1. |
2. Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units : a comparison of two large cohortsYasser Sakr, Bruno François, Jordi Solé-Violan, Katarzyna Kotfis, Ulrich Jaschinski, Angel Estella, Marc Leone, Stephan M. Jakob, Xavier Wittebole, Luis E. Fontes, Viktorija Tomič, 2021, original scientific article Abstract: Background. Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods. This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results. The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion. The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies.
Keywords: respiratory insufficiency, artificial respiration, tidal volume, airway pressures, driving pressure
Published in DiRROS: 16.06.2021; Views: 874; Downloads: 389
 Link to file
This document has many files! More... |
3. Slovenska priporočila za obravnavo odraslih bolnikov s kronično odpovedjo prebavilNada Rotovnik-Kozjek, Tajda Božič, Katja Kogovšek, Borut Štabuc, Laura Petrica, Karla Berlec, Nataša Puzić Ravnjak, Erik Brecelj, Aleš Tomažič, Sanela Banović, Rada Franko, Milena Kovač-Blaž, Janez Breznik, Davorin Ćeranić, David Drobne, Mojca Gašperin, Tomaž Jurca, Maja Ebert Moltara, Rado Janša, Marjana Turk Jerovšek, Taja Jordan, Tina Kamhi, Primož Karner, Milena Kerin-Povšič, Neža Majdič, Denis Mlakar-Mastnak, Andreja Ocepek, Tadeja Pintar, Stojan Potrč, Nataša Smrekar, Monika Sonc, Maja Šeruga, Petra Tavčar, Igor Virant, 2021, professional article Keywords: kronična odpoved prebavil, zdravljenje, onkološko zdravljenje
Published in DiRROS: 11.06.2021; Views: 931; Downloads: 261
 Full text (135,03 KB) |
4. Comparison of European ICU patients in 2012 (ICON) versus 2002 (SOAP)Jean Louis Vincent, Jean-Yves Lefrant, Katarzyna Kotfis, Rahul Nanchal, Ignacio Martin-Loeches, Samir G. Sakka, Xavier Wittebole, Peter Pickkers, Rui P. Moreno, Yasser Sakr, 2018, original scientific article Abstract: Purpose: To evaluate differences in the characteristics and outcomes of intensive care unit (ICU) patients over time. Methods: We reviewed all epidemiological data, including comorbidities, types and severity of organ failure, interventions, lengths of stay and outcome, for patients from the Sepsis Occurrence in Acutely ill Patients (SOAP) study, an observational study conducted in European intensive care units in 2002, and the Intensive Care Over Nations (ICON) audit, a survey of intensive care unit patients conducted in 2012. Results: We compared the 3147 patients from the SOAP study with the 4852 patients from the ICON audit admitted to intensive care units in the same countries as those in the SOAP study. The ICON patients were older (62.5 +/- 17.0 vs. 60.6 +/- 17.4 years) and had higher severity scores than the SOAP patients. The proportion of patients with sepsis at any time during the intensive care unit stay was slightly higher in the ICON study (31.9 vs. 29.6%, p = 0.03). In multilevel analysis, the adjusted odds of ICU mortality were significantly lower for ICON patients than for SOAP patients, particularly in patients with sepsis [OR 0.45 (0.35-0.59), p < 0.001]. Conclusions: Over the 10-year period between 2002 and 2012, the proportion of patients with sepsis admitted to European ICUs remained relatively stable, but the severity of disease increased. In multilevel analysis, the odds of ICU mortality were lower in our 2012 cohort compared to our 2002 cohort, particularly in patients with sepsis.
Keywords: intensive care units -- analysis -- epidemiology -- mortality, sepsis, severity of disease
Published in DiRROS: 30.11.2020; Views: 1276; Downloads: 939
Full text (867,51 KB)
This document has many files! More... |
5. The clinical relevance of oliguria in the critically ill patient : analysis of a large observational databaseJean Louis Vincent, Andrew Ferguson, Peter Pickkers, Stephan M. Jakob, Ulrich Jaschinski, Ghaleb A. Almekhlafi, Marc Leone, Majid Mokhtari, Luis E. Fontes, Philippe R. Bauer, Yasser Sakr, 2020, original scientific article Abstract: Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output < 0.5 ml/kg/h) in acutely ill patients and its association with the need for renal replacement therapy (RRT) and outcome. Methods: International observational study. All adult (> 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient-oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged-oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent-oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19%1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97%1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.
