Kaweesak Chittawatanarat - Academia.edu (original) (raw)

Papers by Kaweesak Chittawatanarat

Research paper thumbnail of Validation of a delirium predictive model in patients admitted to surgical intensive care units: a multicentre prospective observational cohort study

BMJ Open

ObjectiveTo internally and externally validate a delirium predictive model for adult patients adm... more ObjectiveTo internally and externally validate a delirium predictive model for adult patients admitted to intensive care units (ICUs) following surgery.DesignA prospective, observational, multicentre study.SettingThree university-affiliated teaching hospitals in Thailand.ParticipantsAdults aged over 18 years were enrolled if they were admitted to a surgical ICU (SICU) and had the surgery within 7 days before SICU admission.Main outcome measuresPostoperative delirium was assessed using the Thai version of the Confusion Assessment Method for the ICU. The assessments commenced on the first day after the patient’s operation and continued for 7 days, or until either discharge from the ICU or the death of the patient. Validation was performed of the previously developed delirium predictive model: age+(5×SOFA)+(15×benzodiazepine use)+(20×DM)+(20×mechanical ventilation)+(20×modified IQCODE>3.42).ResultsIn all, 380 SICU patients were recruited. Internal validation on 150 patients with the...

Research paper thumbnail of Acute Kidney Injury in Elderly Patients in Thai-Surgical Intensive Care Units (THAI-SICU) Study

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

To demonstrate prevalence, characteristics and outcomes of the elderly patients who were diagnose... more To demonstrate prevalence, characteristics and outcomes of the elderly patients who were diagnosed with acute kidney injury (AKI) in surgical intensive care units (ICUs).

Research paper thumbnail of RESEARCH Open Access Incidence and risk factors of delirium in multi-center Thai surgical intensive care

units: a prospective cohort study

Research paper thumbnail of Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

The Lancet Global Health, 2021

Summary Background Geoeconomic variations in epidemiology, the practice of ventilation, and outco... more Summary Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference –1·69 [–9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5–8] vs 6 [5–8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52–23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75–0·86]; p<0·0001). Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding No funding.

Research paper thumbnail of Prevalence, Outcomes and Risk factors of Acute Kidney Injury in Surgical Intensive Care Unit: A Multi-Center Thai University-Based Surgical Intensive Care Units Study (THAI-SICU Study)

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective Acute kidney injury (AKI) is one of the most common problems in critically ill patients... more Objective Acute kidney injury (AKI) is one of the most common problems in critically ill patients. AKI associates with poor outcome in ICU. The recognition of the prevalence and risk factors of AKI is important. This could lead to the prevention of AKI and improve patient’s outcome. This study aims to identify the prevalence, outcomes and independent risk factors of AKI in Thai surgical intensive care units. Material and Method We conducted the prospective cohort study from nine university-based SICUs. The patients were diagnosed AKI by Acute Kidney Injury Network (AKIN) classification. The types of RRT and outcomes including mortality were collected. The risk factors of AKI were identified. Results A total cohort of 4,652 patients was included for the present study. AKI was diagnosed in 786 (16.89%) patients. The ICU mortality was higher in patients with AKI (29.90% vs. 5.48%, p-value <0.001). Among patients with AKI staging, we found that those with AKIN III had higher ICU mort...

Research paper thumbnail of Cost of Critically Ill Surgical Patients in Thailand: A Prospective Analysis of a Multicenter THAI-SICU Study

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective To quantify the total cost per admission and daily cost of critically ill surgical pati... more Objective To quantify the total cost per admission and daily cost of critically ill surgical patients and cost attributable to Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score, invasive mechanical ventilation and major complications in surgical intensive care unit (SICU) including sepsis, acute respiratory distress syndrome (ARDS), acute lung injury (ALI), acute kidney injury (AKI), cardiac arrest, and myocardial infarction. Material and Method A multicentre, prospective, observational, cost analysis study was carried out in SICU of five university hospitals in Thailand. Patients of age over 18 admitted to SICU (more than 6 hours) from 18 April 2011 to 30 November 2012 were recruited.The total SICU cost per admission (in Thai baht currency year 2011-2012) were recorded using hospital accounting database. Average daily SICU cost was calculated from total ICU cost divided by the ICU length of stay. The occurrence of sepsis, major cardiac and respiratory com...

Research paper thumbnail of Pain Management in Surgical Intensive Care Units: A Multi-Center Prospective Observational Study (THAI-SICU Study)

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective This study is a part of the multi-center Thai university-based Surgical Intensive Care ... more Objective This study is a part of the multi-center Thai university-based Surgical Intensive Care Unit Study (THAI-SICU Study). It aimed to evaluate the patterns of pain management in patients admitted to surgical intensive care units. Material and Method Case record forms (CRFs) were created by the working group. Data regarding pain management in the ICUs were documented on the daily record form. These included types of analgesics used (opioids and non-opioids), routes of administration (oral, intravenous, intramuscular, epidural and intrathecal) and methods of administration (continuous infusion, regular intermittent, as needed, patient-controlled analgesia and patient-controlled epidural analgesia). Results Data were gathered from 4,652 patients. The majority of the patients received analgesics (85.2%). The main stay analgesics were morphine (52.3%) and fentanyl (27%). Analgesics were frequently administered via the intravenous route (76.5%) on an as needed basis (48.6%). Conclusi...

