Complications associated to midline- and long peripheral catheters in adults. Systematic review of literature and proposal for a standardized model for data collection

Introduction: Long peripheral catheters (LPCs) and midline catheters (MCs) are indiscriminately labelled with different names, leading to misclassifications both in primary and secondary studies. The available studies used different methods to report the incidence of catheter-related complications, affecting the possibility of properly comparing the catheter outcomes. The aim of this review was to explore the complications related to LPCs and MCs after reclassifying according to their length. Methods: Systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, conducted on PubMed, Scopus and CINAHL databases. The study protocol was registered in the International Prospective Register of Systematic Reviews. Data regarding LPCs and MCs were compared. Catheter outcomes were classified into major and minor complications, recomputed and reported as cases/1000 catheter-days. Results: Fourteen studies were included. Over-half of the devices were correctly labelled by the authors, misclassifications affected particularly LPCs improperly labelled MCs. The cumulative incidence of catheter-related bloodstream infections was 0.3 and 0.4/1000 catheter-days, that of symptomatic catheter-related thrombosis was 0.9 and 1.8/1000 catheter-days for MCs and LPCs, respectively. Minor complications and catheter failure were higher for LPCs. Conclusions: A misclassification exists in the labelling of MCs and LPCs. A widespread heterogeneity of diagnostic criteria adopted to classify the catheters' outcomes was found, exposing the risk of misestimating the incidence of complications and undermining the possibility of effectively comparing results of the published research. We proposed a list of definitions and relevant variables as a first step toward the development of standardized criteria to be adopted for research purposes

Identifying reliable predictors of protein-energy malnutrition in hospitalized frail older adults. A prospective longitudinal study

BACKGROUND: Decreased food intake is a risk factor for relevant complications (e.g. infections, pressure ulcers), longer hospital stays, higher readmission rates, greater health care costs and increased patient mortality, particularly in frail hospitalized older adults who are malnourished or at risk of malnutrition. Nurses are called to improve this criticality, starting from accurately identify patients for malnutrition at hospital admission and effectively monitoring their food intake. OBJECTIVES: The primary aim was to identify reliable predictive indicators of reduced food intake at hospital admission. The secondary aims were to assess the adequacy of daily energy and protein intake and the impact of nutrient intake on patient outcomes. DESIGN: Prospective observational longitudinal study. SETTING: Internal Medicine Ward of an Academic Teaching University Hospital. PARTICIPANTS: Acute older adults who were malnourished or at risk of malnutrition (Nutritional Risk Score-2002\u202f 65\u202f3, middle-upper arm circumference\u2009<23.5\u202fcm or impaired self-feeding ability) at admission. METHODS: The effective energy and protein intake was monitored during the first 5\u202fdays of hospital stay by a photographic method and compared to the daily energy and protein requirement calculated by specific equations. Data on anthropometry, inflammation/malnutrition laboratory data and body composition (phase\u202fangle calculated using bioelectrical impedance analysis) were collected. RESULTS: Eighty-one subjects (age 81.5\u202f\ub1\u202f11.5\u202fyears) were enrolled. Mean energy intake was 669.0\u202f\ub1\u202f573.9\u202fkcal/day, and mean protein intake was 30.7\u202f\ub1\u202f25.8\u202fg/day. Over 60% of patients ingested\u2009 6450% of their calculated energy and protein requirements: these patients were older (p\u202f=\u202f0.026), had a lower middle-upper arm circumference (p\u202f=\u202f0.022) and total arm area (p\u202f=\u202f0.038), a higher C-reactive protein/albumin ratio and Instant Nutritional Assessment score (p\u202f<\u202f0.01), and experienced longer hospital stays (p\u202f 64\u202f0.04) and higher in-hospital and 30-day post-discharge mortality (p\u202f<\u202f0.001). In the multivariate analysis, lower middle-upper arm circumference, higher C-reactive protein/albumin ratio, and impaired self-feeding at admission were independently associated with critically reduced energy and protein intake. CONCLUSIONS: Middle-upper arm circumference, C-reactive protein/albumin ratio, and impaired self-feeding are easily obtainable indicators of impaired energy and protein intake and poor clinical outcomes. Such parameters should be adopted as screening criteria to assess the risk for critically reduced energy/protein intake in hospitalized older adults. These findings are relevant to improve clinical practice through the implementation of multidisciplinary strategies, given the adverse clinical outcomes related to hospital malnutrition

Impact of Transitory ROSC Events on Neurological Outcome in Patients with Out-of-Hospital Cardiac Arrest

In out-of-hospital cardiac arrest (OHCA), the occurrence of temporary periods of return to spontaneous circulation (t-ROSC) has been found to be predictive of survival to hospital discharge. The relationship between the duration of t-ROSCs and OHCA outcome has not been explored yet. The aim of this prospective observational study was to analyze the duration of t-ROSCs during OHCA and its impact on outcome. Defibrillator-recorded OHCA events were analyzed via dedicated software. The number of t-ROSC episodes and their overall durations were recorded. The study endpoint was the good neurologic outcome at hospital discharge. Among 285 patients included in the study, 45 (15.8%) had one or more t-ROSCs. The likelihood of t-ROSC occurrence was higher in patients with a shockable rhythm (p = 0.009). The cumulative length of t-ROSC episodes was significantly higher for patients who achieved sustained ROSC (p < 0.001). The adjusted cumulative t-ROSC length was an independent predictor for good neurological outcome at hospital discharge (OR 1.588, 95% CI 1.017 to 2.481; p = 0.042). According to our findings and data from previous studies, t-ROSC episodes during OHCA should be considered as a favorable prognostic factor, encouraging continuing resuscitative efforts

Adequacy of protein and calorie delivery according to the expected calculated targets: a day-by-day assessment in critically ill patients undergoing enteral feeding

In critically ill patients requiring mechanical ventilation for longer than 48-72 h enteral nutrition (EN) should be started early. Because EN alone may be unable to reach the target nutritional requirement, supplemental parenteral nutrition (PN) should be administered. This study aimed at describing the daily rate of administered calories and proteins according to the expected calculated targets. The impact of calorie adequacy, deficit or excess on relevant clinical outcomes was explored

Predictors of short- and long-term mortality among acutely admitted older patients: role of inflammation and frailty

Frailty, demographic and clinical variables linked to incident diseases (e.g., dehydration, inflammation) contribute to poor outcomes in older patients acutely hospitalized. Their predictivity on short-, intermediate- and long-term mortality in a comprehensive model has been scarcely investigated

Nephrogenic diabetes insipidus in a geriatric patient affected by SARS-CoV-2: complexity of a diagnosis, complexity of a virus

BACKGROUND: Coronavirus disease 2019 (COVID-19) has an important impact on the kidney through direct and indirect damage mechanisms. Most previous studies have highlighted lesions caused by this virus in the early segments of the nephron. However, due to the antigenic characteristics of the virus, with almost ubiquitous receptors, and the molecular release it triggers, the distal segments of the nephron could also be affected. METHODS: A 71 year-old-man with respiratory failure while suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia presented with typical symptoms of diabetes insipidus after ~20 days of hospitalization. The water deprivation test led to the diagnosis of nephrogenic diabetes insipidus. The aetiological study was complex, in particular because of the patient’s previous lithium therapy. RESULTS: The sequence of pathognomonic events typical of diabetes insipidus associated with anamnestic, clinical and laboratory evidence strongly supported the diagnosis of nephrogenic diabetes insipidus due to SARS-CoV-2 rather than other aetiologies. CONCLUSIONS: The collecting duct could represent a target for SARS-CoV-2 infection, directly or indirectly, as a result of lesions of upstream portions of the nephron, which would cascade into the distal segment. Other molecules, besides angiotensin 2 converting enzyme, might be involved in facilitating the viral aggression. The complexity of the geriatric patient shows the importance of a comprehensive approach that integrates careful monitoring of clinical signs and symptoms and laboratory and instrumental tests. This is especially important in the context of SARS-CoV-2 infection and in the management of its unexpected complications

Impact of a natural versus commercial enteral-feeding on the occurrence of diarrhea in critically ill cardiac surgery patients. A retrospective cohort study

Diarrhea is an important complication in critically ill patients undergoing enteral feeding. The occurrence of diarrhea may lead to systemic and local complications and negatively impacts on nursing workload and patient's wellbeing. An enteral feeding based on blenderized natural food could be beneficial in reducing the risk of diarrhea. No study has compared natural and commercial enteral feedings in critically ill cardiac surgery patients

The severity of early fluid overload assessed by bioelectrical vector impedance as an independent risk factor for longer patient care after cardiac surgery

