Electrophysiological abnormalities can differentiate pre-hospital discharge functional status in critically ill patients with normal strength.
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ABSTRACT:
SUBMITTER: Kelmenson DA
PROVIDER: S-EPMC4992460 | biostudies-literature | 2016 Sep
REPOSITORIES: biostudies-literature
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Electrophysiological abnormalities can differentiate pre-hospital discharge functional status in critically ill patients with normal strength.
Kelmenson Daniel A DA Quan Dianna D Nordon-Craft Amy A Malone Daniel D Schenkman Margaret M Moss Marc M
Intensive care medicine 20160622 9
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Project description:[This corrects the article DOI: 10.1371/journal.pone.0211240.].
| S-EPMC6550420 | biostudies-literature
Project description:ObjectivesSurvivors of the PICU face long-term morbidities across health domains. In this study, we detail active PICU follow-up programs (PFUPs) and identify perceptions and barriers about development and maintenance of PFUPs.MethodsA web link to an adaptive survey was distributed through organizational listservs. Descriptive statistics characterized the sample and details of existing PFUPs. Likert responses regarding benefits and barriers were summarized.ResultsOne hundred eleven respondents represented 60 institutions located in the United States (n = 55), Canada (n = 3), Australia (n = 1), and the United Kingdom (n = 1). Details for 17 active programs were provided. Five programs included broad PICU populations, while the majority were neurocritical care (53%) focused. Despite strong agreement on the need to assess and treat morbidity across multiple health domains, 29% were physician only programs, and considerable variation existed in services provided by programs across settings. More than 80% of all respondents agreed PFUPs provide direct benefits and are essential to advancing knowledge on long-term PICU outcomes. Respondents identified "lack of support" as the most important barrier, particularly funding for providers and staff, and lack of clinical space, though successful programs overcome this challenge using a variety of funding resources.ConclusionsFew systematic multidisciplinary PFUPs exist despite strong agreement about importance of this care and direct benefit to patients and families. We recommend stakeholders use our description of successful programs as a framework to develop multidisciplinary models to elevate continuity across inpatient and outpatient settings, improve patient care, and foster collaboration to advance knowledge.
| S-EPMC9182716 | biostudies-literature
Project description:IntroductionOptimal management of critically ill HIV-positive patients during hospitalization and after discharge is not fully understood. This study describes patient characteristics and outcomes of critically ill HIV-positive patients hospitalized in Conakry, Guinea between August 2017 and April 2018 at discharge and 6 months post-discharge.MethodsWe carried out a retrospective observational cohort study using routine clinical data. Analytic statistics were used to describe characteristics and outcomes.Results401 patients were hospitalized during the study period, 230 (57%) were female, median age was 36 (IQR: 28-45). At admission, 229 patients (57%) were on ART, median CD4 was 64 cells/mm3, 166 (41%) had a VL >1000 copies/ml, and 97 (24%) had interrupted treatment. 143 (36%) patients died during hospitalisation. Tuberculosis was the major cause of death for 102 (71%) patients. Of 194 patients that were followed after hospitalization a further 57 (29%) were lost-to-follow-up (LTFU) and 35 (18%) died, 31 (89%) of which had a TB diagnosis. Of all patients who survived a first hospitalisation, 194 (46%) were re-hospitalised at least once more. Amongst those LTFU, 34 (59%) occurred immediately after hospital discharge.ConclusionOutcomes for critically ill HIV-positive patients in our cohort were poor. We estimate that 1-in-3 patients remained alive and in care 6 months after their hospital admission. This study shows the burden of disease on a contemporary cohort of patients with advanced HIV in a low prevalence, resource limited setting and identifies multiple challenges in their care both during hospitalisation as well as during and after re-transitioning to ambulatory care.
