Motion Phases Recognition Method using Recurrent Neural Network for Rehabilitation Cycling Device

Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries

BackgroundFamily caregivers of former intensive care unit (ICU) patients may suffer from physical and mental problems owing to ICU hospitalisation of their loved ones. These problems can have a major impact on their daily lives. Little is known about experienced consequences of ICU hospitalisation on caregivers in general practice.AimTo explore health problems in family caregivers of former ICU patients and the consequences in their daily lives.Design & settingSemi-structured interviews with family caregivers of former critically ill patients treated in a Dutch ICU.MethodPurposively sampled relatives of former ICU patients were interviewed between April and May 2019. Interviews were conducted until data saturation was reached. Interviews were then thematically analysed.ResultsIn total, 13 family caregivers were interviewed. The interviews took place 3 months to 3 years after ICU discharge. Expressed problems were categorised into six themes: (1) physical functioning (for example, tiredness, headache, and feeling sick more often); (2) mental health (for example, anxiety, more stress and difficulty in expressing emotions); (3) existential dimension and future (for example, uncertainty about the future); (4) quality of life (for example, losing freedom in life); (5) relationship and social participation (for example, experiencing a lack of understanding); and (6) daily functioning (for example, stopping working).ConclusionCaregivers experience several health problems, even years after their relative's ICU episode. Healthcare providers should be focused not only on former ICU patients’ health, but also on their caregivers’, and need to signal and identify caregivers' health problems earlier in order to give them the appropriate care and support they need.

Intensive care unit (ICU) patients experience hypoglycemia at nearly 4 times the rate seen in non-ICU counterparts. Although inpatient hypoglycemia management relies on nurse-driven protocols, protocol adherence varies between institutions and units. To compare hypoglycemia management between ICU and non-ICU patients in an institution with high adherence to a hypoglycemia protocol. This secondary analysis used retrospective medical record data. Cases were ICU patients aged 18 years or older with at least 1 hypoglycemic event (blood glucose level < 70 mg/dL); non-ICU controls were matched by age within 10 years, sex, and comorbidities. Time from initial hypoglycemic blood glucose level to subsequent blood glucose recheck, number of interventions, time to normoglycemia, and number of spontaneous hypoglycemic events were compared between groups. The sample included 140 ICU patients and 280 non-ICU controls. Median time to blood glucose recheck did not differ significantly between groups (19 minutes for both groups). Difference in mean number of interventions before normoglycemia was statistically but not clinically significant (ICU, 1.12; non-ICU, 1.35; P < .001). Eighty-four percent of ICU patients and 86% of non-ICU patients returned to normoglycemia within 1 hour. Median time to normoglycemia was lower in ICU patients than non-ICU patients (21.5 vs 26 minutes; P = .01). About 25% of patients in both groups experienced a spontaneous hypoglycemic event. Adherence to nurse-driven hypoglycemia protocols can be equally effective in ICU and non-ICU patients. Further research is needed to determine protocol adherence barriers and patient characteristics that influence response to hypoglycemia interventions.

