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Pulmonary
Increased red cell distribution width predicts mortality in COVID-19 patients admitted to a Dutch intensive care unit
Anthony D. Mompiere, Jos L.M.L. le Noble, Manon Fleuren-Janssen, Kelly Broen, Frits van Osch, Norbert Foudraine
Acute Crit Care. 2024;39(3):359-368.   Published online August 22, 2024
DOI: https://doi.org/10.4266/acc.2023.01137
  • 817 View
  • 55 Download
AbstractAbstract PDF
Background
Abnormal red blood cell distribution width (RDW) is associated with poor cardiovascular, respiratory, and coronavirus disease 2019 (COVID-19) outcomes. However, whether RDW provides prognostic insights regarding COVID-19 patients admitted to the intensive care unit (ICU) was unknown. Here, we retrospectively investigated the association of RDW with 30-day and 90- day mortalities, duration of mechanical ventilation, and length of ICU and hospital stay in patients with COVID-19. Methods: This study included 321 patients with COVID-19 aged >18 years who were admitted to the ICU between March 2020 and July 2022. The outcomes were mortality, duration of mechanical ventilation, and length of stay. RDW >14.5% was assessed in blood samples within 24 hours of admission. Results: The mortality rate was 30.5%. Multivariable Cox regression analysis showed an association between increased RDW and 30-day mortality (hazard ratio [HR], 3.64; 95% CI, 1.54–8.65), 90-day mortality (HR, 3.66; 95% CI, 1.59–8.40), and shorter duration of invasive ventilation (2.7 ventilator-free days, P=0.033). Conclusions: Increased RDW in COVID-19 patients at ICU admission was associated with increased 30-day and 90-day mortalities, and shorter duration of invasive ventilation. Thus, RDW can be used as a surrogate biomarker for clinical outcomes in COVID-19 patients admitted to the ICU.
Nursing
The effects of environmental interventions for delirium in critically ill surgical patients
Hak-Jae Lee, Yoon-Joong Jung, Nak-Joon Choi, Suk-Kyung Hong
Acute Crit Care. 2023;38(4):479-487.   Published online November 28, 2023
DOI: https://doi.org/10.4266/acc.2023.00990
  • 1,658 View
  • 90 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Background
Delirium occurs at high rates among patients in intensive care units and increases the risk of morbidity and mortality. The purpose of this study was to investigate the effects of environmental interventions on delirium.
Methods
This prospective cohort study enrolled 192 patients admitted to the surgical intensive care unit (SICU) during the pre-intervention (June 2013 to October 2013) and post-intervention (June 2014 to October 2014) periods. Environmental interventions involved a cognitive assessment, an orientation, and a comfortable environment including proper sleep conditions. The primary outcomes were the prevalence, duration, and onset of delirium.
Results
There were no statistically significant differences in incidence rate, time of delirium onset, general characteristics, and mortality between the pre-intervention and post-intervention groups. The durations of delirium were 14.4±19.1 and 7.7±7.3 days in the pre-intervention and post-intervention groups, respectively, a significant reduction (P=0.027). The lengths of SICU stay were 20.0±22.9 and 12.6±8.7 days for the pre-intervention and post-intervention groups, respectively, also a significant reduction (P=0.030).
Conclusions
The implementation of an environmental intervention program reduced the duration of delirium and length of stay in the SICU for critically ill surgical patients.

Citations

Citations to this article as recorded by  
  • Reasons influencing the nurses’ prioritization process while preventing and managing delirium: findings from a qualitative study
    Luisa Sist, Nikita Valentina Ugenti, Stefania Chiappinotto, Rossella Messina, Paola Rucci, Alvisa Palese
    Aging Clinical and Experimental Research.2024;[Epub]     CrossRef
Infection
Predicting factors associated with prolonged intensive care unit stay of patients with COVID-19
Won Ho Han, Jae Hoon Lee, June Young Chun, Young Ju Choi, Youseok Kim, Mira Han, Jee Hee Kim
Acute Crit Care. 2023;38(1):41-48.   Published online February 22, 2023
DOI: https://doi.org/10.4266/acc.2022.01235
  • 3,870 View
  • 105 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
Predicting the length of stay (LOS) for coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU) is essential for efficient use of ICU resources. We analyzed the clinical characteristics of patients with severe COVID-19 based on their clinical care and determined the predictive factors associated with prolonged LOS. Methods: We included 96 COVID-19 patients who received oxygen therapy at a high-flow nasal cannula level or above after ICU admission during March 2021 to February 2022. The demographic characteristics at the time of ICU admission and results of severity analysis (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation [APACHE] II), blood tests, and ICU treatments were analyzed using a logistic regression model. Additionally, blood tests (C-reactive protein, D-dimer, and the PaO2 to FiO2 ratio [P/F ratio]) were performed on days 3 and 5 of ICU admission to identify factors associated with prolonged LOS. Results: Univariable analyses showed statistically significant results for SOFA score at the time of ICU admission, C-reactive protein level, high-dose steroids, mechanical ventilation (MV) care, continuous renal replacement therapy, extracorporeal membrane oxygenation, and prone position. Multivariable analysis showed that MV care and P/F ratio on hospital day 5 were independent factors for prolonged ICU LOS. For D-dimer, no significant variation was observed at admission; however, after days 3 and 5 days of admission, significant between-group variation was detected. Conclusions: MV care and P/F ratio on hospital day 5 are independent factors that can predict prolonged LOS for COVID-19 patients.

Citations

Citations to this article as recorded by  
  • Predictors of prolonged ventilator weaning and mortality in critically ill patients with COVID-19
    Marcella M Musumeci, Bruno Valle Pinheiro2, Luciana Dias Chiavegato1, Danielle Silva Almeida Phillip1, Flavia R Machado3, Fabrício Freires3, Osvaldo Shigueomi Beppu1, Jaquelina Sonoe Ota Arakaki1, Roberta Pulcheri Ramos1
    Jornal Brasileiro de Pneumologia.2023; : e20230131.     CrossRef
  • The distorted memories of patients treated in the intensive care unit during the COVID-19 pandemic: A qualitative study
    Gisela Vogel, Ulla Forinder, Anna Sandgren, Christer Svensen, Eva Joelsson-Alm
    Intensive and Critical Care Nursing.2023; 79: 103522.     CrossRef

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