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1.
Jesús López-Herce Jimena del Castillo Martha Matamoros Sonia Cañadas Ana Rodriguez-Calvo Corrado Cecchetti Antonio Rodriguez-Núñez Angel Carrillo Álvarez 《Intensive care medicine》2013,39(2):309-318
Purpose
To analyze prognostic factors associated with in-hospital cardiac arrest (CA) in children.Methods
A prospective, multicenter, multinational, observational study was performed on pediatric in-hospital CA in 12 countries and included 502 children between 1 month and 18 years. The primary endpoint was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality.Results
Return of spontaneous circulation was achieved in 69.5 % of patients; 39.2 % survived to hospital discharge and 88.9 % of survivors had good neurological outcome. The pre-arrest factors related to mortality were lower Human Development Index [odds ratio (OR) 2.32, 95 % confidence interval (CI) 1.28–4.21], oncohematologic disease (OR 3.33, 95 % CI 1.60–6.98), and treatment with inotropic drugs at the time of CA (OR 2.35, 95 % CI 1.55–3.56). CA and resuscitation factors related to mortality were CA due to neurological disease (OR 5.19, 95 % CI 1.49–18.73) and duration of cardiopulmonary resuscitation greater than 10 min (OR 4.00, 95 % CI 1.49–18.73). Factors related to survival were CA occurring in the pediatric intensive care unit (PICU) (OR 0.38, 95 % CI 0.16–0.86) and shockable rhythm (OR 0.26, 95 % CI 0.09–0.73).Conclusions
In-hospital CA in children has a low survival but most of the survivors have a good neurological outcome. Some prognostic risk factors cannot be modified, making it important to focus efforts on improving hospital organization to care for children at risk of CA in the PICU and, in particular, in other hospital areas. 相似文献2.
Stephan Staubach Ralph Hein-Rothweiler Matthias Hochadel Manuela Segerer Ralf Zahn Jens Jung Gotthard Rieß Hubert Seggewiß Andre Schneider Thomas Fürste Christian Gottkehaskamp Harald Mudra 《Clinical research in cardiology》2014,103(5):345-351
Background
Patient outcome, quality of life as well as health care costs differ between patients with minor versus major stroke during carotid artery stenting. Evaluation of predictors for both subtypes of strokes is of paramount importance.Methods and results
We analyzed data from the prospective, web-based German carotid artery stenting (CAS) registry. All patients entered in this registry were included as of January 2011. During the periprocedural period (until patient discharge or transfer) 1.5 % of the patients (85/5,794) sustained a major and 1.3 % (75/5,784) a minor stroke (total periprocedural stroke rate 2.8 %). Mean age of all patients was 71 years, 72 % were male and 50 % had a symptomatic carotid stenosis. Regression analysis identified age (OR 1.44; 95 % CI 1.05–1.98), symptomatic stenosis (OR 3.17; 95 % CI 1.74–5.76) and procedural duration per 10 min (OR 1.22; 95 % CI 1.13–1.31) as independent predictors for major strokes. Age (OR 1.43; 95 % CI 1.03–1.98), diabetes (OR 1.75; 95 % CI 1.04–2.94), and procedural duration (OR 1.17; 95 % CI 1.08–1.27) predicted for minor strokes. The use of an embolic protection device significantly prevented both type of strokes (OR 0.31; 95?% CI 0.15–0.62 for major strokes; OR 0.40; 95?% CI 0.18–0.91 for minor strokes), female patients suffered less major strokes (OR 0.47; 95?% CI 0.24–0.92). Moreover, minor and major strokes were associated with death, contralateral embolism and a longer hospital stay more frequently.Conclusion
Patients with one or more risk factors for periprocedural stroke seem to require special attention in terms of optimal preprocedural assessment of the carotid stenosis and vascular anatomy, as well as adequate patient preparation. Identifying these risk factors may help in patient selection, encourage further refinement in carotid artery stenting technique and avoid procedural complications. The use of an embolic protection device system was associated with less periprocedural minor and major strokes. 相似文献3.
