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

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

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Cardiopulmonary and analgesics effects of epidural morphine, fentanyl or tramadol in female dog undergoing a ovariohysterectomy

ABSTRACT. Oliveira Neta O.D., Caires L.P., Clark R.M.O, Ferreira M.L., Said R.A., Munhoz A.D. & Tarazi R. [Cardiopulmonary and analgesics effects of epidural morphine, fentanyl or tramadol in female dog undergoing a ovariohysterectomy.] Efeitos cardiorrespiratórios e analgésicos da morfina, fentanil ou tramadol pela via epidural em cadelas submetidas à ovariosalpingohisterectomia. Revista Brasileira de Medicina Veterinária, 36(3):281-288, 2014. Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz, Rodovia Jorge Amado, Km 16, Salobrinho, Ilhéus, BA 45662-900, Brasil. E-mail: [email protected] The objective was to evaluate the cardiorespiratory and analgesic effects provided by epidural morphine, tramadol and fentanyl in female dog submitted to ovariohysterectomy. Eighteen healthy female dogs, aged 3.4±2.2 years old, weithing 31.0±8.0Kg, were premedicated with chlorpromazine (0,5mg/kg), with subsequent propofol (5mg/Kg) anesthetic induction by intravenous route and maintenance with isoflurane anesthesia. The animals were distributed in three groups and received: 1,25mg/kg of lignocaine 2% diluted in 0,26ml/kg of saline solution with0,1 mg/kg of morphine (GM group), 5μg/kg of fentanyl (GF group) or 2mg/kg of tramadol (GT group) epidurally.. Heart rate, arterial blood pressure, respiratory rate, end-tidal carbon dioxide (ETCO2 ), oxyhemoglobin saturation (SpO2 ) and body temperature were evaluated before premedication (M0), 15 minutes after premedication (M1), 10 minutes after epidural opioids administration during maintenance and during postoperative period. Postoperative analgesia was evaluated using the by University of Melbourne pain scale (UMPS) and a simple descriptive scale every hour during six hours (M3 – M8). In M2 time, the arterial blood pressure was significantly lower for all treatments and ETCO2 was higher in GM e GT when compared to GF. Pain scores were lower in GM with a UMPS. In the last three times evaluation (M6, M7 e M8), GF group showed significantly higher pain scores compared to other groups. It can be concluded that epidural morphine, fentanyl or tramadol in female dogs undergoing ovariohysterectomy, produced adequate analgesia with minimal side effects, but analgesia was more effective with epidural morphine than other groups. Hypotension and hypercapnia reported during anesthesia may be a result of isoflurane effects

Avaliação clínica da analgesia pós-operatória proporcionada pelo cetoprofeno associado à morfina pela via intravenosa ou epidural em cadelas submetidas à ovariosalpingohisterectomia