The death of a loved one in the intensive care unit may cause prolonged grief, social distress, and even symptoms of posttraumatic stress in family members. End-of-life interventions, such as grief education materials, telephone follow-up, and cards, are an important part of bereavement care for families. However, use of these interventions varies across institutions, and research findings on their effectiveness are conflicting.Takaoka and colleagues examined the use of multiauthored, customized handwritten sympathy cards mailed to families 2 to 8 weeks post mortem. They interviewed family members and clinicians and identified 3 themes: The use of personalized, written condolences from staff was experienced as a meaningful and compassionate intervention for bereaved families.See Article, pp 422-428Pressure injuries occur twice as often in intensive care unit (ICU) patients as in other acute care patients, with estimated costs of care exceeding $26.8 billion in the United States. Although there are known risk factors for hospital-acquired pressure injury (HAPI), such as decreased mobility, having surgery, and age greater than 65 years, little research has examined the relationship between skin status and HAPI in ICU patients.Alderden and colleagues examined data from routine nursing skin assessments to identify risk factors for HAPI in adult surgical ICU patients. They found the following: Although further study is warranted to examine intraoperative risk factors, the authors recommend nurses consider the impact of skin changes on the development of HAPIs and remove causes of skin irritation.See Article, pp e128-e134Catheter-associated urinary tract infections continue to occur in both intensive care unit (ICU) patients and non-ICU patients, despite national prevention initiatives. Use of bladder scanning and ultrasound technology has helped to decrease the number of indwelling urinary catheter days, but the technology yields inaccuracies in patients with acute kidney injury, especially those with abdominal fluid/ascites.Schallom et al compared the accuracy of new bladder scanning technology and 2-dimensional ultrasound in measuring bladder volume in ICU patients unable to void 6 hours after catheter removal or patients receiving dialysis. They found Both bladder scanning and ultrasound can be used to measure bladder volumes accurately, but findings suggest that ultrasound should be used to measure bladder volume in patients with ascites.See Article, pp 458-467Many intensive care unit (ICU) patients require feeding tubes for nutritional support and medication delivery. Traditional practice includes every-4-hour assessment to verify tube placement. However, complications from malplaced feeding tubes continue to occur owing to inaccurate verification methods and lack of knowledge about tube migration.Using an electromagnetic placement device (EMPD) for tube placement, Bourgault and colleagues explored the factors associated with tube migration in adult ICU patients. They found See Article, pp 439-447

Background: Intensive care unit (ICU) patients experience multiple uncomfortable symptoms, which may be alleviated using music-based intervention, a nondrug treatment. This umbrella review aims to combine the data of systematic reviews and/or meta-analyses to evaluate the effectiveness of music-based intervention in improving uncomfortable symptoms in ICU patients. Methods: A comprehensive literature search was performed on the PubMed, Embase, Cochrane Library, Airiti Library, CINAHL, ProQuest, and Web of Science databases, and Epistemonikos. The search had no language restrictions, and articles on the improvement of symptoms using music-based intervention in adult ICU patients were included. This review protocol was registered on PROSPERO (CRD42021240327). Results: This umbrella review retrieved 5 systematic reviews and 41 original studies, including 39 randomized controlled trials, and 2 nonrandomized controlled trials. Diverse music was the most common music type used for music-based intervention, the intervention music was typically decided by the study participants (61%), and most subjects underwent one intervention session (78%). Furthermore, most music intervention sessions lasted for 30 min (44%). The positive results included decreased anxiety, decreased pain, decreased agitation, decreased anesthesia dose and sedative use, decreased chances of delirium, decreased feelings of uncomfort, and improved sleep quality. Conclusions: A systematic review on the effectiveness of music-based intervention in improving uncomfortable symptoms in ICU patients revealed that 20–30 min intervention sessions showed the best improvement in the uncomfortable symptoms in patients. This study provides a basis for using music-based intervention to relieve the uncomfortable symptoms in critically ill ICU patients, and a reference for empirical clinical practice.

Psychiatric management of Patients in intensive care units.