Ali Al-Alwan William J. Ehlenbach Prema R. Menon Michael P. Young Renee D. Stapleton 《Intensive care medicine》2014,40(4):556-563
Purpose
To evaluate the outcomes, including long-term survival, after cardiopulmonary resuscitation (CPR) in mechanically ventilated patients.Methods
We analyzed Medicare data from 1994 to 2005 to identify beneficiaries who underwent in-hospital CPR. We then identified a subgroup receiving CPR one or more days after mechanical ventilation was initiated [defined by ICD-9 procedure code for intubation (96.04) or mechanical ventilation (96.7x) one or more days prior to procedure code for CPR (99.60 or 99.63)].Results
We identified 471,962 patients who received in-hospital CPR with an overall survival to hospital discharge of 18.4 % [95 % confidence interval (CI) 18.3–18.5 %]. Of those, 42,163 received CPR one or more days after mechanical ventilation initiation. Survival to hospital discharge after CPR in ventilated patients was 10.1 % (95 % CI 9.8–10.4 %), compared to 19.2 % (95 % CI 19.1–19.3 %) in non-ventilated patients (p < 0.001). Among this group, older age, race other than white, higher burden of chronic illness, and admission from a nursing facility were associated with decreased survival in multivariable analyses. Among all CPR recipients, those who were ventilated had 52 % lower odds of survival (OR 0.48, 95 % CI 0.46–0.49, p < 0.001). Median long-term survival in ventilated patients receiving CPR who survived to hospital discharge was 6.0 months (95 % CI 5.3–6.8 months), compared to 19.0 months (95 % CI 18.6–19.5 months) among the non-ventilated survivors (p < 0.001 by logrank test). Of all patients receiving CPR while ventilated, only 4.1 % were alive at 1 year.Conclusions
Survival after in-hospital CPR is decreased among ventilated patients compared to those who are not ventilated. This information is important for clinicians, patients, and family members when discussing CPR in critically ill patients. 相似文献4.
Marc Pineton de Chambrun Nicolas Bréchot Guillaume Lebreton Matthieu Schmidt Guillaume Hekimian Pierre Demondion Jean-Louis Trouillet Pascal Leprince Jean Chastre Alain Combes Charles-Edouard Luyt 《Intensive care medicine》2016,42(12):1999-2007
Purpose
To describe the characteristics, outcomes, and risk factors associated with poor outcome of venoarterial extracorporeal membrane oxygenation (VA-ECMO)-treated patients with refractory shock post-cardiac arrest.Methods
We retrospectively analyzed data collected prospectively (March 2007–January 2015) in a 26-bed tertiary hospital intensive care unit. All patients implanted with VA-ECMO for refractory cardiogenic shock after successful resuscitation from cardiac arrest were included. Refractory cardiac arrest patients, given VA-ECMO under cardiopulmonary resuscitation, were excluded.Results
Ninety-four patients received VA-ECMO for refractory shock post-cardiac arrest. Their hospital and 12-month survival rates were 28 and 27 %, respectively. All 1-year survivors were cerebral performance category 1. Multivariable analysis retained INR >2.4 (OR 4.9; 95 % CI 1.4–17.2), admission SOFA score >14 (OR 5.3; 95 % CI 1.7–16.5), and shockable rhythm (OR 0.3; 95 % CI 0.1–0.9) as independent predictors of hospital mortality, but not SAPS II, out-of-hospital cardiac arrest score, or other cardiac arrest variables. Only 10 % of patients with an admission SOFA score >14 survived, whereas 50 % of those with scores ≤14 were alive at 1 year. Restricting the analysis to the 67 patients with out-of-hospital cardiac arrest of coronary cause yielded similar results.Conclusion
Among 94 patients implanted with VA-ECMO for refractory cardiogenic shock post-cardiac arrest resuscitation, the 24 (27 %) 1-year survivors had good neurological outcomes, but survival was significantly better for patients with admission SOFA scores <14, shockable rhythm, and INR ≤2.4. VA-ECMO might be considered a rescue therapy for patients with refractory cardiogenic shock post-cardiac arrest resuscitation.5.
Angelo Polito Cindy S. Barrett David Wypij Peter T. Rycus Roberta Netto Paola E. Cogo Ravi R. Thiagarajan 《Intensive care medicine》2013,39(9):1594-1601
Background
Neurologic complications in neonates supported with extracorporeal membrane oxygenation (ECMO) are common and diminish their quality of life and survival. An understanding of factors associated with neurologic complications in neonatal ECMO is lacking. The goals of this study were to describe the epidemiology and factors associated with neurologic complications in neonatal ECMO.Patients and methods
Retrospective cohort study of neonates (age ≤30 days) supported with ECMO using data reported to the Extracorporeal Life Support Organization during 2005–2010.Results
Of 7,190 neonates supported with ECMO, 1,412 (20 %) had neurologic complications. Birth weight <3 kg [odds ratio (OR): 1.3; 95 % confidence intervals (CI): 1.1–1.5], gestational age (<34 weeks; OR 1.5, 95 % CI 1.1–2.0 and 34–36 weeks: OR 1.4, 95 % CI 1.1–1.7), need for cardiopulmonary resuscitation prior to ECMO (OR 1.7, 95 % CI 1.5–2.0), pre-ECMO blood pH ≤ 7.11 (OR 1.7, 95 % CI 1.4–2.1), pre-ECMO bicarbonate use (OR 1.3, 95 % CI 1.2–1.5), prior ECMO exposure (OR 2.4, 95 % CI 1.6–2.6), and use of veno-arterial ECMO (OR 1.7, 95 % CI 1.4–2.0) increased neurologic complications. Mortality was higher in patients with neurologic complications compared to those without (62 % vs. 36 %; p < 0.001).Conclusions
Neurologic complications are common in neonatal ECMO and are associated with increased mortality. Patient factors, pre-ECMO severity of illness, and use of veno-arterial ECMO are associated with increased neurologic complications. Patient selection, early ECMO deployment, and refining ECMO management strategies for vulnerable populations could be targeted as areas for improvement in neonatal ECMO. 相似文献6.