Multimodal analgesia refers to the practice of combining multiple analgesic drug classes or techniques to target different points along the pain pathway. The objective of this work was to evaluate clinically if ketoprofen associated or not with intravenous or epidural morphine provided adequate postoperative analgesia in bitches undergoing ovariosalpingohysterectomy (OSH). Forty healthy female dogs, weighing 10.7±6.0 kg, sedated with acepromazine (0.05mg kg –1.iv), induced with propofol (5 mg.kg-1. iv) and maintained with isoflurane anesthesia, were distributed into four groups of 10 animals each. After stabilization of inhalation anesthesia, the bitches in Miv and CMiv groups received 0.2 mg.kg-1 of morphine intravenously diluted in 10ml of saline; whereas Mep and CMep groups received 0.1mg.kg-1 of epidural morphine. Thirty minutes after premedication, 2.0mg.kg-1.im of ketoprofen was administered in groups CMiv and CMep. Heart and respiratory rate, systolic blood pressure, and rectal temperature were measured. The degree of analgesia was assessed by a blind study in the following 6 hours after surgery, using a descriptive scale and a scale composed by physiologic and behavioral parameters. An statistical analysis was performed using the Tukey-Kramer test and nonparametric Kruskal-Wallis test, with statistical significance of 5%. There was no important difference between the four groups regarding postoperative analgesia, heart and respiratory rate, systolic blood pressure and rectal temperature. According to the results it can be concluded that the use of ketoprofen associated with intravenous or epidural morphine provided adequate and safe analgesia in the first six hours of postoperative in bitches undergoing ovariohysterectomy, suggesting that there was no analgesic potentiation when both agents were combined.A analgesia multimodal refere-se à prática de associar várias classes de analgésicos ou técnicas para atuar em diferentes pontos ao longo da via da dor. Objetivou-se avaliar clinicamente a qualidade da analgesia pós-operatória promovida pelo cetoprofeno, associado ou não à morfina pela via intravenosa ou epidural, em cadelas submetidas à ovariosalpingohisterectomia (OSH). Quarenta cadelas hígidas, pesando 10,7±6,0kg, tranquilizadas com acepromazina (0,05mg.kg-1.iv), induzidas com propofol (5mg. kg-1.iv) e mantidas sob anestesia inalatória com isoflurano, foram distribuídas em quatro grupos de 10 animais cada. Em Miv e CMiv as cadelas receberam após estabilização da anestesia inalatória, 0,2mg. kg-1 de morfina pela via intravenosa, diluídos em 10ml de salina; enquanto que os animais de Mep e CMep receberam 0,1mg.kg-1 de morfina pela via epidural. O cetoprofeno foi administrado na dose 2,0mg.kg-1.im, nos grupos CMiv e CMep, 30 minutos após a medicação pré-anestésica. Mensuraram-se as frequências cardíaca (FC) e respiratória (f), pressão arterial sistólica (PAS), e temperatura retal (T). O grau de analgesia foi avaliado pelo método cego nas primeiras seis horas após a cirurgia, através de escalas de dor descritivas e escalas compostas por parâmetros fisiológicos e comportamentais. A estatística foi realizada mediante teste de Tukey-Kramer e análise não paramétrica de Kruskal-Wallis, com nível de significância de 5%. Não houve diferença estatística entre os quatro grupos estudados, em relação à analgesia pós-operatória, FC, f, PAS e T. De acordo com os resultados obtidos, pode-se concluir que o emprego do cetoprofeno, associado à morfina pela via intravenosa ou epidural proporcionou analgesia adequada e segura nas primeiras seis horas de analgesia pós-operatória em cadelas submetidas à OSH, sugerindo não haver potencialização analgésica quando da associação de ambos os agentes

Inability and neglect in ovarian-salpingohysterectomy of a bitch - Case report

ABSTRACT. Marques L.M., Carlos R.S.A., Silva E.B., Clark R.M.O., Sampaio K.M.O.R. & Harvey T.V. [Inability and neglect in ovarian-salpingohysterectomy of a bitch - Case report.] Imperícia e negligência em ovariosalpingohisterectomia de uma cadela - Relato de caso. Revista Brasileira de Medicina Veterinária, 36(4):425-429, 2014. Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz, Rodovia Jorge Amado, Km 16, Salobrinho, Ilhéus, BA 45662-900 Brasil. E-mail: [email protected] The veterinarian is error-prone in professional performance and is subject to punishment by the Board of Veterinary Medicine, establishing a series of penalties based on the Code of Ethics of the Veterinarian and vary according to the offense committed. Research shows that judicial conflicts involving clinic small animals tend to increase in major centers and in most situations, these conflicts include moral damages. The incompetence, recklessness and negligence are characterized as elements of guilt or the externalization of wrongful conduct and offenses arising from these elements are mainly causal, lack of information and knowledge of the professional offender. The objective of this report is to describe a case of recklessness and malpractice in a female Rotweiller sterilization surgery (ovary-salpingo-hysterectomy) and after a laparotomy performed at the Veterinary Hospital of the Universidade Estadual de Santa Cruz, was found an accidental ureter in a ligature and an abdominal cavity encapsulated foreign body

Induction of short gut syndrome and transplantation in a porcine model

Experimental models in small animals have been described for nutritional studies after small bowel transplantation for extensive resection. Herein, we compared the outcome of transplanted pigs that underwent transplantation after total small bowel resection (SBR) with controls without transplantation. Twenty-one Landrace pigs (mean weight 30 kg) were assigned to 1 of 3 groups: group 1 (n = 6) underwent 80% SBR; group 2 (n = 9), total bowel resection; and group 3 (n = 6) total resection plus small bowel transplantation. Postoperative evaluation included biochemical analyses, weights, and evaluation of clinical status. Conventional endoscopies with graft biopsies were obtained every 4 days to assess rejection. Group 1 showed increased body weight after 3 weeks due to bowel adaptation, whereas groups 2 and 3 lost weight, an observation that correlated with biochemical analyses. Median survival in group 3 was 10 +/- 2 days; all hosts died of sepsis related to severe acute rejection. Short gut syndrome appeared in group 2 but not in group 1, where intestinal adaptation was observed by 4 weeks after the resection. Rejection was confirmed in group 3 using conventional endoscopy plus biopsies and at necropsy. Total bowel resection is an adequate model for short gut syndrome in pigs, rejection can be readily identified by using conventional endoscopy.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP