Improving long-term outcomes after discharge from intensive care unit

Critical Care Medicine, Год журнала: 2011, Номер 40(2), С. 502 - 509

Опубликована: Окт. 4, 2011

Millions of patients are discharged from intensive care units annually. These survivors and their families frequently report a wide range impairments in health status which may last for months years after hospital discharge.To on 2-day Society Critical Care Medicine conference aimed at improving the long-term outcomes critical illness families.Thirty-one invited stakeholders participated conference. Stakeholders represented key professional organizations groups, predominantly North America, involved discharge.Invited experts members presented summary existing data regarding potential physical, cognitive mental problems results studies postintensive unit interventions to address these problems. provided reactions, perspectives, concerns strategies mitigating problems.Three major themes emerged regarding: (1) raising awareness education, (2) understanding addressing barriers practice, (3) identifying research gaps resources. Postintensive syndrome was agreed upon as recommended term describe new or worsening cognitive, arising persisting beyond acute hospitalization. The could be applied either survivor family member.Improving requires collaboration between practitioners researchers both inpatient outpatient settings. Strategies were developed improve families.

Язык: Английский

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The Effect of a Quality Improvement Intervention on Perceived Sleep Quality and Cognition in a Medical ICU*

Critical Care Medicine, Год журнала: 2013, Номер 41(3), С. 800 - 809

Опубликована: Янв. 11, 2013

Objectives: To determine if a quality improvement intervention improves sleep and delirium/cognition. Design: Observational, pre–post design. Setting: A tertiary academic hospital in the United States. Patients: 300 medical ICU patients. Interventions: This ICU-wide project involved “usual care” baseline stage, followed by stage incorporating multifaceted sleep-promoting interventions implemented with aid of daily reminder checklists for staff. Measurements Main Results: Primary outcomes were perceived noise ratings (measured on 0–100 scale using valid reliable Richards–Campbell Sleep Questionnaire) delirium/coma-free days. Secondary included length stay mortality. Post-ICU measures cognition evaluated an patient subset. During stages, there 122 178 patients, respectively, more than one night ICU, accounting 634 826 patient-days. Within groups, 78 (63.9%) 83 (46.6%) patients received mechanical ventilation. Over patient-day period, checklist item completion rates ranged from 86% to 94%. In multivariable regression analysis vs. improvements overall Richards-Campbell Questionnaire did not reach statistical significance, but significant (mean ± SD: 65.9±26.6 60.5±26.3, p = 0.001), incidence delirium/coma (odds ratio: 0.46; 95% confidence interval, 0.23–0.89; 0.02), status 1.64; 1.04–2.58; 0.03). Improvements secondary post-ICU significance. Conclusions: An improve delirium is feasible associated nighttime noise, delirium/coma, status. Improvement

Язык: Английский

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The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients

Anaesthesia, Год журнала: 2014, Номер 69(6), С. 540 - 549

Опубликована: Май 11, 2014

Sleep deprivation is common among intensive care patients and may be associated with delirium. We investigated whether the implementation of a bundle non-pharmacological interventions, consisting environmental noise light reduction designed to reduce disturbing during night, was improved sleep reduced incidence The study divided into two parts, before after changing our practice. One hundred sixty-seven 171 were screened for delirium pre- post-intervention, respectively. Compliance interventions > 90%. led an increased mean (SD) efficiency index (60.8 (3.5) vs 75.9 (2.2) after, p = 0.031); sound (68.8 (4.2) dB 61.8 (9.1) 0.002) levels (594 (88.2) lux 301 (53.5) 0.003); number awakenings caused by activities overnight (11.0 (1.1) 9.0 (1.2) 0.003). In addition, introduction (55/167 (33%) 24/171 (14%) < 0.001), less time spent in (3.4 (1.4) days 1.2 (0.9) 0.021). Increases lower odds ratio developing (OR 0.90, 95% CI 0.84-0.97). programme as unit effective reducing delirium, we propose similar should implemented more widely.