| S-EPMC10010544 | biostudies-literature
Project description:ObjectiveRed cell distribution width (RDW) is associated with mortality and bloodstream infection risk in the critically ill. In vascular surgery patients surviving critical care it is not known if RDW can predict subsequent risk of all-cause mortality following hospital discharge. We hypothesized that an increase in RDW at hospital discharge in vascular surgery patients who received critical care would be associated with increased mortality following hospital discharge.Design, setting, and participantsWe performed a two-center observational cohort study of critically ill non-cardiac vascular surgery patients surviving admission 18 years or older treated between November, 1997, and December 2012 in Boston, Massachusetts.ExposuresRDW measured within 24 hours of hospital discharge and categorized a priori as ≤13.3%, 13.3-14.0%, 14.0-14.7%, 14.7-15.8%, >15.8%.Main outcomes and measuresThe primary outcome was all cause mortality in the 90 days following hospital discharge.ResultsThe cohort included 4,715 patients (male 58%; white 83%; mean age 62.9 years). 90 and 365-day post discharge mortality was 7.5% and 14.4% respectively. In the cohort, 47.3% were discharged to a care facility and 14.8% of patients were readmitted within 30 days. After adjustment for age, gender, race, Deyo-Charlson comorbidity Index, patient type, acute organ failures, prior vascular surgery and vascular surgery category, patients with a discharge RDW 14.7-15.8% or >15.8% have an adjusted OR of 90-day post discharge mortality of 2.52 (95%CI, 1.29-4.90; P = 0.007) or 5.13 (95%CI, 2.70-9.75; P <0.001) relative to patients with a discharge RDW ≤13.3%. The adjusted odds of 30-day readmission in the RDW >15.8% group was 1.52 (95%CI, 1.12-2.07; P = 0.007) relative to patients with a discharge RDW ≤13.3%. Similar adjusted discharge RDW-outcome associations are present at 365 days following hospital discharge and for discharge to a care facility.ConclusionsIn critically ill vascular surgery patients who survive hospitalization, an elevated RDW at hospital discharge is a strong predictor of subsequent mortality, hospital readmission and placement in a care facility. Patients with elevated RDW are at high risk for adverse out of hospital outcomes and may benefit from closer post discharge follow-up and higher intensity rehabilitation.
| S-EPMC6124728 | biostudies-literature
Project description:ObjectivesTo analyze functional recovery groups of critically ill COVID-19 survivors during their hospital stay and to identify the associated factors.DesignProspective observational multicenter study.SettingDemographic, clinical, and therapeutic variables were collected, and physical and functional status were evaluated. The Barthel index was evaluated at three time points: 15 days before hospitalization, at ICU discharge, and at hospital discharge from the ward.PatientsPatients with functional independence before COVID-19 diagnosis were recruited from four hospitals and followed up until hospital discharge.Measurements and main resultsThree groups of functional recovery were described for 328 patients: functional independence ( n = 144; 44%), which included patients who preserved their functional status during hospitalization; recovered functionality ( n = 109; 33.2%), which included patients who showed dependence at ICU discharge but recovered their independence by hospital discharge; and functional dependency ( n = 75; 22.8%), which included patients who were dependent at ICU discharge and had not recovered their functional status at hospital discharge. The factors associated with becoming functionally dependent at ICU discharge were time to out-of-bed patient mobilization (odds ratio [OR], 1.20; 95% CI, 1.11-1.29), age (OR, 1.02; 95% CI, 1.01-1.04), hyperglycemia (OR, 2.52; 95% CI, 1.56-4.07), and Simplified Acute Physiology Score (OR, 1.022; 95% CI, 1.01-1.04). Recovery to baseline independence during ward stays was associated with ICU length of stay (OR, 0.97; 95% CI, 0.94-0.99) and muscle strength (Medical Research Council test) at ICU discharge (OR, 1.13; 95% CI, 1.08-1.18).ConclusionsAge, hyperglycemia, and time for patient mobilization out of bed were independent factors associated with becoming physically dependent after their ICU stay. Recovery of physical function at hospital discharge was associated with muscle strength at ICU discharge and length of ICU stay.
| S-EPMC9668359 | biostudies-literature
Project description:Prior research has indicated that adopting strict glycemic control measures might elevate the risk of hypoglycemia and result in higher mortality rates among critically ill patients. However, there is a lack of studies investigating the incidence of hypoglycemia and its consequential outcomes in real-world clinical settings. This retrospective cohort study was conducted at Taichung Veterans General Hospital, utilizing critical care databases covering the period from 2015 to 2020. The objective was to examine the outcomes and identify risk factors associated with hypoglycemia in critically ill patients. Out of the total of 16,699 patients admitted to the intensive care units (ICUs), 2,115(12.7%) experienced at least one episode of hypoglycemia were included in the analysis. Critically ill patients who developed hypoglycemia had a significantly higher hospital mortality rate compared to those who did not experience hypoglycemia. (48.9% vs. 15.9%, p < 0.001). Moreover, patients with more severe hypoglycemia exhibited a higher mortality rate (moderate hypoglycemia: hazard ratio [HR] 1.477, 95% confidence interval [C.I.] 1.351-1.614, p < 0.001; severe hypoglycemia: HR 1.847, 95% C.I. 1.607-2.123, p < 0.001) compared to those without hypoglycemia. Additionally, patients with greater frequency of hypoglycemic episodes also showed a higher mortality rate (one episode HR 1.504, 95% C.I. 1.366-1.657, p < 0.001; multiple episodes HR 1.613, 95% C.I. 1.444-1.801, p < 0.001) compared to those without hypoglycemia. Patient who experienced spontaneous hypoglycemia (53.9% vs. 42.4%, p < 0.001) and those without a prior diagnosis of diabetes (60.2% vs. 37.0%, p < 0.001) had higher mortality rate. Hypoglycemia frequently occurs and serves as an independent risk factor for mortality among critically ill individuals, particularly in cases of severe and recurrent episodes. Patients experiencing spontaneous hypoglycemia, as well as those lacking a diabetes diagnosis, demonstrated elevated mortality rates.
