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Functional status post icu

Stefan J Schaller, Flora T Scheffenbichler, Somnath Bose, Nicole Mazwi, Hao Deng, Franziska Krebs, Christian L Seifert, George Kasotakis, Stephanie D Grabitz, Nicola Latronico, Timothy Houle, Manfred Blobner, Matthias Eikermann
PURPOSE: Early mobilization within 72 h of intensive care unit (ICU) admission improves functional status at hospital discharge. We aimed to assess the effectiveness of early, goal-directed mobilization in critically ill patients across a broad spectrum of initial consciousness levels. METHODS: Post hoc analysis of the international, randomized, controlled, outcome-assessor blinded SOMS trial conducted 2011-2015. Randomization was stratified according to the immediate post-injury Glasgow Coma Scale (GCS) (≤ 8 or > 8)...
January 21, 2019: Intensive Care Medicine
Daniel Yafit, Narin Nard Carmel-Neiderman, Nadav Levy, Avrham Abergel, Alexander Niv, Ravit Yanko-Arzi, Arik Zaretski, Anat Wengier, Dan M Fliss, Gilad Horowitz
OBJECTIVE: Myxedema coma is a serious complication of hypothyroidism that can be precipitated by major surgery. It is extremely rare, with only a few reports in the literature. This study aims to present a relatively large case series of post-surgical myxedema coma and to analyze medical and surgical risk factors. METHODS: Analysis of the patients' surgical records and medical charts. RESULTS: Four patients developed postoperative myxedema coma and were evaluated for risk factors...
November 16, 2018: Auris, Nasus, Larynx
Zainab Suleman, Catrin Evans, Joseph C Manning
OBJECTIVES: To explore parents' experiences of transition and aftercare following their child's discharge from a paediatric intensive care unit to an in-patient ward. METHODS: A qualitative systematic review was conducted. Electronic databases CINAHL, MEDLINE, EMBASE, Psych INFO, and ASSIA were searched for qualitative studies with no date limits imposed. Methodological quality was assessed using the JBI QARI standardised critical appraisal instrument. Data were extracted into a standardised data extraction tool...
November 15, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
Kathleen Bastian, Alexa Hollinger, Alexandre Mebazaa, Elie Azoulay, Elodie Féliot, Karine Chevreul, Marie-Céline Fournier, Bertrand Guidet, Morgane Michel, Philippe Montravers, Sébastien Pili-Floury, Romain Sonneville, Martin Siegemund, Etienne Gayat
PURPOSE: Intensive care unit survivors suffer from prolonged impairment, reduced quality of life, and higher mortality rates after discharge compared to the general population. Socioeconomic status may play a partial but important role in mortality and recovery. Therefore, the detection of factors that are responsible for poor long-term outcomes would be beneficial in designing targeted interventions for at-risk populations. METHODS: For an endpoint analysis, 1834 intensive care unit patients with known French Deprivation Index (FDep) scores were included from the French and euRopean Outcome reGistry in Intensive Care Units (FROG-ICU) study, which was a prospective, observational, multicenter cohort study performed in 20 French intensive care units in 13 different hospitals...
October 23, 2018: Intensive Care Medicine
Leda Tomiko Yamada da Silveira, Janete Maria da Silva, Clarice Tanaka, Carolina Fu
OBJECTIVES: To compare the functional status at intensive care unit (ICU) discharge of patients who were later readmitted to the ICU and patients discharged home and to verify whether a decline in functional status is associated with ICU readmission. DESIGN: Prospective cohort study. SETTING: ICU at a tertiary teaching hospital. PARTICIPANTS: Patients admitted to the ICU, ≥18 years old, submitted to invasive mechanical ventilation (IMV), and discharged to the ward...
August 2, 2018: Physiotherapy
Ayfer Ekim
Improvements in devices and techniques used to provide life support for patients at intensive care units have reduced patient mortality. Increases in the number of survivors from a critical illness have brought long-term complications experienced during the post-intensive care period into question. The term post-intensive care syndrome (PICS) is defined as a new and deteriorating disorder in the cognitive, mental, and physical health status experienced by the survivor after intensive care unit discharge that might continue for months or even years...
September 25, 2018: Comprehensive child and adolescent nursing
Michael D Wood, David M Maslove, John Muscedere, Stephen H Scott, J Gordon Boyd
PURPOSE: To assess the feasibility of using an integrated multimodal data collection strategy to characterize the post-intensive care syndrome (PICS). MATERIALS AND METHODS: Adult patients admitted to the ICU requiring invasive mechanical ventilation for >24 h and/or requiring vasopressor support were eligible for enrollment. We assessed cognitive and sensorimotor function at 3- and 12-months after ICU discharge with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and with the KINARM robot...
