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Moin EE, Seewald NJ, Halpern SD. Use of Life Support and Outcomes Among Patients Admitted to Intensive Care Units. JAMA 2025; 333:1793-1803. [PMID: 40227733 PMCID: PMC11997855 DOI: 10.1001/jama.2025.2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 02/11/2025] [Indexed: 04/15/2025]
Abstract
Importance Nationwide data are unavailable regarding changes in intensive care unit (ICU) outcomes and use of life support over the past 10 years, limiting understanding of practice changes. Objective To portray the epidemiology of US critical care before, during, and after the COVID-19 pandemic. Design, Setting, and Participants Retrospective cohort study of adult patients admitted to an ICU for any reason, using data from the 54 US health systems continuously contributing to the Epic Cosmos database from 2014-2023. Exposures Patient demographics, COVID-19 status, and pandemic era. Main Outcomes and Measures In-hospital mortality unadjusted and adjusted for patient demographics, comorbidities, and illness severity; ICU length of stay; and receipt of life-support interventions, including mechanical ventilation and vasopressor medications. Results Of 3 453 687 admissions including ICU care, median age was 65 (IQR, 53-75) years. Patients were 55.3% male; 17.3% Black and 6.1% Hispanic or Latino; and overall in-hospital mortality was 10.9%. The adjusted in-hospital mortality was elevated during the pandemic in COVID-negative (adjusted odds ratio [aOR], 1.3 [95% CI, 1.2-1.3]) and COVID-positive (aOR, 4.3 [95% CI, 3.8-4.8]) patients and returned to baseline by mid-2022. The median ICU length of stay was 2.1 (IQR, 1.1-4.2) days, with increases during the pandemic among COVID-positive patients (difference for COVID-positive vs COVID-negative patients, 2.0 days [95% CI, 2.0-2.1]). Rates of invasive mechanical ventilation were 23.2% (95% CI, 23.1%-23.2%) before the pandemic, increased to 25.8% (95% CI, 25.8%-25.9%) during the pandemic, and declined below prepandemic baseline thereafter (22.0% [95% CI, 21.9%-22.2%]). The use of vasopressors increased from 7.2% to 21.6% of ICU stays. Conclusions and Relevance Pandemic-era increases in length of stay and adjusted in-hospital mortality among US ICU patients returned to recent historical baselines. Fewer patients are now receiving mechanical ventilation than prior to the pandemic, while more patients are administered vasopressor medications.
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Affiliation(s)
- Emily E. Moin
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia
| | - Nicholas J. Seewald
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
| | - Scott D. Halpern
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
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2
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Moussanang JA, Thery G, Marcq O, Sellam S, Jolly D, Mourvillier B, Goury A. A nurse-driven protocol for early weaning from mechanical ventilation in patients with acute respiratory failure: A pilot study. Intensive Crit Care Nurs 2025; 89:104060. [PMID: 40412242 DOI: 10.1016/j.iccn.2025.104060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 03/24/2025] [Accepted: 04/19/2025] [Indexed: 05/27/2025]
Abstract
OBJECTIVES To assess the compliance and acceptance of a nurse-driven early weaning protocol from the initiation of spontaneous ventilation (SV) to extubation in patients with acute respiratory failure (ARF) in the intensive care unit (ICU). METHODS This monocentric, prospective pilot study included patients admitted to the ICU with ARF and requiring invasive mechanical ventilation (IMV) for more than 48 h, between February 2021 and April 2024. The weaning protocol (WP) was initiated after a successful 30-minute SV trial with pressure support (PS). Every 3 h, nurses reduced PS by 2 cmH2O, fraction of inspired oxygen (FiO2) by 5%, and positive end-expiratory pressure (PEEP) according to a predefined protocol. When minimum PS and PEEP levels were reached, the patient was extubated after a successful T-tube test. The primary outcome was compliance with the WP assessed by the percentage of time spent in agreement with WP. The secondary outcome was nurse acceptance, assessed by an anonymous survey on a visual analogue scale from 0 to 10. RESULTS Of the 50 patients enrolled, 30 (60 %) had COVID-19 pneumonia. The median duration of IMV was 21 days per patient [IQR: 10-34], with a median WP duration of 11 days [IQR: 4-21.5]. Protocol compliance was 76 %. Thirty-two of 37 nurses (86 %) completed the survey and rated the acceptance of the WP as 8/10 [IQR: 7.75-9]. Workload was identified as a barrier to compliance with a median score of 5/10 [IQR: 2-7]. We reported 9/50 (18 %) extubation failures. CONCLUSIONS This nurse-driven protocol for early weaning of patients with ARF had good compliance and acceptance by the nurse team despite the COVID-19 pandemic health crisis. IMPLICATIONS FOR CLINICAL PRACTICE It is essential to incorporate nursing feedback if we are to improve the protocols for ventilatory weaning patients in ICU.
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Affiliation(s)
| | - Guillaume Thery
- CHU Reims, Unité de Médecine Intensive et Réanimation Polyvalente, F-51100 Reims, France; Université de Reims Champagne-Ardenne, UR-3801 PPF, Pharmacologie et Pathologies Fragilisantes, F-51100 Reims, France
| | - Ophélie Marcq
- CHU Reims, Unité de Médecine Intensive et Réanimation Polyvalente, F-51100 Reims, France
| | - Sarah Sellam
- CHU Reims, Unité de Médecine Intensive et Réanimation Polyvalente, F-51100 Reims, France
| | - Damien Jolly
- Université de Reims Champagne-Ardenne, VieFra F-51100 Reims, France; CHU Reims, Unité d'Aide Méthodologique, F-51100 Reims, France
| | - Bruno Mourvillier
- CHU Reims, Unité de Médecine Intensive et Réanimation Polyvalente, F-51100 Reims, France; Université de Reims Champagne-Ardenne, EA-4684 CardioVir, F-51100 Reims, France
| | - Antoine Goury
- CHU Reims, Unité de Médecine Intensive et Réanimation Polyvalente, F-51100 Reims, France; Université de Reims Champagne-Ardenne, UR-3801 PPF, Pharmacologie et Pathologies Fragilisantes, F-51100 Reims, France.
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Partouche N, Maumy M, Chamaraux-Tran TN, Bertrand F, Schneider F, Meyer N, Solis M, Fafi-Kremer S, Noll E, Pottecher J. Does the IL-6/KL-6 ratio distinguish different phenotypes in COVID-19 Acute Respiratory Distress Syndrome? An observational study stemmed from prospectively derived clinical, biological, and computed tomographic data. PLoS One 2025; 20:e0321533. [PMID: 40397955 DOI: 10.1371/journal.pone.0321533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 03/07/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND As new SARS-CoV-2 variants emerge and as treatment of COVID-19 ARDS remains exclusively supportive, there is an unmet need to better characterize its different phenotypes to tailor personalized treatments. Clinical, biological, spirometric and CT data hardly allow deciphering of Heavy (H), Intermediate (I) and Light (L) phenotypes of COVID-19 ARDS and the implementation of tailored specific strategies (prone positioning, PEEP settings, recruitment maneuvers). We hypothesized that the ratio of two pivotal COVID-19 biomarkers (interleukin 6 [IL-6] and Krebs von den Lungen 6 [KL-6], related to inflammation and pneumocyte repair, respectively) would provide a biologic insight into the disease timeline allowing 1) to differentiate H, I and L phenotypes, 2) to predict outcome and 3) to reflect some of CT findings. METHODS AND FINDINGS This was a retrospective analysis of prospectively acquired data (COVID HUS cohort). Inclusion concerned any patient with severe COVID-19 pneumonia admitted to two intensive care units between March 1st and May 1st, 2020, in a high-density cluster of the first epidemic wave (Strasbourg University Hospital, France). Demographic, clinical, biological (standard, IL-6 [new generation ELISA], KL-6 [CLEIA technique]), spirometric (driving pressure, respiratory system compliance) and CT data were collected longitudinally. CT analysis included semi-automatic and automatic lung measurements and allowed segmentation of lung volumes into 4 (poorly aerated, non-aerated, overinflated and normally aerated) and 3 (ground-glass, restricted normally aerated, and overinflated) zones, respectively. The primary outcome was to challenge the IL-6/KL-6 ratio capacity to decipher the three COVID-19 ARDS phenotypes (H, I and L) defined on clinical, spirometric and radiologic grounds. Secondary outcomes were the analysis of the prognostic value of the IL-6/KL-6 ratio and its correlates with CT-acquired data. Multivariate analysis was based on principal component analysis. One hundred and forty-eight ventilated COVID-19 ICU patients from the COVID HUS cohort were assessed for eligibility and 77 were included in the full analysis. Most were male, all were under invasive mechanical ventilation and vasopressor therapy and displayed high severity scores (SAPSII: 48 [42-56]; SOFA: 8 [7-10]). The L, I and H COVID ARDS phenotypes were identified in 11, 15 and 48 patients, respectively. In three patients, the phenotype could not be defined precisely. Thirty patients (39%) died in the ICU and the number of ventilator-free days was 2 [0-2] days. The IL-6/KL-6 ratio was not significantly different between the L, I and H phenotypes and evolved according to similar patterns over time. Surviving and deceased patients displayed an inverse kinetic of KL-6. IL-6 and the IL-6/KL-6 ratio were linearly associated with ground-glass volume on semi-automatic and automatic CT lung measurements. CONCLUSIONS In our population of severe ventilated COVID ARDS patients, the IL-6/KL-6 ratio was not clue to differentiate the H, I and L phenotypes and tailor a personalized ventilatory approach. There was an interesting correlation between IL-6/KL-6 ratio and ground-glass volume as determined by automated lung CT analysis. Such correlation deserves more in-depth pathophysiological study, at best gathered from a prospective cohort with a larger sample size and histological analysis. TRIAL REGISTRATION COVID HUS Trial registration number: NCT04405726.
