scholarly journals Prehospital arterial hypercapnia in acute heart failure is associated with admission to acute care units and emergency room length of stay: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mathias Fabre ◽  
Christophe A. Fehlmann ◽  
Birgit Gartner ◽  
Catherine G. Zimmermann-Ivoll ◽  
Florian Rey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care ◽  
Length Of Stay ◽  
Emergency Room ◽  
Acute Heart Failure ◽  
Acute Care ◽  
Admission Rate ◽  
Arterial Blood ◽  
High Dependency ◽  
Acute Care Unit

Abstract Background Acute Heart Failure (AHF) is a common condition that often presents with acute respiratory distress and requires urgent medical evaluation and treatment. Arterial hypercapnia is common in AHF and has been associated with a higher rate of intubation and non-invasive ventilation in the Emergency Room (ER), but its prognostic value has never been studied in the prehospital setting. Methods A retrospective study was performed on the charts of all patients taken care of by a physician-staffed prehospital mobile unit between June 2016 and September 2019 in Geneva. After approval by the ethics committee, charts were screened to identify all adult patients with a diagnosis of AHF in whom a prehospital arterial blood gas (ABG) sample was drawn. The main predictor was prehospital hypercapnia. The primary outcome was the admission rate in an acute care unit (ACU, composite of intensive care and high-dependency units). Secondary outcomes were ER length of stay (LOS), orientation from ER (intensive care unit, high-dependency unit, general ward, discharge home), intubation rate at 24 h, hospital LOS and hospital mortality. Results A total of 106 patients with a diagnosis of AHF were analysed. Hypercapnia was found in 61 (58%) patients and vital signs were more severely altered in this group. The overall ACU admission rate was 48%, with a statistically significant difference between hypercapnic and non-hypercapnic patients (59% vs 33%, p = 0.009). ER LOS was shorter in hypercapnic patients (5.4 h vs 8.9 h, p = 0.016). Conclusions There is a significant association between prehospital arterial hypercapnia, acute care unit admission, and ER LOS in AHF patients.

scholarly journals Association between Prehospital Arterial Hypercapnia in Acute Heart Failure and Admission to Acute Care Units : A Retrospective Cohort Study

2020 ◽  
Author(s):  
Mathias Fabre ◽  
Christophe A. Fehlmann ◽  
Birgit Gartner ◽  
Catherine G. Zimmermann-Ivoll ◽  
Florian Rey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care ◽  
Acute Heart Failure ◽  
Acute Care ◽  
Vital Signs ◽  
Admission Rate ◽  
Ethics Committee ◽  
High Dependency ◽  
Significant Difference ◽  
Acute Care Unit

Abstract Background: Acute Heart Failure (AHF) is a common condition that often manifests by acute respiratory distress and requires urgent medical evaluation and treatment. Arterial hypercapnia is common in AHF. It has been associated with a higher rate of intubation and non-invasive ventilation in the Emergency Room (ER), but its prognostic value has never been studied in the prehospital setting. Methods: A retrospective study was performed on the charts of all patients taken care of by a physician-staffed prehospital mobile unit between June 2016 and September 2019 in Geneva. After approval by the ethics committee, charts were screened to identify all adult patients with a diagnosis of AHF. The main predictor was prehospital hypercapnia. The primary outcome was admission rate in an acute care unit (ACU, composite of intensive care or high-dependency units). Secondary outcomes were ER length of stay (LOS), orientation from ER (intensive care unit, high-dependency unit, general ward, discharge home), intubation rate at 24 hours, hospital LOS and hospital mortality. Results: A total of 104 patients with a diagnosis of AHF were included. Hypercapnia was found in 59 (57%) patients and vital signs were more severely altered in this group. The overall ACU admission rate was 47%, with a statistically significant difference between hypercapnic and non-hypercapnic patients (58% vs 33% respectively, p=0.014). ER LOS was shorter in hypercapnic patients (5.5 hours vs 8.9 hours, p=0.008). Conclusions: There is a significant association between prehospital arterial hypercapnia and acute care unit admission in AHF patients. Trial Registration:This study was approved on 20.08.2019 by the institutional ethics committee of Geneva, Switzerland (Project ID 2019-01559)

scholarly journals Association between Prehospital Arterial Hypercapnia in Acute Heart Failure and Admission to Acute Care Units: a Retrospective Cohort Study