Research paper thumbnail of The impact of delirium on clinical outcomes in multi-center Thai surgical intensive care units: a prospective cohort study

Objective Delirium in intensive care units (ICU) increases risks in prolonged mechanical ventilat... more Objective Delirium in intensive care units (ICU) increases risks in prolonged mechanical ventilation, hospitalization, and mortality rate. The purpose of this study is to determine if delirium in the surgical intensive care units (SICU) is an independent predictor of clinical outcomes during hospitalization. Material and Method A multi-center, prospective cohort study was conducted between April 2011 and January 2013. All patients who were admitted to nine university-based SICU were enrolled. Delirium was diagnosed by using the Intensive Care Delirium Screening Checklists. The clinical outcomes of study included length of mechanical ventilation, length of hospital stay, ICU and 28 day mortality. Cox proportional hazard regression model was used to assess the effects of delirium on ICU and 28 day mortality. Results A total of 4,652 patients were included. One hundred and sixty-three patients were diagnosed delirium (3.5%, 163 of 4,652). Patients who experienced delirium during ICU admission were significantly older (65.0+15.8 years versus 61.6+17.3 years, p = 0.013), had higher American Society of Anesthesiologists physical status (24.3% versus 12.2%, p<0.001), higher Acute Physiology and Chronic Health Evaluation II score (16 (12-23) versus 10 (7-15), p<0.001), and higher Sequential Organ Failure Assessment score (5 (2-8) versus 2 (1-5), p<0.001) compared to non-delirium. Delirious patients also had higher ventilator days (7 (4-17) versus 2 (1-4), p<0.001, longer length of hospital stay (22 (14-34) versus 15 (9-26), p<0.001) and higher ICU mortality (24% versus 9%, p<0.001), and 28-day mortality (28% versus 13%, p<0.001). Patients who developed delirium in the intensive care unit were associated with increased 28-day mortality (adjusted HR = 2.47, 95% CI: 1.13-5.41, p = 0.023). Conclusion Delirium in an ICU was a major predictor of hospital mortality after adjusted for relevant covariates. Routine monitoring of delirium, early detection, and implementation of preventive strategy are recommended.

Research paper thumbnail of Alternating non-cross-resistant multiagent chemotherapy (ANCRC) and high-dose chemotherapy followed by autologous stem cell support (HDC-ASCS) in first remission to improve outcome in patients with T-cell lymphoma

Journal of Clinical Oncology, 2012

e18538 Background: T-cell lymphomas represent a challenge for the practicing oncologist as eviden... more e18538 Background: T-cell lymphomas represent a challenge for the practicing oncologist as evidence-based medicine is limited and the ORR to chemotherapy, PFS and OS rates are inferior when compared to B-cell lymphoma. CHOP offers limited activity, and there is a growing consensus that alternative regimens should be tested. We studied the impact of ANCRC or HDC-ASCS vs. CHOP in outcome of T-cell lymphoma. Methods: We retrospectively analyzed differences between the ORR, PFS and OS of T-cell lymphoma patients excluding ALCL treated with CHOP or HyperCVAD regimen alternating with HDAM in the front-line setting following by observation or HDC-ASCS. Pre-treatment demographic, clinical, and pathological characteristics were collected. Differences in outcomes were analyzed using a Cox proportional analysis. Results: ALCL, PTCL-NOS and AITL were the most common subtypes. After excluding ALCL (N=29), a total of 49 patients were included in the final analysis; 23 pts treated with CHOP; 12 pt...

Research paper thumbnail of Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2018

Research paper thumbnail of Quetiapine versus haloperidol in the treatment of delirium: a double-blind, randomized, controlled trial

