- MeSH
- Humans MeSH
- Critical Care * organization & administration statistics & numerical data trends MeSH
- Education, Special trends MeSH
- Check Tag
- Humans MeSH
- Publication type
- Introductory Journal Article MeSH
- Geographicals
- Czech Republic MeSH
Cieľ: Mortalita je najtvrdší výstup charakterizujúci závažnosť ochorení a výsledok zdravotnej starostlivosti. Je spájaná najmä so staršími pacientmi. Informácie o 24-hodinovej nemocničnej mortalite (M24) u seniorov hospitalizovaných na nechirurgických pracoviskách sú limitované.
Aim: Mortality is the hardest outcome characterising the severity of diseases and the result of the health care. It is connected mainly with elderly patients (pts.). Information on 24-hours hospital mortality (M24) in seniors admitted to nonsurgical departments is scarce. Patients and methods: In a retrospective observational study, we investigated M24 in pts. of 65 years of age and older, who were discharged from an university geriatric department in years 2016-2018. The identification of diseases which primarily led to M24 and their classification was independently performed by authors from geriatric and internal medicine departments. Results: We proved that M24 is rather frequent (2.3 % out of all hospitalised pts.). There was a 2.4-fold M24 incidence increase from the age 65-69 years up to ≥ 90 years (from 1.4 to 3.3 %). The average age of deceased M24 pts. (n = 101) was 80.8 years and was not different from the age of those who deceased later. The majority of M24 (58.4 %) occurred during the first 12 hours after the admission to the hospital. There were many diseases (n = 25) that primarily led to M24 with dominating cardiovascular pathologies (39.6 %), followed closely by infective diseases (33.7 %). Therapeutically irreversible advanced chronic diseases led to M24 in 15.8 %. There was a higher frequency of acute diseases therapeutically irreversibly decompensating pre-existing diseases (43.6 %) than that of acute diseases incompatible with survival (33.7 %).
- MeSH
- Hospitalization statistics & numerical data MeSH
- Cardiovascular Diseases mortality MeSH
- Humans MeSH
- Hospital Mortality * MeSH
- Mortality * MeSH
- Kidney Diseases mortality MeSH
- Critical Care statistics & numerical data MeSH
- Lung Diseases mortality MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Observational Study MeSH
Cíl studie: Charakterizovat pacienty s covidem-19 hospitalizované na naší JIP, zjistit jejich mortalitu a výskyt komorbidit považovaných za rizikové faktory pro těžký průběh nemoci. Metodika: Retrospektivní observační studie na JIP vyššího typu s 5-8 lůžky. Populace 91 dospělých pacientů s covidem-19 vyžadujících intenzivní péči. Výsledky: Průměrný věk pacientů byl 67 let (38-88). Nejčastějšími komorbiditami byly hypertenze (56 pacientů, 61%) a diabetes (35 pacientů, 38%). 24 pacientů (26%) bylo obézních s BMI 30-40, 10 nemocných (11%) s BMI >40. Průměrné SOFA skóre při příjmu bylo 3,5 (1-10). Jako maximální ventilační podpora byla použita HFNO (high flow nasal oxygen) terapie u 14 (15%) pacientů (z nich 9 mělo limitaci terapie ve smyslu nezahajování invazivní plicní ventilace (D.N.I.)), neinvazivní plicní ventilace (NIV) u 17 (18%) pacientů (z nich 9 mělo limitaci péče ve smyslu D.N.I.). Stav 37 (40%) pacientů si vyžádal intubaci a připojení na UPV (umělou plicní ventilaci). Celková mortalita v našem souboru byla 37% (34 pacientů). U pacientů s 2 a více komorbiditami byla mortalita 46%, u nemocných bez komorbidit 44% (jednalo se ale jen o 4 nemocné vysokého věku). Pokud jde o věkové rozložení, nejvyšší mortalita byla ve věkové skupině 80-90 let (89%). Ve skupině pacientů mladších 50 let byla v našem souboru mortalita překvapivě vysoká (27%), jednalo se ale celkem o 3 pacienty. Mortalita pacientů, jejichž stav si vyžádal invazivní umělou plicní ventilaci, byla 43%. Závěr: Mortalita pacientů s covidem-19 na naší JIP za sledované období byla 37%, což je výrazně vyšší než za stejné období v letech 2019-2020 před začátkem pandemie. Mortalita stoupala se stoupajícím věkem. Téměř všichni pacienti měli některou z výše uvedených komorbidit.
