DETERMINANTS OF MORTALITY IN ICU PATIENTS WITH NEW-ONSET SUPRAVENTRICULAR ARRHYTHMIAS AFTER NON-CARDIOTHORACIC SURGERY/TRAUMA

2004 ◽  
Vol 32 (Supplement) ◽  
pp. A42
Author(s):  
Charles Weissman ◽  
Taras Shirov ◽  
Sergei Goodman
Keyword(s):  
Cardiothoracic Surgery ◽  
Supraventricular Arrhythmias ◽  
Icu Patients ◽  
New Onset

scholarly journals Incidence, Risk Factors and Outcomes of New Onset Supraventricular Arrhythmias in African American Patients with Severe Sepsis

2016 ◽  
Vol 26 (2) ◽  
pp. 205 ◽  
Author(s):  
O'Dene Lewis ◽  
Julius Ngwa ◽  
Richard F. Gillum ◽  
Alicia Thomas ◽  
Wayne Davis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Supraventricular Arrhythmias ◽  
Incidence Risk ◽  
New Onset

<p><strong>Purpose</strong>: New onset supraventricular arrhythmias (SVA) are commonly reported in mixed intensive care settings. We sought to determine the incidence, risk factors and outcomes of new onset SVA in African American (AA) patients with severe sepsis admitted to medical intensive care unit (MICU).</p><p><strong>Methods:</strong> Patients admitted to MICU between January 2012 through December 2012 were studied. Patients with a previous history of arrhythmia or with new onset of ventricular arrhythmia were excluded. Data on risk factors, critical care interventions and outcomes were obtained.</p><p><strong>Results:</strong> One hundred and thirty-one patients were identified. New onset SVA occurred in 34 (26%) patients. Of those 34, 20 (59%) had atrial fibrillation (AF), 6 (18%) had atrial flutter and 8 (24%) had other forms of SVA. Compared with patients without SVA, patients with new onset SVA were older (69 ± 12 yrs vs 59 ± 13 yrs, P=.003), had congestive heart failure (47% vs 24%, P=.015) and dyslipidemia (41% vs 15%, P=.002). Additionally, they had a higher mean mortality prediction model (MPM II) score (65 ± 25 vs 49 ± 26, P=.001) and an increased incidence of respiratory failure (85% vs 55%, P=.001). Hospital mortality in patients with new onset SVA was 18 (53%) vs 30 (31%); P=.024; however, in a multivariate analysis, new onset SVA was associated with nonsignificantly increased odds (OR 2.58, 95% CI 0.86-8.05) for in-hospital mortality.</p><p><strong>Conclusion:</strong> New onset SVA was prevalent in AA patients with severe sepsis and occurred more frequently with advanced age, increased severity of illness, congestive heart failure, and acute respiratory failure; it was associated with higher unadjusted in hospital mortality. However, after multiple adjustments, new onset SVA did not remain an independent predictor of mortality. <em>Ethn Dis.</em>2016;26(2):205-212; doi:10.18865/ ed.26.2.205</p>

scholarly journals Compared the Microbiota Profiles between Samples from Bronchoalveolar Lavage and Endotracheal Aspirates in Severe Pneumonia: A Real-World Experience

2022 ◽  
Vol 11 (2) ◽  
pp. 327
Author(s):  
Yeong-Nan Cheng ◽  
Wei-Chih Huang ◽  
Chen-Yu Wang ◽  
Pin-Kuei Fu
Keyword(s):  
Microbial Community ◽  
Bronchoalveolar Lavage ◽  
Microbial Community Composition ◽  
Severe Pneumonia ◽  
Metagenomic Sequencing ◽  
Microbial Composition ◽  
Icu Patients ◽  
Mechanically Ventilated ◽  
The Difference ◽  
New Onset

Lower respiratory tract sampling from endotracheal aspirate (EA) and bronchoalveolar lavage (BAL) are both common methods to identify pathogens in severe pneumonia. However, the difference between these two methods in microbiota profiles remains unclear. We compared the microbiota profiles of pairwise EA and BAL samples in ICU patients with respiratory failure due to severe pneumonia. We prospectively enrolled 50 ICU patients with new onset of pneumonia requiring mechanical ventilation. EA and BAL were performed on the first ICU day, and samples were analyzed for microbial community composition via 16S rRNA metagenomic sequencing. Pathogens were identified in culture medium from BAL samples in 21 (42%) out of 50 patients. No difference was observed in the antibiotic prescription pattern, ICU mortality, or hospital mortality between BAL-positive and BAL-negative patients. The microbiota profiles in the EA and BAL samples are similar with respect to diversity, microbial composition, and microbial community correlations. The antibiotic treatment regimen was rarely changed based on the BAL findings. The samples from BAL did not provide more information than EA in the microbiota profiles. We suggest that EA is more useful than BAL for microbiome identification in mechanically ventilated patients.