2020 ◽  
Author(s):  
Mathias Fabre ◽  
Christophe A Fehlmann ◽  
Birgit Gartner ◽  
Catherine G Zimmermann ◽  
Florian Rey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care ◽  
Acute Heart Failure ◽  
Acute Care ◽  
Vital Signs ◽  
Admission Rate ◽  
High Dependency ◽  
Medical Evaluation ◽  
Significant Difference ◽  
Acute Care Unit

Abstract Background Acute Heart Failure (AHF) is a common condition that often manifests by acute respiratory distress and requires urgent medical evaluation and treatment. Arterial hypercapnia is common in AHF. It has been associated with a higher rate of intubation and non-invasive ventilation in the Emergency Room (ER), but its prognostic value has never been studied in the prehospital setting. Methods A retrospective study was performed on the charts of all patients taken care of by a physician-staffed prehospital mobile unit between June 2016 and September 2019 in Geneva. After approval by the ethics committee, charts were screened to identify all adult patients with a diagnosis of AHF. The main predictor was prehospital hypercapnia. The primary outcome was admission rate in an acute care unit (ACU, composite of intensive care or high-dependency units). Secondary outcomes were ER length of stay (LOS), orientation from ER (intensive care unit, high-dependency unit, general ward, discharge home), intubation rate at 24 hours, hospital LOS and hospital mortality. Results A total of 104 patients with a diagnosis of AHF were included. Hypercapnia was found in 59 (57%) patients and vital signs were more severely altered in this group. The overall ACU admission rate was 47%, with a statistically significant difference between hypercapnic and non-hypercapnic patients (58% vs 33% respectively, p = 0.014). ER LOS was shorter in hypercapnic patients (5.5 hours vs 8.9 hours, p = 0.008). Conclusions There is a significant association between prehospital arterial hypercapnia and acute care unit admission in AHF patients.

P3531Continual measurement of arterial dP/dtmax enables mini-invasive monitoring of left ventricular contractility in acute heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Vondrakova ◽  
D V Vondrakova ◽  
A K Kruger ◽  
M J Janotka ◽  
P N Neuzil ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Intensive Care ◽  
Acute Heart Failure ◽  
Hemodynamic Monitoring ◽  
Continuous Wave ◽  
Left Ventricular ◽  
Waveform Analysis ◽  
Arterial Line ◽  
Arterial Blood

Abstract Introduction Continuous reliable evaluating of left ventricular (LV) contractile function in patients with advanced heart failure requiring intensive care remains challenging. Recently, continual monitoring of dP/dtmax from arterial line became available for hemodynamic monitoring. However, the relation between arterial dP/dtmax and LV dP/dtmax measurement is not fully understood. Purpose The aim of our study was to determine the relation of arterial dP/dtmax and LV dP/dtmax assessed by echocardiography in patients with acute heart failure. Methods Forty-eight patients with acute heart failure requiring intensive care and hemodynamic monitoring were recruited into the study (mean age 70.4 years, 65% were males). Hemodynamic variables including arterial dP/dtmax were continually monitored using arterial line pressure waveform analysis. LV dP/dtmax was assessed using continuous-wave Doppler analysis of mitral regurgitation flow. Results The values from continual arterial dP/dtmax monitoring significantly correlated with the LV dP/dtmax assessed by echocardiography (r=0.72, 95% confidence interval [CI] 0.54–0.83, P<0.0001). Linear regression revealed that (LV dP/dtmax) = 0.87×(arterial dP/dtmax) + 291, P<0.0001. Arterial dP/dtmax significantly correlated also with the stroke volume (r=0.55, P<0.0001), cardiac output (r=0.32, P=0.0289), mean arterial blood pressure (r=0.43, P=0.0155) and systolic blood pressure (r=0.79, P<0001). On the other hand arterial dP/dtmax did not correlate with the systemic vascular resistance (SVR), heart rate, dynamic arterial elastance, diastolic blood pressure or central venous pressure. Conclusion Our results revealed that arterial dP/dtmax values tightly and highly significantly correlate with LV dP/dtmax. Arterial dP/dtmax could be, therefore, used for continual monitoring of LV contractility. Acknowledgement/Funding Institutional grant MH CZ - DRO (Na Homolce Hospital- NNH, 00023884), IG150501