Keywords: critical care, critical illness, urine, oliguria, kidney, renal insufficiency, kidney diseases, acute kidney failure, mortality, urine output, renal replacement therapy
Published in DiRROS: 18.11.2020; Views: 1243; Downloads: 867
Full text (727,74 KB)
This document has many files! More... |
6. Prevalence of and factors associated with healthcare-associated infections in Slovenian acute care hospitals : results of the third national surveyIrena Klavs, Mojca Serdt, Aleš Korošec, Tatjana Lejko-Zupanc, Blaž Pečavar, 2019, original scientific article Abstract: Introduction. In the third Slovenian national healthcare-associated infections (HAIs) prevalence survey, conducted within the European point prevalence survey of HAIs and antimicrobial use in acute care hospitals, we estimated the prevalence of all types of HAIs and identified factors associated with them. Methods. Patients were enrolled into a one-day cross-sectional study in November 2017. Descriptive analyses were performed to describe the characteristics of patients, their exposure to invasive procedures and the prevalence of different types of HAIs. Univariate and multivariate analyses of association of having at least one HAI with possible risk factors were performed to identify risk factors. Results. Among 5,743 patients, 4.4% had at least one HAI and an additional 2.2% were still treated for HAIs on the day of the survey, with a prevalence of HAIs of 6.6%. The prevalence of pneumoniae was the highest (1.8%), followed by surgical site infections (1.5%) and urinary tract infections (1.2%). Prevalence of blood stream infections was 0.3%. In intensive care units (ICUs), the prevalence of patients with at least one HAI was 30.6%. Factors associated with HAIs included central vascular catheter (adjusted odds ratio [aOR] 4.1; 95% confidence intervals [CI]: 3.1–5.4), peripheral vascular catheter (aOR 3.0; 95% CI: 2.3–3.9), urinary catheter (aOR 1.8; 95% CI: 1.4–2.3). Conclusions. The prevalence of HAIs in Slovenian acute care hospitals in 2017 was substantial, especially in ICUs. HAIs prevention and control is an important public health priority. National surveillance of HAIs in ICUs should be developed to support evidence-based prevention and control.
Keywords: healthcare-associated infections, prevalence, survey, risk factors, Slovenia
Published in DiRROS: 16.10.2020; Views: 1776; Downloads: 712
Full text (255,15 KB)
This document has many files! More... |
7. |
8. |
9. Slovenska priporočila za obravnavo kaheksije pri bolnikih z rakomNada Rotovnik-Kozjek, Živa Mrevlje, Barbara Koroušić-Seljak, Katja Kogovšek, Branko Zakotnik, Iztok Takač, Matjaž Horvat, Tadej Dovšak, Vojislav Didanovič, Andrej Kansky, Jožica Červek, Vaneja Velenik, Franc Anderluh, Milena Kerin, Matjaž Sever, Primož Strojan, Borut Štabuc, Mojca Unk, Jernej Benedik, Erik Brecelj, Tadeja Pintar, Lidija Kompan, Marko Novak, Laura Petrica, Denis Mlakar-Mastnak, Brigita Avramović Brumen, Eva Peklaj, Rajmonda Jankovič, Urška Jelenko, Edita Rotner, Sanja Đukić, Petra Tavčar, 2012, published professional conference contribution Keywords: onkologija, kaheksija, priporočila, klasifikacija
Published in DiRROS: 17.09.2019; Views: 2126; Downloads: 641
Full text (158,92 KB) |
10. Spremljanje bolnikov z MRSA na Onkološkem inštitutu v LjubljaniMilena Kerin-Povšič, 2009, professional article Abstract: Meticilin rezistenten Staphylococcus aureus (MRSA) je pomemben povzročitelj bolnišničnih okužb. Širi se predvsem prek rok zdravstvenega osebja in bolnikov. Možnosti antibiotičnega zdravljenja so omejene. Najpogosteje uporabljamo glikopeptidne antibiotike, ki imajo slab baktericidni učinek. Onkološki bolniki imajo zaradi bolezni in postopkov zdravljenja oslabljene obrambne mehanizme, zato so bolj nagnjeni k okužbam. Dodatni dejavniki tveganja za okužbo so slaba prehranjenost, invazivni diagnostični in terapevtski posegi, pogoste hospitalizacije itd. Pomembno je dosledno izvajanje ukrepov za preprečevanje širjenja MRSA: higiena rok, iskanje bolnikov z dejavniki tveganja za nosilstvo MRSA, izolacija in dekolonizacija bolnika ter racionalna uporaba antibiotikov. Pogostnost pojavljanja MRSA je kazalec uspešnosti bolnišnične higiene. Na Onkološkem inštitutu izvajamo aktivno iskanje bolnikov z dejavniki tveganja od leta 2004. Prisotnost MRSA je bila največkrat ugotovljena v pooperativni ali kronični rani. Najpogostejši dejavnik tveganja je predhodna hospitalizacija, zlasti na kirurških oddelkih. Število bolnikov z MRSA v zadnjih letih upada.
Published in DiRROS: 31.08.2018; Views: 2356; Downloads: 562
Full text (112,11 KB) |