Drug Design, Development and Therapy, 2013

Background: Atypical antipsychotic drugs may have low propensity to induce extrapyramidal side ef... more Background: Atypical antipsychotic drugs may have low propensity to induce extrapyramidal side effects in delirious patients. This study aimed to compare the efficacy and tolerability between quetiapine and haloperidol in controlling delirious behavior. Methods: A 7-day prospective, double-blind, randomized controlled trial was conducted from June 2009 to April 2011 in medically ill patients with delirium. Measures used for daily assessment included the Delirium Rating Scale-revised-98 (DRS-R-98) and total sleep time. The Clinical Global Impression, Improvement (CGI-I) and the Modified (nine-item) Simpson-Angus Scale were applied daily. The primary outcome was the DRS-R-98 severity scores. The data were analyzed on an intention-to-treat basis. Results: Fifty-two subjects (35 males and 17 females) were randomized to receive 25-100 mg/day of quetiapine (n = 24) or 0.5-2.0 mg/day of haloperidol (n = 28). Mean (standard deviation) doses of quetiapine and haloperidol were 67.6 (9.7) and 0.8 (0.3) mg/day, respectively. Over the trial period, means (standard deviation) of the DRS-R-98 severity scores were not significantly different between the quetiapine and haloperidol groups (−22.9 [6.9] versus −21.7 [6.7]; P = 0.59). The DRS-R-98 noncognitive and cognitive subscale scores were not significantly different. At end point, the response and remission rates, the total sleep time, and the Modified (nine-item) Simpson-Angus scores were also not significantly different between groups. Hypersomnia was common in the quetiapine-treated patients (33.3%), but not significantly higher than that in the haloperidol-treated group (21.4%). Limitations: Patients were excluded if they were not able to take oral medications, and the sample size was small. Conclusion: Low-dose quetiapine and haloperidol may be equally effective and safe for controlling delirium symptoms. Clinical trials registration number: clinicaltrials.gov NCT00954603.

Research paper thumbnail of Prevalence and Impact of Overweight and Obesity in Critically Ill Surgical Patients: Analysis of THAI-SICU Study

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective To investigate the prevalence of overweight and obesity, and their impacts in patients ... more Objective To investigate the prevalence of overweight and obesity, and their impacts in patients admitted to a surgical intensive care unit (SICU) in Thailand. Material and Method We conducted an analysis using the THAI-SICU database. All 4,579 patients who had weight and height measured were classified into four groups using body mass index (BMI) based on the World Health Organization criteria, which were 1) underweight (BMI <18.5 kg/m2), 2) normal BMI (BMI 18.5-24.9 kg/m2), 3) overweight (BMI 25-29.9 kg/m2), and 4) obese (BMI >30 kg/m2) groups. Primary outcome was prevalence of overweight and obesity. Secondary outcomes were 28-day survival, and SICU outcomes between four patient groups. Results There were 768 (16.8%) of underweight, 2,624 (57.3%) of normal BMI, 858 (18.7%) of overweight, and 329 (7.2%) of obese patients. Compared to other three patient groups, obese had the highest 28-day survival (log-rank, p<0.001), lowest incidence of systemic inflammatory response sy...

Research paper thumbnail of Mixed fibers diet in surgical ICU septic patients

Asia Pacific Journal of Clinical Nutrition, 2010

Diarrhea commonly occurs in surgical critically ill patients, especially septic patients and fibe... more Diarrhea commonly occurs in surgical critically ill patients, especially septic patients and fiber formulas have been reported to improve diarrhea. Most reports have used soluble or insoluble fiber exclusively, while the effects of a mixed fiber diet remain unclear. This study compares diarrhea scores between mixed-fiber and non-fiber diets in surgical septic patients receiving broad spectrum antibiotics. We conducted a prospective randomized control double blind study in a general surgical ICU. Patients who received broad spectrum antibiotics and no contraindication to enteral feeding were randomly allocated to a fiber or non-fiber diet for up to 14 days. Nutritional delivery and diarrhea scores were recorded daily. Intention to treat analysis was performed. Thirty-four patients were enrolled in the study, 17 in the fiber group and 17 in non-fiber group. These two patients groups were similar in demographics, disease severity, nutritional status, cause of sepsis and total feeding p...

Research paper thumbnail of Height prediction from anthropometric length parameters in Thai people

Asia Pacific Journal of Clinical Nutrition, 2012

Height is an important clinical parameter. However, there were no specific measurements available... more Height is an important clinical parameter. However, there were no specific measurements available for particular clinical situations. Although many anthropometric measurements were suggested, no formula was recommended in Thailand. The objective of this study was to develop a formula for height prediction with acceptable validity. Two thousand volunteers were included and were divided consecutively according to both age and gender. Model and validation groups were further separated independently. Linear regression was analyzed to create a predictive formula. Ten parameters were included and analyzed. Of these, demispan, sitting height and knee height were selected with a correlation coefficient of more than 0.5 and significant F test in all age groups and genders. All single parameters and the highest predictive value of double (sitting and knee height) and triple regression models (demispan, sitting and knee height) were proposed and these were modified into a simple formula. After...

Research paper thumbnail of The Impacts of Surgical Intensive Care Unit Admission Source on Morbidity and Mortality Outcomes: The Results from the THAI-SICU Study

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

The present study aims to examine the association between admission source and outcomes in surgic... more The present study aims to examine the association between admission source and outcomes in surgical ICU (SICU) patients.