Sophie Buyse Luis Teixeira Lionel Galicier Eric Mariotte Virginie Lemiale Amélie Seguin Philippe Bertheau Emmanuel Canet Adrienne de Labarthe Michaël Darmon Michel Rybojad Benoit Schlemmer Elie Azoulay 《Intensive care medicine》2010,36(10):1695-1702
Objective
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition associated with multiple organ dysfunction. We sought to describe ICU management and outcomes in HLH patients meeting HLH-2004 criteria and to identify determinants of mortality.Design
Retrospective study between January 1998 and January 2009.Setting
Medical ICU of a teaching hospital.Patients
Among the 72 patients fulfilling the HLH-2004 criteria, we report the 56 patients with complete follow-up and no missing data.Interventions
None.Measurements and main results
Clinical and laboratory data were abstracted from the medical records. Median SOFA score at admission was 6.5 (IQR, 4–8). At ICU admission, the number of HLH-2004 criteria was 6 (5–7). Sixty-six precipitating factors were found in 52 patients and consisted of 43 tumoral causes (8 Castleman’s diseases, 18 B cell lymphoma and 17 various malignancies), 13 non-viral infections and 10 viral infections. Underlying immune deficiency was present in 38 (67.8%) patients. Etoposide was used in 45 patients, corticosteroids in 31 and intravenous immunoglobulins in 3. Mechanical ventilation was required in 32 patients, vasoactive agents in 30 and renal replacement therapy in 19. Hospital mortality was 29/56 patients. By multivariate analysis, factors associated with increased hospital death were shock at ICU admission [OR, 4.33; 95% confidence interval (95% CI), 1.11–16.90; P = 0.03] and platelet count <30 g/l (OR, 4.75; 95% CI, 1.20–18.81; P = 0.02). B cell lymphoma [odds ratio (OR), 0.17; 95% CI, 0.04–0.80; P = 0.02] and Castleman’s disease (OR, 0.11; 95% CI, 0.02–0.90; P = 0.04) were associated with increased hospital survival.Conclusions
Aggressive supportive care combined with specific treatment of the precipitating factor can produce meaningful survival in patients with HLH responsible for multiple organ failures. Survival is highest in patients with HLH related to Castleman’s disease or B cell lymphoma. 相似文献7.
David Konrad Gabriella Jäderling Max Bell Fredrik Granath Anders Ekbom Claes-Roland Martling 《Intensive care medicine》2010,36(1):100-106
Purpose
To prospectively evaluate the implementation of a rapid response team in the form of a medical emergency team (MET) with regard to cardiac arrests and hospital mortality.Methods
Prospective before-and-after trial of implementation of a MET at the Karolinska University Hospital, Stockholm, Sweden. All adult patients, apart from cardiothoracic, admitted to the hospital were regarded as participants in the study. A control period of 5 years and 203,892 patients preceded the 2-year intervention period of 73,825 patients.Main results
Number of MET calls was 9.3 per 1,000 hospital admissions. Cardiac arrests per 1,000 admissions decreased from 1.12 to 0.83, OR 0.74 (95% CI 0.55–0.98, p = 0.035). Adjusted for age, sex, hospital length of stay, acute/elective admission as well as co-morbidities, MET implementation was associated with a reduction in total hospital mortality by 10%, OR 0.90 (95% CI 0.84–0.97), p = 0.003. Hospital mortality was also reduced for medical patients by 12%, OR 0.88 (95% CI 0.81–0.96, p = 0.002) and for surgical patients not operated upon by 28%, OR 0.72 (95% CI 0.56–0.92, p = 0.008).For patients fulfilling the MET criteria
Thirty-day mortality pre-MET was 25% versus 7.9% following MET compared with historical controls. Similarly, 180-day mortality was 37.5% versus 15.8%, respectively.Conclusions
Implementing the MET team was associated with significant improvement in both cardiac arrest rate and overall adjusted hospital mortality. Significant reductions in hospital mortality for un-operated surgical patients as well as for medical patients were also seen. Thus, introduction of the MET seemed to improve outcome for hospitalized patients. 相似文献8.
Ute Amann Inge Kirchberger Margit Heier Hildegard Golüke Wolfgang von Scheidt Bernhard Kuch Annette Peters Christa Meisinger 《Clinical research in cardiology》2014,103(8):655-664
Background
Use of the four evidence-based medications [EBMs: antiplatelet agent, beta-blocker, statin and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB)] after acute myocardial infarction (AMI) has a clear impact on 1-year survival. Aim of this study was to evaluate the association between different EBM combinations at discharge and long-term survival after AMI.Methods
From a German population-based AMI registry, 2,886 men and 958 women were included, aged 28–74 years, hospitalized with an incident AMI between 2000 and 2008. All data were collected by standardized interviews and chart review. All-cause mortality was assessed for all registered persons in 2010. Median follow-up time was 6.0 years (interquartile range 4.1 years). Survival analyses and multivariate Cox regression analysis were conducted.Results
Of the 3,844 patients, 70.3 % were prescribed all four EBMs; 23.8 % received three, 4.6 % two, and 1.3 % were discharged with one or no EBM. Long-term survival was 71.7 % [95 % confidence interval (CI) 55.4–82.9 %], 64.7 % (95 % CI 59.2–69.6 %) and 60.2 % (95 % CI 51.9–67.5 %) in patients with four, three and <3 EBMs, respectively. Patients prescribed three or less EBMs without ACEI/ARB showed similar long-term survival to those receiving four EBMs. In Cox regression analysis after adjustment for confounding variables, the hazard ratio for long-term mortality in patients with four EBMs versus three or less EBMs was 0.63 (95 % CI 0.53–0.74).Conclusions
Prescribing of a combination of all four EBMs appeared to improve clinical outcomes in AMI patients by significantly reducing long-term mortality. Hospital discharge is a critical time for optimal long-term management. 相似文献9.
Spyridon Liosis Timm Bauer Rudolf Schiele Helmut Gohlke Martin Gottwik Hugo Katus Georg Sabin Ralf Zahn Steffen Schneider Bernhard Rauch Jochen Senges Uwe Zeymer 《Clinical research in cardiology》2013,102(9):671-677
Background
Predictors of long-term mortality after discharge after acute myocardial infarction (AMI) are well characterized. However, these established risk factors are based on data almost exclusively derived from older studies without consistent use of revascularization therapy and adjunctive therapy with statins, platelet inhibitors, beta-blockers and ACE inhibitors/ARBs. We therefore sought to investigate predictors of 1-year mortality in survivors of AMI treated with contemporary guideline-adherent therapy.Methods and results
We performed a retrospective analysis of 3,782 patients surviving acute ST-elevation and non ST-elevation myocardial infarction who were enrolled in the prospective, randomized, double-blind, controlled OMEGA trial with 104 German centers. The primary objective of the OMEGA study was to determine the effect of highly purified omega-3 fatty acid ethyl esters-90 on the rate of sudden cardiac death in patients surviving AMI and receiving current guideline-adherent treatment within the 1-year of follow-up. 80.8 % of the patients received early revascularization therapy. At discharge, 94.2 % of the patients received beta-blocker, 90.4 % ACE inhibitor/angiotensin receptor blocker, 94.3 % statin, 95.4 % aspirin and 88.4 % clopidogrel. During the 1-year follow-up 139 patients (3.7 %) died. Multivariate logistic regression analysis revealed the following independent predictors of 1-year mortality in decreasing order of importance: ejection fraction <45 % [odds ratio (OR) 2.28, 95 % confidence interval (CI) 1.53–3.41], age ≥70 years (OR 2.17, 95 % CI 1.42–3.32), no acute revascularization (OR 2.02, 95 % CI 1.33–3.08), prior stroke/transient ischemic attack (OR 1.90, 95 % CI 1.09–3.30), peripheral arterial disease (OR 1.86, 95 % CI 1.12–3.10), heart rate >85/min (OR 1.82, 95 % CI 1.23–2.71), chronic obstructive lung disease (OR 1.77, 95 % CI 1.01–3.10) and HDL cholesterol <40 mg/dl (OR 1.75, 95 % CI 1.15–2.67).Conclusions
In patients surviving AMI and treated with contemporary guideline-adherent therapy, 1-year mortality was low. Nevertheless, traditional risk factors such as ejection fraction <45 %, older age, no acute revascularization and comorbidities were the strongest predictors of long-term mortality supporting the findings from previous studies. 相似文献10.
