Intensive Care Stay (intensive + care_stay)

Distribution by Scientific Domains

Selected Abstracts

Elective Intraaortic Balloon Counterpulsation in High-Risk Off-Pump Coronary Artery Bypass Grafting

Hunaid A. Vohra M.R.C.S.
However, the benefits of insertion of IABP electively in high-risk off-pump coronary artery bypass grafting (OPCAB) have not been established. Six hundred and twenty-five patients who underwent OPCAB form the study group. High-risk patients fulfilling two or more of the following: left main stem stenosis >70%, unstable angina, and poor left ventricular function, who had elective insertion of IABP preoperatively by the open technique (group I; n = 20) were compared with a similar high-risk group that did not (group II; n = 25). There were no significant differences in risk factors between the two groups (Euroscore 5.68). The mean number of grafts was similar. Postoperatively, there were no significant differences in the need for inotropes, duration of ventilation, arrhythmias, cerebrovascular, gastrointestinal, and infective complications (p = NS). There were no IABP-related complications. Acute renal failure requiring hemofiltration was higher in group II (n = 5; p < 0.05). Four patients (16%) in group II required postoperative IABP. Although intensive care stay was longer in group I (27.6 15.3 vs. 18.6 9.1 hours; p < 0.05), patients in group I were discharged earlier from hospital. There was no difference in mortality between the two groups (n = 1 in each group). In high-risk patients undergoing OPCAB, routine preoperative insertion of IABP electively reduces the incidence of acute renal failure. In addition it avoids the need for emergency insertion postoperatively and may result in earlier discharge. [source]

Patients' recovery after critical illness at early follow-up

Michelle A Kelly
Aim., To determine the quality of life, particularly physical function, of intensive care survivors during the early recovery process. Background., Survivors of critical illness face ongoing challenges after discharge from the intensive care unit and on returning home. Knowledge about health issues during early phases of recovery after hospital discharge is emerging, yet still limited. Design., Descriptive study where the former critically ill patients completed instruments on general health and quality of life (SF-36) in the first six months of recovery. Methods., Participants responded to the SF-36 questionnaire and questions about problems, one to six months after intensive care, either face-to-face or by telephone. Results., Thirty-nine participants had a mean age of 60 years; of them, 59% were men and had been in intensive care for 1,69 days (median = 5). Most participants (69%) rated their health as good or fair, but 54% rated general health as worse than a year ago. Mean quality of life scores for all scales ranged from 25,655%, with particularly low scores for Role-Physical (25) and Pain (451). Half the participants reported difficulty with mobility, sleep and concentration, and 72% that their responsibilities at home had changed. No relationships were found between SF-36 scores and admission diagnosis, gender, age or length of intensive care stay. Conclusions., These survivors of critical illness and hospitalisation in an intensive care unit perceive their general health to be good despite experiencing significant physical limitations and disturbed sleep during recovery. Relevance to clinical practice., Knowledge of issues in these early phases of recovery and discussion and resolution of patient problems could normalise the experience for the patient and help to facilitate better quality of life. [source]

Cocaine-related admissions to an intensive care unit: a five-year study of incidence and outcomes

ANAESTHESIA, Issue 2 2010
S. Galvin
Summary Cocaine misuse is increasing and it is evidently considered a relatively safe drug of abuse in Ireland. To address this perception, we reviewed the database of an 18-bed Dublin intensive care unit, covering all admissions from 2003 to 2007. We identified cocaine-related cases, measuring hospital mortality and long-term survival in early 2009. Cocaine-related admissions increased from around one annually in 2003,05 to 10 in 2007. Their median (IQR [range]) age was 25 (21,35 [17,47]) years and 78% were male. The median (IQR [range]) APACHE II score was 16 (11,27 [5,36]) and length of intensive care stay was 5 (3,9 [1,16]) days. Ten patients died during their hospital stay. A further five had died by the time of follow-up, a median of 24 months later. One was untraceable. Cocaine toxicity necessitating intensive care is increasingly common in Dublin. Hospital mortality in this series was 52%. These findings may help to inform public attitudes to cocaine. [source]

Non-invasive ventilation for treatment of postoperative respiratory failure after oesophagectomy

P. Michelet
Background: The aim of this case,control study was to compare the efficacy of non-invasive positive pressure ventilation (NPPV) with that of conventional treatment in patients who develop postoperative acute respiratory failure (ARF) after oesophagectomy. Methods: Thirty-six consecutive patients with ARF treated by NPPV were matched for diagnosis, age within 5 years, sex, preoperative radiochemotherapy and Charlson co-morbidity index with 36 patients who received conventional treatment (control group). Results: NPPV was associated with a lower reintubation rate (nine versus 23 patients; P = 0008), lower frequency of acute respiratory distress syndrome (eight versus 19 patients; P = 0015), and a reduction in intensive care stay (mean(s.d.) 14(13) versus 22(18) days; P = 0034). Anastomotic leakage was less common in patients receiving NPPV (two versus ten; P = 0027). These patients also showed a greater improvement in gas exchange in the first 3 days after onset of ARF (P = 0013). Conclusion: The use of NPPV for the treatment of postoperative ARF may decrease the incidence of endotracheal intubation and related complications, without increasing the risk of anastomotic leakage after oesophagectomy. Copyright 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]