Research paper thumbnail of Height prediction from anthropometric length parameters in Thai people

Asia Pacific journal of clinical nutrition, 2012

Height is an important clinical parameter. However, there were no specific measurements available... more Height is an important clinical parameter. However, there were no specific measurements available for particular clinical situations. Although many anthropometric measurements were suggested, no formula was recommended in Thailand. The objective of this study was to develop a formula for height prediction with acceptable validity. Two thousand volunteers were included and were divided consecutively according to both age and gender. Model and validation groups were further separated independently. Linear regression was analyzed to create a predictive formula. Ten parameters were included and analyzed. Of these, demispan, sitting height and knee height were selected with a correlation coefficient of more than 0.5 and significant F test in all age groups and genders. All single parameters and the highest predictive value of double (sitting and knee height) and triple regression models (demispan, sitting and knee height) were proposed and these were modified into a simple formula. After...

Research paper thumbnail of Thai-shock survey 2013: survey of shock management in Thailand

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

OBJECTIVE Pragmatic surveys for shock management by Thai physicians are unavailable. The objectiv... more OBJECTIVE Pragmatic surveys for shock management by Thai physicians are unavailable. The objective of this study is to identify the shock management patterns on both; the incidence of septic shock and hemorrhagic shock here in Thailand. MATERIAL AND METHOD Two thousand questionnaires were sent to physicians who are called on to care for patients in shock across Thailand. The questionnaire is composed of 58 items regarding all aspects of the management of septic and hemorrhagic shock. A frequency scale has been defined by 5 levels of patient proportion estimates from routine practices. RESULTS Between April and August, 2013, 533 of the distributed questionnaires (26.7%) were returned. In severe sepsis and septic shock management, 406 physicians (76.2%) have reported the routine use of the quantitative resuscitation protocols. Urine output, mean arterial pressures and central venous pressures have been more frequently used than central venous oxygen saturation and lactate levels for t...

Research paper thumbnail of Agreement of Variables Selection and Program Development for Data Collection in Thai Intensive Care Unit by Delphi Method

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective The objective of this study was to determine the data collection variables and program ... more Objective The objective of this study was to determine the data collection variables and program for Thai intensive care units (ICU) as well as to obtain agreement using the modified Delphi method. Material and Method The variables for program development were modified from the THAI-SICU study case record form. The first open discussion on the prototype was performed in a program development workshop. After revision, the stakeholder agreement was performed by modified Delphi method on the final browser program. All the categorical variable details were scored by a rating scale at five levels. The agreement level was defined as the median score at of least four and the interquartile range (IQR) up to two. Results During June to September 2015, a total of 20 questionnaires from invited intensive care unit (ICU) expert stakeholders were returned (11 from physicians or surgeons, and 9 from critical care nurses). All of the seven parts of the variable groups, including: 1) patient charac...

Research paper thumbnail of Incidence, Outcomes and Risk Factors for Mortality of Symptomatic upper Gastrointestinal Hemorrhage in Surgical Critical Ill Patients (THAI SICU Study)

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective This multicenter university-based study reports the incidence, outcomes and defined ris... more Objective This multicenter university-based study reports the incidence, outcomes and defined risk factors for mortality of upper gastrointestinal hemorrhage (UGIH) patients in the surgical intensive care units (ICU) patients in Thailand. Material and Method This is part of a multicenter prospective observational study in the ICU in Thailand (THAI-SICU study). Patients who had a clinical presentation of upper gastrointestinal hemorrhage or an endoscopic diagnosis from April 2011 to January 2013 were enrolled into this sub-study. Results A total of 4,652 patients were analyzed. Fifty-five patients (1.18%) had symptomatic UGIH during ICU admission. The median age (interquartile range, IQR) was 72 (63-78) years old and the median APACHE II score (IQR) was 17 (13-22). In a comparison between the UGIH patients who survived and those who non-survived APACHE II score were higher in the non-survivors. The ICU mortality rate and 28-day mortality rate in these patients were 30.91% and 40%, re...

Research paper thumbnail of Re-Admission within 72 Hours in Thai Surgical Intensive Care Units (Thai-SICU) Study: Characteristics, and Outcomes

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective To identify incidence, characteristics and outcomes of patients who were re-admitted to... more Objective To identify incidence, characteristics and outcomes of patients who were re-admitted to surgical intensive care units (SICUs). Material and Method Multicenter prospective cohort study conducted in 9 university-affiliated surgical ICUs in Thailand (THAI-SICU study) from April 2011 to January 2013. Results A total of 144 patients (3.1%) re-admitted to our surgical ICUs from 4,652 cases were recruited. Re-admission baseline characteristics were advanced age (mean = 71 years), low body mass index, and higher APACHE-II and SOFA score within 24 hours of first ICU admission. Many significant comorbidities were found in the re-admission group, including: hypertension, cardiovascular diseases, and respiratory diseases. ICU mortality and hospital mortality were higher in readmission group than those in the non re-admission group (20.1% vs. 9.3%, p<0.001 and 27.8% vs. 11.3%, p<0.001, respectively). The relative risk ratio for mortality between re-admission and non re-admission ...