Язык: Английский

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An investigation of sound levels on intensive care units with reference to the WHO guidelines

Critical Care, Год журнала: 2013, Номер 17(5)

Опубликована: Сен. 3, 2013

Abstract Introduction Patients in intensive care units (ICUs) suffer from sleep deprivation arising nursing interventions and ambient noise. This may exacerbate confusion ICU-related delirium. The World Health Organization (WHO) suggests that average hospital sound levels should not exceed 35 dB with a maximum of 40 overnight. We monitored five ICUs to check compliance these guidelines. Methods Sound were recorded adult the UK. Two level monitors concurrently for 24 hours at ICU central stations adjacent patients. Sample values determine generated by equipment external noise also an empty side room. Results Average always exceeded 45 dBA 50% time between 52 59 individual ICUs. There was diurnal variation decreasing after evening handovers overnight minimum 51 4 AM. Peaks above 85 occurred all sites, up 16 times per hour more frequently during day. WHO guidelines on could be only achieved room switching off. Conclusion All had greater than recommendations, but recommended are so low they achievable ICU. Levels patients higher those stations. Unit-wide reduction programmes or mechanical means isolating noise, such as earplugs, considered.

Язык: Английский

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Molecular regulations of circadian rhythm and implications for physiology and diseases

Signal Transduction and Targeted Therapy, Год журнала: 2022, Номер 7(1)

Опубликована: Фев. 8, 2022

The term "circadian rhythms" describes endogenous oscillations with ca. 24-h period associated the earth's daily rotation and light/dark cycle. Such rhythms reflect existence of an intrinsic circadian clock that temporally orchestrates physiological processes to adapt internal environment external cues. At molecular level, consists multiple sets transcription factors resulting in autoregulatory transcription-translation feedback loops. Notably, addition their primary role as generator rhythm, biological plays a key controlling functions almost all tissues organs. It regulates several intracellular signaling pathways, ranging from cell proliferation, DNA damage repair response, angiogenesis, metabolic redox homeostasis, inflammatory immune response. In this review, we summarize findings showing crosstalk between some describing scenario wherein reciprocal regulation impinges upon aspects mammalian physiology. Moreover, based on evidence indicating can be challenged by environmental factors, social behaviors, well pre-existing pathological conditions, discuss implications misalignment human pathologies, such cancer diseases. Accordingly, disruption rhythm has been reported affect are relevant Expanding our understanding field represents intriguing transversal medicine challenge order establish precision medicine.

Язык: Английский

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Low-dose Dexmedetomidine Improves Sleep Quality Pattern in Elderly Patients after Noncardiac Surgery in the Intensive Care Unit

Anesthesiology, Год журнала: 2016, Номер 125(5), С. 979 - 991

Опубликована: Авг. 27, 2016

Patients admitted to the intensive care unit (ICU) after surgery often develop sleep disturbances. The authors tested hypothesis that low-dose dexmedetomidine infusion could improve architecture in nonmechanically ventilated elderly patients ICU surgery.This was a pilot, randomized controlled trial. Seventy-six age 65 yr or older who were noncardiac and did not require mechanical ventilation receive (continuous at rate of 0.1 μg kg h; n = 38) placebo (n for 15 h, i.e., from 5:00 PM on day until 8:00 AM first surgery. Polysomnogram monitored during period study-drug infusion. primary endpoint percentage stage 2 non-rapid eye movement (stage N2) sleep.Complete polysomnogram recordings obtained 61 (30 group 31 group). Dexmedetomidine increased N2 median 15.8% (interquartile range, 1.3 62.8) with 43.5% (16.6 80.2) (difference, 14.7%; 95% CI, 0.0 31.9; P 0.048); it also prolonged total time, decreased N1 sleep, efficiency, improved subjective quality. incidence hypotension without significant intervention.In surgery, prophylactic may overall

Язык: Английский

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RETRACTED: Coronavirus disease (COVID‐19) and immunity booster green foods: A mini review

Food Science & Nutrition, Год журнала: 2020, Номер 8(8), С. 3971 - 3976

Опубликована: Июнь 1, 2020

This review focused on the use of plant-based foods for enhancing immunity all aged groups against COVID-19. In humans, coronaviruses are included in spectrum viruses that cause common cold and, recently, severe acute respiratory syndrome (SARS). Emerging infectious diseases, such as SARS present a major threat to public health. The novel coronavirus has spread rapidly multiple countries and been declared pandemic by World Health Organization. COVID-19 is usually caused virus which most probably people with low response being affected. Plant-based increased intestinal beneficial bacteria helpful make up 85% immune system. By plenty water, minerals like magnesium Zinc, micronutrients, herbs, food rich vitamins C, D E, better life style one can promote health overcome this infection. Various studies investigated powerful antioxidant glutathione bioflavonoid quercetin may prevent various infections including conclusion, play vital role enhance control

Язык: Английский

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Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action

