Development and validation of early prediction models for new-onset functional impairment at hospital discharge of ICU admission

Ohbe, Hiroyuki; Goto, Tadahiro; Nakamura, Kensuke; Matsui, Hiroki; Yasunaga, Hideo

doi:10.1007/s00134-022-06688-z

Cited by 18 publications

(13 citation statements)

References 47 publications

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“…For this study, we used a commercially available database containing routinely collected administrative data and discharge summaries at multicenter acute care hospitals in Japan. The database was built by the Medical Data Vision Co., Ltd. and consists of inpatient and outpatient data from over 350 voluntarily participating acute care hospitals ( 16 ). Participating hospitals provided data on all patients during the participation period.…”

Section: Methodsmentioning

confidence: 99%

Intensive Care Unit versus High-dependency Care Unit for COVID-19 Patients with Invasive Mechanical Ventilation

Ohbe

Sasabuchi

Iwagami³

et al. 2023

Annals ATS

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Rationale High-dependency care units (HDUs), also termed “intermediate care units”, “step-down units”, or “respiratory HDUs”, are areas in which degrees of patient care and costs are between those of the intensive care unit (ICU) and the general ward. In general, patients requiring mechanical ventilation are treated in the ICU rather than in the HDU, except for the use of HDU beds as surge capacity beds during a massive strain; however, the HDU, as well as ICU, are used as the standard care units for mechanically ventilated patients with coronavirus disease (COVID-19) in Japan. Objectives To assess the outcomes of patients with COVID-19 with invasive mechanical ventilation treated in the HDU versus those treated in the ICU. Methods In this retrospective cohort study, we used a multicenter inpatient database in Japan to identify mechanically ventilated patients with COVID-19 in the ICU or HDU on the start day of invasive mechanical ventilation from February 10, 2020, to November 30, 2021. The primary outcome was in-hospital mortality within 30 days from the start of the first invasive mechanical ventilation. Propensity score matching was performed to compare the outcomes of patients treated in the ICU with those treated in the HDU. Results Of 1,985 eligible patients with COVID-19 with invasive mechanical ventilation, 1,303 (66%) were treated in the ICU, and 682 (34%) were treated in the HDU on the start day of invasive mechanical ventilation. After propensity score matching, patients treated in the ICU had significantly lower in-hospital mortality within 30 days than those treated in the HDU (18.3% vs. 24.2%; risk difference, −5.8%; 95% confidence interval, −10.9% to −0.8%). Conclusions This multicenter observational study in Japan suggests that care for mechanically ventilated patients with COVID-19 in the ICU may significantly reduce in-hospital mortality within 30 days compared with care in the HDU. Establishing a critical care system that would allow patients with COVID-19 requiring ventilators to be treated in the ICU is desirable. Because this study was an observational study, our finding represents an association, not causation. Further studies of different critical care systems are warranted to confirm our findings.

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Section: Methodsmentioning

confidence: 99%

Intensive Care Unit versus High-dependency Care Unit for COVID-19 Patients with Invasive Mechanical Ventilation

Ohbe

Sasabuchi

Iwagami³

et al. 2023

Annals ATS

Self Cite

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“…Another pivotal area for investigation is the prediction of ICU survivors at risk of developing PICS [ 162 ]. Early prediction/identification can result in timely interventions, potentially preventing, halting, or attenuating the progression of PICS [ 163 ].…”

Section: Future Research Directionmentioning

confidence: 99%

From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome

Liu,

Tronstad,

Flaws

et al. 2024

j intensive care

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Background As advancements in critical care medicine continue to improve Intensive Care Unit (ICU) survival rates, clinical and research attention is urgently shifting toward improving the quality of survival. Post-Intensive Care Syndrome (PICS) is a complex constellation of physical, cognitive, and mental dysfunctions that severely impact patients’ lives after hospital discharge. This review provides a comprehensive and multi-dimensional summary of the current evidence and practice of exercise therapy (ET) during and after an ICU admission to prevent and manage the various domains of PICS. The review aims to elucidate the evidence of the mechanisms and effects of ET in ICU rehabilitation and highlight that suboptimal clinical and functional outcomes of ICU patients is a growing public health concern that needs to be urgently addressed. Main body This review commences with a brief overview of the current relationship between PICS and ET, describing the latest research on this topic. It subsequently summarises the use of ET in ICU, hospital wards, and post-hospital discharge, illuminating the problematic transition between these settings. The following chapters focus on the effects of ET on physical, cognitive, and mental function, detailing the multi-faceted biological and pathophysiological mechanisms of dysfunctions and the benefits of ET in all three domains. This is followed by a chapter focusing on co-interventions and how to maximise and enhance the effect of ET, outlining practical strategies for how to optimise the effectiveness of ET. The review next describes several emerging technologies that have been introduced/suggested to augment and support the provision of ET during and after ICU admission. Lastly, the review discusses future research directions. Conclusion PICS is a growing global healthcare concern. This review aims to guide clinicians, researchers, policymakers, and healthcare providers in utilising ET as a therapeutic and preventive measure for patients during and after an ICU admission to address this problem. An improved understanding of the effectiveness of ET and the clinical and research gaps that needs to be urgently addressed will greatly assist clinicians in their efforts to rehabilitate ICU survivors, improving patients’ quality of survival and helping them return to their normal lives after hospital discharge.

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“…There is a persistent elevation in serum urea observed in critically ill patients [43], and this has been validated as an early marker of new-onset functional impairment in critically ill patients [44], unlike nonspecific markers such as the C-reactive protein [45]. This rise in serum urea reflects the catabolic shift towards muscle proteolysis and amino acid metabolism [22 ▪▪ ].…”

Section: The Urea To Creatinine Ratio As a Biological Signature For N...mentioning

confidence: 99%

Novel nutritional strategies to prevent muscle wasting

McClelland

Davies

Puthucheary

2023

Current Opinion in Critical Care

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Purpose of reviewMuscle wasting in critical illness has proven to be refractory to physical rehabilitation, and to conventional nutritional strategies. This presents one of the central challenges to critical care medicine in the 21st century. Novel strategies are needed that facilitate nutritional interventions, identify patients that will benefit and have measurable, relevant benefits.Recent findingsDrug repurposing was demonstrated to be a powerful technique in the coronavirus disease 2019 pandemic, and may have similar applications to address the metabolic derangements of critical illness. Newer biological signatures may aid the application of these techniques and the association between changes in urea:creatinine ratio and the development of skeletal muscle wasting is increasing. A core outcome set for nutrition interventions in critical illness, supported by multiple international societies, was published earlier this year should be adopted by future nutrition trials aiming to attenuate muscle wasting.SummaryThe evidence base for the lack of efficacy for conventional nutritional strategies in preventing muscle wasting in critically ill patients continues to grow. Novel strategies such as metabolic modulators, patient level biological signatures of nutritional response and standardized outcome for measurements of efficacy will be central to future research and clinical care of the critically ill patient.

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Development and validation of early prediction models for new-onset functional impairment at hospital discharge of ICU admission

Cited by 18 publications

References 47 publications

Intensive Care Unit versus High-dependency Care Unit for COVID-19 Patients with Invasive Mechanical Ventilation

Intensive Care Unit versus High-dependency Care Unit for COVID-19 Patients with Invasive Mechanical Ventilation

From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome

Novel nutritional strategies to prevent muscle wasting

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