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Affiliation(s)
- Nicolas Partouche
- Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, UR3072, FMTS, FHU Omicare, Faculté de Médecine, Maïeutique et Sciences de la Santé, Université de Strasbourg, Strasbourg, France
| | - Myriam Maumy
- LIST3N, University of Technology of Troyes, Troyes, France
| | - Thien-Nga Chamaraux-Tran
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), CNRS UMR7104, INSERM U1258, Université de Strasbourg, 1 Rue Laurent Fries, Illkirch-Graffenstaden, France
| | | | - Francis Schneider
- Service de Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nicolas Meyer
- Service de santé Publique, GMRC, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Morgane Solis
- Faculté de Médecine, Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France - INSERM, UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Samira Fafi-Kremer
- Faculté de Médecine, Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France - INSERM, UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Eric Noll
- Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, UR3072, FMTS, FHU Omicare, Faculté de Médecine, Maïeutique et Sciences de la Santé, Université de Strasbourg, Strasbourg, France
| | - Julien Pottecher
- Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, UR3072, FMTS, FHU Omicare, Faculté de Médecine, Maïeutique et Sciences de la Santé, Université de Strasbourg, Strasbourg, France
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4
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Matsumoto K, Prowle JR, Puthucheary Z, Cecconi M, Fazzini B, Malcolm H, Nydahl P, Osman M, Santini A, Schaller SJ, Thomson W, van den Berke D, Poll M, Stephens T. Uncertainty and decision-making in critical care: lessons from managing COVID-19 ARDS in preparation for the next pandemic. BMJ Open Respir Res 2025; 12:e002637. [PMID: 40350182 PMCID: PMC12067812 DOI: 10.1136/bmjresp-2024-002637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 04/02/2025] [Indexed: 05/14/2025] Open
Abstract
PURPOSE Coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) was an emergent syndrome that led to high volumes of critically ill ventilated patients. We explored influences on decision-making regarding management of COVID-19 ARDS mechanical ventilation to identify modifiable factors to improve preparedness for future pandemics. METHODS A systematic review and small group interviews informed the development of an international questionnaire (UK, Italy, Germany and Netherlands) on factors influencing COVID-19 ARDS ventilation decision-making in critical care professionals. Participants ranked four themes in order of importance: disease (uncertainties around COVID-19 ARDS), contextual (cognitive strain), environmental (structural logistics) and team factors. Participants also ranked the subthemes within each theme. Thematic analysis was used to derive findings from qualitative data. Kruskal-Wallis, Mann-Whitney U and Kendall's tau were used for quantitative data analysis. RESULTS Patient factors (comorbidities, clinical/biochemical parameters) were the most studied influences in the extant literature on decision-making; uncertainty was one of the least studied. 371 critical care professionals responded to the questionnaire. Disease uncertainty (lack of applicable guidelines, unfamiliarity with pathophysiology) was ranked as the most important influence on ventilation decision-making for COVID-19 ARDS across regions, professions and experience levels (p<0.001). Participants expressed underconfidence in their decision-making (median score: 9/20); this was unaffected by experience (p=0.79) or profession (p=0.58). Qualitative findings supported and extended the initial proposed influences, including the impact of team factors (+ve) and resource limitations (-ve) on disease uncertainty. CONCLUSION Future pandemic preparedness programmes should target modifiable influences such as information sharing, teamworking and resource limitations to mitigate against the negative influence of uncertainty and thereby improve decision-making overall.
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Affiliation(s)
- Kenki Matsumoto
- Barts Health NHS Trust, London, UK
- Queen Mary University of London Faculty of Medicine and Dentistry, London, UK
| | - John R Prowle
- Barts Health NHS Trust, London, UK
- Queen Mary University of London Faculty of Medicine and Dentistry, London, UK
| | - Zudin Puthucheary
- Queen Mary University of London Faculty of Medicine and Dentistry, London, UK
| | - Maurizio Cecconi
- Anesthesia and Critical Care, Istituto Clinico Humanitas, Rozzano, Lombardia, Italy
| | - Brigitta Fazzini
- Barts Health NHS Trust, London, UK
- Queen Mary University of London Faculty of Medicine and Dentistry, London, UK
| | - Hannah Malcolm
- Barts Health NHS Trust, London, UK
- Queen Mary University of London Faculty of Medicine and Dentistry, London, UK
| | - Peter Nydahl
- University Hospital Schleswig Holstein, Kiel, Germany
- Paracelsus Medical University, Salzburg, Austria
| | | | - Alessandro Santini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - William Thomson
- Barts Health NHS Trust, London, UK
- Queen Mary University of London Faculty of Medicine and Dentistry, London, UK
| | - Danielle van den Berke
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcel Poll
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Maastricht University, Maastricht, The Netherlands
| | - Timothy Stephens
- Barts Health NHS Trust, London, UK
- Queen Mary University of London Faculty of Medicine and Dentistry, London, UK
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5
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Glemain B, Assaad C, Ghosn W, Moulaire P, de Lamballerie X, Zins M, Severi G, Touvier M, Deleuze JF, Lapidus N, Carrat F, Ancel PY, Charles MA, Severi G, Touvier M, Zins M, Kab S, Renuy A, Le-Got S, Ribet C, Pellicer M, Wiernik E, Goldberg M, Artaud F, Gerbouin-Rérolle P, Enguix M, Laplanche C, Gomes-Rima R, Hoang L, Correia E, Barry AA, Senina N, Allegre J, Szabo de Edelenyi F, Druesne-Pecollo N, Esseddik Y, Hercberg S, Deschasaux M, Charles MA, Benhammou V, Ritmi A, Marchand L, Zaros C, Lordmi E, Candea A, de Visme S, Simeon T, Thierry X, Geay B, Dufourg MN, Milcent K, Rahib D, Lydie N, Lusivika-Nzinga C, Pannetier G, Lapidus N, Goderel I, Dorival C, Nicol J, Robineau O, Lai C, Belhadji L, Esperou H, Couffin-Cadiergues S, Gagliolo JM, Blanché H, Sébaoun JM, Beaudoin JC, Gressin L, Morel V, Ouili O, Deleuze JF, Ninove L, Priet S, Villarroel PMS, Fourié T, Mohamed Ali S, Amroun A, Seston M, Ayhan N, Pastorino B, de Lamballerie X. Revisiting the link between COVID-19 incidence and infection fatality rate during the first pandemic wave. Sci Rep 2025; 15:15638. [PMID: 40325150 PMCID: PMC12053613 DOI: 10.1038/s41598-025-99078-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 04/16/2025] [Indexed: 05/07/2025] Open
Abstract
Several studies found an association between COVID-19 incidence, cumulated over the first pandemic wave, and the risk of death for infected individuals. They attributed this association to hospital overload. We studied this association across the French departments using 82,467 serological samples and a hierarchical Bayesian model with spatial smoothing. In high-incidence areas, we hypothesized that hospital overload would increase infection fatality rate (IFR) without increasing infection hospitalization rate (IHR). The analyses were adjusted for intensive care beds per capita, age of the population, and diabetes prevalence (as a surrogate for obesity). We found that increasing departmental incidence from 3 to 9% rose IFR from 0.42 to 1.14% (difference 0.72%, 95% CI 0.49-1.01%), and IHR from 1.66 to 3.61% (difference 1.94%, 95% CI 1.18-2.80%). An increase in incidence from 6 to 12% in people under 60 was associated with an increased proportion of people over 60 among those infected, from 11.6 to 17.4% (difference 5.8%, 95% CI 2.9-8.8%). Higher incidence increased the risk of death for infected individuals and their risk of hospitalization by the same magnitude. These findings could be explained by a higher age among infected individuals in high-incidence areas, rather by than hospital overload.
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Affiliation(s)
- Benjamin Glemain
- Département de santé publique, Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, Hôpital Saint-Antoine, Paris, F-75012, France.