September 12, 2018: Journal of Critical Care
Rebekah Haylett, Owen Gustafson
PURPOSE: To report the feasibility of assessing pre-admission functional status of ICU trauma patients, with repeat assessment at six months post ICU discharge using a standardised measure. MATERIALS AND METHODS: A prospective longitudinal observational cohort design recruited consecutive adult major trauma admissions to a UK general ICU, between 1st November 2016 and 1st November 2017. The 12-item World Health Organisation Disability Schedule 2.0 was completed to assess pre-admission functional status as soon as possible after ICU admission...
August 26, 2018: Journal of Critical Care
Carol L Hodgson, Kimberley J Haines, Michael Bailey, Jonathan Barrett, Rinaldo Bellomo, Tracey Bucknall, Belinda J Gabbe, Alisa M Higgins, Theodore J Iwashyna, Julian Hunt-Smith, Lynne J Murray, Paul S Myles, Jennie Ponsford, David Pilcher, Andrew A Udy, Craig Walker, Meredith Young, D J Jamie Cooper
PURPOSE: To determine predictors of inability to return to work due to health six-months after intensive care admission; and compare functional recovery between patients who had not returned to work and employed patients. METHODS: Participants were working adults admitted to ICU who received >24 h of mechanical ventilation. Outcomes included inability to return to work due to health at six-months post-ICU admission, disability, health status, anxiety, depression and post-traumatic stress...
August 13, 2018: Journal of Critical Care
Aalap C Shah, Kevin Ma, David Faraoni, Daniel C S Oh, G Alec Rooke, Gail A Van Norman
BACKGROUND: Pulmonary hypertension (PHTN) is associated with increased post-procedure morbidity and mortality. Pre-procedure echocardiography (ECHO) is a widely used tool for evaluation of these patients, but its accuracy in predicting post-procedure outcomes is unproven. Self-reported exercise tolerance has not been evaluated for operative risk stratification of PHTN patients. OBJECTIVE: We analyzed whether self-reported exercise tolerance predicts outcomes (hospital length-of-stay [LOS], mortality and morbidity) in PHTN patients (WHO Class I-V) undergoing anesthesia and surgery...
2018: PloS One
Avelino C Verceles, Chris L Wells, John D Sorkin, Michael L Terrin, Jeffrey Beans, Toye Jenkins, Andrew P Goldberg
PURPOSE: To compare the effects of adding a progressive multimodal rehabilitation program to usual care (MRP + UC) versus UC alone on 1) functional mobility, strength, endurance and 2) ventilator weaning and discharge status of patients with ICU-acquired weakness (ICUAW) receiving prolonged mechanical ventilation (PMV). METHODS: Randomized pilot trial of an individualized MRP + UC versus UC in middle-aged and older ICU survivors with ICUAW receiving PMV...
October 2018: Journal of Critical Care
Hsin-Ju Tang, Hsin-Yi Jean Tang, Chia-Ming Chang, Pei-Fang Su, Ching-Huey Chen
Older ICU survivors are often challenged with clusters of geriatric syndromes and functional decline. The purpose of this study was (a) to assess patterns of geriatric syndromes and functional status from admission to 6 months post discharge and (b) to examine the predictors of longitudinal functional status. This is a prospective cohort study. Demographic information, clinical variables, geriatric syndromes, and functional status were collected longitudinally. A total of 192 medical ICU older adult survivors were included in the analysis...
July 1, 2018: Clinical Nursing Research
Qinglin Yang, Huijuan Meng, Zhong Li, Chuntao Lai, Jiawei Wang, Yingying Su
OBJECTIVE: To compare the accuracy of electroencephalography (EEG) grading scale with amplitude-integrated electroencephalography (aEEG) in predicting poor outcomes (3-month), who sustained coma after cardiopulmonary resuscitation (CPR) in adults. METHODS: A retrospective study was conducted. The patients with post-anoxic coma admitted to intensive care unit (ICU) of Tongren Hospital, Capital Medical University from March 2010 to June 2017 were enrolled. EEG was registered and recorded at least once within 7 days of coma after CPR, while not being subjected to therapeutic hypothermia...
June 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Nina Acharya, Dermot R Doherty, Nick Barrowman, Gyaandeo Maharajh, Tara Girolamo, Katie O'Hearn, J Dayre McNally
BACKGROUND: Consistent with accepted practice in stable ambulatory populations, the majority of ICU research has evaluated vitamin D status using a single blood 25-hydroxyvitamin D (25(OH)D) level. Only a limited number of ICU studies have measured the active hormone, 1,25-dihydroxyvitamin D (calcitriol) and none have used change in calcitriol levels to evaluate axis functioning. The objective of this study was to describe the impact of Congenital Heart Disease (CHD) surgery on calcitriol levels and evaluate the relationship between change in postoperative levels and clinical course...
August 2018: Pediatric Research
Lauren E Ferrante, Margaret A Pisani, Terrence E Murphy, Evelyne A Gahbauer, Linda S Leo-Summers, Thomas M Gill
BACKGROUND: Frailty is a strong indicator of vulnerability among older persons, but its association with ICU outcomes has not been evaluated prospectively (ie, with objective measurements obtained prior to ICU admission). Our objective was to prospectively evaluate the relationship between frailty and post-ICU disability, incident nursing home admission, and death. METHODS: The parent cohort included 754 adults aged ≥ 70 years, who were evaluated monthly for disability in 13 functional activities and every 18 months for frailty (1998-2014)...
June 2018: Chest
Florence Riché, Benjamin G Chousterman, Patrice Valleur, Alexandre Mebazaa, Jean-Marie Launay, Etienne Gayat
BACKGROUND: Sepsis is a leading cause of mortality and critical illness worldwide and is associated with an increased mortality rate in the months following hospital discharge. The occurrence of persistent or new organ dysfunction(s) after septic shock raises questions about the mechanisms involved in the post-sepsis status. The present study aimed to explore the immune profiles of patients one year after being discharged from the intensive care unit (ICU) following treatment for abdominal septic shock...
February 21, 2018: Critical Care: the Official Journal of the Critical Care Forum
Leda Tomiko Yamada da Silveira, Janete Maria da Silva, Júlia Maria Pavan Soler, Carolina Yea Ling Sun, Clarice Tanaka, Carolina Fu
Objective: To assess the functional status of post-ICU patients using the Barthel Index (BI) and the Katz Index (KI) and to assess which is more suitable for this population. Design: Retrospective longitudinal study. Setting: Public tertiary hospital in São Paulo (Brazil). Participants: Patients aged ≥18 years old, admitted to ICU, who were treated with mechanical ventilation (MV) ≥ 24 h and were discharged to ward...
May 1, 2018: International Journal for Quality in Health Care
R Scott Watson, Lisa A Asaro, James H Hertzog, Lauren R Sorce, Alicia G Kachmar, Leslie A Dervan, Derek C Angus, David Wypij, Martha A Q Curley
RATIONALE: Whether a nurse-implemented goal-directed sedation protocol resulting in more awake yet calm intubated children affects postdischarge functional status, health-related quality of life, or risk for post-traumatic stress disorder is unknown. OBJECTIVES: To compare postdischarge outcomes in children with acute respiratory failure cluster-randomized to a sedation protocol or usual care. METHODS: A stratified random sample of 1,360 patients from 31 centers in the RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) trial was assessed by mail, electronically, and/or telephone 6 months after ICU discharge...
June 1, 2018: American Journal of Respiratory and Critical Care Medicine
Paul E Wischmeyer
Without doubt, in medicine as in life, one size does not fit all. We do not administer the same drug or dose to every patient at all times, so why then would we live under the illusion that we should give the same nutrition at all times in the continuum of critical illness? We have long lived under the assumption that critical illness and trauma lead to a consistent early increase in metabolic/caloric need, the so-called "hypermetabolism" of critical illness. What if this is incorrect? Recent data indicate that early underfeeding of calories (trophic feeding) may have benefits and may require consideration in well-nourished patients...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
Marc R Nickels, Leanne M Aitken, James Walsham, Adrian G Barnett, Steven M McPhail
INTRODUCTION: In-bed cycling with patients with critical illness has been shown to be safe and feasible, and improves physical function outcomes at hospital discharge. The effects of early in-bed cycling on reducing the rate of skeletal muscle atrophy, and associations with physical and cognitive function are unknown. METHODS AND ANALYSIS: A single-centre randomised controlled trial in a mixed medical-surgical intensive care unit (ICU) will be conducted. Adult patients (n=68) who are expected to be mechanically ventilated for more than 48 hours and remain in ICU for a further 48 hours from recruitment will be randomly allocated into either (1) a usual care group or (2) a group that receives usual care and additional in-bed cycling sessions...
October 22, 2017: BMJ Open
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