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Ferrà C Marcos P Misis M Morgades M Bordejé ML Oriol A Lloveras N Sancho JM Xicoy B Batlle M Klamburg J Feliu E Ribera JM 《International journal of hematology》2007,85(3):195-202
Patients who are admitted to the intensive care unit (ICU) with hematologic malignancies have a poor prognosis, although outcomes
have improved in recent years. This study analyzed ICU mortality, short- and long-term survival, and prognostic factors for
100 consecutive critically ill patients with a hematologic malignancy who were admitted to our polyvalent ICU from January
2000 to May 2006. The median age was 55 years (range, 15-75 years; male-female ratio, 60:40). The main acute life-threatening
diseases precipitating ICU transfer were respiratory failure (45 patients, 45%) and septic shock (33 patients, 33%). Forty-two
patients (42%) were discharged from the ICU.The ICU mortality rate from 2004 to 2006 was lower than from 2000 to 2003 (49%
versus 69%,P < .047).The 1- and 2-year probabilities of survival for patients discharged from the ICU were 67% (95% confidence interval
[CI], 51%-84%) and 54% (95% CI, 34%-73%), respectively. A multivariate analysis revealed hemodynamic instability (odds ratio,
2.11; 95% CI, 1.17-3.83;P = .014) and mechanical ventilation (odds ratio, 4.27; 95% CI, 1.70-10.74;P = .002) to be the main predictors of a poor survival prognosis. Almost half of patients with hematologic malignancy and life-threatening
complications can be discharged from the ICU. Age and underlying disease characteristics do not influence ICU outcome, which
is mainly determined by hemodynamic and ventilatory status. 相似文献
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Insulin-based regimens decrease morbidity and mortality among critically ill patients by way of keeping glucose at tight control. Utilizing these regimens involves multiple measurements of glucose by way of finger pricking or through indwelling vascular catheters in order to adjust insulin doses. The limitations and risks of these methods of glucose monitoring are related to potential erroneous measurements, increased risk of infection, and a significant excess workload. An automated blood glucose monitoring device for glucose monitoring of critically ill patients is needed to improve patient care while avoiding the disadvantages of currently used glucose monitoring methodologies. 相似文献
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Posttraumatic Stress and Complicated Grief in Family Members of Patients in the Intensive Care Unit 下载免费PDF全文
Background Family members of patients in intensive care units (ICUs) are at risk for mental health morbidity both during and after a
patient’s ICU stay.
Objectives To determine prevalences of and factors associated with anxiety, depression, posttraumatic stress and complicated grief in
family members of ICU patients.
Design Prospective, longitudinal cohort study.
Participants Fifty family members of patients in ICUs at a large university hospital participated.
Measurements We used the Control Preferences Scale to determine participants’ role preferences for surrogate decision-making. We used the
Hospital Anxiety and Depression Scale, Impact of Event Scale, and Inventory of Complicated Grief to measure anxiety and depression
(at enrollment, 1 month, 6 months), posttraumatic stress (6 months), and complicated grief (6 months).
Results We interviewed all 50 participants at enrollment, 39 (78%) at 1 month, and 34 (68%) at 6 months. At the three time points,
anxiety was present in 42% (95% CI, 29–56%), 21% (95% CI, 10–35%), and 15% (95% CI, 6–29%) of participants. Depression was
present in 16% (95% CI, 8–28%), 8% (95% CI, 2–19%), and 6% (95% CI, 1–18%). At 6 months, 35% (95% CI, 21–52%) of participants
had posttraumatic stress. Of the 38% who were bereaved, 46% (95% CI, 22–71%) had complicated grief. Posttraumatic stress was
not more common in bereaved than nonbereaved participants, and neither posttraumatic stress nor complicated grief was associated
with decision-making role preference or with anxiety or depression during the patient’s ICU stay.
Conclusions Symptoms of anxiety and depression diminished over time, but both bereaved and nonbereaved participants had high rates of
posttraumatic stress and complicated grief. Family members should be assessed for posttraumatic stress and complicated grief. 相似文献
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Felix Zubia-Olaskoaga Enrique Maraví-Poma Iratxe Urreta-Barallobre María-Rosario Ramírez-Puerta Mónica Mourelo-Fariña María-Pilar Marcos-Neira Miguel Ángel García-García 《Pancreatology》2018,18(2):161-167
Background/objectives
Development and validation of a multivariate prediction model for patients with acute pancreatitis (AP) admitted in Intensive Care Units (ICU).Methods
A prospective multicenter observational study, in 1 year period, in 46 international ICUs (EPAMI study). Patients: adults admitted to an ICU with AP and at least one organ failure. Interventions: Development of a multivariate prediction model, using the worst data of the stay in ICU, based in multivariate analysis, simple imputation in a development cohort. The model was validated in another cohort.Results
374 patients were included (mortality of 28.9%). Variables with statistical significance in multivariate analysis were age, no alcoholic and no biliary etiology, development of shock, development of respiratory failure, need of continuous renal replacement therapy, and intra-abdominal pressure. The model created with these variables presented an AUC of ROC curve of 0.90 (CI 95% 0.81–0.94) in the validation cohort. We developed a multivariable prediction model, and AP cases could be classified as low mortality risk (between 2 and 9.5 points, mortality of 1.35%), moderate mortality risk (between 10 and 12.5 points, 28.92% of mortality), and high mortality risk (13 points of more, mortality of 88.37%). Our model presented better AUC of ROC curve than APACHE II (0.91 vs 0.80) and SOFA in the first 24?h (0.91 vs 0.79).Conclusions
We developed and validated a multivariate prediction model, which can be applied in any moment of the stay in ICU, with better discriminatory power than APACHE II and SOFA in the first 24?h. 相似文献18.
Harris KM Petrovic O Dávila-Román VG Yusen RD Littenberg B Barzilai B 《Echocardiography (Mount Kisco, N.Y.)》1999,16(6):559-565
Since its advent, the use of transesophageal echocardiography (TEE) has grown rapidly. In patients undergoing TEE in the intensive care unit over two time periods (4 years apart), we evaluated whether TEE led to new/unsuspected findings or changes in patient management. Results showed that the indications for which patients underwent TEE changed considerably between the two time periods. Hemodynamic instability was an indication for TEE in 41% of the patients in the first interval and 56% of the patients in the second interval. TEE frequently established a new diagnosis (41%) and led to significant management changes (28%) in both time periods. These changes occurred despite the use of a pulmonary artery catheter in nearly 2/3 of the patients studied. Therefore, despite increasing and changing use, TEE frequently establishes unsuspected diagnosis and directly influences patient management when used in intensive care patients. 相似文献
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目的分析神经重症监护室(NICU)中肺炎克雷伯菌(KP)流行病学特征,为NICU的消毒管理和KP的感染控制提供科学合理的临床指导。方法选取2015—2018年在华北理工大学附属开滦总医院NICU住院的KP感染患者93例。采集KP感染患者KP及其床单位环境KP、NICU病房环境KP,采用脉冲场凝胶电泳(PFGE)技术分析KP间的同源性,进一步探讨KP感染患者与其床单位环境、NICU病房环境的关系。结果93例KP感染患者分离出KP 94株;患者所在床单位环境分离出KP 13株。聚类分析结果显示,KP感染患者与其床单位环境同源性100%的KP 15组,其中KP感染患者KP 24株,床单位环境KP 9株。同源性100%患者入住NICU时间间隔最长为117 d。结论KP是NICU常见致病菌,而空气传播是其主要传播途径,并可在NICU空气中定植4个月左右,且枕头、被子等也可传播KP。 相似文献