The organizational structure of an intensive care unit influences treatment of hypotension among critically ill patients: A retrospective cohort study

Boone, M. Dustin; Massa, Jennifer; Mueller, Ariel; Jinadasa, Sayuri P.; Lee, Joon; Kothari, Rishi; Scott, Daniel; Callahan, Julie; Celi, Leo Anthony; Hacker, Michele R.

doi:10.1016/j.jcrc.2016.02.009

Cited by 3 publications

(3 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Data on hypotension, vasopressor therapy, acute kidney injury, delirium, pneumonia, acute respiratory distress syndrome, systemic corticosteroid use, and nasogastric or orogastric tube use during intubation were recorded. Delirium and hypotension were defined by standardized criteria . Hypotension was defined as a mean arterial pressure of less than 60 mm Hg in at least 2 consecutive invasive or noninvasive measurements that were preceded by at least 2 measurements that were more than 60 mm Hg .…”

Section: Methodsmentioning

confidence: 99%

“…Delirium and hypotension were defined by standardized criteria. 26,27 Hypotension was defined as a mean arterial pressure of less than 60 mm Hg in at least 2 consecutive invasive or noninvasive measurements that were preceded by at least 2 measurements that were more than 60 mm Hg. 27 Vasopressor therapy was defined as the requirement of vasopressors as hemodynamic support for at least 8 hours.…”

Section: Study Population Datamentioning

confidence: 99%

See 1 more Smart Citation

Unilateral Vocal Fold Immobility After Prolonged Endotracheal Intubation

Campbell

Shinn

Kimura

et al. 2020

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

and mechanical ventilation are life-saving treatments for acute respiratory failure but are complicated by significant rates of dyspnea and dysphonia after extubation. Unilateral vocal fold immobility (UVFI) after extubation can alter respiration and phonation, but its incidence, risk factors, and pathophysiology remain unclear.OBJECTIVES To determine the incidence of UVFI after prolonged (>12 hours) mechanical ventilation in a medical intensive care unit and investigate associated clinical risk factors for UVFI after prolonged mechanical ventilation. DESIGN, SETTING, AND PARTICIPANTSThis subgroup analysis of a prospective cohort study was conducted in a single-center medical intensive care unit from August 17, 2017, through May 31, 2018, among 100 consecutive adult patients who were intubated for more than 12 hours. Patients were identified within 36 hours of extubation and recruited for study enrollment. Those with an established tracheostomy prior to mechanical ventilation, known laryngeal or tracheal pathologic characteristics, or a history of head and neck radiotherapy were excluded.EXPOSURE Invasive mechanical ventilation via an endotracheal tube. MAIN OUTCOMES AND MEASURESThe incidence of UVFI as determined by flexible nasolaryngoscopy.RESULTS One hundred patients (62 men [62%]; median age, 58.5 years [range, 19.0-87.0 years]) underwent endoscopic evaluation after extubation. Seven patients had UVFI, of which 6 cases (86%) were left sided. Patients with hypotension while intubated (odds ratio [OR], 10.8; 95% CI, 1.6 to ϱ), patients requiring vasopressors while intubated (OR, 16.7; 95% CI, 2.4 to ϱ), and patients with a preadmission diagnosis of peripheral vascular disease (OR, 6.2; 95% CI, 1.2-31.9) or coronary artery disease (OR, 5.1; 95% CI, 1.0-25.5) were more likely to develop UVFI.CONCLUSIONS AND RELEVANCE Unilateral vocal fold immobility occurred in 7 of 100 patients in the medical intensive care unit who were intubated for more than 12 hours. Unilateral vocal fold immobility was associated with inpatient hypotension and preadmission vascular disease, suggesting that ischemia of the recurrent laryngeal nerve may play a role in disease pathogenesis.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Study Population Datamentioning

confidence: 99%

Unilateral Vocal Fold Immobility After Prolonged Endotracheal Intubation

Campbell

Shinn

Kimura

et al. 2020

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

show abstract

“…Several studies have shown that the organizational structure of an ICU influences patient outcomes and an OBICU is no exception. 3 The establishment of such a unit for the treatment of critically ill patients depends on hospital size and available resources. 4 In the last decade, there has been emerging interest in increasing the efficient allocation of healthcare resources, including staff distribution for critically ill patients.…”

Section: Staffingmentioning

confidence: 99%

Building an obstetric intensive care unit during the COVID-19 pandemic at a tertiary hospital and selected maternal-fetal and delivery considerations

Aziz

Ona

Martinez

et al. 2020

Seminars in Perinatology

View full text Add to dashboard Cite

During the novel Coronavirus Disease 2019 pandemic, New York City became an international epicenter for this highly infectious respiratory virus. In anticipation of the unfortunate reality of community spread and high disease burden, the Anesthesia and Obstetrics and Gynecology departments at NewYork-Presbyterian / Columbia University Irving Medical Center, an academic hospital system in Manhattan, created an Obstetric Intensive Care Unit on Labor and Delivery to defray volume from the hospital's preexisting intensive care units. Its purpose was threefold: (1) to accommodate the anticipated influx of critically ill pregnant and postpartum patients due to novel coronavirus, (2) to care for critically ill obstetric patients who would previously have been transferred to a non-obstetric intensive care unit, and (3) to continue caring for our usual census of pregnant and postpartum patients, who are novel Coronavirus negative and require a higher level of care. In this chapter, we share key operational details for the conversion of a non-intensive care space into an obstetric intensive care unit, with an emphasis on the infrastructure, personnel and workflow, as well as the goals for maternal and fetal monitoring.

show abstract

Incidence and Outcomes of Acute Laryngeal Injury After Prolonged Mechanical Ventilation*

Shinn

Kimura

Campbell

et al. 2019

Critical Care Medicine

107

131

View full text Add to dashboard Cite

Objectives: Upper airway injury is a recognized complication of prolonged endotracheal intubation, yet little attention has been paid to the consequences of laryngeal injury and functional impact. The purpose of our study was to prospectively define the incidence of acute laryngeal injury and investigate the impact of injury on breathing and voice outcomes. Design: Prospective cohort study. Setting: Tertiary referral critical care center. Patients: Consecutive adult patients intubated greater than 12 hours in the medical ICU from August 2017 to May 2018 who underwent laryngoscopy within 36 hours of extubation. Interventions: Laryngoscopy following endotracheal intubation. Measurements and Main Results: One hundred consecutive patients (62% male; median age, 58.5 yr) underwent endoscopic examination after extubation. Acute laryngeal injury (i.e., mucosal ulceration or granulation tissue in the larynx) was present in 57 patients (57%). Patients with laryngeal injury had significantly worse patient-reported breathing (Clinical Chronic Obstructive Pulmonary Disease Questionnaire: median, 1.05; interquartile range, 0.48–2.10) and vocal symptoms (Voice Handicap Index-10: median, 2; interquartile range, 0–6) compared with patients without injury (Clinical Chronic Obstructive Pulmonary Disease Questionnaire: median, 0.20; interquartile range, 0–0.80; p < 0.001; and Voice Handicap Index-10: median, 0; interquartile range, 0–1; p = 0.005). Multivariable logistic regression independently associated diabetes, body habitus, and endotracheal tube size greater than 7.0 with the development of laryngeal injury. Conclusions: Acute laryngeal injury occurs in more than half of patients who receive mechanical ventilation and is associated with significantly worse breathing and voicing 10 weeks after extubation. An endotracheal tube greater than size 7.0, diabetes, and larger body habitus may predispose to injury. Our results suggest that acute laryngeal injury impacts functional recovery from critical illness.

show abstract

The organizational structure of an intensive care unit influences treatment of hypotension among critically ill patients: A retrospective cohort study

Cited by 3 publications

References 19 publications

Unilateral Vocal Fold Immobility After Prolonged Endotracheal Intubation

Unilateral Vocal Fold Immobility After Prolonged Endotracheal Intubation

Building an obstetric intensive care unit during the COVID-19 pandemic at a tertiary hospital and selected maternal-fetal and delivery considerations

Incidence and Outcomes of Acute Laryngeal Injury After Prolonged Mechanical Ventilation*

Contact Info

Product

Resources

About