Enhancing Recovery From Sepsis

JAMA, Journal Year: 2018, Volume and Issue: 319(1), P. 62 - 62

Published: Jan. 2, 2018

Importance

Survival from sepsis has improved in recent years, resulting an increasing number of patients who have survived treatment. Current guidelines do not provide guidance on posthospital care or recovery.

Observations

Each year, more than 19 million individuals develop sepsis, defined as a life-threatening acute organ dysfunction secondary to infection. Approximately 14 survive hospital discharge and their prognosis varies. Half recover, one-third die during the following one-sixth severe persistent impairments. Impairments include development average 1 2 new functional limitations (eg, inability bathe dress independently), 3-fold increase prevalence moderate cognitive impairment (from 6.1% before hospitalization 16.7% after hospitalization), high mental health problems, including anxiety (32% survive), depression (29%), posttraumatic stress disorder (44%). About 40% are rehospitalized within 90 days discharge, often for conditions that potentially treatable outpatient setting, such infection (11.9%) exacerbation heart failure (5.5%). Compared with hospitalized other diagnoses, those at increased risk recurrent matched (8.0%) (P < .001), renal (3.3% vs 1.2%,P cardiovascular events (adjusted hazard ratio [HR] range, 1.1-1.4). Reasons deterioration multifactorial accelerated progression preexisting chronic conditions, residual damage, impaired immune function. Characteristics associated complications treatment fully understood but both poorer presepsis status, characteristics septic episode severity infection, host response infection), quality timeliness initial care, avoidance treatment-related harms). Although there is paucity clinical trial evidence support specific postdischarge rehabilitation treatment, experts recommend referral physical therapy improve exercise capacity, strength, independent completion activities daily living. This recommendation supported by observational study involving 30 000 survivors found was lower 10-year mortality compared propensity-matched controls HR, 0.94; 95% CI, 0.92-0.97,P .001).

Conclusions Relevance

In months management should focus (1) identifying physical, mental, problems referring appropriate (2) reviewing adjusting long-term medications, (3) evaluating commonly result hospitalization, failure, aspiration. For poor declining prior experience further it may be palliation symptoms.

Language: Английский

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Delirium

Nature Reviews Disease Primers, Journal Year: 2020, Volume and Issue: 6(1)

Published: Nov. 12, 2020

Language: Английский

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Severe covid-19 pneumonia: pathogenesis and clinical management

BMJ, Journal Year: 2021, Volume and Issue: unknown, P. n436 - n436

Published: March 10, 2021

Severe covid-19 pneumonia has posed critical challenges for the research and medical communities. Older age, male sex, comorbidities increase risk severe disease. For people hospitalized with covid-19, 15-30% will go on to develop associated acute respiratory distress syndrome (CARDS). Autopsy studies of patients who died SARS CoV-2 infection reveal presence diffuse alveolar damage consistent ARDS but a higher thrombus burden in pulmonary capillaries. When used appropriately, high flow nasal cannula (HFNC) may allow CARDS avoid intubation, does not disease transmission. During invasive mechanical ventilation, low tidal volume ventilation positive end expiratory pressure (PEEP) titration optimize oxygenation are recommended. Dexamethasone treatment improves mortality while remdesivir have modest benefit time recovery shows no statistically significant or other clinical outcomes. Covid-19 survivors, especially ARDS, at long term physical mental impairments, an interdisciplinary approach is essential illness recovery.

Language: Английский

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Rehabilitation After Critical Illness in People With COVID-19 Infection

American Journal of Physical Medicine & Rehabilitation, Journal Year: 2020, Volume and Issue: 99(6), P. 470 - 474

Published: April 13, 2020

Abstract The current COVID-19 pandemic will place enormous pressure on healthcare systems around the world. Large numbers of people are predicted to become critically ill with acute respiratory distress syndrome and require management in intensive care units. High levels physical, cognitive, psychosocial impairments can be anticipated. Rehabilitation providers serve as an important link continuum care, helping move patients from sites eventual discharge community. Likely impairment patterns, considerations for practitioner resilience, organization services meet demand discussed. Innovative approaches such virtual rehabilitation, likely common this environment.