scholarly journals Association between prehospital arterial hypercapnia and mortality in acute heart failure: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mathias Fabre ◽  
Christophe A. Fehlmann ◽  
Kevin E. Boczar ◽  
Birgit Gartner ◽  
Catherine G. Zimmermann-Ivol ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Primary Outcome ◽  
Crude Odds Ratio ◽  
Arterial Blood Gas ◽  
Logistic Regression Models ◽  
Arterial Blood ◽  
High Dependency ◽  
Prehospital Cardiac Arrest

Abstract Background Acute Heart Failure (AHF) is a potentially lethal pathology and is often encountered in the prehospital setting. Although an association between prehospital arterial hypercapnia in AHF patients and admission in high-dependency and intensive care units has been previously described, there is little data to support an association between prehospital arterial hypercapnia and mortality in this population. Methods This was a retrospective study based on electronically recorded prehospital medical files. All adult patients with AHF were included. Records lacking arterial blood gas data were excluded. Other exclusion criteria included the presence of a potentially confounding diagnosis, prehospital cardiac arrest, and inter-hospital transfers. Hypercapnia was defined as a PaCO2 higher than 6.0 kPa. The primary outcome was in-hospital mortality, and secondary outcomes were 7-day mortality and emergency room length of stay (ER LOS). Univariable and multivariable logistic regression models were used. Results We included 225 patients in the analysis. Prehospital hypercapnia was found in 132 (58.7%) patients. In-hospital mortality was higher in patients with hypercapnia (17.4% [23/132] versus 6.5% [6/93], p = 0.016), with a crude odds-ratio of 3.06 (95%CI 1.19–7.85). After adjustment for pre-specified covariates, the adjusted OR was 3.18 (95%CI 1.22–8.26). The overall 7-day mortality was also higher in hypercapnic patients (13.6% versus 5.5%, p = 0.044), and ER LOS was shorter in this population (5.6 h versus 7.1 h, p = 0.018). Conclusion Prehospital hypercapnia is associated with an increase in in-hospital and 7-day mortality in patient with AHF.

scholarly journals Intensive Care Unit and Acute Care Unit Length of Stay After Congenital Heart Surgery

2020 ◽  
Vol 110 (4) ◽  
pp. 1396-1403 ◽  
Author(s):  
Stephen A. Hart ◽  
Ronn E. Tanel ◽  
Alaina K. Kipps ◽  
Amanda K. Hoerst ◽  
Margaret A. Graupe ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Acute Care ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Unit Length ◽  
Congenital Heart Surgery ◽  
Acute Care Unit

scholarly journals Intensive care unit versus high-dependency care unit for patients with acute heart failure: a nationwide propensity score-matched cohort study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Hiroyuki Ohbe ◽  
Hiroki Matsui ◽  
Hideo Yasunaga
Keyword(s):  
Heart Failure ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Propensity Score ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
High Dependency ◽  
Significant Difference

Abstract Background A structure and staffing model similar to that in general intensive care unit (ICUs) is applied to cardiac intensive care unit (CICUs) for patients with acute heart failure. However, there is limited evidence on the structure and staffing model of CICUs. The present study aimed to assess whether critical care for patients with acute heart failure in the ICUs is associated with improved outcomes than care in the high-dependency care units (HDUs), the hospital units in which patient care levels and costs are between the levels found in the ICU and general ward. Methods This nationwide, propensity score-matched, retrospective cohort study was performed using a national administrative inpatient database in Japan. We identified all patients who were hospitalized for acute heart failure and admitted to the ICU or HDU on the day of hospital admission from April 2014 to March 2019. Propensity score-matching analysis was performed to compare the in-hospital mortality between acute heart failure patients treated in the ICU and HDU on the day of hospital admission. Results Of 202,866 eligible patients, 78,646 (39%) and 124,220 (61%) were admitted to the ICU and HDU, respectively, on the day of admission. After propensity score matching, there was no statistically significant difference in in-hospital mortality between patients who were admitted to the ICU and HDU on the day of admission (10.7% vs. 11.4%; difference, − 0.6%; 95% confidence interval, − 1.5% to 0.2%). In the subgroup analyses, there was a statistically significant difference in in-hospital mortality between the ICU and HDU groups among patients receiving noninvasive ventilation (9.4% vs. 10.5%; difference, − 1.0%; 95% confidence interval, − 1.9% to − 0.1%) and patients receiving intubation (32.5% vs. 40.6%; difference, − 8.0%; 95% confidence interval, − 14.5% to − 1.5%). There were no statistically significant differences in other subgroup analyses. Conclusions Critical care in ICUs was not associated with lower in-hospital mortality than critical care in HDUs among patients with acute heart failure. However, critical care in ICUs was associated with lower in-hospital mortality than critical care in HDUs among patients receiving noninvasive ventilation and intubation.

Length of Stay and Readmission Rates in Pediatric Acute Heart Failure

2021 ◽  
Vol 40 (4) ◽  
pp. S122-S123
Author(s):  
D.S. Burstein ◽  
C. Connelly ◽  
C.S. Almond ◽  
R.A. Niebler ◽  
J.A. Godown ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Acute Heart Failure ◽  
Readmission Rates

scholarly journals Colonization and Infection With MRSA and CRKP and Its Result in an Increased Mortality Rate Within the Intensive Care and High-Dependency Units in Barbados

2020 ◽  
Vol 41 (S1) ◽  
pp. s173-s174
Author(s):  
Keisha Gustave
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
High Mortality ◽  
Average Length ◽  
Cohort Analysis ◽  
Health Concern ◽  
Queen Elizabeth Hospital ◽  
Surveillance Program ◽  
Average Length Of Stay ◽  
High Dependency

Background: Methicillin-resistant Staphylococcus aureus(MRSA) and carbapenem-resistant Klebsiella pneumoniae (CRKP) are a growing public health concern in Barbados. Intensive care and critically ill patients are at a higher risk for MRSA and CRKP colonization and infection. MRSA and CRKP colonization and infection are associated with a high mortality and morbidly rate in the intensive care units (ICUs) and high-dependency units (HDUs). There is no concrete evidence in the literature regarding MRSA and CRKP colonization and infection in Barbados or the Caribbean. Objectives: We investigated the prevalence of MRSA and CRKP colonization and infection in the patients of the ICU and HDU units at the Queen Elizabeth Hospital from 2013 to 2017. Methods: We conducted a retrospective cohort analysis of patients admitted to the MICU, SICU, and HDU from January 2013 through December 2017. Data were collected as part of the surveillance program instituted by the IPC department. Admissions and weekly swabs for rectal, nasal, groin, and axilla were performed to screen for colonization with MRSA and CRKP. Follow-up was performed for positive cultures from sterile isolates, indicating infection. Positive MRSA and CRKP colonization or infection were identified, and patient notes were collected. Our exclusion criteria included patients with a of stay of <48 hours and patients with MRSA or CRKP before admission. Results: Of 3,641 of persons admitted 2,801 cases fit the study criteria. Overall, 161 (5.3%) were colonized or infected with MRSA alone, 215 (7.67%) were colonized or infected with CRKP alone, and 15 (0.53%) were colonized or infected with both MRSA and CRKP. In addition, 10 (66.6%) of patients colonized or infected with MRSA and CRKP died. Average length of stay of patients who died was 50 days. Conclusions: The results of this study demonstrate that MRSA and CRKP cocolonization and coinfection is associated with high mortality in patients within the ICU and HDU units. Patients admitted to the ICU and HDU with an average length of stay of 50 days are at a higher risk for cocolonization and coinfection with MRSA and CRKP. Stronger IPC measures must be implemented to reduce the spread and occurrence of MRSA and CRKP.Funding: NoneDisclosures: None

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