Ondansetron is widely used for prophylaxis of postoperative nausea and vomiting (PONV) after general anesthesia. While previous studies have emphasized its early use, the effects of ondansetron in intensive care unit (ICU) patients following cardiac surgery remain unclear. This study investigates the association between postoperative ondansetron exposure and the risk of mortality, acute kidney injury (AKI), and postoperative atrial fibrillation (POAF) in ICU patients after cardiac surgery. We conducted a retrospective cohort study utilizing data from the MIMIC-IV database. Adult patients who underwent cardiac surgery and were subsequently admitted to the ICU were included. Cox proportional hazards models were employed to assess the effect of ondansetron exposure on ICU and 28-day mortality. Multivariable logistic regression analyses examined the associations between ondansetron exposure and the incidence of AKI (2-day and 7-day) and POAF. Sensitivity analyses included Propensity Score Matching (PSM) and the inclusion of patients with ICU stays of less than 24h to ensure robustness of results. Subgroup analyses explored the effects of age and other clinical factors, with interaction tests to examine differential impacts. A total of 7,170 were included. The incidence of AKI was 74.4% at 2days and 76.7% at 7days post-surgery. The 28-day postoperative mortality rate was 1.4%, while the ICU mortality rate was 1.0%. POAF occurred in 17.4% of the patients. Ondansetron exposure was not associated with 28-day mortality or ICU mortality (p > 0.05). However, after PSM, ondansetron exposure was significantly associated with an elevated risk of AKI at 2days (OR 1.28, 95% CI 1.13-1.45, p < 0.001] and 7days (OR 1.25, 95% CI 1.15-1.45, p < 0.001), as well as POAF (OR 1.20, 95% CI 1.04-1.39, p = 0.014).Subgroup analysis revealed a stronger association in patients aged over 65 years, where ondansetron was linked to an increased risk of 7-day AKI (OR 1.51, 95% CI 1.29-1.78, p < 0.001) and POAF (OR 1.31, 95% CI 1.12-1.53, p = 0.001). Interaction tests showed a significant interaction between ondansetron exposure and age (P for interaction = 0.018 for AKI and P for interaction = 0.02 for POAF). Sensitivity analyses, including patients with ICU stays of less than 24h, confirmed the robustness of these findings. In ICU patients following cardiac surgery, postoperative use of ondansetron is associated with an increased risk of both 7-day AKI and POAF, particularly in patients aged 65 years and older. These findings suggest that the use of ondansetron in this population should be approached with caution, especially in elderly patients who may be more susceptible to these complications. Further research is needed to explore the mechanisms underlying the association between ondansetron and these adverse outcomes.

BackgroundFew data are available regarding the epidemiology of invasive aspergillosis (IA) in ICU patients. The aim of this study was to examine epidemiology and economic outcomes (length of stay, hospital costs) among ICU patients with IA who lack traditional risk factors for IA, such as cancer, transplants, neutropenia or HIV infection.MethodsRetrospective cohort study using Premier Inc. Perspective™ US administrative hospital database (2005–2008). Adults with ICU stays and aspergillosis (ICD-9 117.3 plus 484.6) who received initial antifungal therapy (AF) in the ICU were included. Patients with traditional risk factors (cancer, transplant, neutropenia, HIV/AIDS) were excluded. The relationship of antifungal therapy and co-morbidities to economic outcomes were examined using Generalized linear models.ResultsFrom 6,424 aspergillosis patients in the database, 412 (6.4%) ICU patients with IA were identified. Mean age was 63.9 years and 53% were male. Frequent co-morbidities included steroid use (77%), acute respiratory failure (76%) and acute renal failure (41%). In-hospital mortality was 46%. The most frequently used AF was voriconazole (71% received at least once). Mean length of stay (LOS) was 26.9 days and mean total hospital cost was $76,235. Each 1 day lag before initiating AF therapy was associated with 1.28 days longer hospital stay and 3.5% increase in costs (p < 0.0001 for both).ConclusionsInvasive aspergillosis in ICU patients is associated with high mortality and hospital costs. Antifungal timing impacts economic outcomes. These findings underscore the importance of timely diagnosis, appropriate treatment, and consideration of Aspergillus as a potential etiology in ICU patients.

BackgroundMedical device-related pressure injury (MDRPI) in intensive care unit (ICU) patients is a serious issue. We aimed to evaluate the risk factors for MDRPI associated with ICU patients through systematic review and meta-analysis, and provide insights into the clinical prevention of MDRPI.MethodsWe searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, and China BioMedical Literature Database (CBM) (from inception to January 2023) for studies that identified risk factors of MDRPI in ICU patients. In order to avoid the omission of relevant literature, we performed a secondary search of the above database on February 15, 2023. Meta-analysis was performed using Revman 5.3.ResultsFifteen studies involving 4850 participants were selected to analyze risk factors for MDRPI in ICU patients. While conducting a meta-analysis, we used sensitivity analysis to ensure the reliability of the results for cases with significant heterogeneity among studies. When the source of heterogeneity cannot be determined, we only described the risk factor. The risk factors for MDRPI in ICU patients were elder age (OR = 1.06, 95% CI: 1.03–1.10), diabetes mellitus (OR = 3.20, 95% CI: 1.96–5.21), edema (OR = 3.62, 95% CI: 2.31–5.67), lower Braden scale score (OR = 1.22, 95%CI: 1.11–1.33), higher SOFA score (OR = 4.21, 95%CI: 2.38–7.47), higher APACHE II score (OR = 1.38, 95%CI: 1.15–1.64), longer usage time of medical devices (OR = 1.11, 95%CI: 1.05–1.19), use of vasoconstrictors (OR = 6.07, 95%CI: 3.15–11.69), surgery (OR = 4.36, 95% CI: 2.07–9.15), prone position (OR = 24.71, 95% CI: 7.34–83.15), and prone position ventilation (OR = 17.51, 95% CI: 5.86–52.36). Furthermore, we found that ICU patients who used subglottic suction catheters had a higher risk of MDRPI, whereas ICU patients with higher hemoglobin and serum albumin levels had a lower risk of MDRPI.ConclusionThis study reported the risk factors for MDRPI in ICU patients. A comprehensive analysis of these risk factors will help to prevent and optimize interventions, thereby minimizing the occurrence of MDRPI.

This study aimed to review the oral hygiene status, oral care guidelines, and outcomes of oral care in intensive care unit (ICU) patients from a dental perspective for effective oral care. A literature search using the keywords “Hospital dentistry” OR “Oral care” OR “Intensive care unit” OR “Hospital inpatient” OR “Hospitalization” OR “Emergency service” AND “Oral health” OR “Oral hygiene” OR “Dental plaque” was conducted in PubMed, Medline, and Google Scholar to identify publications reporting on the oral care of the patients admitted to ICUs. A total of 17,400 articles were initially identified. Of these, 58 were selected and classified into three categories for critical review. Seven of these studies evaluated the oral status of ICU patients, and most of the studies indicated that ICU patients had poor oral hygiene or required active dental treatment. Thirty-three of these studies evaluated oral care methods for ICU patients, and in general, oral care methods using chlorhexidine as adjuncts along with tooth brushing were recommended. However, there were insufficient studies to evaluate oral hygiene through effective assessment tools from a dental perspective. In 36 studies on the outcomes of oral care in ICU patients, interventions by dental professionals showed effective results in preventing hospital-acquired infection. This review highlights the importance of establishing guidelines for the evaluation of oral status in ICU patients and summarizes data that may be useful for future studies. Further studies on maintaining good oral hygiene among ICU patients are needed.

Nutrition therapy in the intensive care unit during the COVID-19 pandemic: Findings from the ISIIC point prevalence study

BackgroundThe immuno-receptor Triggering Expressed on Myeloid cells-1 (TREM-1) is activated during bacterial infectious diseases, where it amplifies the inflammatory response. Small studies suggest that TREM-1 could be involved in viral infections, including COVID-19. We here aim to decipher whether plasma concentration of the soluble form of TREM-1 (sTREM-1) could predict the outcome of hospitalized COVID-19 patients.MethodsWe conducted a multicentre prospective observational study in 3 university hospitals in France. Consecutive hospitalized patients with confirmed infection with SARS-CoV-2 were enrolled. Plasma concentration of sTREM-1 was measured on admission and then at days 4, 6, 8, 14, 21, and 28 in patients admitted into an ICU (ICU cohort: ICUC) or 3 times a week for patients hospitalized in a medical ward (Conventional Cohort: ConvC). Clinical and biological data were prospectively recorded and patients were followed-up for 90 days. For medical ward patients, the outcome was deemed complicated in case of requirement of increased oxygen supply > 5 L/min, transfer to an ICU, or death. For Intensive Care Unit (ICU) patients, complicated outcome was defined by death in the ICU.ResultsPlasma concentration of sTREM-1 at inclusion was higher in ICU patients (n = 269) than in medical ward patients (n = 562) (224 pg/mL (IQR 144–320) vs 147 pg/mL (76–249), p < 0.0001), and higher in patients with a complicated outcome in both cohorts: 178 (94–300) vs 135 pg/mL (70–220), p < 0.0001 in the ward patients, and 342 (288–532) vs 206 pg/mL (134–291), p < 0.0001 in the ICU patients. Elevated sTREM-1 baseline concentration was an independent predictor of complicated outcomes (Hazard Ratio (HR) = 1.5 (1.1–2.1), p = 0.02 in ward patients; HR = 3.8 (1.8–8.0), p = 0.0003 in ICU patients). An sTREM-1 plasma concentration of 224 pg/mL had a sensitivity of 42%, and a specificity of 76% in the ConvC for complicated outcome. In the ICUC, a 287 pg/mL cutoff had a sensitivity of 78%, and a specificity of 74% for death. The sTREM-1 concentrations increased over time in the ConvC patients with a complicated outcome (p = 0.017), but not in the ICUC patients.ConclusionsIn COVID-19 patients, plasma concentration of sTREM-1 is an independent predictor of the outcome, although its positive and negative likelihood ratio are not good enough to guide clinical decision as a standalone marker.