Objectives: To determinate characteristics of covid-19 patients in our ICU, to determinate mortality and presence of comorbidities considered as risk factor for severe course of disease. Methods: Retrospective observation study in ICU with 5-8 beds. Population of 91 adults with covid-19 admitted to ICU. Results: Median age was 67 years (38-88). Hypertension (56 patients, 61%) and diabetes (35 patients, 38%) were the most common comorbidities. 24 patients (26%) were obese with BMI 30-40, 10 patients (11%) with BMI >40. Average SOFA score on admission was 3,5 (1-10). HFNO (high flow nasal oxygen) therapy was the highest ventilation support used in 14 (15%) patients (while 9 (64%) of them had limitation of therapy by order D.N.I.), NIV (non-invasive ventilation) in 17 (18%) patients (9 of them (52%) had limitation of therapy with order D.N.I.). Conditions of 37 (40%) patients required intubation and invasive mechanical ventilation. Overall mortality in our cohort was 37%. Mortality of patients with 2 or more comorbidities was 46%, mortality of patients without comorbidities was 44% (in total 4 patients with high age). The highest mortality was in the group of patients 80-90 years (89%). Mortality in the group of patients younger than 50 years was surprisingly high (27%), but these were 3 patients in total. Mortality of patients requiring IPV was 43%. Conclusion: Mortality of covid-19 patients in our ICU was 37% which is much higher than mortality in the same period in 2019 and 2020 before the beginning of pandemic. Mortality increased with higher age. Almost all our patients had at least one of the comorbidities mentioned above.
- MeSH
- COVID-19 * mortality MeSH
- COVID-19 Drug Treatment MeSH
- Hospitalization statistics & numerical data MeSH
- Intensive Care Units * statistics & numerical data MeSH
- Humans MeSH
- Advance Directives statistics & numerical data MeSH
- Critical Care statistics & numerical data MeSH
- Aged MeSH
- Respiration, Artificial statistics & numerical data MeSH
- Age Factors MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Acute Kidney Injury * physiopathology therapy MeSH
- Renal Dialysis standards statistics & numerical data MeSH
- Hemoperfusion standards statistics & numerical data MeSH
- Humans MeSH
- Renal Replacement Therapy * methods statistics & numerical data MeSH
- Critical Care standards statistics & numerical data MeSH
- Randomized Controlled Trials as Topic MeSH
- Check Tag
- Humans MeSH
BACKGROUND: We evaluated the feasibility and effectiveness of thoracoscopic and a staged surgical and transcatheter ablation technique to treat stand-alone atrial fibrillation (AF). METHODS: . Between 2009 and 2016, a cohort of 65 patients underwent bilateral totally thoracoscopic ablation of symptomatic paroxysmal AF (n=30; 46%), persistent AF (n=18; 28%) or long-standing persistent AF (n=17; 26%) followed by catheter ablation in case of AF recurrence. Surgical box lesion procedure included bilateral pulmonary vein and left atrial posterior wall ablation using irrigated bipolar radiofrequency with documentation of conduction block. RESULTS: There were no intra- or peri-operative ablation-related complications. There was no operative mortality, no myocardial infarction, and no stroke. Skin-to-skin procedure time was 120.5 ± 22.0 min and the postoperative average length of stay was 8.1 ± 3.0 days. At discharge, 60 patients (92%) were in sinus rhythm. Median follow-up time was 866 days (IQR, 612-1185 days). One-year success rate after surgical procedure was 78% (off antiarrhythmic drugs). Eleven patients (17%) underwent catheter re-ablation. Sixty (92%) patients were free of atrial fibrillation after hybrid ablation (on demand) at 1 year follow up after the last ablation. The success at 24-months was achieved in 96% (paroxysmal) and 78% (persistent) patients. At the last follow-up control, 69% patients discontinued oral anticoagulant therapy. CONCLUSIONS: . Combination of mini-invasive surgical and endocardial treatment (two-stage hybrid procedure) is a safe and effective method for the treatment of isolated (lone) AF. This procedure provided good midterm outcomes.