| | - Charles Assaad
- Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, F-75012, Paris, France
| | - Walid Ghosn
- Centre d'épidémiologie sur les causes médicales de décès de l'Inserm-CépiDc, Paris, France
| | - Paul Moulaire
- Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, F-75012, Paris, France
| | - Xavier de Lamballerie
- Unité des Virus Émergents, Aix Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection, Marseille, France
| | - Marie Zins
- Paris University, Paris, France
- Université Paris-Saclay, Université de Paris, UVSQ, Inserm UMS 11, Villejuif, France
| | - Gianluca Severi
- CESP UMR1018, Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Villejuif, France
- Department of Statistics, Computer Science and Applications, University of Florence, Florence, Italy
| | - Mathilde Touvier
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Jean-François Deleuze
- Fondation Jean Dausset-CEPH (Centre d'Etude du Polymorphisme Humain), CEPH-Biobank, Paris, France
| | - Nathanaël Lapidus
- Département de santé publique, Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, Hôpital Saint-Antoine, Paris, F-75012, France
| | - Fabrice Carrat
- Département de santé publique, Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, Hôpital Saint-Antoine, Paris, F-75012, France
| | - Pierre-Yves Ancel
- Centre for Research in Epidemiology and StatisticS (CRESS), Inserm, INRAE, Universite de Paris, Paris, France
| | - Marie-Aline Charles
- Centre for Research in Epidemiology and StatisticS (CRESS), Inserm, INRAE, Universite de Paris, Paris, France
| | - Gianluca Severi
- CESP UMR1018, Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Villejuif, France
- Department of Statistics, Computer Science and Applications, University of Florence, Florence, Italy
| | - Mathilde Touvier
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Marie Zins
- Paris University, Paris, France
- Université Paris-Saclay, Université de Paris, UVSQ, Inserm UMS 11, Villejuif, France
| | - Sofiane Kab
- Université Paris-Saclay, Université de Paris, UVSQ, Inserm UMS 11, Villejuif, France
| | - Adeline Renuy
- Université Paris-Saclay, Université de Paris, UVSQ, Inserm UMS 11, Villejuif, France
| | - Stephane Le-Got
- Université Paris-Saclay, Université de Paris, UVSQ, Inserm UMS 11, Villejuif, France
| | - Celine Ribet
- Université Paris-Saclay, Université de Paris, UVSQ, Inserm UMS 11, Villejuif, France
| | - Mireille Pellicer
- Université Paris-Saclay, Université de Paris, UVSQ, Inserm UMS 11, Villejuif, France
| | - Emmanuel Wiernik
- Université Paris-Saclay, Université de Paris, UVSQ, Inserm UMS 11, Villejuif, France
| | - Marcel Goldberg
- Université Paris-Saclay, Université de Paris, UVSQ, Inserm UMS 11, Villejuif, France
| | - Fanny Artaud
- CESP UMR1018, Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Villejuif, France
| | | | - Mélody Enguix
- CESP UMR1018, Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Villejuif, France
| | - Camille Laplanche
- CESP UMR1018, Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Villejuif, France
| | - Roselyn Gomes-Rima
- CESP UMR1018, Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Villejuif, France
| | - Lyan Hoang
- CESP UMR1018, Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Villejuif, France
| | - Emmanuelle Correia
- CESP UMR1018, Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Villejuif, France
| | - Alpha Amadou Barry
- CESP UMR1018, Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Villejuif, France
| | - Nadège Senina
- CESP UMR1018, Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Villejuif, France
| | - Julien Allegre
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Fabien Szabo de Edelenyi
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Nathalie Druesne-Pecollo
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Younes Esseddik
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Serge Hercberg
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Mélanie Deschasaux
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Marie-Aline Charles
- Centre for Research in Epidemiology and StatisticS (CRESS), Inserm, INRAE, Universite de Paris, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Clovis Lusivika-Nzinga
- Département de santé publique, Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, Hôpital Saint-Antoine, Paris, F-75012, France
| | - Gregory Pannetier
- Département de santé publique, Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, Hôpital Saint-Antoine, Paris, F-75012, France
| | - Nathanael Lapidus
- Département de santé publique, Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, Hôpital Saint-Antoine, Paris, F-75012, France
| | - Isabelle Goderel
- Département de santé publique, Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, Hôpital Saint-Antoine, Paris, F-75012, France
| | - Céline Dorival
- Département de santé publique, Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, Hôpital Saint-Antoine, Paris, F-75012, France
| | - Jérôme Nicol
- Département de santé publique, Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, Hôpital Saint-Antoine, Paris, F-75012, France
| | - Olivier Robineau
- Département de santé publique, Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, Hôpital Saint-Antoine, Paris, F-75012, France
| | | | | | | | | | | | - Hélène Blanché
- Fondation Jean Dausset-CEPH (Centre d'Etude du Polymorphisme Humain), CEPH-Biobank, Paris, France
| | - Jean-Marc Sébaoun
- Fondation Jean Dausset-CEPH (Centre d'Etude du Polymorphisme Humain), CEPH-Biobank, Paris, France
| | - Jean-Christophe Beaudoin
- Fondation Jean Dausset-CEPH (Centre d'Etude du Polymorphisme Humain), CEPH-Biobank, Paris, France
| | - Laetitia Gressin
- Fondation Jean Dausset-CEPH (Centre d'Etude du Polymorphisme Humain), CEPH-Biobank, Paris, France
| | - Valérie Morel
- Fondation Jean Dausset-CEPH (Centre d'Etude du Polymorphisme Humain), CEPH-Biobank, Paris, France
| | - Ouissam Ouili
- Fondation Jean Dausset-CEPH (Centre d'Etude du Polymorphisme Humain), CEPH-Biobank, Paris, France
| | - Jean-François Deleuze
- Fondation Jean Dausset-CEPH (Centre d'Etude du Polymorphisme Humain), CEPH-Biobank, Paris, France
| | - Laetitia Ninove
- Unité des Virus Émergents, Aix Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection, Marseille, France
| | - Stéphane Priet
- Unité des Virus Émergents, Aix Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection, Marseille, France
| | | | - Toscane Fourié
- Unité des Virus Émergents, Aix Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection, Marseille, France
| | - Souand Mohamed Ali
- Unité des Virus Émergents, Aix Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection, Marseille, France
| | - Abdenour Amroun
- Unité des Virus Émergents, Aix Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection, Marseille, France
| | - Morgan Seston
- Unité des Virus Émergents, Aix Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection, Marseille, France
| | - Nazli Ayhan
- Unité des Virus Émergents, Aix Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection, Marseille, France
| | - Boris Pastorino
- Unité des Virus Émergents, Aix Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection, Marseille, France
| | - Xavier de Lamballerie
- Unité des Virus Émergents, Aix Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection, Marseille, France
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6
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Wang X, Ma H, He X, Gu X, Ren Y, Yang H, Tong Z. Efficacy of early pulmonary rehabilitation in severe and critically ill COVID-19 patients: a retrospective cohort study. BMC Pulm Med 2025; 25:203. [PMID: 40301769 PMCID: PMC12039096 DOI: 10.1186/s12890-025-03678-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Accepted: 04/21/2025] [Indexed: 05/01/2025] Open
Abstract
BACKGROUND Respiratory sequelae, induced by lung injury, reduced muscle strength, and nutritional disturbance, are common in hospitalized patients with coronavirus disease 2019 (COVID-19). Therefore, optimal treatment is essential for reducing the mortality in severe forms of the disease and critically ill patients. Pulmonary rehabilitation (PR) has been used in many chronic respiratory diseases, but the role of early PR in severe and critically ill COVID-19 patients remains to be fully understood. METHODS Hospitalized severe to critically ill COVID-19 patients were recruited from Beijing Chaoyang Hospital between December 1, 2022, and June 30, 2023. In all, we recruited 272 patients, with 39 in the PR group and 233 in the control group. The PR intervention consisted of the prone position, airway clearance therapy (ACT), and resistance respiratory training (RRT). The primary outcome was the composite disease progression outcome rate, defined as death or intensive care unit (ICU) admission. Adverse events (AEs) and serious adverse events (SAEs) were recorded in the PR group. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) was used to balance confounding bias, generating weighting cohort and matched cohort. RESULTS The rate of the primary outcome was lower in the PR group (28.2% [11/39] in the PR group vs. 48.9% [114/233] in the control group). Significant differences were observed in both the original and weighting cohorts. Subgroup analyses showed that receiving ≥ 2 types of PR, receiving RRT, length from admission to intervention ≤ 4 days, and baseline P/F ≤ 150 mmHg were associated with lower rates of progression. Total rates of 2.6% (1/39) for AEs and 10.26% (4/39) for SAEs were reported. CONCLUSIONS Early pulmonary rehabilitation may prevent disease progression and reduce mortality in patients with severe COVID-19. These findings may be helpful for formulating an optimal rehabilitation strategy.
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Affiliation(s)
- Xue Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Haomiao Ma
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoya He
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Sports and Medicine Integrative Innovation Center, Capital University of Physical Education and Sports, Beijing, China
| | - Xiaomeng Gu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yi Ren
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huqin Yang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
- Beijing Research Center for Respiratory Infectious Diseases, Beijing, China.
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
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7
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Pettenuzzo T, Balzani E, Sella N, Giani M, Bassi M, Fincati V, Cescon R, Pacchiarini G, Pandolfo G, Ceccato R, Grønlykke L, Staudacher DL, Nesseler N, Raasveld SJ, Carron M, Pistollato E, Mormando G, Zarantonello F, De Cassai A, Boscolo A, Rezoagli E, Foti G, Navalesi P. Prone positioning during veno-venous extracorporeal membrane oxygenation: a systematic review and meta-analysis. Intensive Care Med 2025:10.1007/s00134-025-07877-2. [PMID: 40298974 DOI: 10.1007/s00134-025-07877-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Accepted: 03/19/2025] [Indexed: 04/30/2025]
Abstract
PURPOSE The evidence supporting the benefit on clinical outcomes of prone positioning during veno-venous extracorporeal membrane oxygenation (V-V ECMO) for acute hypoxemic respiratory failure remains inconclusive. We aimed to assess the association of prone positioning, compared to no prone positioning, with 28-day mortality and other clinical outcomes in different patient subgroups. METHODS A systematic review and meta-analysis of randomized and non-randomized controlled trials (RCTs) using a random-effects model was conducted. An electronic database search up to September 1st, 2024 was performed (PROSPERO CRD42024517602). The RoB 2 and ROBINS-I tools were used for risk of bias assessments. RESULTS We analyzed two RCTs and 20 non-RCTs (3,465 patients). Compared to no prone positioning, the use of prone positioning was associated with lower 28-day (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.42-0.98, p = 0.040, I2 = 66%, low certainty of evidence [CoE]) and hospital mortality (OR 0.67, 95% CI 0.54-0.83, p < 0.001, I2 = 39%, low CoE), despite fewer 28-day ventilator-free days and longer ECMO duration. Younger age (p = 0.005), a higher sequential organ failure assessment (SOFA) score (p = 0.022), non-Covid-19 etiology (p = 0.003), and lower rates of prone positioning before cannulation (p = 0.049) were associated with a greater benefit from prone positioning. CONCLUSION In this analysis, among patients supported with V-V ECMO for acute hypoxemic respiratory failure, we observed improved 28-day and hospital mortality in those who received prone positioning, compared to those who did not. However, these findings do not imply causation. Further research is needed to clarify the role of prone positioning in this population.
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Affiliation(s)
- Tommaso Pettenuzzo
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, Padua, Italy
| | - Eleonora Balzani
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Nicolò Sella
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, Padua, Italy
| | - Marco Giani
- Emergency Medicine Department, San Gerardo Hospital, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Mara Bassi
- Department of Medicine, University of Padua, Padua, Italy
| | | | | | - Giorgia Pacchiarini
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, Padua, Italy
| | | | | | - Lars Grønlykke
- Department of Cardiothoracic Anesthesia and Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Dawid L Staudacher
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Nicolas Nesseler
- Department of Anesthesia and Critical Care, Rennes University Hospital, Rennes, France
- Centre d'Investigation Clinique de Rennes, University of Rennes, Rennes, France
| | - Senta Jorinde Raasveld
- Department of Critical Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Michele Carron
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, Padua, Italy
- Department of Medicine, University of Padua, Padua, Italy
| | | | - Giulia Mormando
- Department of Medicine, University of Padua, Padua, Italy
- Emergency Medicine Department, Padua University Hospital, Padua, Italy
| | | | - Alessandro De Cassai
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, Padua, Italy
- Department of Medicine, University of Padua, Padua, Italy
| | - Annalisa Boscolo
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, Padua, Italy
- Department of Medicine, University of Padua, Padua, Italy
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Emanuele Rezoagli
- Emergency Medicine Department, San Gerardo Hospital, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Foti
- Emergency Medicine Department, San Gerardo Hospital, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paolo Navalesi
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, Padua, Italy.
- Department of Medicine, University of Padua, Padua, Italy.