Attending to the needs of family members of critically ill patients is an important and necessary step in providing appropriate holistic care for both the patient and the family. Family interaction can significantly impact on the experience of critical illness, notwithstanding the challenge of meeting families' needs for many clinicians in the intensive care unit (ICU). Family needs have been extensively researched; however, a previous Joanna Briggs Institute (JBI) systematic review was the first published systematic review recommending effective interventions for addressing family needs of critically ill patients in an acute intensive care setting. Since its publication in 2011, additional research findings have been published and it was deemed appropriate to update the original systematic review. This systematic review aims to establish recent best practice in addressing the needs of family members with a relative or loved one admitted to an adult critical care unit. Studies that included family members (including children) of adult patients in an ICU were considered for inclusion in this review. Patients with any clinical condition, length of stay or outcome were included. This review considered interventions that addressed the five previously identified categories of family needs: support - support groups, training in coping strategies and journal or diary writing; assurance - face-to-face meetings and participation in ward rounds; proximity - changes to visitation policies; information - staff and/or family education, handouts and brochures and the use of technology (e.g. SMS messages); and comfort - changes to the ICU physical environment. This review considered any randomized controlled trials (RCTs) that evaluated the effectiveness of interventions in addressing family needs of critically ill patients in an adult ICU. In the absence of RCTs, other research designs such as quasi-experimental, as well as pre- and post-studies were considered for inclusion in the narrative summary to enable the identification of current approaches and possible future strategies for addressing family needs of critically ill patients. This review considered studies that evaluated outcomes with a validated tool that measured information comprehension, coping mechanisms, anxiety, depression, stress and satisfaction. An extensive search of the major databases was conducted. Databases searched included PubMed, CINAHL, psycINFO, Health source, Web of Science, EMBASE, the Cochrane Library and Database of Abstracts of Reviews of Effects. The original search of this review included published and unpublished studies and articles in English from 1980 to 2010. The updated search identified articles for inclusion from 2010 to 2014. Quantitative articles selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review. Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. Data was extracted from the articles included in this review using standardized data extraction tools from the JBI Meta Analysis of Statistics Assessment and Review Instrument package. The studies included in this review were not suitable for meta-analysis and therefore the results are presented as a narrative summary. Originally, 14 studies and one dissertation met the inclusion criteria and were included in the review. Of these, 12 were quasi-experimental studies and three were prospective randomized trials. In this current update, 14 new articles were identified for inclusion - one RCT, 10 quasi-experimental studies and three observational studies. The settings were in ICUs in Sweden, USA, United Kingdom, the Netherlands, France, Hong Kong, Saudi Arabia and Iran. The evidence identified from all studies in the review includes the use of support groups for family members of patients admitted to an ICU, structured communication and/or education programs for family members, the use of leaflets or brochures to meet family information needs, use of a diary, changes in the physical environment and open or more flexible visiting hours. This current update of the original review makes several reiterative and new recommendations for clinical practice to address family needs of patients admitted to a critical care unit; however, the need for significant further research in this area is again highlighted. Future intervention studies focusing on family needs could include the use of technology such as DVDs (Digital Versatile Discs) and SMS (Short Message Service) for informing families and interventions specifically designed to improve family comfort. Communication interventions help promote family involvement in their loved one's care and facilitate their decision-making capacity, as well as improving clinician and family interaction, family comprehension of their loved one's condition and also reduce the development of post-traumatic stress-related symptoms (Grade A). Family satisfaction may be increased with the provision of comfortable physical environments with noise reduction measures (Grade B). More rigorous high-quality studies investigating interventions to meet the needs of family with a relative in ICU are needed. The majority of included studies in this updated review focused on family satisfaction wherein more robust data on family needs would better inform health professionals in their practice.