scholarly journals Intensive Care Patients from the First COVID-19 Wave: One-Year Survival after Tocilizumab Treatment

2021 ◽  
Vol 11 (11) ◽  
pp. 1234
Author(s):  
Gabriele Melegari ◽  
Enrico Giuliani ◽  
Chiara Dallai ◽  
Lucia Veronesi ◽  
Elisabetta Bertellini ◽  
...  
Keyword(s):  
Treated Group ◽  
Cytokine Storm ◽  
Icu Patients ◽  
Intensive Care Patients ◽  
One Year ◽  
The One ◽  
Mortality Hazard Ratio ◽  
New Onset

Introduction: An infection by COVID-19 triggers a dangerous cytokine storm, so tocilizumab has been introduced in Italy as an agent blocking the cytokine storm. This paper aims to describe the one-year survival of ICU patients treated with tocilizumab. Methods: This observational study enrolled all patients confirmed to be infected by COVID-19 who were admitted to the ICU in our center. We offered tocilizumab to all non-septic patients if they did not present any contraindications. Results: We enrolled 68 ICU patients in our center on 72 occasions during the enrollment period; we excluded four patients due to study criteria. The one-year mortality hazard ratio of treated patients was 0.64, with a confidence interval of 0.31 to 1.19, with p = 0.169. Among the survivors, 32 of 35 patients answered the phone interview (14 patients in the treated group and 18 in the untreated group); overall, the effect of COVID-19 on quality of life was 58.14%. These effects were lower in the tocilizumab group, with p = 0.016 *. Conclusions: Our observational data follow the most relevant largest trial. Patients treated with tocilizumab had lower rates of new-onset symptoms later COVID-19 ICU hospitalizations. As reported by recent medical literature, the presence of these symptoms suggests that a follow-up program for these types of patients could be useful.

Disappointing Success of Electrical Cardioversion for New-Onset Atrial Fibrillation in Cardiosurgical ICU Patients*

2015 ◽  
Vol 43 (11) ◽  
pp. 2354-2359 ◽  
Author(s):  
Mattia Arrigo ◽  
Natalie Jaeger ◽  
Burkhardt Seifert ◽  
Donat R. Spahn ◽  
Dominique Bettex ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Electrical Cardioversion ◽  
Icu Patients ◽  
Onset Atrial Fibrillation ◽  
New Onset

Delirium – Does it Matter?

2008 ◽  
Vol 9 (3) ◽  
pp. 248-249 ◽  
Author(s):  
Valerie Page
Keyword(s):  
Critical Care ◽  
Cognitive Impairment ◽  
Icu Patients ◽  
Current State ◽  
Disturbance Of Consciousness ◽  
State Of Research ◽  
New Onset

Delirium is a disturbance of consciousness associated with new-onset changes in cognition. It is associated with increased mortality and long-term cognitive impairment for ICU patients. This article reviews the current state of research in delirium in critical care.

scholarly journals Secondary bacterial infections trigger New Onset Atrial Fibrillation in ICU Covid-19 ARDS patients

2021 ◽  
Author(s):  
George E Zakynthinos ◽  
Vasiliki Tsolaki ◽  
Nikitas Karavidas ◽  
Vassileios Vazgiourakis ◽  
George Dimeas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Secondary Infection ◽  
Control Group ◽  
Control Groups ◽  
Icu Patients ◽  
Icu Admission ◽  
And Control ◽  
Onset Atrial Fibrillation ◽  
Echocardiographic Findings ◽  
New Onset

