Dipayan Chaudhuri

Early Renal Replacement Therapy Versus Standard Care in the ICU: A Systematic Review, Meta-Analysis, and Cost Analysis

Objective: Renal replacement therapy (RRT) is the treatment of choice for severe acute kidney injury, but there are no firm guidelines as to the time of initiation of RRT in the critically ill. The primary objective of this study is to determine 1-month mortality rates of early versus late dialysis in critical care. As secondary end points, we provide a cost analysis of early versus late RRT initiation, intensive care unit (ICU) length of stay (LOS), hospital LOS, and number of patients on dialysis at day 60 postrandomization. Data Sources: We identified all randomized controlled trials (RCTs) through EMLINE and MEDBASE that examined adult patients admitted to critical care who were randomized to receiving early dialysis versus standard of care. Study Selection: Inclusion criteria: (1) RCTs conducted after the year 2000, (2) the population evaluated had to be adults admitted to ICU, (3) the intervention had to be early RRT versus standard care, and (4) outcomes had to measure patient mortality. Data Extraction: Two independent investigators reviewed search results and identified appropriate studies. Information was extracted using standardized case report forms. Data Synthesis: Overall, 7 RCTs were included with a total of 1400 patients. Early RRT showed no survival benefit when compared to standard treatment (odds ratio [OR], 0.90 95% confidence interval [95% CI] 0.70-1.15, P = .39). There was no significant difference in length of hospital stay in patients with early RRT (−1.55 days [95% CI −4.75 to 1.65, P = .34]), in length of ICU stay (−0.79 days [95% CI −2.09 to 0.52], P = .24), or proportion of patients on dialysis at day 60 (OR 0.93 [95% CI 0.62 to 1.43], P = .79). Per patient, there is likely a small increase in costs (<US

Early vs. late tracheostomy in intensive care settings: Impact on ICU and hospital costs

1000) owing to increased total dialysis. Conclusion: Across all measured domains, there is no clear benefit to early RRT. Moreover, this intervention may result in increased costs and exposes patients to an invasive therapy with potential harm.

Cost Analysis of Noninvasive Helmet Ventilation Compared with Use of Noninvasive Face Mask in ARDS

Introduction: Up to 12% of the 800,000 patients who undergo mechanical ventilation in the United States every year require tracheostomies. A recent systematic review showed that early tracheostomy was associated with better outcomes: more ventilator‐free days, shorter ICU stays, less sedation and reduced long‐term mortality. However, the financial impact of early tracheostomies remain unknown. Objectives: To conduct a cost‐analysis on the timing of tracheostomy in mechanically ventilated patients. Methods: We extracted individual length of hospital stay and length of ICU stay data from the studies included in the systematic review from Hosokawa et al. We also searched for any recent randomized control trials on the topic that were published after this review. The weighted length of stay was estimated using a random effects model. Average daily hospital and ICU costs per patients were obtained from a cost study by Kahn et al. We estimated hospital and ICU costs by multiplying LOS with respective average daily cost per patient. We calculated difference in costs by subtracting hospital costs, ICU costs and total direct variable costs from early tracheotomy to late tracheotomy. 95% confidence intervals were estimated using bootstrap re‐sampling procedures with 1000 iterations. Results: The average weighted cost of ICU stay in patients with an early tracheostomy was

Dynamic Assessment of Fluid Responsiveness in Surgical ICU Patients Through Stroke Volume Variation is Associated With Decreased Length of Stay and Costs: A Systematic Review and Meta-Analysis

4316 less when compared to patients with late tracheostomy (95% CI: 403–8229). Subgroup analysis revealed that very early tracheostomies (<4 days) cost on average

556: CRITICAL CARE AT THE END OF LIFE

3672 USD less than late tracheostomies (95% CI: –1309, 10,294) and that early tracheostomies (<10 days but >4) cost on average

1294: INITIATION OF “EARLY” DIALYSIS IN ICU PATIENTS WITH AKI

6385 USD less than late tracheostomies (95% CI: –4396–17,165). Conclusion: This study shows that early tracheostomy can significantly reduce direct variable and likely total hospital costs in the intensive care unit based on length of stay alone. This is in addition to the already shown benefits of early tracheostomy in terms of ventilator dependent days, reduced length of stays, decreased pain, and improved communication. Further prospective studies on this topic are needed to prove the cost‐effectiveness of early tracheostomy in the critically ill population. HighlightsEarly tracheostomy reduces ICU & hospital costs.Early tracheostomy reduces ICU length of stay.Findings are consistent after sensitivity analysis.

Critical care at the end of life: a population-level cohort study of cost and outcomes

Intensive care unit (ICU) costs have doubled since 2000, totalling 108 billion dollars per year. Acute respiratory distress syndrome (ARDS) has a prevalence of 10.4% and a 28-day mortality of 34.8%. Noninvasive ventilation (NIV) is used in up to 30% of cases. A recent randomized controlled trial by Patel et al. (2016) showed lower intubation rates and 90-day mortality when comparing helmet to face mask NIV in ARDS. The population in the Patel et al. trial was used for cost analysis in this study. Projections of cost savings showed a decrease in ICU costs by

A48 PROPHYLACTIC ENDOTRACHEAL INTUBATION IN CRITICALLY ILL PATIENTS WITH UPPER GASTROINTESTINAL BLEED: A SYSTEMATIC REVIEW AND META-ANALYSIS

2527 and hospital costs by

Mo1096 PROPHYLACTIC ENDOTRACHEAL INTUBATION IN CRITICALLY ILL PATIENTS WITH UPPER GASTROINTESTINAL BLEEDS: A SYSTEMATIC REVIEW AND META-ANALYSIS

3103 per patient, along with a 43.3% absolute reduction in intubation rates. Sensitivity analysis showed consistent cost reductions. Projected annual cost savings, assuming the current prevalence of ARDS, were

1177: AUTOMATED VERSUS NONAUTOMATED VENTILATION WEANING IN THE ICU

237538 in ICU costs and