- MeSH
- Anti-Arrhythmia Agents therapeutic use MeSH
- Operative Time MeSH
- Length of Stay statistics & numerical data MeSH
- Electrocardiography, Ambulatory MeSH
- Atrial Fibrillation drug therapy surgery MeSH
- Kaplan-Meier Estimate MeSH
- Catheter Ablation methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Critical Care statistics & numerical data MeSH
- Feasibility Studies MeSH
- Thoracoscopy methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Evaluation Study MeSH
BACKGROUND: Hospital-acquired pneumonia (HAP) in intensive care patients is a frequent reason for mechanical ventilation (MV). The management of MV and ventilator weaning vary, depending on the type of lung inflammation. This retrospective, observational study screened the data from all patients admitted to the intensive care unit (ICU) of the Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc between 2011 and 2016. The aims were to determine the parameters of pressure-controlled ventilation, the frequencies of tracheostomy, bronchoscopy, reconnection to MV, the length of ICU and hospital stay and the mortality in subgroups with early-/late-onset HAP compared to a subgroup with community-acquired pneumonia (CAP) and patients with MV without pneumonia. The primary outcome of this study was MV length. RESULTS: Over the study period, a total of 2672 patients were hospitalised. Excluded were 137 organ donors, 66 patient without MV and 20 patients placed on volume-controlled ventilation. The cohort comprised 2.447 patients requiring MV. A total of 1.927 patients (78.7%) were indicated for MV without signs of pneumonia. CAP was diagnosed in 131 patients (5.4%). The criteria for HAP were met by 389 patients (16.0%). Early-onset and late-onset HAP was diagnosed in 63 (2.6%) and 326 (13.3%) patients, respectively. In the subgroups without pneumonia, with CAP, early- and late-onset HAP, the median MV times were 3, 6, 6 and 12 days, respectively, and the median peak inspiratory pressure (Pinsp) of MV was 20, 25, 25 and 27 cm H2O, respectively. The median positive end-expiratory pressure (PEEP) was 5, 8, 8 and 11 cm H2O, respectively. The median inspired oxygen concentrations (FiO2) were 0.45, 0.7, 0.7 and 0.8, respectively. The median length of hospital stays was 8, 15, 15 and 17 days. The mortality rates were 11.4%, 3.8%, 9.5% and 31.3%, respectively. CONCLUSIONS: During MV, the late-onset HAP subgroup was shown to have the highest Pinsp, PEEP and FiO2, the longest MV time, ICU and hospital stay, the highest frequency of tracheostomy, reconnection to MV, pulmonary hygiene bronchoscopy and the highest mortality compared to the early-onset HAP and CAP subgroups. The lowest values were found in the mechanically ventilated patients without pneumonia. The differences were due to the severity of lung damage that is graduated from CAP over early-onset HAP after late-onset HAP.