Research paper thumbnail of Validation of a delirium predictive model in patients admitted to surgical intensive care units: a multicentre prospective observational cohort study

BMJ Open

ObjectiveTo internally and externally validate a delirium predictive model for adult patients adm... more ObjectiveTo internally and externally validate a delirium predictive model for adult patients admitted to intensive care units (ICUs) following surgery.DesignA prospective, observational, multicentre study.SettingThree university-affiliated teaching hospitals in Thailand.ParticipantsAdults aged over 18 years were enrolled if they were admitted to a surgical ICU (SICU) and had the surgery within 7 days before SICU admission.Main outcome measuresPostoperative delirium was assessed using the Thai version of the Confusion Assessment Method for the ICU. The assessments commenced on the first day after the patient’s operation and continued for 7 days, or until either discharge from the ICU or the death of the patient. Validation was performed of the previously developed delirium predictive model: age+(5×SOFA)+(15×benzodiazepine use)+(20×DM)+(20×mechanical ventilation)+(20×modified IQCODE>3.42).ResultsIn all, 380 SICU patients were recruited. Internal validation on 150 patients with the...

Research paper thumbnail of Acute Kidney Injury in Elderly Patients in Thai-Surgical Intensive Care Units (THAI-SICU) Study

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

To demonstrate prevalence, characteristics and outcomes of the elderly patients who were diagnose... more To demonstrate prevalence, characteristics and outcomes of the elderly patients who were diagnosed with acute kidney injury (AKI) in surgical intensive care units (ICUs).

Research paper thumbnail of RESEARCH Open Access Incidence and risk factors of delirium in multi-center Thai surgical intensive care

units: a prospective cohort study

Research paper thumbnail of Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

The Lancet Global Health, 2021

Summary Background Geoeconomic variations in epidemiology, the practice of ventilation, and outco... more Summary Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference –1·69 [–9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5–8] vs 6 [5–8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52–23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75–0·86]; p<0·0001). Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding No funding.

Research paper thumbnail of Prevalence, Outcomes and Risk factors of Acute Kidney Injury in Surgical Intensive Care Unit: A Multi-Center Thai University-Based Surgical Intensive Care Units Study (THAI-SICU Study)

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective Acute kidney injury (AKI) is one of the most common problems in critically ill patients... more Objective Acute kidney injury (AKI) is one of the most common problems in critically ill patients. AKI associates with poor outcome in ICU. The recognition of the prevalence and risk factors of AKI is important. This could lead to the prevention of AKI and improve patient’s outcome. This study aims to identify the prevalence, outcomes and independent risk factors of AKI in Thai surgical intensive care units. Material and Method We conducted the prospective cohort study from nine university-based SICUs. The patients were diagnosed AKI by Acute Kidney Injury Network (AKIN) classification. The types of RRT and outcomes including mortality were collected. The risk factors of AKI were identified. Results A total cohort of 4,652 patients was included for the present study. AKI was diagnosed in 786 (16.89%) patients. The ICU mortality was higher in patients with AKI (29.90% vs. 5.48%, p-value <0.001). Among patients with AKI staging, we found that those with AKIN III had higher ICU mort...

Research paper thumbnail of Cost of Critically Ill Surgical Patients in Thailand: A Prospective Analysis of a Multicenter THAI-SICU Study

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective To quantify the total cost per admission and daily cost of critically ill surgical pati... more Objective To quantify the total cost per admission and daily cost of critically ill surgical patients and cost attributable to Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score, invasive mechanical ventilation and major complications in surgical intensive care unit (SICU) including sepsis, acute respiratory distress syndrome (ARDS), acute lung injury (ALI), acute kidney injury (AKI), cardiac arrest, and myocardial infarction. Material and Method A multicentre, prospective, observational, cost analysis study was carried out in SICU of five university hospitals in Thailand. Patients of age over 18 admitted to SICU (more than 6 hours) from 18 April 2011 to 30 November 2012 were recruited.The total SICU cost per admission (in Thai baht currency year 2011-2012) were recorded using hospital accounting database. Average daily SICU cost was calculated from total ICU cost divided by the ICU length of stay. The occurrence of sepsis, major cardiac and respiratory com...

Research paper thumbnail of Pain Management in Surgical Intensive Care Units: A Multi-Center Prospective Observational Study (THAI-SICU Study)

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective This study is a part of the multi-center Thai university-based Surgical Intensive Care ... more Objective This study is a part of the multi-center Thai university-based Surgical Intensive Care Unit Study (THAI-SICU Study). It aimed to evaluate the patterns of pain management in patients admitted to surgical intensive care units. Material and Method Case record forms (CRFs) were created by the working group. Data regarding pain management in the ICUs were documented on the daily record form. These included types of analgesics used (opioids and non-opioids), routes of administration (oral, intravenous, intramuscular, epidural and intrathecal) and methods of administration (continuous infusion, regular intermittent, as needed, patient-controlled analgesia and patient-controlled epidural analgesia). Results Data were gathered from 4,652 patients. The majority of the patients received analgesics (85.2%). The main stay analgesics were morphine (52.3%) and fentanyl (27%). Analgesics were frequently administered via the intravenous route (76.5%) on an as needed basis (48.6%). Conclusi...

Research paper thumbnail of The impact of delirium on clinical outcomes in multi-center Thai surgical intensive care units: a prospective cohort study

Objective Delirium in intensive care units (ICU) increases risks in prolonged mechanical ventilat... more Objective Delirium in intensive care units (ICU) increases risks in prolonged mechanical ventilation, hospitalization, and mortality rate. The purpose of this study is to determine if delirium in the surgical intensive care units (SICU) is an independent predictor of clinical outcomes during hospitalization. Material and Method A multi-center, prospective cohort study was conducted between April 2011 and January 2013. All patients who were admitted to nine university-based SICU were enrolled. Delirium was diagnosed by using the Intensive Care Delirium Screening Checklists. The clinical outcomes of study included length of mechanical ventilation, length of hospital stay, ICU and 28 day mortality. Cox proportional hazard regression model was used to assess the effects of delirium on ICU and 28 day mortality. Results A total of 4,652 patients were included. One hundred and sixty-three patients were diagnosed delirium (3.5%, 163 of 4,652). Patients who experienced delirium during ICU admission were significantly older (65.0+15.8 years versus 61.6+17.3 years, p = 0.013), had higher American Society of Anesthesiologists physical status (24.3% versus 12.2%, p<0.001), higher Acute Physiology and Chronic Health Evaluation II score (16 (12-23) versus 10 (7-15), p<0.001), and higher Sequential Organ Failure Assessment score (5 (2-8) versus 2 (1-5), p<0.001) compared to non-delirium. Delirious patients also had higher ventilator days (7 (4-17) versus 2 (1-4), p<0.001, longer length of hospital stay (22 (14-34) versus 15 (9-26), p<0.001) and higher ICU mortality (24% versus 9%, p<0.001), and 28-day mortality (28% versus 13%, p<0.001). Patients who developed delirium in the intensive care unit were associated with increased 28-day mortality (adjusted HR = 2.47, 95% CI: 1.13-5.41, p = 0.023). Conclusion Delirium in an ICU was a major predictor of hospital mortality after adjusted for relevant covariates. Routine monitoring of delirium, early detection, and implementation of preventive strategy are recommended.

Research paper thumbnail of Alternating non-cross-resistant multiagent chemotherapy (ANCRC) and high-dose chemotherapy followed by autologous stem cell support (HDC-ASCS) in first remission to improve outcome in patients with T-cell lymphoma

Journal of Clinical Oncology, 2012

e18538 Background: T-cell lymphomas represent a challenge for the practicing oncologist as eviden... more e18538 Background: T-cell lymphomas represent a challenge for the practicing oncologist as evidence-based medicine is limited and the ORR to chemotherapy, PFS and OS rates are inferior when compared to B-cell lymphoma. CHOP offers limited activity, and there is a growing consensus that alternative regimens should be tested. We studied the impact of ANCRC or HDC-ASCS vs. CHOP in outcome of T-cell lymphoma. Methods: We retrospectively analyzed differences between the ORR, PFS and OS of T-cell lymphoma patients excluding ALCL treated with CHOP or HyperCVAD regimen alternating with HDAM in the front-line setting following by observation or HDC-ASCS. Pre-treatment demographic, clinical, and pathological characteristics were collected. Differences in outcomes were analyzed using a Cox proportional analysis. Results: ALCL, PTCL-NOS and AITL were the most common subtypes. After excluding ALCL (N=29), a total of 49 patients were included in the final analysis; 23 pts treated with CHOP; 12 pt...

Research paper thumbnail of Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2018

Research paper thumbnail of Quetiapine versus haloperidol in the treatment of delirium: a double-blind, randomized, controlled trial

Drug Design, Development and Therapy, 2013

Background: Atypical antipsychotic drugs may have low propensity to induce extrapyramidal side ef... more Background: Atypical antipsychotic drugs may have low propensity to induce extrapyramidal side effects in delirious patients. This study aimed to compare the efficacy and tolerability between quetiapine and haloperidol in controlling delirious behavior. Methods: A 7-day prospective, double-blind, randomized controlled trial was conducted from June 2009 to April 2011 in medically ill patients with delirium. Measures used for daily assessment included the Delirium Rating Scale-revised-98 (DRS-R-98) and total sleep time. The Clinical Global Impression, Improvement (CGI-I) and the Modified (nine-item) Simpson-Angus Scale were applied daily. The primary outcome was the DRS-R-98 severity scores. The data were analyzed on an intention-to-treat basis. Results: Fifty-two subjects (35 males and 17 females) were randomized to receive 25-100 mg/day of quetiapine (n = 24) or 0.5-2.0 mg/day of haloperidol (n = 28). Mean (standard deviation) doses of quetiapine and haloperidol were 67.6 (9.7) and 0.8 (0.3) mg/day, respectively. Over the trial period, means (standard deviation) of the DRS-R-98 severity scores were not significantly different between the quetiapine and haloperidol groups (−22.9 [6.9] versus −21.7 [6.7]; P = 0.59). The DRS-R-98 noncognitive and cognitive subscale scores were not significantly different. At end point, the response and remission rates, the total sleep time, and the Modified (nine-item) Simpson-Angus scores were also not significantly different between groups. Hypersomnia was common in the quetiapine-treated patients (33.3%), but not significantly higher than that in the haloperidol-treated group (21.4%). Limitations: Patients were excluded if they were not able to take oral medications, and the sample size was small. Conclusion: Low-dose quetiapine and haloperidol may be equally effective and safe for controlling delirium symptoms. Clinical trials registration number: clinicaltrials.gov NCT00954603.

Research paper thumbnail of Prevalence and Impact of Overweight and Obesity in Critically Ill Surgical Patients: Analysis of THAI-SICU Study

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective To investigate the prevalence of overweight and obesity, and their impacts in patients ... more Objective To investigate the prevalence of overweight and obesity, and their impacts in patients admitted to a surgical intensive care unit (SICU) in Thailand. Material and Method We conducted an analysis using the THAI-SICU database. All 4,579 patients who had weight and height measured were classified into four groups using body mass index (BMI) based on the World Health Organization criteria, which were 1) underweight (BMI <18.5 kg/m2), 2) normal BMI (BMI 18.5-24.9 kg/m2), 3) overweight (BMI 25-29.9 kg/m2), and 4) obese (BMI >30 kg/m2) groups. Primary outcome was prevalence of overweight and obesity. Secondary outcomes were 28-day survival, and SICU outcomes between four patient groups. Results There were 768 (16.8%) of underweight, 2,624 (57.3%) of normal BMI, 858 (18.7%) of overweight, and 329 (7.2%) of obese patients. Compared to other three patient groups, obese had the highest 28-day survival (log-rank, p<0.001), lowest incidence of systemic inflammatory response sy...

Research paper thumbnail of Mixed fibers diet in surgical ICU septic patients

Asia Pacific Journal of Clinical Nutrition, 2010

Diarrhea commonly occurs in surgical critically ill patients, especially septic patients and fibe... more Diarrhea commonly occurs in surgical critically ill patients, especially septic patients and fiber formulas have been reported to improve diarrhea. Most reports have used soluble or insoluble fiber exclusively, while the effects of a mixed fiber diet remain unclear. This study compares diarrhea scores between mixed-fiber and non-fiber diets in surgical septic patients receiving broad spectrum antibiotics. We conducted a prospective randomized control double blind study in a general surgical ICU. Patients who received broad spectrum antibiotics and no contraindication to enteral feeding were randomly allocated to a fiber or non-fiber diet for up to 14 days. Nutritional delivery and diarrhea scores were recorded daily. Intention to treat analysis was performed. Thirty-four patients were enrolled in the study, 17 in the fiber group and 17 in non-fiber group. These two patients groups were similar in demographics, disease severity, nutritional status, cause of sepsis and total feeding p...

Research paper thumbnail of Height prediction from anthropometric length parameters in Thai people

Asia Pacific Journal of Clinical Nutrition, 2012

Height is an important clinical parameter. However, there were no specific measurements available... more Height is an important clinical parameter. However, there were no specific measurements available for particular clinical situations. Although many anthropometric measurements were suggested, no formula was recommended in Thailand. The objective of this study was to develop a formula for height prediction with acceptable validity. Two thousand volunteers were included and were divided consecutively according to both age and gender. Model and validation groups were further separated independently. Linear regression was analyzed to create a predictive formula. Ten parameters were included and analyzed. Of these, demispan, sitting height and knee height were selected with a correlation coefficient of more than 0.5 and significant F test in all age groups and genders. All single parameters and the highest predictive value of double (sitting and knee height) and triple regression models (demispan, sitting and knee height) were proposed and these were modified into a simple formula. After...

Research paper thumbnail of The Impacts of Surgical Intensive Care Unit Admission Source on Morbidity and Mortality Outcomes: The Results from the THAI-SICU Study

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

The present study aims to examine the association between admission source and outcomes in surgic... more The present study aims to examine the association between admission source and outcomes in surgical ICU (SICU) patients.