Conversion to shockable rhythms during resuscitation and survival for out-of hospital cardiac arrest
Win Wah Khin Lay Wai Pin Pin Pek Andrew Fu Wah Ho Omer Alsakaf Michael Yih Chong Chia Julina Md Noor Kentaro Kajino Nurun Nisa Amatullah De Souza Marcus Eng Hock Ong 《The American journal of emergency medicine》2017,35(2):206-213
Background
In out of hospital cardiac arrest (OHCA), the prognostic influence of conversion to shockable rhythms during resuscitation for initially non-shockable rhythms remains unknown. This study aimed to assess the relationship between initial and subsequent shockable rhythm and post-arrest survival and neurological outcomes after OHCA.Methodology
This was a retrospective analysis of all OHCA cases collected from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry in 7 countries in Asia between 2009 and 2012. We included OHCA cases of presumed cardiac etiology, aged 18-years and above and resuscitation attempted by EMS. We performed multivariate logistic regression analyses to assess the relationship between initial and subsequent shockable rhythm and survival and neurological outcomes. 2-stage seemingly unrelated bivariate probit models were developed to jointly model the survival and neurological outcomes. We adjusted for the clustering effects of country variance in all models.Results
40,160 OHCA cases met the inclusion criteria. There were 5356 OHCA cases (13.3%) with initial shockable rhythm and 33,974 (84.7%) with initial non-shockable rhythm. After adjustment of baseline and prehospital characteristics, OHCA with initial shockable rhythm (odds ratio/OR = 6.10, 95% confidence interval/CI = 5.06–7.34) and subsequent conversion to shockable rhythm (OR = 2.00,95%CI = 1.10–3.65) independently predicted better survival-to-hospital-discharge outcomes. Subsequent shockable rhythm conversion significantly improved survival-to-admission, discharge and post-arrest overall and cerebral performance outcomes in the multivariate logistic regression and 2-stage analyses.Conclusion
Initial shockable rhythm was the strongest predictor for survival. However, conversion to subsequent shockable rhythm significantly improved post-arrest survival and neurological outcomes. This study suggests the importance of early resuscitation efforts even for initially non-shockable rhythms which has prognostic implications and selection of subsequent post-resuscitation therapy. 相似文献11.
Efficacy and Safety of Certolizumab Pegol for Crohn’s Disease: A Systematic Review and Meta-Analysis
Introduction
The authors performed a systematic review and meta-analysis of data from randomized controlled trials (RCTs) to evaluate the efficacy and safety of certolizumab pegol.Methods
The authors searched PubMed, MEDLINE via Medscape, BioMed Central, Google Scholar, China National Knowledge Infrastructure (CNKI), the Cochrane library, and the Directory of Open Access Journals. The outcomes of interest were response and remission rates and the treatment-related toxicity rate.Results
A total of five RCTs, involving 1,891 participants, were included. The meta-analysis revealed that certolizumab significantly increased the overall (induction + maintenance therapy) response [odds ratio (OR) 1.565, 95% CI 1.056–2.321, P = 0.026] and remission rates (OR 1.626, 95% CI 1.297–2.038, P < 0.001) compared with placebo. Certolizumab significantly increased the response and remission rates when given as maintenance therapy (OR 2.171, 95% CI 1.644–2.866, P < 0.001 and OR 1.888, 95% CI 1.390–2.565, P < 0.001), but not as induction therapy (OR 1.234, 95% CI 0.912–1.671, P = 0.173 and OR 1.361, 95% CI 0.974–1.901, P = 0.071). Certolizumab (induction + maintenance therapy) did not significantly increase the treatment-related toxicity rate compared with placebo (OR 0.985, 95% CI 0.799–1.214, P = 0.887).Conclusion
Certolizumab may be an efficacious treatment for Crohn’s disease as maintenance therapy and appears to have a favorable safety profile. 相似文献12.
Purpose
Percutaneous transhepatic biliary drainage (PTBD) is performed for the palliation of malignant biliary obstructions. The purpose of this study was to identify factors related to the occurrence of immediate cholangitis as a complication after PTBDMethods
We retrospectively assessed 409 apparently stable patients with malignant biliary obstruction who underwent PTBD between January 2008 and December 2010. New onset cholangitis was defined as fever (>38 °C) that arose within 24 h after the intervention. Variables significantly associated with the occurrence of immediate cholangitis were selected and their odds ratio and 95 % confidence interval were calculated using logistic regression analysis.Results
There were 106 (25.9 %) cases of immediate cholangitis following PTBD, and among those 106 cases, 45 (42.5 %) had sepsis. In multivariate analysis, history of cholangitis (OR 4.7, 95 % CI 2.45–9.18), biliary drainage within 6 months (OR 2.3, 95 % CI 1.26–4.15), CRP ≥5 mg/dL (OR 2.2, 95 % CI 1.23–4.03), and serum albumin <3 g/dL (OR 1.9, 95 % CI 1.023–3.40) were predictive of immediate cholangitis after PTBD for malignant biliary obstructions.Conclusions
Cholangitis is a common immediate complication after PTBD. Patients should always be given prophylactic antibiotics before the drainage procedures. The results of this study could highlight the patients who require closer follow-up in order to make PTBD a safer procedure. 相似文献13.