EClinicalMedicine, Год журнала: 2021, Номер 40, С. 101111 - 101111

Опубликована: Сен. 8, 2021

Coronavirus disease 2019 (COVID-19) has evolved into a worldwide pandemic, and been found to be closely associated with mental neurological disorders. We aimed comprehensively quantify the association between disorders, both pre-existing subsequent, risk of susceptibility, severity mortality COVID-19.In this systematic review meta-analysis, we searched PubMed, Web Science, Embase, PsycINFO, Cochrane library databases for studies published from inception up January 16, 2021 updated at July 7, 2021. Observational including cohort case-control, cross-sectional case series that reported estimates or disorders COVID-19 illness were included. Two researchers independently extracted data conducted quality assessment. Based on I2 heterogeneity, used random effects model calculate pooled odds ratios (OR) 95% confidence intervals (95% CI). Subgroup analyses meta-regression analysis also performed. This study was registered PROSPERO (registration number: CRD 42021230832).A total 149 (227,351,954 participants, 89,235,737 patients) included in analysis, which 27 morbidity (132,727,798), 56 (83,097,968) 115 (88,878,662). Overall, significant high infection (pre-existing mental: OR 1·67, CI 1·12-2·49; neurological: 2·05, 1·58-2·67), (mental: pre-existing, 1·40, 1·25-1·57; sequelae, 4·85, 2·53-9·32; 1·43, 1·09-1·88; 2·17, 1·45-3·24), 1·47, 1·26-1·72; 2·08, 1·61-2·69; 2·03, 1·66-2·49) COVID-19. revealed stronger among younger patients, those subsequent living low- middle-income regions. Younger patients higher than elders. For type-specific susceptibility contracting mood anxiety, attention-deficit hyperactivity disorder (ADHD); as well sleep disturbance; schizophrenia. dementia; delirium altered status; besides, dementia multiple specific diseases. Heterogeneities substantial across most analysis.The findings show an important role context provide clues directions identifying protecting vulnerable populations pandemic. Early detection intervention are urgently needed control induced by However, there heterogeneity studies, results should interpreted caution. More explore long-term sequela, underlying brain mechanisms sake elucidating causal pathways these associations.This is supported grants National Key Research Development Program China, Natural Science Foundation Special Fund PKUHSC Prevention Control COVID-19, Fundamental Funds Central Universities.

Язык: Английский

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Cognitive Dysfunction in ICU Patients

Critical Care Medicine, Год журнала: 2013, Номер 41, С. S81 - S98

Опубликована: Авг. 29, 2013

In contrast to other clinical outcomes, long-term cognitive function in critical care survivors has not been deeply studied. this narrative review, we summarize the existing literature on prevalence, mechanisms, risk factors, and prediction of impairment after surviving illness. Depending exact subgroup, up 100% may suffer some degree at hospital discharge; approximately 50%, decrements will persist years later. Although mechanisms acquiring are poorly understood, several factors have identified. Unfortunately, no easy means predicting exists. Despite barrier, research is ongoing test possible treatments for impairment. particular, potential role exercise recovery an exciting area exploration. Opportunities exist incorporate physical rehabilitation strategies across a spectrum environments (in ICU, ward, home, posthospital discharge).

Язык: Английский

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Effects of earplugs and eye masks combined with relaxing music on sleep, melatonin and cortisol levels in ICU patients: a randomized controlled trial

Critical Care, Год журнала: 2015, Номер 19(1)

Опубликована: Март 10, 2015

Abstract Introduction Intensive care unit (ICU) environmental factors such as noise and light have been cited important causes of sleep deprivation in critically ill patients. Previous studies indicated that using earplugs eye masks can improve REM healthy subjects simulated ICU environment, quality This study aimed to determine the effects with relaxing background music on sleep, melatonin cortisol levels Methods Fifty patients who underwent a scheduled cardiac surgery were expected stay at least 2 nights Cardiac Surgical (CSICU) included. They randomized or without combined 30-minute during postoperative CSICU. Urine was analyzed for nocturnal levels. Subjective evaluated Chinese version Richards-Campbell Sleep Questionnaire (a visual analog scale, ranging 0–100). Results Data from 45 (20 intervention group, 25 control group) analyzed. Significant differences found between groups depth falling asleep, awakenings, asleep again after awakening overall ( P < 0.05). Perceived better group. No group urinary night before surgery, first second post-surgery > The significantly lower than those = 0.01). opposite pattern seen 0.00). Conclusion combination non-pharmacological interventions is useful promoting adult patients; however, any influence level may masked by several timing medication use individual differences. Larger scale would be needed examine potential influences these biological markers efficacy sleep. Trial registration Clinical Registry: ChiCTR-IOR-14005511 . Registered 21 November 2014.

Язык: Английский

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