Research paper thumbnail of Height prediction from anthropometric length parameters in Thai people

Asia Pacific journal of clinical nutrition, 2012

Height is an important clinical parameter. However, there were no specific measurements available... more Height is an important clinical parameter. However, there were no specific measurements available for particular clinical situations. Although many anthropometric measurements were suggested, no formula was recommended in Thailand. The objective of this study was to develop a formula for height prediction with acceptable validity. Two thousand volunteers were included and were divided consecutively according to both age and gender. Model and validation groups were further separated independently. Linear regression was analyzed to create a predictive formula. Ten parameters were included and analyzed. Of these, demispan, sitting height and knee height were selected with a correlation coefficient of more than 0.5 and significant F test in all age groups and genders. All single parameters and the highest predictive value of double (sitting and knee height) and triple regression models (demispan, sitting and knee height) were proposed and these were modified into a simple formula. After...

Research paper thumbnail of Thai-shock survey 2013: survey of shock management in Thailand

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

OBJECTIVE Pragmatic surveys for shock management by Thai physicians are unavailable. The objectiv... more OBJECTIVE Pragmatic surveys for shock management by Thai physicians are unavailable. The objective of this study is to identify the shock management patterns on both; the incidence of septic shock and hemorrhagic shock here in Thailand. MATERIAL AND METHOD Two thousand questionnaires were sent to physicians who are called on to care for patients in shock across Thailand. The questionnaire is composed of 58 items regarding all aspects of the management of septic and hemorrhagic shock. A frequency scale has been defined by 5 levels of patient proportion estimates from routine practices. RESULTS Between April and August, 2013, 533 of the distributed questionnaires (26.7%) were returned. In severe sepsis and septic shock management, 406 physicians (76.2%) have reported the routine use of the quantitative resuscitation protocols. Urine output, mean arterial pressures and central venous pressures have been more frequently used than central venous oxygen saturation and lactate levels for t...

Research paper thumbnail of Agreement of Variables Selection and Program Development for Data Collection in Thai Intensive Care Unit by Delphi Method

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective The objective of this study was to determine the data collection variables and program ... more Objective The objective of this study was to determine the data collection variables and program for Thai intensive care units (ICU) as well as to obtain agreement using the modified Delphi method. Material and Method The variables for program development were modified from the THAI-SICU study case record form. The first open discussion on the prototype was performed in a program development workshop. After revision, the stakeholder agreement was performed by modified Delphi method on the final browser program. All the categorical variable details were scored by a rating scale at five levels. The agreement level was defined as the median score at of least four and the interquartile range (IQR) up to two. Results During June to September 2015, a total of 20 questionnaires from invited intensive care unit (ICU) expert stakeholders were returned (11 from physicians or surgeons, and 9 from critical care nurses). All of the seven parts of the variable groups, including: 1) patient charac...

Research paper thumbnail of Incidence, Outcomes and Risk Factors for Mortality of Symptomatic upper Gastrointestinal Hemorrhage in Surgical Critical Ill Patients (THAI SICU Study)

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective This multicenter university-based study reports the incidence, outcomes and defined ris... more Objective This multicenter university-based study reports the incidence, outcomes and defined risk factors for mortality of upper gastrointestinal hemorrhage (UGIH) patients in the surgical intensive care units (ICU) patients in Thailand. Material and Method This is part of a multicenter prospective observational study in the ICU in Thailand (THAI-SICU study). Patients who had a clinical presentation of upper gastrointestinal hemorrhage or an endoscopic diagnosis from April 2011 to January 2013 were enrolled into this sub-study. Results A total of 4,652 patients were analyzed. Fifty-five patients (1.18%) had symptomatic UGIH during ICU admission. The median age (interquartile range, IQR) was 72 (63-78) years old and the median APACHE II score (IQR) was 17 (13-22). In a comparison between the UGIH patients who survived and those who non-survived APACHE II score were higher in the non-survivors. The ICU mortality rate and 28-day mortality rate in these patients were 30.91% and 40%, re...

Research paper thumbnail of Re-Admission within 72 Hours in Thai Surgical Intensive Care Units (Thai-SICU) Study: Characteristics, and Outcomes

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Objective To identify incidence, characteristics and outcomes of patients who were re-admitted to... more Objective To identify incidence, characteristics and outcomes of patients who were re-admitted to surgical intensive care units (SICUs). Material and Method Multicenter prospective cohort study conducted in 9 university-affiliated surgical ICUs in Thailand (THAI-SICU study) from April 2011 to January 2013. Results A total of 144 patients (3.1%) re-admitted to our surgical ICUs from 4,652 cases were recruited. Re-admission baseline characteristics were advanced age (mean = 71 years), low body mass index, and higher APACHE-II and SOFA score within 24 hours of first ICU admission. Many significant comorbidities were found in the re-admission group, including: hypertension, cardiovascular diseases, and respiratory diseases. ICU mortality and hospital mortality were higher in readmission group than those in the non re-admission group (20.1% vs. 9.3%, p<0.001 and 27.8% vs. 11.3%, p<0.001, respectively). The relative risk ratio for mortality between re-admission and non re-admission ...