Objectives: To identify risk factors and develop a prediction score for in-hospital symptomatic venous thromboembolism in critically ill patients. Design: Retrospective cohort study. Setting: Henry Ford Health System, a five-hospital system including 18 ICUs. Patients: We obtained data from the electronic medical record of all adult patients admitted to any ICU (total 264 beds) between January 2015 and March 2018. Interventions: None. Measurements and Main Results: Symptomatic venous thromboembolism was defined as deep vein thrombosis, pulmonary embolism, or both, diagnosed greater than 24 hours after ICU admission and confirmed by ultrasound, CT, or nuclear medicine imaging. A prediction score (the ICU-Venous Thromboembolism score) was derived from independent risk factors identified using multivariable logistic regression. Of 37,050 patients who met the eligibility criteria, 529 patients (1.4%) developed symptomatic venous thromboembolism. The ICU-Venous Thromboembolism score consists of six independent predictors: central venous catheterization (5 points), immobilization greater than or equal to 4 days (4 points), prior history of venous thromboembolism (4 points), mechanical ventilation (2 points), lowest hemoglobin during hospitalization greater than or equal to 9 g/dL (2 points), and platelet count at admission greater than 250,000/μL (1 point). Patients with a score of 0–8 (76% of the sample) had a low (0.3%) risk of venous thromboembolism; those with a score of 9–14 (22%) had an intermediate (3.6%) risk of venous thromboembolism (hazard ratio, 6.7; 95% CI, 5.3–8.4); and those with a score of 15–18 (2%) had a high (17.7%) risk of venous thromboembolism (hazard ratio, 28.1; 95% CI, 21.7–36.5). The overall C-statistic of the model was 0.87 (95% CI, 0.85–0.88). Conclusions: Clinically diagnosed symptomatic venous thromboembolism occurred in 1.4% of this large population of ICU patients with high adherence to chemoprophylaxis. Central venous catheterization and immobilization are potentially modifiable risk factors for venous thromboembolism. The ICU-Venous Thromboembolism score can identify patients at increased risk for venous thromboembolism.
Background: Venous thromboembolism (VTE) is a potentially life-threatening complication among critically ill patients. Neurocritical care patients are presumed to be at high risk for VTE; however, data regarding risk factors in this population are limited. We designed this study to evaluate the frequency, risk factors, and clinical impact of VTE in neurocritical care patients. Methods: We obtained data from the electronic medical record of all adult patients admitted to neurological intensive care unit (NICU) at Henry Ford Hospital between January 2015 and March 2018. Venous thromboembolism was defined as deep vein thrombosis, pulmonary embolism, or both diagnosed by Doppler, chest computed tomography (CT) angiography or ventilation–perfusion scan >24 hours after admission. Patients with ICU length of stay <24 hours or who received therapeutic anticoagulants or were diagnosed with VTE within 24 hours of admission were excluded. Results: Among 2188 consecutive NICU patients, 63 (2.9%) developed VTE. Prophylactic anticoagulant use was similar in patients with and without VTE (95% vs 92%; P = .482). Venous thromboembolism was associated with higher mortality (24% vs 13%, P = .019), and longer ICU (12 [interquartile range, IQR 5-23] vs 3 [IQR 2-8] days, P < .001) and hospital (22 [IQR 15-36] vs 8 [IQR 5-15] days, P < .001) length of stay. In a multivariable analysis, potentially modifiable predictors of VTE included central venous catheterization (odds ratio [OR] 3.01; 95% confidence interval [CI], 1.69-5.38; P < .001) and longer duration of immobilization (Braden activity score <3, OR 1.07 per day; 95% CI, 1.05-1.09; P < .001). Nonmodifiable predictors included higher International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) scores (which accounts for age >60, prior VTE, cancer and thrombophilia; OR 1.66; 95% CI, 1.40-1.97; P < .001) and body mass index (OR 1.05; 95% CI, 1.01-1.08; P = .007). Conclusions: Despite chemoprophylaxis, VTE still occurred in 2.9% of neurocritical care patients. Longer duration of immobilization and central venous catheterization are potentially modifiable risk factors for VTE in critically ill neurological patients.
hospital cardiac arrest, 2 had severe sepsis and died in hospital, and 1 had a gun shot wound to the head. One patient with terminal brain cancer who had sepsis had prolonged hypoxemia both out-of-hospital and during intubation (due to caked secretions obstructing the glottic opening) that was thought to contribute to her poor outcome. Her lowest oxygen saturation during intubation was 81% with duration of hypoxemia of 132 seconds.Conclusions: Hypoxemia during intubation in the ED is common. Prolonged hypoxemia was observed in 8% of cases with a valid oximetry waveform. No patient with prolonged hypoxemia was found to have hypoxic encephalopathy at hospital discharge. Patients at the extreme of transient hypoxemia (prolonged hypoxemia) were not observed to have adverse patient outcomes; this suggests that the more minor outcome of transient hypoxemia may not be an important patient-centered outcome.Study Objectives: Rapid sequence intubation (RSI) is a critical ED procedure in which a sedative and paralytic are administered near simultaneously to facilitate orotracheal intubation. It is commonly recommended that the sedative agent be administered before the paralytic agent. However, administration of the paralytic agent first may allow for decreased apnea time and increased first-pass success by shortening the time between the start of RSI drug administration and paralysis. The objective of this study was to determine if RSI drug order is associated with first-pass success or hypoxemia.Methods: We performed an observational study using video review as the method of data collection. In our ED resuscitation bays there are three ceiling-mounted video cameras. Software captures the output from the three cameras and combines them with the video output from the patient cardiac and vital sign monitor. Senior emergency medicine residents perform the majority of tracheal intubations under the supervision of the attending emergency physician. Using the electronic medical record to identify ED intubations, we reviewed videos for the year 2013. Data collection forms were used by trained reviewers to record the course of intubation for each patient. Data points included whether a sedative and paralytic were administered and in what order, vital signs, attempt duration, and first-attempt success. An attempt began when the laryngoscope blade entered the mouth and ended when it left the mouth. The first-pass success rates and attempt duration by drug order use are presented. The analysis is descriptive.Results: During the study period 676 cases were identified, of which videos were available for 593 (88%). In 503 of the 593 cases (85%), the first method was RSI and orotracheal intubation; in 306 (61%) cases the sedative was administered first, in 69 (14%) cases the paralytic was administered first, and in 128 (26%) the order could not be determined. First-pass success (95% CI) in cases in which the sedative and paralytic were administered first was 92% (89%-95%) and 94% (89%-100%), respectively, with a difference of 2% (-4% to 8...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.