Language: Английский

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Incidence and Prevalence of Delirium Subtypes in an Adult ICU: A Systematic Review and Meta-Analysis*

Critical Care Medicine, Journal Year: 2018, Volume and Issue: 46(12), P. 2029 - 2035

Published: Oct. 2, 2018

Objectives: Use systematic review and meta-analytic methodology to estimate the pooled incidence, prevalence, proportion of delirium cases for each subtype (hypoactive, hyperactive, mixed) in an adult ICU population. Data Sources: We conducted a search MEDLINE, EMBASE, CINAHL, SCOPUS, Web Science, PsycINFO databases following Preferred Reporting Items Systematic Reviews Meta-Analyses standards from database inception until October 22, 2017, with no restrictions. Study Selection: included original research adults admitted any medical, surgical, or speciality that reported incidence prevalence estimates according subtype. Extraction: were extracted on sample size, population demographics, condition information, estimates. Synthesis: Forty-eight studies (27,342 patients; 4,550 delirium) overall 31% (95% CI, 24–41; I 2 = 99%) met inclusion criteria. The ( n 18 studies) subtypes hyperactive (4% [95% 2–6]; 92%]), hypoactive (11% 8–17; 97%]), mixed (7% 4–11; 97%]). 31 3–6; 94%]), (17% 13–22; (10% 6–16; 99%]). study populations similarly high severity illness mechanically ventilated was higher (severity illness: 29% 18–46%; 95%], 100% ventilated: 35% 23–55%; 93%]) compared delirium. Conclusions: Despite significant heterogeneity between studies, these data show majority delirious patients have delirium, finding potential monitoring, management, prognostic implications. varies between-study is greater illness.

Language: Английский

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Delirium in Older Patients With COVID-19 Presenting to the Emergency Department

JAMA Network Open, Journal Year: 2020, Volume and Issue: 3(11), P. e2029540 - e2029540

Published: Nov. 19, 2020

Importance

Delirium is common among older emergency department (ED) patients, associated with high morbidity and mortality, frequently goes unrecognized. Anecdotal evidence has described atypical presentations of coronavirus disease 2019 (COVID-19) in adults; however, the frequency outcomes delirium ED patients COVID-19 infection have not been well described.

Objective

To determine how adults present to their hospital outcomes.

Design, Setting, Participants

This multicenter cohort study was conducted at 7 sites US. Participants included consecutive presenting on or after March 13, 2020.

Exposure

diagnosed by positive nasal swab for severe acute respiratory syndrome 2 (99% cases) classic radiological findings (1% cases).

Main Outcomes Measures

The primary outcome as identified from medical record according a validated review approach.

Results

A total 817 were included, whom 386 (47%) male, 493 (62%) White, 215 (27%) Black, 54 (7%) Hispanic Latinx. mean (SD) age 77.7 (8.2) years. Of 226 (28%) had presentation, sixth most all symptoms signs. Among delirium, 37 (16%) symptom 84 (37%) no typical signs, such fever shortness breath. Factors than 75 years (adjusted relative risk [aRR], 1.51; 95% CI, 1.17-1.95), living nursing home assisted (aRR, 1.23; 0.98-1.55), prior use psychoactive medication 1.42; 1.11-1.81), vision impairment 1.98; 1.54-2.54), hearing 1.10; CI 0.78-1.55), stroke 1.47; 1.15-1.88), Parkinson 1.88; 1.30-2.58). intensive care unit stay 1.67; 1.30-2.15) death 1.24; 1.00-1.55).

Conclusions Relevance

In this US departments, often seen without other addition, poor death. These suggest clinical importance including checklists signs that guide screening, testing, evaluation.

Language: Английский

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Surviving sepsis campaign: research priorities for sepsis and septic shock

Intensive Care Medicine, Journal Year: 2018, Volume and Issue: 44(9), P. 1400 - 1426

Published: July 3, 2018

Language: Английский

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Septic-Associated Encephalopathy: a Comprehensive Review

Neurotherapeutics, Journal Year: 2020, Volume and Issue: 17(2), P. 392 - 403

Published: April 1, 2020

Language: Английский

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The inter-relationship between delirium and dementia: the importance of delirium prevention

Nature Reviews Neurology, Journal Year: 2022, Volume and Issue: 18(10), P. 579 - 596

Published: Aug. 26, 2022

Language: Английский

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ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Anaesthesiology Intensive Therapy, Journal Year: 2018, Volume and Issue: 50(2), P. 160 - 167

Published: June 8, 2018

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Kotfis K, Marra A, Ely E. ICU delirium — a diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiology Intensive Therapy. 2018;50(2). APA Kotfis, K., Marra, A., & Ely, (2018). Therapy, 50(2). Chicago Katarzyna, Annachiara Wesley Ely. 2018. "ICU unit". Therapy 50 (2). Harvard MLA Katarzyna et al. unit." vol. 50, no. 2, Vancouver

Language: Английский

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