Year in review in Intensive Care Medicine 2010: II. Pneumonia and infections, cardiovascular and haemodynamics, organization, education, haematology, nutrition, ethics and miscellanea

Antonelli, Massimo; Azoulay, Élie; Bonten, Marc J. M.; Chastre, Jean; Citerio, Giuseppe; Conti, Giorgio; Backer, Daniel De; Gerlach, Herwig; Hedenstierna, Göran; Joannidis, Michael; MacRae, Duncan; Mancebo, Jordi; Maggiore, Salvatore Maurizio; Mebazaa, Alexandre; Preiser, Jean‐Charles; Pugin, Jérôme; Wernerman, Jan; Zhang, Haibo

doi:10.1007/s00134-010-2123-y

Cited by 8 publications

(5 citation statements)

References 108 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Future studies should establish their place in clinical practice and establish their correlations with clinical GI signs and symptoms, as well as with prognosis [27]. …”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study

et al. 2013

View full text Add to dashboard Cite

PurposeThe study aimed to develop a gastrointestinal (GI) dysfunction score predicting 28-day mortality for adult patients needing mechanical ventilation (MV).Methods377 adult patients from 40 ICUs with expected duration of MV for at least 6 h were prospectively studied. Predefined GI symptoms, intra-abdominal pressures (IAP), feeding details, organ dysfunction and treatment were documented on days 1, 2, 4 and 7.ResultsThe number of simultaneous GI symptoms was higher in nonsurvivors on each day. Absent bowel sounds and GI bleeding were the symptoms most significantly associated with mortality. None of the GI symptoms alone was an independent predictor of mortality, but gastrointestinal failure (GIF)—defined as three or more GI symptoms—on day 1 in ICU was independently associated with a threefold increased risk of mortality. During the first week in ICU, GIF occurred in 24 patients (6.4 %) and was associated with higher 28-day mortality (62.5 vs. 28.9 %, P = 0.001). Adding the created subscore for GI dysfunction (based on the number of GI symptoms) to SOFA score did not improve mortality prediction (day 1 AUROC 0.706 [95 % CI 0.647–0.766] versus 0.703 [95 % CI 0.643–0.762] in SOFA score alone).ConclusionsAn increasing number of GI symptoms independently predicts 28 day mortality with moderate accuracy. However, it was not possible to develop a GI dysfunction score, improving the performance of the SOFA score either due to data set limitations, definition problems, or possibly indicating that GI dysfunction is often secondary and not the primary cause of other organ failure.

show abstract

“…Future studies should establish their place in clinical practice and establish their correlations with clinical GI signs and symptoms, as well as with prognosis [27]. …”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study

et al. 2013

View full text Add to dashboard Cite

show abstract

“…About 14% of patients admitted to ICUs have evidence of coinfection [ 3 ]. Most ICU patients also have other risk factors for acquiring secondary fungal or bacterial infections, including immunosuppression, urinary catheters, central lines, endotracheal tubes, and mechanical ventilators [ 4 ]. Further, secondary nonviral infections (SNIs) are associated with high morbidity and mortality [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin Testing With Secondary Coinfection in Patients With COVID-19

Nadeem¹,

Aljaghber²,

Elgohary³

et al. 2022

Cureus

View full text Add to dashboard Cite

BackgroundThe coronavirus disease (COVID-19) virus has caused millions of deaths. It is difficult to differentiate between pure viral COVID-19 pneumonia and secondary infection. Clinicians often use procalcitonin (PCT) to decide on empiric antibiotic therapy. MethodologyWe performed a retrospective study of patients admitted with COVID-19 between January 1st, 2020, and June 30th, 2020. Patient demographics, clinical findings, and laboratory findings with a focus on PCT levels were recorded. Coinfection was considered if clinicians ordered a septic workup (urine, blood, and respiratory cultures) or if the physicians started or escalated antimicrobial therapy. PCT levels on the day of culture and daily for the next three days were recorded. Significant PCT change was defined as a decrease in PCT levels of >50% from the initial elevated PCT level. ResultsIn total, 143 (59.8%) patients had one secondary infection. These included pulmonary infections (118, 49.4%), blood infections (99, 41.4%), and urine infections (64, 26.8%). Many patients had more than one documented positive culture: respiratory system and blood together in 80 (33.4%) patients, sputum and urine in 55 (23.1%) patients, and urine and blood in 46 (19.2%) patients. Out of the 143 patients with a positive culture, PCT was abnormal on the day of positive culture in 93 (65.5%), while PCT was abnormal in 64 out of 96 on the day of negative culture (66.7%) (p = 0.89). Individual analysis for PCT levels of respiratory cultures showed out of 118 positive sputum cultures, 86 (72%) had abnormal PCT on the day of culture. PCT in positive versus negative cultures was not significantly different, with median PCT (interquartile range, IQR) of 1.66 (6.61) versus 1.03 (2.23) (p = 0.172). For blood cultures, out of 99 positive blood cultures, 73 (73%) had abnormal PCT levels on the day of the culture. PCT in positive versus negative cultures was significantly elevated, with a median of 1.61 (5.97) vs. 0.65 (1.77) (p < 0.001). For urine, out of 64 positive cultures, 41 (64.1%) had abnormal PCT levels on the day of the culture. PCT in positive versus negative cultures was not significantly different, with a median of 0.71 (2.92) vs. 0.93 (4.71) (p = 0.551). To observe the change in PCT after culture, PCT values for the next three days after culture were analyzed. We found that patients with positive cultures had higher PCT levels than those with negative cultures. There was no significant improvement over the following three days. Patients with abnormal PCT on the day of the suspected infection had a longer length of stay in the hospital, with a median (IQR) of 23.9 days (3.16) vs. 16.9 days (2.18) (p = 0.021). ConclusionsSecondary coinfections in patients with COVID-19 infections are not associated with PCT elevation on the day of suspected secondary infection. However, most patients with bacteremia had a significant elevation of PCT on the day of bacteremia before collection and reporting of positive culture. Patients with abnormal PCT levels on the day of suspected i...

show abstract

“…Terms, such as acute GI injury, food intolerance and GI failure, have been used interchangeably or to indicate different GI conditions across the literature [ 25 ]. Moreover, lack of objective measures of GI functions and validated biomarkers add to the complexity in this area [ 26 ]. In this regard, the Working Group on Abdominal Problems of the European Society of Intensive Care Medicine presented a consensus statement on the definitions and grading system of GI dysfunction for ICU patients [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal complications are associated with a poor outcome in non-critically ill pneumonia patients

et al. 2020

View full text Add to dashboard Cite

Background Development of gastrointestinal (GI) complications is adversely associated with prognosis in the critically ill. However, little is known about their impact on the outcome of non-critically ill patients. In this study, we aimed to investigate the incidence of GI complications and their influence on prognosis of hospitalized pneumonia patients. Methods Adult patients admitted with a diagnosis of pneumonia from 2012 to 2014 were included. Medical records were reviewed to obtain patients’ demographics, physical signs, comorbidities, laboratory results, clinical events, and the Confusion, Urea, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score was calculated to assess the severity of pneumonia. GI complications, including bowel distension, diarrhea, GI bleeding and ileus, were evaluated during the first 3 days of hospitalization and their association with patient outcomes, such as hospital mortality and length of stay, was analyzed. Results A total of 1001 patients were enrolled, with a mean age of 73.7 years and 598 (59%) male. Among them, 114 (11%) patients experienced at least one GI complication and diarrhea (5.2%) was the most common. The hospital mortality was 14% and was independently associated with an increase in the CURB-65 score (odds ratio [OR] 1.952 per point increase; 95% confidence interval [CI] 1.516–2.514), comorbid malignancy (OR 1.943; 95% CI 1.209–3.123), development of septic shock (OR 25.896; 95% CI 8.970–74.765), and the presence of any GI complication (OR 1.753; 95% CI 1.003–3.065). Conclusions Compared to a critical care setting, GI complications are not commonly observed in a non-critical care setting; however, they still have a negative impact on prognosis of pneumonia patients, including higher mortality and prolonged length of hospital stay.

show abstract

Year in review in Intensive Care Medicine 2010: II. Pneumonia and infections, cardiovascular and haemodynamics, organization, education, haematology, nutrition, ethics and miscellanea

Cited by 8 publications

References 108 publications

Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study

Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study

Procalcitonin Testing With Secondary Coinfection in Patients With COVID-19

Gastrointestinal complications are associated with a poor outcome in non-critically ill pneumonia patients

Contact Info

Product

Resources

About