| S-EPMC11751111 | biostudies-literature
Project description:Chimeric antigen receptor (CAR) T-cells directed against CD19 have drastically altered outcomes for children with relapsed and refractory acute lymphoblastic leukemia (r/r ALL). Pediatric patients with r/r ALL treated with CAR-T are at increased risk of both cytokine release syndrome (CRS) and sepsis. We sought to investigate the biologic differences between CRS and sepsis and to develop predictive models which could accurately differentiate CRS from sepsis at the time of critical illness. We identified 23 different cytokines that were significantly different between patients with sepsis and CRS. Using elastic net prediction modeling and tree classification, we identified cytokines that were able to classify subjects as having CRS or sepsis accurately. A markedly elevated interferon γ (IFNγ) or a mildly elevated IFNγ in combination with a low IL1β were associated with CRS. A normal to mildly elevated IFNγ in combination with an elevated IL1β was associated with sepsis. This combination of IFNγ and IL1β was able to categorize subjects as having CRS or sepsis with 97% accuracy. As CAR-T therapies become more common, these data provide important novel information to better manage potential associated toxicities.
| S-EPMC7594400 | biostudies-literature
Project description:Diagnosing pediatric intensive care unit-acquired weakness (PICU-AW) is challenging. The Medical Research Council (MRC) score is a widely used screening method for muscle weakness in critically ill adults; however, its utility in critically ill children has not been established. Our objective was to determine the feasibility and interobserver reliability of muscle strength testing using MRC score in critically ill children. A prospective observational substudy of critically ill children aged 1 to 17 years and limited to bed rest during the first 48 hours of PICU admission was evaluated with weekly MRC exams independently performed by two clinical raters. MRC exams were attempted on all 33 participants, but could be completed in only 21 (64%), 9 of who (43%) received at least one exam while in the PICU, and in the remaining 12 (57%), MRC exams could only be completed after PICU discharge. Of the 95 attempted MRC exams, 55 (57%) could not be conducted or completed, most commonly due to patient sedation, and inability to comply due to cognitive ability, pain, or noncooperation. The inter-rater reliability for MRC sum score was excellent (intraclass correlation coefficient: 0.87). However, the inter-rater reliability was only moderate when used to determine PICU-AW (Cohen kappa: 0.48). MRC testing in the PICU was not feasible as an early screening tool for muscle weakness in the majority of critically ill children in this study. Further research is needed to find an appropriate screening tool that is both feasible and predicts clinically relevant outcomes in children, such as function and recovery following critical illness.
| S-EPMC6513132 | biostudies-literature
Project description:The efficacy and safety of normal saline (NS) for fluid therapy in critically ill patients remain controversy. In this review, we summarized the evidence of randomized controlled trials (RCTs) which compared NS with other solutions in critically ill patients. The results showed that when compared with 6% hydroxyethyl starch (HES), NS may reduce the onset of acute kidney injury (AKI). However, there is no significant different in mortality and incidence of AKI when compared with 10% HES, albumin and buffered crystalloid solution. Therefore, it is important to prescribe intravenous fluid for patients according to their individual condition.
| S-EPMC6114124 | biostudies-literature
Project description:ObjectivesPost-intensive care syndrome (PICS) is a recognised sequela after critical care. The development of an index that predicts PICS mental disorders will be of significance for the selection of subsequent interventions. The purpose of this study was to find factors associated with PICS mental disorders. We hypothesised that grip strength during hospitalisation may be associated with the PICS mental status after discharge.DesignA post-hoc analysis of a multicentre prospective observational study.SettingNine hospitals in Japan.ParticipantsPatients who were newly admitted to intensive care unit and stayed for at least 48 hours were included. Exclusion criteria were patients younger than 18 years, those who required assistance with ambulation prior to admission, those with concomitant central nervous system disorders and those with terminal conditions.Primary and secondary outcome measuresPsychiatric symptoms 3 months after discharge were assessed using the Hospital Anxiety and Depression Scale (HADS). The HADS total score (HADS-total) was assigned as the primary outcome.Results98 patients were included into this study. Grip strength at discharge negatively correlated with HADS-total 3 months after discharge (r=-0.37, p<0.001, 95% CI -0.53 to -0.18). A multivariate analysis showed that grip strength was associated with anxiety (p=0.025, 95% CI -0.21 to -0.015). Area under the curve for HADS anxiety score with grip strength at discharge was higher than that with Medical Research Council scores and the Barthel Index (0.71, 0.60, 0.61).ConclusionsGrip strength at discharge correlated with mental disorders 3 months after discharge. Therefore, it may be useful for predicting postdischarge mental disorders.Trial registration numberUMIN000036503.
| S-EPMC10163493 | biostudies-literature