Abstract Background Cardiac arrhythmias, mainly atrial fibrillation (AF), is frequently reported in COVID-19 patients, yet causality has not been explored. Intensive Care Unit patients frequently present AF during critical illness. Sepsis is one of the main contributors of AF occurrence in ICU patients. The aim of the study was to explore if Covid-19 myocardial involvement is the only contributor for New Onset Atrial Fibrillation (NOAF) in intubated ICU patients. Methods Consecutive intubated, Covid-19ARDS patients, were prospectively studied for factors triggering NOAF. Demographics, data on Covid-19 infection duration, severity of illness and ARDS are reported. Echocardiographic findings, troponin levels and secondary infection (sepsis/septic shock) data were collected on the day of AF and compared to the preceding days’ and/or ICU admission data. Comparison was also performed between NOAF and control group (no AF) on admission. Results Among 105 patients screened, 79 were eligible; nineteen presented NOAF (24%). Baseline characteristics did not differ between the NOAF and control groups. Troponin levels were mildly elevated upon ICU admission in both groups. NOAF occurred on the 18 ± 4.8 days from Covid-19 symptoms’ onset, and the 8.5 ± 2.1 ICU day. Seventeen patients in the NOAF group (89.5%) presented a septic secondary infection vs 25 (41.6%) in the control group (p < 0.001). In sixteen NOAF patients (84.2%), AF occurred concurrently with a secondary septic episode. Noradrenaline, lactate levels and inflammation biomarkers presented a gradual increase in the days preceding the AF day (all p < 0.05). Troponin increased compared to admission (p = 0.017). AF did not resolve or re-occurred if sepsis persisted. Upon ICU admission left ventricular ejection fraction was rather normal, yet, global longitudinal strain was equally impaired (< 16.5%) in 63% vs 78% in the NOAF and control groups, respectively. The right ventricle was mildly dilated, and 36 (45.6%) patients had pericardial effusion. Echocardiographic findings did not change on NOAF occurrence. Conclusion Secondary infections seem to be major contributors for NOAF in Covid-19 patients, probably playing the role of the “second hit” in an affected myocardium from Covid-19.

scholarly journals Prospective randomized double-blind study of efficacy and safety of 1c class antiarrhythmic agent (propafenone) for supraventricular arrhythmias in septic shock compared to amiodarone

2019 ◽  
Author(s):  
Martin Balik ◽  
Petr Waldauf ◽  
Michal Maly ◽  
Vojtech Matousek ◽  
Tomas Brozek ◽  
...  
Keyword(s):  
Septic Shock ◽  
Sinus Rhythm ◽  
Controlled Trial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Supraventricular Arrhythmia ◽  
Supraventricular Arrhythmias ◽  
Double Blind ◽  
Wide Range ◽  
New Onset

Abstract Background: Septic shock often leads to supraventricular arrhythmias which contribute to haemodynamic compromise. A large retrospective study in this population generated the hypothesis that propafenone could be more effective than amiodarone in achieving and maintaining sinus rhythm in new-onset supraventricular arrhythmia. Moreover, the success of cardioversion can be predicted by certain echocardiographic parameters, which can guide the decision whether to aim for rhythm or rate control. Methods: A prospective double-blind multi-center randomized controlled trial includes patients with new-onset arrhythmia related to septic shock (2016 definition), but without severe impairment of the left ventricular ejection fraction. After baseline echocardiography, the patient will be randomised to receive a bolus and maintenance dose of either amiodarone or propafenone. The primary outcome is the proportion of patients that have achieved rhythm control at 24 hours after the start of the infusion. The secondary outcomes are the composite percentage of patients that needed rescue treatments (DC cardioversion or unblinding and cross over of the antiarrhythmics) within 24 hours, recurrence of arrhythmias, ICU mortality, 28-day and 1-year mortality. In the post-hoc analysis we plan to separately assess subgroups of patients with pulmonary hypertension and right ventricular dysfunction without left ventricular systolic dysfunction. In the exploratory part of the study we will assess whether (1.) the presence of a transmitral diastolic A wave and its higher velocity-time integral is predictive for the sustainability of mechanical sinus rhythm and whether (2.) the indexed left atrial endsystolic volume is predictive of recurrent arrhythmia. Discussion: Amiodarone has become the first-line agent of use in almost any tachyarrhythmia in the critically ill. Nevertheless, it has a wide range of side effects and may not be the most effective drug in all circumstances. In light of this, we designed a prospective randomised controlled trial. Considering that in the observational study the restoration of sinus rhythm within 24h occurred in 74% of the amiodarone-treated patients and in 89% of patients treated with propafenone, we plan to include 200 patients to have an 80% chance to demonstrate the superiority of propafenone at p=0.05. Assuming a 10% dropout, we plan to randomize 220 patients. Trial Registration: ClinicalTrials.gov Identifier: NCT03029169, registered on 24.1.2017. Keywords: Supraventricular arrhythmia, septic shock, propafenone, amiodarone, intensive care.

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