenin ise farklı alan tecrübeleri ile yoğrulan, yeniyi üretebilen, kendini tanıyan birey olma kavramına, bir başka ifadeyle birey yetiştirme programına dahil olmaya duyduğumuz inançtı. Yenişehirlioğlu'nun kültür ve sanata yaygın bakış açısı aktif olarak yurtiçi ve dışında farklı oluşumlarla projeler yapmasını sağlamıştır. 1989 yılında T.C. Dışişleri Bakanlığı ile ortak çalışma sonucu yayınlanan Yurtdışındaki Osmanlı Mimari Eserleri üzerine bir kitap hazırlayan Yenişehirlioğlu ardından Tekfur Sarayı kazıları ile Eyüp Çömlekçiler Projesi'ni hayata geçirmiş, Topkapı Çini Projesi ile çalışmalarını sürdürmüştür. Yenişehirlioğlu'nun, sanatın ve içinde üretildiği toplumun irdelenmesi üzerine sayısız akademik çalışmaları­nın dışında Tübitak ve dergi hakemlikleri de mevcuttur. Ayrıca UNESCO Türkiye kültür varlıkları komisyon ve ASTAD SCOTT üyelikleri yanı sıra Ankara Mimarlar Derneği, Uçan Süpürge ve yerel yönetimlerle kültür envanteri gibi ortak çalışmaları da mevcuttur. 1991'de Fransız Kültür Bakanlığı Kültür Şövalyeliği ünvanına layık görülen Yenişehirlioğlu 1992 yılında iki ayrı ödül daha alır. Bunlardan ilki İtalya'da alanında ünlü kadın profosyonellere verilen "Adelaide Ristori" Ödülü diğeri ise Hacettepe Ünversitesi Senatosu'nun Bilim Ödülü'dür. Bu ödülleri 2006'da "Türkiye ve Yunanistan Arasında Mübadeleden Kalan Ortak Kültür Mirasının Korunması" Projesi ile Europa Nostra Ödülü takip eder. Sonuç olarak, bilimde ilerlemek "yeni'nin peşinde koşmakla sağlanır. Bunun en güzel örneği Prof. Dr. Filiz Yenişehirlioğlu hocamızdır

Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units

evere intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by diseasespecific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed