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  • 1
    Online Resource
    Online Resource
    Corticosteroid Therapy in Critical Illness due to Seasonal and Pandemic Influenza
    Hindawi Limited ; 2015
    In:  Canadian Respiratory Journal Vol. 22, No. 5 ( 2015), p. 271-274
    Details
    In: Canadian Respiratory Journal, Hindawi Limited, Vol. 22, No. 5 ( 2015), p. 271-274
    Abstract: BACKGROUND: Survey data suggest that Canadian intensivists administer corticosteroids to critically ill patients primarily in response to airway obstruction, perceived risk for adrenal insufficiency and hemodynamic instability. OBJECTIVE: To describe variables independently associated with systemic corticosteroid therapy during an influenza outbreak. METHODS: The present analysis was retrospective cohort study involving critically ill patients with influenza in two Canadian cities. Hospital records were reviewed for critically ill patients treated in the intensive care units (ICUs) of eight hospitals in Canada during the 2008 to 2009 and 2009 to 2010 influenza outbreaks. Abstracted data included demographic information, symptoms at disease onset, chronic comorbidities and baseline illness severity scores. Corticosteroid use data were extracted for every ICU day and expressed as hydrocortisone dose equivalent in mg. Multivariable regression models were constructed to identify variables independently associated with corticosteroid therapy in the ICU. RESULTS: The study cohort included 90 patients with a mean (± SD) age of 55.0±17.3 years and Acute Physiology and Chronic Health Evaluation II score of 19.8±8.3. Patients in 2009 to 2010 were younger with more severe lung injury but similar exposure to corticosteroids. Overall, 54% of patients received corticosteroids at a mean daily dose of 343±330 mg of hydrocortisone for 8.5±4.8 days. Variables independently associated with corticosteroid therapy in the ICU were history of airway obstruction (OR 4.8 [95% CI 1.6 to 14.9]) and hemodynamic instability (OR 4.6 [95% CI 1.2 to 17.8] ). CONCLUSION: Observational data revealed that hemodynamic instability and airway obstruction were associated with corticosteroid therapy in the critical care setting, similar to a recent survey of stated practice. Efforts to determine the effects of corticosteroids in the ICU for these specific clinical situations are warranted.
    Type of Medium: Online Resource
    ISSN: 1198-2241
    URL: Article
    DOI: 10.1155/2015/658434
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2015
    detail.hit.zdb_id: 2207107-6
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  • 2
    Online Resource
    Online Resource
    A Patient with Microcytic Anemia and Fever
    Hindawi Limited ; 2006
    In:  Canadian Journal of Infectious Diseases and Medical Microbiology Vol. 17, No. 6 ( 2006), p. 345-346
    Details
    In: Canadian Journal of Infectious Diseases and Medical Microbiology, Hindawi Limited, Vol. 17, No. 6 ( 2006), p. 345-346
    Abstract: A 62-year-old man with a history of mechanical aortic valve insertion and ascending aorta replacement in 1997 presented to his family doctor in August 2004 with a two-week history of melena after recently returning from a six-month vacation in Mexico. The patient had no other abdominal complaints. He took warfarin but did not take nonsteroidal anti-inflammatory agents, acetylsalicylic acid or alcohol. The patient had no history of liver or peptic ulcer disease. He had lost 7 kg over the past month, but did not complain of fever or night sweats. On physical examination, vital signs were normal, the second heart sound was mechanical, and there were no abnormal findings. Laboratory investigations showed a borderline microcytic anemia (hemoglobin 76 g/L; mean corpuscular volume 79 fL; mean corpuscular hemoglobin concentration 323 g/L), a therapeutic international normalized ratio (2.6) and an elevated creatinine level (112 µmol/L). His stool was positive for occult blood, although the ferritin level was high (623 µg/L). Other routine blood work was normal. The patient was admitted to hospital for investigation of the anemia.
    Type of Medium: Online Resource
    ISSN: 1712-9532
    URL: Article
    DOI: 10.1155/2006/673435
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2006
    detail.hit.zdb_id: 2207109-X
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  • 3
    Online Resource
    Online Resource
    Predictors of ICU Mortality among Mechanically Ventilated Patients: An Inception Cohort Study from a Tertiary Care Center in Addis Ababa, Ethiopia
    Hindawi Limited ; 2022
    In:  Critical Care Research and Practice Vol. 2022 ( 2022-12-8), p. 1-6
    Details
    In: Critical Care Research and Practice, Hindawi Limited, Vol. 2022 ( 2022-12-8), p. 1-6
    Abstract: Background. Mechanical ventilation is a life-saving intervention for patients with critical illnesses, yet it is associated with higher mortality in resource-constrained settings. This study intended to determine factors associated with the mortality of mechanically ventilated adult intensive care unit (ICU) patients. Methods. A one-year retrospective inception cohort study was conducted using manual chart review in ICU patients (age 〉 13) admitted to Tikur Anbessa Specialized Hospital (Addis Ababa, Ethiopia) from September 2019 to September 2020; mechanically ventilated patients were followed to hospital discharge. Demographic, clinical, and outcome data were collected; logistic regression was used to determine mortality predictors in the ICU. Result. A total of 160 patients were included; 85/160 (53.1%) were females and the mean (SD) age was 38.9 (16.2) years. The commonest indication for ICU admission was a respiratory problem (n = 97/160, 60.7%). ICU and hospital mortality were 60.7% (n = 97/160) and 63.1% (n = 101/160), respectively. Coma (Glasgow Coma Score 〈 8 or 7 with an endotracheal tube (7T)) (adjusted odds ratio [AOR] 6.3, 95% confidence interval 1.19–33.00), cardiovascular diagnosis (AOR 5.05 [1.80–14.15] ), and a very low serum albumin level ( 〈 2 g/dl) (AOR 4.9 [1.73–13.93]) were independent predictors of mortality ( P 〈 0.05 ). The most commonly observed complication was ICU acquired infection (n = 48, 30%). Conclusions. ICU mortality in ventilated patients is high. Coma, a very low serum albumin level ( 〈 2 g/dl), and cardiovascular diagnosis were independent predictors of mortality. A multifaceted approach focused on developing and implementing context appropriate guidelines and improving skilled healthcare worker availability may prove effective in reducing mortality.
    Type of Medium: Online Resource
    ISSN: 2090-1313 , 2090-1305
    URL: Article
    DOI: 10.1155/2022/7797328
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2022
    detail.hit.zdb_id: 2573849-5
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