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8
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Sjauw DJT, Hessels LM, Duiverman ML, Elshof J, Janssen ML, Türk Y, Heunks L, Baart SJ, Wils EJ. High-flow nasal oxygen vs. conventional oxygen therapy in patients with COVID-19 related acute hypoxemic respiratory failure and a do not intubate order: a multicentre cohort study. Respir Res 2025; 26:161. [PMID: 40281556 PMCID: PMC12032817 DOI: 10.1186/s12931-025-03231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Accepted: 04/10/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND High-flow nasal oxygen (HFNO) is frequently used to treat patients with acute hypoxemic respiratory failure (AHRF) due to viral pneumonia, including COVID-19. However, its clinical effect compared to conventional oxygen therapy (COT) remains largely unexplored in patients with a do not intubate (DNI) order. We aimed to assess whether HFNO compared to COT is associated with improved clinical outcomes in hospitalized patients with AHRF due to COVID-19 and a DNI order. METHODS This analysis included patients with a DNI order and SARS-CoV-2 infection, selected from three observational studies, who were treated with COT only or HFNO. The primary endpoint was in-hospital mortality, the secondary endpoint was hospital length of stay (LOS). The effect of HFNO vs. COT was assessed using multivariable regression, accounting for pre-selected confounders. RESULTS Between March 2020 and September 2021, 116 patients received HFNO and 110 patients received COT. Median age was 78 [72-83], and 78% of the patients had a Clinical Frailty Scale score of 4 to 9. In-hospital mortality was 64% for HFNO and 71% for COT (p = 0.29), with an adjusted odds ratio of 0.72 (95% confidence interval [0.34-1.54], p = 0.40). Hospital LOS was 11 [6-18] days for HFNO, and 7 [4-12] days for COT (p < 0.001), with a remaining difference after adjusting for confounders (p < 0.01). CONCLUSION The lack of survival benefit and increased hospital LOS should be taken into account when considering HFNO for patients with a DNI order, suffering from AHRF due to viral pneumonia, like COVID-19. CLINICAL TRIAL REGISTRATION HFNO-COVID-19 study: DTR, NL9067 (Dutch Trial Registry), registration date: 27-11-2020.
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Affiliation(s)
- Daphne J T Sjauw
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lisa M Hessels
- Department of Respiratory Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
- Department of Infectious Disease Epidemiology, Utrecht Medical Center, Utrecht, The Netherlands
| | - Marieke L Duiverman
- Department of Pulmonary Diseases / Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Judith Elshof
- Department of Pulmonary Diseases / Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs L Janssen
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Yasemin Türk
- Department of Respiratory Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Leo Heunks
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands.
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
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9
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Azeli Y, Solà-Muñoz S, Trenado J, Jacob J, Cubedo M, Delgado R, Mugica EM, Fontan I, Bracero A, López-López C, Carricondo-Avivar MDM, Luque-Hernández MJ, Villalba E, Simón S, Castejón ME, Goñi C, Cardenete C, Quintela Z, Abejón R, Bermejo Á, Martín M, Soto-García MÁ, Morales-Alvarez J, Cuartas-Alvarez T, Castro-Delgado R, Jiménez-Fàbrega X. A transfer triage tool for COVID-19 mass critical care surges. Sci Rep 2025; 15:11726. [PMID: 40188194 PMCID: PMC11972393 DOI: 10.1038/s41598-025-95337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/20/2025] [Indexed: 04/07/2025] Open
Abstract
The objective of this study is to develop and validate a predictive model for mortality among severe COVID-19 patients who are candidates for inter-hospital transfer. A multicenter prospective observational study was conducted between 1 January 2021 and 30 April 2021 (third and fourth pandemic waves) in regional coordination centers of the Emergency Medical Services of eight Spanish autonomous communities. Hospitalized patients with severe COVID-19 transferred to other hospitals were included. Clinical variables from the initial evaluation, the triage score, and in-hospital mortality rates were collected. A Lasso-type regression analysis was performed to fit the mortality predictive model and its performance was evaluated by a leave-one-out cross-validation. Subsequently, the regional mass triage (MATER) score was created. 1,018 transferred patients were included, with a mean age of 62.3 years (SD 12), of whom 65.1% were male and 89.6% were admitted to an Intensive Care Unit. In-hospital mortality was 23.0%. The MATER score included six variables and presented good discrimination ability with an area under the curve of 0.79 (95% CI 0.77-0.81) and a good calibration with a Brier score of 0.135. The MATER score successfully predicted the mortality rate of severe COVID-19 patients and can be helpful in decision-making for triage and transfer prioritization in mass critical care surges.
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Affiliation(s)
- Youcef Azeli
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain.
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain.
- Hospital Universitari Sant Joan de Reus, Reus, Spain.
- Institut d'Investigació Sanitària Pere i Virgili (IISPV), Tarragona, Spain.
| | - Silvia Solà-Muñoz
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
| | - José Trenado
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain
- Facultad de Medicina de la Universidad de Barcelona, Barcelona, Spain
- Hospital Mutua de Terrassa, Barcelona, Spain
| | - Javier Jacob
- Facultad de Medicina de la Universidad de Barcelona, Barcelona, Spain
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Ricardo Delgado
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Gerencia de Urgencias, Emergencias y Transporte Sanitario, GUETS, SESCAM, Castilla-La Mancha, Spain
| | - Edurne Miren Mugica
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Emergencias Osakidetza, The Basque Country, Spain
| | - Iraitz Fontan
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Emergencias Osakidetza, The Basque Country, Spain
| | - Antonio Bracero
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Hospital Reina Sofía, Córdoba, Córdoba, Spain
| | - Cristina López-López
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Centro de Emergencias Sanitarias 061, Andalucía, Spain
| | - Maria Del Mar Carricondo-Avivar
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Centro de Emergencias Sanitarias 061, Andalucía, Spain
| | - María José Luque-Hernández
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Centro de Emergencias Sanitarias 061, Andalucía, Spain
| | - Eloy Villalba
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- SAMU061 Islas Baleares, Islas Baleares, Spain
| | - Silvia Simón
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias y Emergencias 061 de La Rioja, La Rioja, Spain
| | - María Elena Castejón
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- SAMU, Servicio de Emergencias Sanitarias, Alicante, Spain
| | - Cristina Goñi
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias Extrahospitalarias y Osasunbidea, Navarra, Spain
| | - César Cardenete
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias Médicas de Madrid-SUMMA 112, Madrid, Spain
| | - Zita Quintela
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias Médicas de Madrid-SUMMA 112, Madrid, Spain
| | - Raquel Abejón
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias Médicas de Madrid-SUMMA 112, Madrid, Spain
| | - Ángel Bermejo
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias Médicas de Madrid-SUMMA 112, Madrid, Spain
| | - Mario Martín
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias Médicas de Madrid-SUMMA 112, Madrid, Spain
| | - Maria Ángeles Soto-García
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jorge Morales-Alvarez
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Tatiana Cuartas-Alvarez
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Research Group on Prehospital Care and Disasters), Asturias, Spain
| | - Rafael Castro-Delgado
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Research Group on Prehospital Care and Disasters), Asturias, Spain
- Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Xavier Jiménez-Fàbrega
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Facultad de Medicina de la Universidad de Barcelona, Barcelona, Spain
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10
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Gacouin A, Maamar A, Terzi N, Tadié JM. Association of obesity on short- and long-term survival in patients with moderate to severe pneumonia-related ARDS: a retrospective cohort study. BMC Pulm Med 2025; 25:153. [PMID: 40181311 PMCID: PMC11969934 DOI: 10.1186/s12890-025-03614-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 03/20/2025] [Indexed: 04/05/2025] Open
Abstract
BACKGROUND The incidence of obesity among patients admitted to the intensive care unit (ICU) is increasing, and pneumonia remains the leading cause of acute respiratory distress syndrome (ARDS). The association of obesity on both short- and long-term outcomes in patients with pneumonia-induced ARDS has been the subject of only limited research. METHODS We conducted a retrospective analysis of a prospective cohort consisting of ARDS patients who had microbiologically confirmed pneumonia and a PaO2/FiO2 ratio ≤ 150 mmHg. Patients were assessed for mortality at 28 days, 90 days, and at 1 year from the diagnosis of ARDS and compared between obese defined by a body mass index (BMI) ≥ 30 kg.m2 and non-obese patients. Models were adjusted for age, sex, COPD, coronary artery disease, immunodepression, severity score and acute kidney injury on admission to the ICU, severity of ARDS (PaO2/FiO2 ratio ≤ 100 mmHg), severe hypercapnia (PaCO2 ≥ 50 mmHg), ventilatory ratio and plateau pressure the first day of ARDS, influenza, COVID-19, pneumocystosis, and bacteria involved in pneumonia. We also investigated the continuous spectrum of BMI on the risk of mortality. RESULTS Of 603 patients, 227 patients (37.6%) were obese. Obesity was associated with female gender (p = 0.009), hypertension (p < 0.001), diabetes mellitus (p < 0.001), COVID-19 pneumonia (p = 0.008), and PaO2/FiO2 ratio ≤ 100 mmHg (p = 0.006). Obesity was independently associated with lower mortality at 28 days (adjusted Odds Ratio (OR) 0.55, 95% confident interval (CI) 0.33-0.90, p = 0.02) but not at 90 days (adjusted OR 0.70, 95% CI 0.45-1.09, p = 0.11) nor at 1 year from the diagnosis of ARDS (adjusted OR 0.73, 95% CI 0.47-1.13, p = 0.16). Mortality at 28 days was significantly lower in obese patients than in non-obese patients when propensity score matching was used (15.2% versus 22%, p = 0.04). BMI was also independently associated with lower mortality at 28 days (p = 0.038) but not with mortality at 90 days (p = 0.12) and 1 year (p = 0.12). CONCLUSION Our results suggest that in patients with pneumonia-related ARDS, obesity is independently associated with better survival at 28 days but not at 90 days and 1 year from the diagnosis of ARDS.
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Affiliation(s)
- Arnaud Gacouin
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France.
- Faculté de Médecine, Université Rennes1, 35043, Biosit, Rennes, France.
- Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, IFR 140, 35033, Rennes, France.
| | - Adel Maamar
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
- Faculté de Médecine, Université Rennes1, 35043, Biosit, Rennes, France
| | - Nicolas Terzi
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
- Faculté de Médecine, Université Rennes1, 35043, Biosit, Rennes, France
- Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, IFR 140, 35033, Rennes, France
| | - Jean-Marc Tadié
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
- Faculté de Médecine, Université Rennes1, 35043, Biosit, Rennes, France
- Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, IFR 140, 35033, Rennes, France
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Chandrasekhar T, Ravishankar C, Geethanjali A, Lahari T. Outcomes in Patients with Long COVID-19 One Year After their Discharge from Intensive Care Units. Cureus 2025; 17:e81739. [PMID: 40330357 PMCID: PMC12051819 DOI: 10.7759/cureus.81739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2025] [Indexed: 05/08/2025] Open
Abstract
Introduction Survivors of prolonged severe COVID-19 who are treated at ICUs are at risk for physical and psychological complications, including lung injury and multi-organ dysfunction. As the number of survivors of severe COVID-19 increases, it is necessary to understand the trajectory of the disease and the patient care needed after discharge from the ICU. This study tries to efficiently assess the long-term clinical sequelae among patients with prolonged severe COVID-19 who were admitted to the ICU, one year after their discharge. The parameters tested included the chronic obstructive pulmonary disease assessment test (CAT) score, pulmonary function tests, and laboratory data. Materials and methods The study population included 454 patients who were followed up one year after surviving ICU admission for severe COVID-19. All the patients who presented with signs and symptoms to the hospital were examined further. They underwent the necessary investigations, assessments, and systemic examinations. The results of all the laboratory and radiological investigations were reviewed. During the SARS-CoV-2 pandemic, all the patient details were entered into a hospital information management system from which the data was retrieved. Mean with standard deviation (SD) or median or interquartile ranges (IQR) were used to assess the continuous variables, whereas numbers and percentages were used for categorical variables. Statistical significance was calculated by the Chi-square test. Results The median age of the study population was 64 (IQR 57-74) years and 64.7% (294/454) were male patients. The median follow-up time was 367 days. During the follow-up period, 14.9% (68/454) of the patients were readmitted to the ICU. The mean length of hospital stay was 12 days (IQR 8-20 days). Among the readmitted patients (n=68), 17.6% (12/68) were on mechanical ventilation and the remaining 82.3% (56/68) received oxygen therapy. One patient underwent extracorporeal membrane oxygenation. The hospital mortality rate observed among these ICU survivors was 10.2%. The Health-Related Quality of Life (HRQOL) score at baseline i.e. before the ICU admission (52.5 (SD, 9.2); p<0.001) was better than that observed at the one-year follow-up (44.3 (SD, 9.5); p<0.001). Moreover, the clinical frailty scale and cognitive symptoms were significantly different at the follow up assessment versus the baseline (p<0.001). The proportion of patients with a grade of 0-2 on the Modified Medical Research Council (mMRC) dyspnea scale was almost similar at baseline and the one-year follow-up, whereas a breathlessness grade of 3-4 on the scale was observed in 39.8% of the study population. Conclusion The management of ICU survivors after severe COVID requires a multi-disciplinary approach. It includes preventive measures and rehabilitation services along with appropriate treatment strategies to relieve the residual symptoms.
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Affiliation(s)
- Talarisree Chandrasekhar
- Department of Critical Care Medicine, Krishna Institute of Medical Sciences Saveera Hospital, Anantapur, IND
| | - Calerappa Ravishankar
- Department of Critical Care Medicine, Krishna Institute of Medical Sciences Saveera Hospital, Anantapur, IND
| | - Anke Geethanjali
- Department of Microbiology, Krishna Institute of Medical Sciences Saveera Hospital, Anantapur, IND
| | - Talari Lahari
- Department of Ophthalmology, Krishna Institute of Medical Sciences Saveera Hospital, Anantapur, IND
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Elander L, Abdirashid A, Andersson H, Idh J, Johansson H, Chew MS. Frequency and outcomes of critically ill COVID-19 patients with tracheostomy, a retrospective two-center cohort study. Acta Anaesthesiol Scand 2025; 69:e70011. [PMID: 40103328 DOI: 10.1111/aas.70011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 02/11/2025] [Accepted: 02/12/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND The optimal use of tracheostomy in COVID-19 patients is debated, and considerable uncertainties on the frequency, timing, and outcomes of tracheostomy remain. The objective was to study the frequency and timing of tracheostomy in a real-world population of critically ill COVID-19 patients. The secondary aim was to study whether early tracheostomy was associated with days alive and out of intensive care unit (ICU), days free of invasive mechanical ventilation (IMV), 60-day mortality, ventilator weaning rate, and ICU discharge rate compared to late tracheostomy. METHODS The study is a retrospective two-center cohort study. All COVID-19 patients admitted to critical care in the Region Östergötland County Council, Sweden, between March 2020 and September 2021 were included. Early (≤10 days from tracheal intubation) and late (>10 days) tracheostomy were compared. Through the Swedish intensive care registry, 249 mechanically ventilated COVID-19-positive patients ≥18 years old with respiratory failure were included. The pre-defined primary outcomes were the frequency and timing of tracheostomy. Secondary outcomes were days free of mechanical ventilation and intensive care, ICU discharge rate, ventilator weaning rate, and 60-day mortality. RESULTS Of 319 identified patients (70% men), 249 (78%) underwent endotracheal intubation. Of these, 145 (58%) underwent tracheostomy and 99 (68%) were performed early. Tracheostomy patients (vs. non-tracheostomy) had fewer IMV-free days and ICU-free days (27 [0-43] vs. 52 [43-55], p < .001, and 24 [0-40] vs. 49 [41-52], p < .001). Late (vs. early) tracheostomy patients had fewer IMV- and ICU-free days (16 [0-31] vs. 36 [0-47], p < .001 and 8 [0-28] vs. 32 [0-44], p < .001). Early tracheostomy (vs. late) was associated with a significantly higher ICU discharge rate (adjusted HR = 0.59, 95% CI [0.40-0.86], p = .006), but not with the weaning rate (adjusted HR = 0.64, 95% CI [0.12-3.32], p = .5) or 60-day mortality (adjusted HR = 1.27, 95% CI [0.61-2.67], p = .5). CONCLUSIONS Tracheostomy is common in critically ill COVID-19 patients. In patients predicted to need a tracheostomy at some point, early, rather than late, tracheostomy might be a means to reduce the time spent in ICU. However, we do not have sufficient evidence to suggest that early tracheostomy reduces mortality or weaning rates, compared with late tracheostomy.
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Affiliation(s)
- Louise Elander
- Department of Anaesthesiology and Intensive Care in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Anaesthesiology and Intensive Care, Centre for Clinical Research, Sörmland, Nyköping Hospital, Nyköping, Sweden
- Department of Anaesthesiology and Intensive Care in Norrköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anzal Abdirashid
- Department of Anaesthesiology and Intensive Care in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Henrik Andersson
- Department of Anaesthesiology and Intensive Care in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jonna Idh
- Department of Anaesthesia and Intensive Care, Västervik Hospital, Västervik, Sweden
| | | | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Engelbogen B, Donaldson L, McAuley SA, Fourlanos S. SARS-CoV-2 booster vaccination does not worsen glycemia in people with type 1 diabetes using insulin pumps: an observational study. Acta Diabetol 2025; 62:481-486. [PMID: 39254746 DOI: 10.1007/s00592-024-02372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/28/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Despite an increased risk for adverse outcomes from SARS-CoV-2 infection among individuals with type 1 diabetes (T1D), vaccine hesitancy persists due to safety concerns including dysglycemia. The impact of booster vaccination on individuals using automated insulin delivery (AID) systems remains unclear. METHODS We used continuous glucose monitoring (CGM) data from 53 individuals with T1D using insulin pump therapy who received their third and/or fourth COVID-19 vaccination. CGM data from the 14 days before and 3 and 7 days after each vaccination were compared. The primary outcome was glucose time in range (TIR) (70-180 mg/dL) 3 and 7 days post-vaccination compared with the 14 days prior. Secondary outcomes included other CGM metrics such as time below range (< 70 mg/dL), time above range (> 180 mg/dL), mean glucose, co-efficient of variation and average total daily insulin. RESULTS The cohort comprised 53 adults (64% women, 64% AID), totaling 74 vaccination periods (84% Pfizer-BioNTech boosters), mean ± SD age 40.0 ± 15.9 years, duration of diabetes 26.0 ± 15.4 years. There was no significant difference between pre-vaccination TIR (61.0%±18.5) versus 3 (60.5%±22.8) and 7 days post-vaccination (60.2%±21.8; p = 0.79). Level 1 hypoglycemia, time in range 54-69 mg/dL, was lower 3 (1.1%±1.7) and 7 days post-vaccination (1.1%±1.6), compared with 14 days pre-vaccination (1.4%±1.4; p = 0.021). CONCLUSION The study provides evidence that SARS-CoV-2 booster vaccination does not acutely worsen glycemia in people with T1D receiving insulin pump therapy.
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Affiliation(s)
- Braden Engelbogen
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, Australia.
| | - Laura Donaldson
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Sybil A McAuley
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, Australia
| | - Spiros Fourlanos
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, Melbourne, Australia
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Vasković I, Marković M, Udovičić I, Arsenović L, Stojić M, Ignjatović A, Jovanović D, Nešković V. Effectiveness of different anticoagulation regimens in critically ill patients - experience from COVID 19 patients. Blood Coagul Fibrinolysis 2025; 36:82-89. [PMID: 40053316 DOI: 10.1097/mbc.0000000000001354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Accepted: 02/23/2025] [Indexed: 04/05/2025]
Abstract
This study compared the efficacy of therapeutic anticoagulation guided by anti-Xa levels vs. a D-dimer-based protocol in ICU patients with COVID-19. Given the heightened risk of thrombosis despite anticoagulation therapy in some cases, we hypothesised that anti-Xa measurement improves anticoagulation effectiveness and clinical outcomes in this population. We retrospectively analysed data from ICU patients at COVID Hospital Karaburma between April 2020 and December 2021. The primary outcome was the incidence of failed noninvasive ventilation necessitating intubation. Secondary endpoints included mortality rates, thromboembolic and bleeding complications, and anticoagulation effectiveness assessed by antifactor Xa activity. The analysis included 395 patients - 137 in the anti-Xa group and 258 in the D-dimer group. The D-dimer group showed a higher rate of failed noninvasive ventilation requiring intubation (65.7% vs. 50%, P = 0.009). The overall mortality was 48.3%, significantly higher in the D-dimer group (52.7%) compared to the anti-Xa group (40.1%, P = 0.02). Thromboembolic complications were lower in the anti-Xa group (2.9%) than in the D-dimer group (9.7%, P = 0.014), with no significant difference in bleeding. Following the first LMWH administration, 70.8% of patients had anti-Xa levels below the therapeutic and 11.7% below the prophylactic range. Anti-Xa-guided anticoagulation improves survival and reduces thromboembolic complications compared to D-dimer-based treatment without increasing bleeding risk. This study highlights the potential of the anti-Xa assay in managing anticoagulation in critically ill COVID-19 patients. Our findings provide a foundation for future research on using anti-Xa measurements as a guiding tool to optimise anticoagulation therapy in other critically ill populations.