Background and aims: Fluid overload is a common postoperative complication in patients undergoing cardiac surgery. Although this condition is notably associated with relevant adverse outcomes, assessment of hydration status in clinical practice is challenging. Bioelectrical impedance vector analysis (BIVA) has emerged as a potentially effective method to monitor hydration changes, but the available evidence in critically ill patients undergoing cardiac surgery is limited and sometimes conflicting. The aim of this study was to explore by mean of BIVA the evolution over time of hydration status and its impact on relevant outcomes. Methods: Prospective observational study enrolling 130 patients undergoing cardiac surgery. Height normalized impedance was calculated both before surgery (baseline) and in the first five postoperative days. Relevant clinical and laboratory data were collected daily close to BIVA measurements. Length of mechanical ventilation (MV), intensive care unit (ICU) and hospital stay exceeding the 75th percentile of the study population were considered as study endpoints. Results: Compared to baseline, a significant reduction in impedance was found at first postoperative day, demonstrating a relevant fluid overload. An adjusted impedance at first postoperative day shorter than the best respective threshold was associated to longer MV (7.4 times), ICU stay (4.7 times) and hospital stay (5.6 times). A significant change in impedance and phase angle was documented throughout the observation days (p < 0.001), without returning to the baseline value. The co-existence of low impedance and high plasma osmolarity increased significantly the risk of incurring the study outcomes. Conclusions: In patients with cardiac surgery-induced fluid overload, recovery to baseline conditions occurs slowly. A relevant early fluid overload should be considered predictive for longer time of MV, ICU and total hospital stay

Calcium Citrate Versus Calcium Carbonate in the Management of Chronic Hypoparathyroidism: A Randomized, Double-Blind, Crossover Clinical Trial

In hypoparathyroidism (HypoPT), calcium supplementation is virtually always required, although the disease is likely to be associated with an increased risk of nephrolithiasis. The use of calcium citrate (Ca-Cit) theoretically could have a positive impact on the nephrolithiasis risk because citrate salts are used to reduce this risk. Our objective was to evaluate the potential therapeutic advantage of Ca-Cit in comparison with calcium carbonate (CaCO3) in HypoPT, on nephrolithiasis risk factors, as well as to their ability to maintain desirable serum calcium levels. We also evaluated these preparations on quality of life (QOL). This randomized, double-blind, crossover trial recruited 24 adults with postsurgical chronic hypoparathyroidism at Campus Bio-Medico University of Rome. Participants were randomized 1:1 to Ca-Cit or CaCO3 for 1 month and then crossed over to the other treatment for another month. The primary outcomes were changes in albumin-adjusted serum calcium and in ion activity product of calcium oxalate levels (AP[CaOx] index). Secondary efficacy outcomes included changes in SF-36 survey score, fatigue score, constipation, and adverse events. No difference in terms of AP(CaOx) index was observed between the two groups. However, Ca-Cit was associated with a significant reduction in the oxalate/creatinine ratio compared with CaCO3 (-2.46 mmol/mol [SD 11.93] versus 7.42 mmol/mol [SD 17.63], p = 0.029). Serum calcium and phosphorus concentration was not different between the two calcium preparations. Ca-Cit was associated with less constipation (p = 0.047). No difference was found in QOL scores. Although Ca-Cit did not modify the AP(CaOx) index when compared with CaCO3, it was associated with a reduction in urinary oxalate excretion that could have a potential beneficial effect on nephrolithiasis risk. These results are likely to have clinical implications in HypoPT, particularly those who do not tolerate CaCO3 and those affected by nephrolithiasis. A longer-term experience is needed to confirm these findings. (c) 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR)

Neck circumference predicts mortality in hospitalized COVID-19 patients

We aimed to determine whether neck circumference predicts mortality among hospitalized COVID-19 patients with respiratory failure. We performed a prospective multicenter (Italy and Brasil) study carried out from March to December 2020 on 440 hospitalized COVID-19 patients with respiratory failure. Baseline neck circumference was measured. The study outcome was 30-and 60-days mortality. Female and male participants were classified as “large neck” when exceeding fourth-quartile. Patients had a median age of 65 years (IQR 54–76), 68% were male. One-quarter of patients presented with grade-1 or higher obesity. The median neck circumference was 40 cm (IQR 38–43): 38 cm (IQR 36–40) for female and 41 cm (IQR 39–44) for male subjects. “Large neck” patients had a significantly higher prevalence of hypertension (63 vs. 48%), diabetes (33 vs. 19%), obesity (26 vs. 14%), and elevated C-reactive protein (CRP) (98 vs. 88%). The cumulative mortality rate was 13.1% (n = 52) and 15.9% (n = 63) at 30 and 60 days, respectively. After adjusting for age, BMI, relevant comorbidities, and high C-reactive protein to albumin ratio, “large neck” patients showed a significantly increased risk of death at 30-(adjusted HR 2.50; 95% CI 1.18–5.29; p = 0.017) and 60-days (adjusted HR 2.26; 95% CI 1.14–4.46; p = 0.019). Neck circumference is easy to collect and provides additional prognostic information to BMI. Among hospitalized COVID-19 patients with respiratory failure, those with large neck phenotype had a more than double risk of death at 30 and 60 days