Maarten van Vliet Ilona W. M. Verburg Mark van den Boogaard Nicolette F. de Keizer Niels Peek Nicole M. A. Blijlevens Peter Pickkers 《Intensive care medicine》2014,40(9):1275-1284
Purpose
To explore trends over time in admission prevalence and (risk-adjusted) mortality of critically ill haematological patients and compare these trends to those of several subgroups of patients admitted to the medical intensive care unit (medical ICU patients).Methods
A total of 1,741 haematological and 60,954 non-haematological patients admitted to the medical ICU were analysed. Trends over time and differences between two subgroups of haematological medical ICU patients and four subgroups of non-haematological medical ICU patients were assessed, as well as the influence of leukocytopenia.Results
The proportion of haematological patients among all medical ICU patients increased over time [odds ratio (OR) 1.06; 95 % confidence interval (CI) 1.03–1.10 per year; p < 0.001]. Risk-adjusted mortality was significantly higher for haematological patients admitted to the ICU with white blood cell (WBC) counts of <1.0 × 109/L (47 %; 95 % CI 41–54 %) and ≥1.0 × 109/L (45 %; 95 % CI 42–49 %), respectively, than for patients admitted with chronic heart failure (27 %; 95 % CI 26–28 %) and with chronic liver cirrhosis (38 %; 95 % CI 35–42 %), but was not significantly different from patients admitted with solid tumours (40 %; 95 % CI 36–45 %). Over the years, the risk-adjusted hospital mortality rate significantly decreased in both the haematological and non-haematological group with an OR of 0.93 (95 % CI 0.92–0.95) per year. After correction for case-mix using the APACHE-II score (with WBC omitted), a WBC <1.0 × 109/L was not a predictor of mortality in haematological patients (OR 0.86; 95 % CI 0.46–1.64; p = 0.65). We found no case–volume effect on mortality for haematological ICU patients.Conclusions
An increasing number of haematological patients are being admitted to Dutch ICUs. While mortality is significantly higher in this group of medical ICU patients than in subgroups of non-haematological ones, the former show a similar decrease in raw and risk-adjusted mortality rate over time, while leukocytopenia is not a predictor of mortality. These results suggest that haematological ICU patients have benefitted from improved intensive care support during the last decade. 相似文献14.
Wilhelm Grander Kathrin Müllauer Bernhard Koller Herbert Tilg Martin Dünser 《Clinical research in cardiology》2013,102(8):599-606
Purpose
A heart rate >90 bpm serves as one of four characteristics defining the systemic inflammatory response syndrome and is used in scoring systems to predict in-hospital mortality of intensive care unit (ICU) patients. Despite its central role in critical illness, specific data regarding the relationship between heart rate and outcome are rare.Methods
In this post hoc analysis of a prospectively collected database, we analyzed the value of heart rate averaged from four predefined time points during the last 24 h before ICU discharge as a predictor of post-ICU in-hospital and post-hospital mortality in medical ICU patients. Furthermore, the relationship between heart rate and inflammation, as well as the influence of rate control medications on the association between heart rate and outcome were identified.Results
Among the 702 ICU patients discharged from the ICU, 7.1 % died before hospital discharge. At 4 years of follow-up, post-hospital mortality was 14.4 %. Multivariate Cox proportional hazards models revealed heart rate before ICU discharge (HR 5.95; 95 % CI 1.24–28.63; p = 0.03) as an independent predictor of post-ICU in-hospital mortality. Both heart rate (HR 2.56; 95 % CI, 1.05?6.34; p = 0.04) and the C-reactive protein serum concentration before ICU discharge (HR, 1.26; 95 % CI, 1.09–1.46; p = 0.002) were independently associated with post-hospital mortality. Heart rate control therapy reduced the risk of post-ICU in-hospital (HR 0.38; 95 % CI, 0.18–0.81; p = 0.01) and post-hospital (HR, 0.47; 95 % CI, 0.22–1.00; p = 0.05) mortality.Conclusion
Heart rate evaluated 24 h before ICU discharge was independently associated with post-ICU in-hospital and post-hospital mortality. Pharmacological interventions to control heart rate may beneficially influence post-ICU mortality. 相似文献15.