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Affiliation(s)
- Igor Vasković
- Clinic for Anesthesiology and Intensive Care, Military Medical Academy
| | - Marija Marković
- Clinic for Anesthesiology and Intensive Care, Military Medical Academy
| | - Ivo Udovičić
- Clinic for Anesthesiology and Intensive Care, Military Medical Academy
| | | | - Mihailo Stojić
- Clinic for Anesthesiology and Intensive Care, Military Medical Academy
| | | | - Dragana Jovanović
- Clinic for Anesthesiology and Intensive Care, Military Medical Academy
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Kléber M, Meunier-Beillard N, Fournel I, Ksiazek E, Jacquier M, Ecarnot F, Rigaud JP, Declerq PL, Quenot JP, Labruyère M. Barriers to and facilitators of rehabilitation according to socio-economic status, after acute respiratory distress syndrome due to COVID-19: A qualitative study in the RECOVIDS cohort. PLoS One 2025; 20:e0316318. [PMID: 40019878 PMCID: PMC11870383 DOI: 10.1371/journal.pone.0316318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 12/10/2024] [Indexed: 03/03/2025] Open
Abstract
BACKGROUND The COVID-19 pandemic may have compounded social disparities in access to healthcare, with possible deleterious consequences on the functional prognosis of patients after a stay in the intensive care unit (ICU). In the previous RECOVIDS study, we reported that despite comparable pulmonary sequelae and similar access to rehabilitation, socio-economically "vulnerable" patients had lower quality of life at 6 months after an ICU stay. We aimed to describe the barriers to, and facilitators of participation in rehabilitation, among patients from the RECOVIDS study, regardless of their socio-economic situation. METHODS Qualitative study using semi-structured interviews with adult patients admitted to ICU for PCR-proven SARS-CoV-2 infection, and who had acute respiratory distress syndrome (ARDS) or had received high flow nasal oxygen. In addition, patients had to have been living at home for the month prior to the interview and had to be proficient in French. Eligible patients were randomly selected, aiming to select the same number of socially deprived and non-socially-deprived patients. Interviews were transcribed for thematic analysis. RESULTS In total, 31 interviews were performed from 10/2021 to 01/2022; 16 with socially deprived, and 15 with non-deprived participants. Average age was 65.2 (±11.6) years. Four themes emerged from the analysis of the interviews, namely: (1) the impact of the patient's professional and socio-economic situation; (2) the feeling that age and socio-economic situation influence access to rehabilitation; (3) a perception that the healthcare system was saturated, and that inequalities exist in access to rehabilitation resources; (4) perception of previous own health and expectations of post-resuscitation health status. CONCLUSION A precarious socio-economic situation has a substantial impact on access to rehabilitation after ICU admission for ARDS caused by COVID-19. It represents a barrier to rehabilitation through the combined action of various social determinants that deserve to be detected early, in order to take appropriate action to ensure that the most socially vulnerable individuals can benefit from access to rehabilitation.
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Affiliation(s)
- Mathilde Kléber
- Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, Dijon, France
| | - Nicolas Meunier-Beillard
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
- DRCI, USMR, CHU Dijon Bourgogne, Dijon, France
| | - Isabelle Fournel
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
| | - Eléa Ksiazek
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
| | - Marine Jacquier
- Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, Dijon, France
- Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France
| | - Fiona Ecarnot
- SINERGIES, University of Franche-Comté, Besançon, France
- Department of Cardiology, University Hospital Besancon, Besançon, France
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Centre Hospitalier de Dieppe, Dieppe, France
- Espace de Réflexion Éthique de Normandie, University Hospital Caen, Caen, France
| | | | - Jean-Pierre Quenot
- Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, Dijon, France
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
- DRCI, USMR, CHU Dijon Bourgogne, Dijon, France
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Dijon, France
| | - Marie Labruyère
- Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, Dijon, France
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
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Chandler JK, Jandali B, Joyce K, Smith D, Chollet-Hinton L, Ratnayake I, Brownback KR. Outcomes of Prone Positioning in Mechanically Ventilated COVID-19 Patients. Respir Care 2025. [PMID: 40028865 DOI: 10.1089/respcare.11259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2025]
Abstract
Background: Prone positioning in mechanically ventilated patients with severe ARDS is associated with reduced mortality. COVID-19 causes variable pulmonary involvement in some patients suffering from severe respiratory failure and ARDS. Although proning in the COVID-19 patient population is increasingly common, more data are needed to fully understand its utility in those with ARDS due to COVID-19. Methods: We conducted a single-center retrospective study, inclusive of 100 consecutive subjects intubated for ARDS from COVID-19, admitted to the ICU from September 2020 to December 2020. Data were collected daily from time of intubation for 7 d along with 30-d outcomes. Results: The study included a total of 53 subjects proned and 47 nonproned during their hospitalization. Proned subjects had a mean age of 61.8 years and 56.6% were male, compared with a mean age of 66.3 years and 57.4% male in the nonproned group. Age, sex, other baseline characteristics, and treatments were similar between groups, except that proned subjects had a higher body mass index than nonproned subjects (34.1 ± 7.5 vs 30.5 ± 7.4, kg/m2 P = .02) and lower initial P/F ratios (119.1 ± 54.5 vs 154.0 ± 92.7 mm Hg, P = .047). Proned subjects received more neuromuscular blockade (OR 6.63, 95% CI 3.25-13.12, P < .001) and higher sedation levels (two sedatives: OR = 3.00, 95% CI 1.77-5.08; ≥3 sedatives: OR = 7.13, 95% CI 3.96-12.81) with similar ICU stays, ventilator days, newly initiated renal replacement therapy, and 30-d outcomes including being alive, out of the ICU, or discharged from the hospital when compared with nonproned subjects. There were a total of 15 (28.3%) complications related to proning. Proned subjects were reintubated significantly less than the nonproned group (1.9% vs 19.1%, P = .006). Conclusions: Proning mechanically ventilated COVID-19 subjects was associated with more frequent use of neuromuscular blockade and sedation, and lower rates of re-intubation, for respiratory failure when compared with nonproned subjects.
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Affiliation(s)
- Jonathan K Chandler
- Dr. Chandler, Jandali, Joyce, Smith, and Brownback are affiliated with Division of Pulmonary Disease, Critical Care and Sleep Medicine, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Badr Jandali
- Dr. Chandler, Jandali, Joyce, Smith, and Brownback are affiliated with Division of Pulmonary Disease, Critical Care and Sleep Medicine, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Katie Joyce
- Dr. Chandler, Jandali, Joyce, Smith, and Brownback are affiliated with Division of Pulmonary Disease, Critical Care and Sleep Medicine, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Dale Smith
- Dr. Chandler, Jandali, Joyce, Smith, and Brownback are affiliated with Division of Pulmonary Disease, Critical Care and Sleep Medicine, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Lynn Chollet-Hinton
- Dr. Chollet-Hinton and Ratnayake are affiliated with Department of Biostatistics & Data Science, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Isuru Ratnayake
- Dr. Chollet-Hinton and Ratnayake are affiliated with Department of Biostatistics & Data Science, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Kyle R Brownback
- Dr. Chandler, Jandali, Joyce, Smith, and Brownback are affiliated with Division of Pulmonary Disease, Critical Care and Sleep Medicine, The University of Kansas School of Medicine, Kansas City, Kansas, USA
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Hernández G, Dianti J, Paredes I, Moran F, Marquez M, Calle A, Colinas L, Alonso G, Carneiro P, Morales G, Suarez-Sipmann F, Canabal A, Goligher E, Roca O. Humidified Noninvasive Ventilation versus High-Flow Therapy to Prevent Reintubation in Patients with Obesity: A Randomized Clinical Trial. Am J Respir Crit Care Med 2025; 211:222-229. [PMID: 39514845 DOI: 10.1164/rccm.202403-0523oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 11/08/2024] [Indexed: 11/16/2024] Open
Abstract
Rationale: The optimal strategy to prevent reintubation in patients with obesity remains uncertain. Objectives: We aimed to determine whether noninvasive ventilation (NIV) with active humidification is superior to a high-flow nasal cannula (HFNC) in preventing reintubation in patients with obesity at intermediate risk. Methods: We conducted a randomized controlled trial in two ICUs in Spain (June 2020-June 2021). We included patients ready for planned extubation with a body mass index >30 and three or fewer risk factors for reintubation. Patients with hypercapnia at the end of the spontaneous breathing trial were excluded. Patients were randomized to undergo NIV with active humidification or HFNC for 48 hours after extubation. The primary outcome was the reintubation rate within 7 days after extubation. As a secondary analysis, we performed a post hoc Bayesian analysis using three different priors. Measurements and Main Results: Of 144 patients (median age, 61 [25th-75th percentile range, 61-67] yr; 65 [45%] men), 72 received NIV and 72 received an HFNC. Reintubation was required in 17 (23.6%) patients receiving NIV and in 24 (33.3%) patients receiving HFNC (difference between groups, 9.7; 95% confidence interval, -4.9, 24.4). All of the secondary analysis showed nonsignificant differences. In the exploratory Bayesian analysis, the probability of a reduction in reintubation with NIV was 99% (data-driven prior), 90% (minimally informative prior), or 89% (skeptical prior). Conclusions: Among adult critically ill patients with obesity at intermediate risk for extubation failure, the rate of reintubation was not significantly lower with NIV than with HFNC. Nevertheless, there is a risk for underpowered results. Clinical trial registered with www.clinicaltrials.gov (NCT04125342).
