Does sepsis treatment differ between primary and overflow intensive care units?

Vishnupriya, Kittane; Falade, Olufunmilayo; Workneh, Addisu; Chandolu, Satish; Landis, Regina; Elizabeth, Kaweesa; Iyengar, Reethi; Wright, Scott M.; Sevransky, Jonathan

doi:10.1002/jhm.1955

Cited by 7 publications

(7 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another smaller study suggested that outcome differences may have occurred because of reduced compliance with HU care guidelines (e.g., deep venous thrombosis and gastrointestinal prophylaxis) in the boarding unit. 18 In our study, mortality tended to be 24% greater in the BUDF than in the HU ( p = 0.69).…”

Section: Discussionsupporting

confidence: 41%

There’s no place like home

Pascual

Blank

Holena

et al. 2014

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

BACKGROUND Intensive care units (ICUs) function frequently at capacity, requiring incoming critically ill patients to be placed in alternate geographically distinct ICUs. In some medical ICU populations, “boarding” in an overflow ICU has been associated with increased mortality. We hypothesized that surgical ICU patients experience more complications when boarding in an overflow ICU and that the frequency of these complications are greatest in boarders farthest from the home unit (HU). METHODS A 5-year (June 2005 to June 2010) retrospective review of a prospectively maintained ICU database was performed, and demographics, severity of illness, length of stay, and incidence of ICU complications were extracted. Distances between boarding patients’ rooms and the HU were measured. Complications occurring in patients located in the same floor (BUSF) and different floor (BUDF) boarding units were compared and stratified by distance from HU to the patient room. Logistic regression was used to develop control for known confounders. RESULTS A total of 7,793 patients were admitted to the HU and 833 to a boarding unit (BUSF, n = 712; BUDF, n = 121). Boarders were younger, had a lower length of stay, and Acute Physiology and Chronic Health Evaluation II and were more of tentrauma/emergency surgery patients. Compared with in-HU patients, the incidence of aspiration pneumonia (2.2% vs. 3.6%, p < 0.01) was greater in BUSF patients and highest in those farthest from the HU (odds ratio [OR],2.39;p =0.01). Delirium occurred less often in HU than in BUDF patients (3.3% vs. 8.3 %, p < 0.01), and both delirium (OR, 6.09, p < 0.01) and ventilator-associated pneumonia (OR, 4.49, p < 0.05) were more frequent in patients farther from the HU. CONCLUSION Certain ICU complications occur more frequently in boarding patients particularly if they are located on a different floor or far from the HU. When surgical ICU bed availability forces overflow admissions to non–home ICUs, greater interdisciplinary awareness, education, and training may be needed to ensure equivalent care and outcomes. LEVEL OF EVIDENCE Epidemiologic study, level III. Therapeutic study, level IV.

show abstract

Section: Discussionsupporting

confidence: 41%

There’s no place like home

Pascual

Blank

Holena

et al. 2014

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

show abstract

“…Bedspacing has been shown to be associated with worse outcomes among several patient populations. For example, critically ill patients who “board” in emergency departments (EDs) awaiting intensive care unit (ICU) beds or are bedspaced to alternate ICUs (eg, a medical patient admitted to a surgical ICU), may experience worse clinical outcomes (eg, prolonged hospital length of stay [LOS] and increased ICU and in-hospital mortality) and care inefficiencies 4–7…”

Section: Introductionmentioning

confidence: 99%

Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study

et al. 2020

View full text Add to dashboard Cite

BackgroundSpecialty wards cohort hospitalised patients to improve outcomes and lower costs. When demand exceeds capacity, patients overflow and are “bedspaced” to alternate wards. Some studies have demonstrated that bedspacing among medicine service patients is associated with adverse patient-centred outcomes, however, results have been inconsistent and have primarily been performed within national health systems. The objective of this study was to assess the association of bedspacing with patient-centred outcomes among United States patients admitted to general medicine services.MethodsWe performed a retrospective cohort study of internal medicine, family medicine and geriatric service patients who were bedspaced vs cohorted for the entirety of their hospital stay within three large, urban United States hospitals (quaternary referral centre, tertiary referral centre and community hospital, with different patient demographics and case-mixes) in 2014 and 2015. We performed quantile regression to determine differences in length of stay (LOS) between bedspaced vs cohorted patients and logistic regression for in-hospital mortality and discharge to home.ResultsAmong 18 802 patients in 33 wards, 6119 (33%) patients were bedspaced. Bedspaced patients had significantly longer LOS compared with cohorted patients at the 25th (0.1 days, 95% CI: 0.05 to 0.2, p=0.001), 50th (0.2 days, 95% CI: 0.1 to 0.3, p=0.003) and 75th (0.3 days, 95% CI: 0.2 to 0.5, p<0.001) percentiles; and no statistically significant differences in odds of mortality (OR=0.9, 95% CI: 0.6 to 1.3, p=0.5) or discharge to home (OR=0.9, 95% CI: 0.9 to 1.0, p=0.06) in adjusted analyses.ConclusionBedspacing is associated with adverse patient-centred outcomes. Future work is needed to confirm these findings, understand mechanisms contributing to adverse outcomes and identify factors that mitigate these adverse effects in order to provide high-value, patient-centred care to hospitalised patients.

show abstract

“…[2] Early goal-directed therapy is the standard of care. [5] Sepsis is a complex condition characterized by the simultaneous activation of inflammation and coagulation in response to microbial agents. Today, sepsis is a severe multisystem disease with difficult treatments.…”

Section: Discussionmentioning

confidence: 99%

Bicarbonate may alters bacterial susceptibility to antibiotics by targeting Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus

Kesi̇ci̇

Demırci

Kesici

2019

Journal of Contemporary Medicine

View full text Add to dashboard Cite

Introduction: Acute acidemia is a common clinical condition in critical diseases. Acidemia is associated with poor prognosis in case of persistence. In the case of metabolic acidosis, it is beneficial to increase the pH by administering sodium bicarbonate (NaHCO 3) since cell functions are impaired. The aim of this study was to investigate the antibacterial efficacy of NaHCO 3 used in metabolic acidosis, especially in critically ill patients in intensive care units, and to reveal its contribution to antimicrobial therapy for possible concomitant sepsis. Methods: S. aureus ATCC 29213, P. aeruginosa ATCC 27853 and E. coli ATCC 25922 strains were seeded into liquid Müller Hinton medium (Oxoid, UK) and the in-vitro effect of Group C (Control-1 mL sterile saline) and Group B (Sodium Bicarbonate-NaHCO 3) on these bacteria following 24 hours of incubation at 37 degreesC was investigated. Following the use of Epoch spectrophotometer (BioTek Inst. Inc. Vermont, USA) for the 0. and 24. hours, the growth in wells was analyzed in CFU/mL and log10 CFU/mL by comparison with the standard curve. Results: From the start to the 24. hour, there was a significant decrease in bacterial colony numbers of S. aureus ATCC 29213, P. aeruginosa ATCC 27853 and E. coli ATCC 25922 strains in Group B when compared to the control group (p<0.01). The intra-group antibacterial efficacy comparison revealed a significant decrease in bacterial colony numbers in Group B between 0-24 hours (p<0.01). There was a significant increase in all bacterial colony numbers in the control group (p=0.04).

show abstract

Does sepsis treatment differ between primary and overflow intensive care units?

Cited by 7 publications

References 26 publications

There’s no place like home

There’s no place like home

Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study

Bicarbonate may alters bacterial susceptibility to antibiotics by targeting Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus

Contact Info

Product

Resources

About