Christina Routsi Maria Pratikaki Evangelia Platsouka Christina Sotiropoulou Vasileios Papas Theodoros Pitsiolis Athanassios Tsakris Serafeim Nanas Charis Roussos 《Intensive care medicine》2013,39(7):1253-1261
Purpose
Carbapenem-resistant (CR) Gram-negative pathogens have increased substantially. This study was performed to identify the risk factors for development of CR Gram-negative bacteremia (GNB) in intensive care unit (ICU) patients.Methods
Prospective study; risk factors for development of CR-GNB were investigated using two groups of case patients: the first group consisted of patients who acquired carbapenem susceptible (CS) GNB and the second group included patients with CR-GNB. Both case groups were compared to a shared control group defined as patients without bacteremia, hospitalized in the ICU during the same period.Results
Eighty-five patients with CR- and 84 patients with CS-GNB were compared to 630 control patients, without bacteremia. Presence of VAP (OR 7.59, 95 % CI 4.54–12.69, p < 0.001) and additional intravascular devices (OR 3.69, 95 % CI 2.20–6.20, p < 0.001) were independently associated with CR-GNB. Presence of VAP (OR 2.93, 95 % CI 1.74–4.93, p < 0.001), presence of additional intravascular devices (OR 2.10, 95 % CI 1.23–3.60, p = 0.007) and SOFA score on ICU admission (OR 1.11, 95 % CI 1.03–1.20, p = 0.006) were independently associated with CS-GNB. The duration of exposure to carbapenems (OR 1.079, 95 % CI 1.022–1.139, p = 0.006) and colistin (OR 1.113, 95 % CI 1.046–1.184, p = 0.001) were independent risk factors for acquisition of CR-GNB. When the source of bacteremia was other than VAP, previous administration of carbapenems was the only factor related with the development of CR-GNB (OR 1.086, 95 % CI 1.003–1.177, p = 0.042).Conclusions
Among ICU patients, VAP development and the presence of additional intravascular devices were the major risk factors for CR-GNB. In the absence of VAP, prior use of carbapenems was the only factor independently related to carbapenem resistance. 相似文献16.
Aliénor Xhaard Loic Epelboin David Schnell François Vincent Vincent Levy Marion Malphettes Élie Azoulay Michaël Darmon 《Supportive care in cancer》2013,21(7):1885-1891
Background
Although recent studies have demonstrated an improvement in the prognosis of critically ill cancer patients, little is known regarding the prognosis of patients with non-aggressive underlying malignancies. The aims of this study were to assess the prognosis of critically ill patients with chronic lymphocytic leukemia (CLL) and to evaluate risk factors for hospital mortality.Methods
In retrospective mono-center cohort study, consecutive adult patients with CLL requiring ICU admission from 1997 to 2008 were included.Results
Sixty-two patients of 67 years (62–75) were included. Median time interval between CLL diagnosis and ICU admission was 6.7 years (2.6–10.8). Nine patients (15 %) had stage C disease at the time of ICU admission, and seven patients (11 %) had Richter syndrome. Most ICU admissions were related to bacterial or fungal pulmonary infections (n?=?47; 76 %). ICU, in-hospital, and 90-day mortality were 35 % (n?=?22), 42 % (n?=?26), and 58 % (n?=?36), respectively. Only three factors were independently associated with in-hospital mortality: oxygen saturation lower than 95 % when breathing room air (odds ratio (OR) 5.80; 95 % confidence interval (CI) 1.23–27.33), need for vasopressors (OR 27.94; 95 % CI 5.37–145.4), and past history of infection (OR 6.62; 95 % CI 1.34–32.68). The final model did not change when disease-related variables (Binet classification, Richter syndrome, long-term steroids) or treatment-related variables (fludarabine, rituximab, or alemtuzumab) were included.Conclusion
Acute pulmonary infections remain the leading cause of ICU admission in patients with CLL. The severity at ICU admission and past history of infection were the only factors associated with hospital mortality. Neither disease characteristics nor previous cancer treatments were associated with outcome. 相似文献17.
Julio A. Farias Analía Fernández Ezequiel Monteverde Nilda Vidal Pilar Arias María J. Montes Gabriela Rodríguez Mariela Allasia Maria E. Ratto Roxana Jaén Claudia Meregalli Karina Fiquepron Ana R. Calvo Alejandro Siaba Lidia Albano Rossana Poterala Pablo Neira Andrés Esteban 《Intensive care medicine》2010,36(6):1015-1022
Objective
To determine the epidemiological features, course, and outcomes of critically ill pediatric patients with Influenza A (H1N1) virus.Design
Prospective cohort of children in pediatric intensive care units (PICUs) due to Influenza A (H1N1) virus infection.Setting
Seventeen medical-surgical PICUs in tertiary care hospital in Argentina.Patients
All consecutive patients admitted to the PICUs with influenza A (H1N1) viral infection from 15 June to 31 July 2009.Measurements and main results
Of 437 patients with acute lower respiratory infection in PICUs, 147 (34%) were diagnosed with influenza A (H1N1) related to critical illness. The median age of these patients was 10 months (IQR 3–59). Invasive mechanical ventilation was used in 117 (84%) on admission. The rate of acute respiratory distress syndrome (ARDS) was 80% (118 of 147 patients). Initial non-invasive ventilation failed in 19 of 22 attempts (86%). Mortality at 28 days was 39% (n = 57). Chronic complex conditions (CCCs), acute renal dysfunction (ARD) and ratio PaO2/FiO2 at day 3 on MV were independently associated with a higher risk of mortality. The odds ratio (OR) for CCCs was 3.06, (CI 95% 1.36–6.84); OR for ARD, 3.38, (CI 95% 1.45–10.33); OR for PaO2/FiO2, 4 (CI 95% 1.57–9.59). The administration of oseltamivir within 24 h after admission had a protective effect: OR 0.2 (CI 95% 0.07–0.54).Conclusions
In children with ARDS, H1N1 as an etiologic agent confers high mortality, and the presence of CCCs in such patients increases the risk of death. 相似文献18.