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Affiliation(s)
- Gonzalo Hernández
- Toledo University Hospital, Toledo, Spain
- Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Grupo de Investigación en Disfunción y Fallo Orgánico en la Agresión, Madrid, Spain
- Universidad Alfonso X el Sabio, Madrid, Spain
| | - Jose Dianti
- Unidad de Cuidados Críticos, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
- Interdepartmental Division of Critical Care Medicine and
| | | | | | | | | | | | | | | | | | | | - Alfonso Canabal
- La Princesa University Hospital, Madrid, Spain
- Francisco de Vitoria University, Madrid, Spain
| | - Ewan Goligher
- Unidad de Cuidados Críticos, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
- Interdepartmental Division of Critical Care Medicine and
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Oriol Roca
- Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Institut de Investigació i Innovació Parc Taulí, Parc Taulí Hospital Universitari, Sabadell, Spain; and
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
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De Souza Dos Santos G, Alves de Carvalho França de Macedo V, Oliniski Reikdal S, Graf ME, Mario Martin B, Joaquim Meier M. Ventilator-associated pneumonia risk factors in patients with severe COVID-19 in southern Brazil: A retrospective observational study. Infect Dis Health 2025; 30:38-49. [PMID: 39168742 DOI: 10.1016/j.idh.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 08/23/2024]
Abstract
BACKGOUND During the SARS-CoV-2 pandemic, a significant number of critical patients required ventilatory assistance in health institutions. In this context, Ventilator-Associated Pneumonia (VAP) was the most prevalent nosocomial infection among critically ill patients. We aimed to analyze the occurrence of VAP in critically ill patients with SARS-CoV-2 and the risk factors associated with the outcome. METHOD This is a multicenter, retrospective cohort study which included patients ≥18 years old, diagnosed with COVID-19, admitted to intensive care units (ICU) and who received invasive mechanical ventilation (MV) for >2 consecutive days. The associations between the variables were initially tested, and those that showed potential associations (p<0.05) were included in the multivariate logistic regression model. RESULTS One third of patients had an episode of VAP, with an incidence density of 34.97 cases per 1000 MV days. In addition, 42.37% (50) of the microorganisms causing VAP were multidrug-resistant, predominantly gram-negative bacteria (61.32%). More than 50% of participants developed healthcare-associated infections and 243 (73.64%) died. The factors associated with greater chances of VAP were: prone position (OR= 3.77), BMI 25-29.9 kg/m2 (OR= 4.76), pressure injury (OR= 4.41), length of stay in the ICU (OR= 1.06), positive tracheal aspirate before VAP (OR= 5.41) and dyspnea (OR= 3.80). CONCLUSIONS Patients with COVID-19 are at high risk of VAP, which leads to an increased risk of death (OR = 2.18). Multiple factors increase the chances of VAP in this population, namely: work overload in health institutions, prone position, prolonged ICU time, infusion of multiple drugs, invasive devices, and in particular, immobility in bed.
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Affiliation(s)
- Gabriela De Souza Dos Santos
- Specialized Care Planning Board, State Health Department of Parana, Curitiba, 828230-140, Brazil; Postgraduate Nursing Department, Federal University of Parana, Curitiba, 80210-170, Brazil.
| | - Viviane Alves de Carvalho França de Macedo
- Hospital Infection Control and Epidemiology Center, Santa Casa de Curitiba, Curitiba, 80010-030, Brazil; Medicine School Department, Positive University, Curitiba, 81280-330, Brazil; Department of Infectious Diseases, Faculty of Medicine at the University of São Paulo, 01246903, Brazil
| | - Samantha Oliniski Reikdal
- Nursing Department, Dom Bosco Universitary Center, Curitiba, 81010-000, Brazil; Nursing Department, Santa Cruz Universitary Center, Curitiba, 81050-180, Brazil
| | - Maria Esther Graf
- Infection Control Program, Hospital de Clınicas, Curitiba, 80060-900, Brazil; Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, 81050-000, Brazil
| | - Beatris Mario Martin
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland Herston, Brisbane, Queensland 4029, Australia
| | - Marineli Joaquim Meier
- Postgraduate Nursing Department, Federal University of Parana, Curitiba, 80210-170, Brazil
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Zhu Y, Hu H, Guo X, Zhang H, Li D, Dela Cruz CS, Xie W, Xie L, Sharma L, Chang D. Early antiviral use and supplemental oxygen decrease the risk of secondary bacterial infections: a multi-centre, nested, case-control study. J Hosp Infect 2025; 156:87-95. [PMID: 39701496 DOI: 10.1016/j.jhin.2024.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 11/14/2024] [Accepted: 12/10/2024] [Indexed: 12/21/2024]
Abstract
BACKGROUND The purpose of this study was to evaluate the treatment strategies that dictate the host susceptibility to secondary bacterial infections during coronavirus disease 2019 (COVID-19). METHODS This nested, case-control study was conducted in three general hospitals in China between 1st December 2022 and 1st March 2023. A total of 456 confirmed COVID-19 patients matched 1:2 (152 cases and 304 controls) based on age, sex, disease severity and age-adjusted Charlson Comorbidity Index (aCCI) using propensity-score matching (PSM) were included. Association of secondary bacterial infections with treatment strategies including the supportive measures, antiviral, and antibacterial therapies were the main outcome measures. FINDINGS Conditional logistic regression analyses demonstrated that among categorical variables, use of antibiotics, antivirals, intravenous injection of human immunoglobulin, glucocorticoids or anticoagulants were not associated with the risk of secondary bacterial infections in the COVID-19 patients. The use of supplemental oxygen by either low (odds ratio (OR): 0.18, P<0.001) or high flow (OR: 0.06, P<0.001), but not through ventilators were associated with significant protection against secondary bacterial infection. In contrast, feeding through gastric tube (OR: 10.97, P<0.001) or parenteral nutrition (OR: 3.97, P=0.002) was associated with significant increase in the risk of secondary bacterial infections. Similar data were obtained when data were analysed using continuous variables. Further, the early (<5 days post symptom onset, OR: 0.09, P<0.001), but not the late use of antivirals was associated with protection against secondary bacterial infections. CONCLUSIONS Oxygen supplementation in non-ventilator settings and early use of antivirals were associated with decreased incidences of secondary bacterial infections, while parenteral nutrition or tube feedings were associated with increased incidences of secondary bacterial infections.
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Affiliation(s)
- Y Zhu
- Department of Pulmonary and Critical Care Medicine at the Seventh Medical Center, College of Pulmonary and Critical Care Medicine of the Eighth Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine at the First Medical Center, College of Pulmonary and Critical Care Medicine of the Eighth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - H Hu
- Department of Pulmonary and Critical Care Medicine at the Seventh Medical Center, College of Pulmonary and Critical Care Medicine of the Eighth Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine at the First Medical Center, College of Pulmonary and Critical Care Medicine of the Eighth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - X Guo
- Department of Pulmonary and Critical Care Medicine at the Third Medical Center, College of Pulmonary and Critical Care Medicine of the Eighth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - H Zhang
- Department of Pulmonary and Critical Care Medicine at the Seventh Medical Center, College of Pulmonary and Critical Care Medicine of the Eighth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - D Li
- Department of Pulmonary and Critical Care Medicine at the Seventh Medical Center, College of Pulmonary and Critical Care Medicine of the Eighth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - C S Dela Cruz
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - W Xie
- Peking University Clinical Research Institute, Beijing, China
| | - L Xie
- Department of Pulmonary and Critical Care Medicine at the Seventh Medical Center, College of Pulmonary and Critical Care Medicine of the Eighth Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine at the First Medical Center, College of Pulmonary and Critical Care Medicine of the Eighth Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine at the Third Medical Center, College of Pulmonary and Critical Care Medicine of the Eighth Medical Center, Chinese PLA General Hospital, Beijing, China; State Key Laboratory of Kidney Disease, Beijing, China
| | - L Sharma
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - D Chang
- Department of Pulmonary and Critical Care Medicine at the Seventh Medical Center, College of Pulmonary and Critical Care Medicine of the Eighth Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine at the First Medical Center, College of Pulmonary and Critical Care Medicine of the Eighth Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine at the Third Medical Center, College of Pulmonary and Critical Care Medicine of the Eighth Medical Center, Chinese PLA General Hospital, Beijing, China; State Key Laboratory of Kidney Disease, Beijing, China.
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20
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Caamaño E, Rodrigo LV, Garcia-Ramos S, Garcia AC, Cerro SR, Power M, Asencio JM, Piñeiro P, Hortal J, Garutti I. Risk factors for readmission of COVID-19 ICU survivors: A three-year follow up. Indian J Med Res 2025; 161:190-198. [PMID: 40257144 PMCID: PMC12010781 DOI: 10.25259/ijmr_726_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 01/24/2025] [Indexed: 04/22/2025] Open
Abstract
Background & objectives Evidence suggests that individuals who have been hospitalised due to COVID-19 are more susceptible to future mortality and readmission, thereby imposing a substantial strain on their quality of life. The available data on intensive care unit (ICU) survivors, particularly in terms of long-term outcomes, is notably insufficient. This study focused on the long-term outcomes for ICU survivors of COVID-19, specifically readmission and mortality, as well as possible risk factors that could lead to their need for readmission. Methods We conducted a prospective observational study of 505 individuals admitted to the ICU of a tertiary care hospital between March 2020 and March 2021. Follow up concluded in January 2024. We evaluated the need for hospital and ICU readmissions, examining potential risk factors, including patient comorbidities, clinical situation at the time of the previous hospital and ICU admission, and evolution and treatment in the ICU. As a secondary objective, we determined the prevalence of long-term mortality. Results Among 341 ICU survivors, 75 (22%) required hospital readmission, with a median time to readmission of 415 days (IQR: 166-797). The most frequent cause of readmission was respiratory conditions (29.3%). The median hospital stay during readmission was six days. Independent risk factors for hospital readmission included age, elevated creatinine levels at ICU admission, and length of stay in the ICU. Of the 75 readmitted to the hospital, 19 required ICU readmission. Ten individuals died following hospital discharge. Interpretation & conclusions Patients requiring ICU admission due to COVID-19 have a significant risk of hospital readmission, particularly those with advanced age, elevated creatinine levels at ICU admission, and longer ICU stays.