Effects of a disinfection device on colonization of sink drains and patients during a prolonged outbreak of multidrug-resistant Pseudomonas aeruginosa in an intensive care unit

Dear Editor, Extracorporeal membrane oxygenation (ECMO) has a significant impact on intensive care unit (ICU) patient costs. Human resources are a major cost driver for ECMO in severe acute respiratory distress syndrome (ARDS) [1]. However, recent developments in ECMO technology has allowed safe patient management by a single caregiver [2–4]. In the present report, we analyze the direct ICU costs of patients with influenza A (H1N1)-related ARDS supported with miniaturized ECMO systems and managed by a single caregiver. We performed an observational study of all patients (n = 10) with H1N1-associated ARDS treated with ECMO in Hospital S. Joao (Porto, Portugal), between November 2009 and April 2011. The clinical data and ECMO treatment details of this ICU patient cohort have been described in a previous report [5]. Patients were admitted in medical ICUs and managed by a single caregiver using miniaturized ECMO circuits (Rotaflow Centrifugal Pump plus Quadrox PLS and CARDIOHELP; Maquet Cardiopulmonary AG). In our single caregiver model, the ICU nurse primarily managed the ECMO patient under the coordination of 24/7 inhouse ICU physicians, with the backup of an on-call ECMO specialist. Our multidisciplinary ECMO specialist team (ICU physicians, ICU nurses, and cardiovascular perfusionists) is responsible for managing equipment and supplies, circuit preparation, patient transportation, troubleshooting, daily rounds, education, and service administration. Per patient ICU direct costs were analyzed retrospectively from clinical records and hospital databases using both top-down and bottom-up approaches. Bottom-up analysis was performed for all drugs, transfusion requirements, laboratory and imagiology exams. Regarding disposable items, bottom-up analysis was possible for ECMO-specific disposables and for renal replacement therapies. Costs with human resources were assessed using the top-down approach. Specific ECMO costs were also individualized for each ICU episode: (1) disposables devices; (2) laboratory tests; (3) transfusion requirements; and (4) drugs. The Ethics Committee of the Hospital S. Joao approved this study and waived the need for patients’ informed consent. Variables are reported as median and interquartile ranges, if not otherwise indicated. The cost drivers of H1N1-related ARDS patients treated with miniaturized ECMO are presented in Table 1. ECMO support corresponded to 63.6 (62.5–88.5) % of the ICU length of stay (LOS). The ICU LOS positively correlated (r = 0.97; p \ 0.001) with ICU patient costs [42,721 (33,358–56,801) €], but not with specific ECMO costs [r = 0.17; p = 0.63; 7,516 (5,599–7,736) €]. ECMO-specific costs represented 17.6 (13.1–18.1) % of the total ICU direct costs, mostly ECMO disposable devices [94.8 (87.1–96.1) %]. Daily ICU costs with antibiotics, sedation, analgesia and neuromuscular blockade, fluids and nutrition, vasoactive drugs, anticoagulation medications, and other unspecific drugs were higher during the period of ECMO support compared with the period without ECMO support. In conclusion, the use of miniaturized ECMO had a small impact on direct ICU costs in our cohort of H1N1-related severe ARDS patients managed by a single caregiver and did not correlate with the ICU LOS. Knowledge of the incremental costs associated with miniaturized ECMO will contribute to the clarification of its cost-effectiveness in severe ARDS.