Klaus Distelmaier Alexander Niessner Dominik Haider Irene M. Lang Gottfried Heinz Gerald Maurer Herbert Koinig Barbara Steinlechner Georg Goliasch 《Intensive care medicine》2013,39(8):1444-1451
Purpose
Information on predisposing risk factors influencing long-term survival after extracorporeal membrane oxygenation (ECMO) support remains scarce. In critically ill patients chronic obstructive pulmonary disease (COPD) is an independent risk factor for mortality and morbidity. We assessed the influence of COPD on cardiovascular and all-cause mortality in patients undergoing ECMO therapy.Methods
We prospectively included 191 patients undergoing veno-arterial ECMO therapy following cardiovascular surgery at a university-affiliated tertiary care center into our registry.Results
The median follow-up time was 51 months (IQR 34–71 months) corresponding to 4,197 overall months of follow-up. A total of 125 patients (65 %) died; 88 % of deaths were due to cardiovascular causes. Long-term survival was decreased in patients with COPD after 1 year (23 % vs. 44 %) and after 6 years (14 % vs. 35 %) compared to patients without COPD. COPD was independently associated with all-cause mortality with a hazard ratio of 4.22 (95 % CI 1.04–17.11, p = 0.04) and cardiovascular mortality with a hazard ratio of 5.87 (95 % CI 1.41–24.47, p = 0.02).Conclusions
We identified COPD as a strong and independent predictor of long-term all-cause mortality and cardiovascular mortality in patients undergoing ECMO therapy following cardiovascular surgery. The current study presents valuable information for a comprehensive decision-making process prior to ECMO implantation and helps to identify high-risk patients that may benefit from intensified treatment of co-morbidities and close check-ups after hospital discharge. 相似文献19.
Djamel Mokart Géraldine Slehofer Jérôme Lambert Antoine Sannini Laurent Chow-Chine Jean-Paul Brun Pierre Berger Ségolène Duran Marion Faucher Jean-Louis Blache Colombe Saillard Norbert Vey Marc Leone 《Intensive care medicine》2014,40(1):41-49
Background
In severe sepsis, guidelines recommend de-escalating the empirical antimicrobial treatment as soon as the microbiological results are available. We aimed to determine the rate of de-escalation of the empirical antimicrobial treatment in neutropenic patients with severe sepsis. The characteristics of antimicrobial treatment associated with de-escalation and its impact on short- and long-term survival were also determined.Methods
In the intensive care unit (ICU) of a cancer referral center, we prospectively collected observational data related to the antimicrobial management in neutropenic patients who developed severe sepsis and were admitted to ICU for at least 48 h. De-escalation of antimicrobial therapy consisted either of deleting one of the empirical antibiotics of a combined treatment, or, whenever possible, to use a betalactam antibiotic with a narrower spectrum of activity. Multivariate logistic regression was conducted to determine the factors associated with de-escalation, while a Cox proportional hazards model with a time-dependent covariate was fitted to assess the effect of de-escalation on 30-day survival. Finally 1-year survival after ICU discharge was compared across de-escalation groups.Results
Cumulative incidence of de-escalation of the empirical antimicrobial treatment among the 101 patients of the cohort was 44 %, [95 % confidence interval (CI) 38–53 %], including 30 (68 %) patients with ongoing neutropenia. A microbiological documentation was available in 63 (63 %) patients. Factors associated with de-escalation were the adequation of the empirical antimicrobial treatment in ICU [OR = 10.8 (95 % CI 1.20–96)] for adequate documented treatment versus appropriate empirical treatment, the compliance with guidelines regarding the empirical choice of the anti-pseudomonal betalactam [OR = 10.8 (95 % CI 1.3–89.5)]. De-escalation did not significantly modify the hazard of death within the first 30 days [HR = 0.51 (95 % CI 0.20–1.33)], nor within 1 year after ICU discharge [HR = 1.06 (95 % CI 0.54–2.08)].Conclusion
Our data suggest that, in ICU, de-escalation of the empirical antimicrobial treatment is frequently applied in neutropenic cancer patients with severe sepsis. No evidence of any prognostic impact of this de-escalation was found. 相似文献20.
Lutz Frankenstein Henrik Hees Tobias Taeger Hanna Froehlich Andreas Dösch Rita Cebola Christian Zugck Hugo A. Katus 《Clinical research in cardiology》2013,102(10):771-780