- MeSH
- Length of Stay statistics & numerical data MeSH
- Community-Acquired Infections therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Ventilator Weaning MeSH
- Critical Care statistics & numerical data MeSH
- Pneumonia therapy MeSH
- Retrospective Studies MeSH
- Respiration, Artificial methods MeSH
- Pneumonia, Ventilator-Associated therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
PURPOSE: The intensity of procedural pain in intensive care unit (ICU) patients is well documented. However, little is known about procedural pain distress, the psychological response to pain. METHODS: Post hoc analysis of a multicenter, multinational study of procedural pain. Pain distress was measured before and during procedures (0-10 numeric rating scale). Factors that influenced procedural pain distress were identified by multivariable analyses using a hierarchical model with ICU and country as random effects. RESULTS: A total of 4812 procedures were recorded (3851 patients, 192 ICUs, 28 countries). Pain distress scores were highest for endotracheal suctioning (ETS) and tracheal suctioning, chest tube removal (CTR), and wound drain removal (median [IQRs] = 4 [1.6, 1.7]). Significant relative risks (RR) for a higher degree of pain distress included certain procedures: turning (RR = 1.18), ETS (RR = 1.45), tracheal suctioning (RR = 1.38), CTR (RR = 1.39), wound drain removal (RR = 1.56), and arterial line insertion (RR = 1.41); certain pain behaviors (RR = 1.19-1.28); pre-procedural pain intensity (RR = 1.15); and use of opioids (RR = 1.15-1.22). Patient-related variables that significantly increased the odds of patients having higher procedural pain distress than pain intensity were pre-procedural pain intensity (odds ratio [OR] = 1.05); pre-hospital anxiety (OR = 1.76); receiving pethidine/meperidine (OR = 4.11); or receiving haloperidol (OR = 1.77) prior to the procedure. CONCLUSIONS: Procedural pain has both sensory and emotional dimensions. We found that, although procedural pain intensity (the sensory dimension) and distress (the emotional dimension) may closely covary, there are certain factors than can preferentially influence each of the dimensions. Clinicians are encouraged to appreciate the multidimensionality of pain when they perform procedures and use this knowledge to minimize the patient's pain experience.
- MeSH
- Surgical Procedures, Operative adverse effects MeSH
- Emotions * MeSH
- Middle Aged MeSH
- Humans MeSH
- Pain Measurement MeSH
- Critical Care statistics & numerical data MeSH
- Pain, Procedural psychology MeSH
- Prospective Studies MeSH
- Cross-Sectional Studies MeSH
- Stress, Psychological etiology MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- MeSH
- Health Services Accessibility statistics & numerical data MeSH
- Practice Patterns, Physicians' statistics & numerical data MeSH
- Humans MeSH
- Critical Care statistics & numerical data MeSH
- Surveys and Questionnaires MeSH
- Patient Care Team organization & administration MeSH
- Emergency Medical Services statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Publication type
- Letter MeSH
- Geographicals
- Europe MeSH
AIM: The aim of this study was to evaluate the incidence of health care-associated infections (HAIs) in patients treated in Polish intensive care units (ICUs). METHODS: This retrospective analysis was based on the results of active targeted surveillance, according to the recommendation of the ECDC (European Centre of Disease Control and Prevention, HAI-Net light protocol), conducted in 2013-2015 in seven ICUs for adults located in southern Poland (observational study). RESULTS: The incidence of HAI was 22.6% and 28.7/1000 person-days (pds). The incidence of pneumonia (PN) was 8.0%, bloodstream infections (BSIs) 7.2% and urinary tract infections (UTIs) 3.7%. The incidence per 1000 pds was as follows: PN 10.2, BSIs 9.2 and UTIs 4.7. PN was the most common source of secondary bloodstream infection (45%); the second was UTIs (22%). Mortality (directly and indirectly) associated with HAI was 10.8% and was related to the presence of PN or primary BSIs. HAIs were usually (69.2%) caused by Gram-negative bacteria; Klebsiella spp. and nonfermenting Gram-negative rods demonstrated very high antibiotic resistance. CONCLUSION: Despite the lack of widely implemented active targeted surveillance programmes and top-down incentives, it is possible to carry out effective surveillance of HAIs in ICUs in Poland. The results of this study are comparable with the ECDC data, but the results are alarmingly high in two fields: epidemiology of PN and BSIs and very high antibiotic resistance in Gram-negative rods, which indicate the need for intense control in this area and for further studies to clarify the source of the observed discrepancy.
- MeSH
- Drug Resistance, Microbial physiology MeSH
- Length of Stay statistics & numerical data MeSH
- Gram-Negative Bacterial Infections epidemiology mortality MeSH
- Gram-Positive Bacterial Infections epidemiology mortality MeSH
- Urinary Tract Infections epidemiology MeSH
- Cross Infection epidemiology mortality MeSH
- Intensive Care Units statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Critical Care statistics & numerical data MeSH
- Retrospective Studies MeSH
- Pneumonia, Ventilator-Associated epidemiology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
- Geographicals
- Poland MeSH