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Affiliation(s)
- Estrela Caamaño
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
- Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Laura Velasco Rodrigo
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - Sergio Garcia-Ramos
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - Alberto Calvo Garcia
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - Silvia Ramos Cerro
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - Mercedes Power
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - Jose Manuel Asencio
- Department of General Surgery, Gregorio Maranon National Hospital, Madrid, Spain
| | - Patricia Piñeiro
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - Javier Hortal
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - Ignacio Garutti
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
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21
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Berger A, Lelubre C, Chevalier C, Massart J, Fagnoul D, Dangotte S, Marinakis S, Homsy K, Elnakadi B, Biston P, Piagnerelli M. Developing a veno-venous extracorporeal membrane oxygenation program during the COVID-19 pandemic: Don't forget to notify the blood bank. Transfus Clin Biol 2025; 32:15-19. [PMID: 39510441 DOI: 10.1016/j.tracli.2024.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 10/28/2024] [Accepted: 10/30/2024] [Indexed: 11/15/2024]
Abstract
OBJECTIVES During the SARS-CoV-2 pandemic, there has been significant increased use of vvECMO as rescue therapy. Patients with COVID-19 as anticoagulation is needed for vvECMO support, may develop bleeding complications requiring an increased number of RBC transfusions. We would like to report the RBC transfusion needs following the implementation of an ECMO program. Data on blood usage in this population is important in view of the decline in donations due to the pandemic. STUDY DESIGN AND METHODS We analyzed data on RBC transfusions in patients who required vvECMO for COVID-19 related ARDS in a Belgian ICU from March 2020 to March 2022. The primary end point was RBC transfusion requirements. and the relationship to outcome. We also analyzed the evolution of this requirement during the four waves. RESULTS We admitted 538 patients for hypoxemic ARDS due to COVID-19. Sixty patients (11%) required vvECMO, of whom 27 (45%) died. Forty-seven (78%) of the vvECMO patients were transfused a total of 403 packed RBC units. Sites of hemorrhagic complications were ECMO cannulation sites and lungs. RBC transfusion per patient per day on vvECMO was 0.50 [0.30-0.67] units. There were no differences in hemorrhagic complications in vvECMO survivors and non-survivors. The percentage of vvECMO patients receiving a RBC transfusion increased slightly during the last COVID-19 wave, with 92 % of patients transfused. CONCLUSIONS vvECMO program is associated with a major need for RBC transfusions. These data are important when blood availability is decreased due to a pandemic and illustrates the need for studies on optimizing blood management including therapeutic anticoagulation target, threshold for RBC transfusion or alternatives to RBC transfusion.
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Affiliation(s)
- Alexis Berger
- Intensive Care, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
| | - Christophe Lelubre
- Internal Medicine, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
| | - Charles Chevalier
- Hematology Unit, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
| | - Jacqueline Massart
- Intensive Care, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
| | - David Fagnoul
- Intensive Care, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
| | - Steeve Dangotte
- Department of Cardiothoracic Surgery, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
| | - Sotirios Marinakis
- Department of Cardiothoracic Surgery, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
| | - Karim Homsy
- Department of Cardiothoracic Surgery, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
| | - Badih Elnakadi
- Department of Cardiothoracic Surgery, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
| | - Patrick Biston
- Intensive Care, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
| | - Michael Piagnerelli
- Intensive Care, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium; Experimental Medicine Laboratory, CHU-Charleroi Chimay, A Vésale Hospital. ULB 222 Unit, Université Libre de Bruxelles, 6110 Montigny-le-Tilleul, Belgium.
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22
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Glück C, Widmeier E, Maier S, Staudacher DL, Wengenmayer T, Supady A. Microbiological findings in a cohort of patients with coronavirus disease 2019 and venovenous extracorporeal membrane oxygenation. Med Klin Intensivmed Notfmed 2025:10.1007/s00063-024-01245-6. [PMID: 39888410 DOI: 10.1007/s00063-024-01245-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 10/01/2024] [Accepted: 12/30/2024] [Indexed: 02/01/2025]
Abstract
BACKGROUND Venovenous extracorporeal membrane oxygenation (VV ECMO) is an established support option for patients with very severe respiratory failure and played an important role during the coronavirus disease 2019 (COVID-19) pandemic. Bacteria and fungi can lead to severe infectious complications in critically ill patients. The aim of this study was to describe the microbiological spectrum of bacteria and fungi detected in patients with COVID-19-associated respiratory failure supported with VV ECMO in our center. METHODS This retrospective single-center analysis included all patients with COVID-19-associated respiratory failure supported with VV ECMO in our center between March 2020 and May 2022. All findings from microbiological samples, taken as part of clinical routine assessment from initiation of VV ECMO until day 30 were included. Samples were described by site and time of detection and microbiological characteristics. RESULTS From March 2020 through May 2022, 88 patients with COVID-19-associated respiratory failure received VV ECMO support at our center. In 83/88 patients (94.3%), one or more pathogens were found in microbiological samples. Most pathogens were isolated from samples from the respiratory tract (88.6%). Earliest detection occurred in samples from the respiratory tract with a median time of 5 days to first detection. The most frequently detected pathogens were Staphylococcus spp., Candida spp., Klebsiella spp., Escherichia coli and Enterococcus spp. CONCLUSION In this cohort of severely ill COVID-19 patients receiving VV ECMO support, pathogens were frequently detected.
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Affiliation(s)
- Christian Glück
- Interdisciplinary Medical Intensive Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Eugen Widmeier
- Interdisciplinary Medical Intensive Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Sven Maier
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany
| | - Dawid L Staudacher
- Interdisciplinary Medical Intensive Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Tobias Wengenmayer
- Interdisciplinary Medical Intensive Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Alexander Supady
- Interdisciplinary Medical Intensive Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
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23
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Chiu LC, Li HH, Juan YH, Ko HW, Kuo SCH, Lee CS, Chan TM, Lin YJ, Chuang LP, Hu HC, Kao KC, Hsu PC. Ventilatory variables and computed tomography features in COVID-19 ARDS and non-COVID-19-related ARDS: a prospective observational cohort study. Eur J Med Res 2025; 30:57. [PMID: 39875972 PMCID: PMC11773838 DOI: 10.1186/s40001-025-02303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 01/16/2025] [Indexed: 01/30/2025] Open
Abstract
BACKGROUND This study compared the ventilatory variables and computed tomography (CT) features of patients with coronavirus disease 2019 (COVID-19) versus those of patients with pulmonary non-COVID-19-related acute respiratory distress syndrome (ARDS) during the early phase of ARDS. METHODS This prospective, observational cohort study of ARDS patients in Taiwan was performed between February 2017 and June 2018 as well as between October 2020 and January 2024. Analysis was performed on clinical characteristics, including consecutive ventilatory variables during the first week after ARDS diagnosis. Analysis was also performed on CT scans obtained within one week after ARDS onset. RESULTS A total of 222 ARDS patients were divided into a COVID-19 ARDS group (n = 44; 19.8%) and a non-COVID-19 group (all pulmonary origin) (n = 178; 80.2%). No significant difference was observed between the two groups in terms of all-cause hospital mortality (38.6% versus 47.8%, p = 0.277). Pulmonary non-COVID-19 patients presented higher values for mechanical power (MP), MP normalized to predicted body weight (MP/PBW), MP normalized to compliance (MP/compliance), ventilatory ratio (VR), peak inspiratory pressure (Ppeak), and dynamic driving pressure (∆P) as well as lower dynamic compliance from day 1 to day 7 after ARDS onset. In both groups, non-survivors exceeded survivors and presented higher values for MP, MP/PBW, MP/compliance, VR, Ppeak, and dynamic ∆P with lower dynamic compliance from day 1 to day 7 after ARDS onset. The CT severity score for each of the five lung lobes and total CT scores were all significantly higher in the non-COVID-19 group (all p < 0.05). Multivariable logistic regression models revealed that Sequential Organ Failure Assessment (SOFA) score was independently associated with mortality in the COVID-19 group. In the non-COVID-19 group, body mass index, immunocompromised status, SOFA score, MP/PBW and total CT severity scores were independently associated with mortality. CONCLUSIONS In the early course of ARDS, physicians should be aware of the distinctions between COVID-19-related ARDS and non-COVID-19-related ARDS in terms of ventilatory variables and CT imaging presentations. It is also important to tailor the mechanical ventilation settings according to these distinct subsets of ARDS.
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Affiliation(s)
- Li-Chung Chiu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Hsien Li
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan
- Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Hsiang Juan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Taoyuan, Chang Gung University, Taoyuan, Taiwan
| | - How-Wen Ko
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Scott Chih-Hsi Kuo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Shu Lee
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, New Taipei Municipal TuCheng Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tien-Ming Chan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Yu-Jr Lin
- Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Li-Pang Chuang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Chung Hu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chin Kao
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ping-Chih Hsu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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24
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Göttert EAF. What is fair? Ethical analysis of triage criteria and disability rights during the COVID-19 pandemic and the German legislation. JOURNAL OF MEDICAL ETHICS 2025; 51:139-143. [PMID: 37973368 DOI: 10.1136/jme-2023-109326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
This essay discusses the ethical challenges and dilemmas in allocating scarce medical resources during the COVID-19 pandemic, using the German legislative process as a starting point. It is guided by the right to non-discrimination of people with disability and generally contrasts utilitarian and rights-based principles of allocation. Three approaches that were suggested in the German discussion, are presented, the lottery principle, the first come first served principle and the probability to survive principle. Arguments in favour and against each principle are discussed. The focus is on the utilitarian probability to survive principle, which was adopted in German legislation in 2022, and its discriminatory potential against people with disability. The essay suggests ways to mitigate the concerns of discrimination related to the probability to survive principle. It concludes that resolving the triage dilemma requires a balanced approach between utilitarian and rights-based concerns, which promotes both maximising the number of patients surviving and the right not to be discriminated against and be treated equally. It calls for a further debate on how many ethical values such as equity, fairness and non-discrimination we are willing to sacrifice for a higher number of survivors and when we are willing to sacrifice survivors to secure ethical values.
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Affiliation(s)
- Elena Ana Francesca Göttert
- Institute for Ethics, History and Philosophy of Medicine, Medizinische Hochschule Hannover, Hannover, Germany
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25
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Timoteo PDS, de Medeiros KS, Tourinho FSV. Clinical and epidemiological characteristics and outcomes of patients affected by COVID-19 in the Intensive Care Unit. Rev Bras Enferm 2025; 77Suppl 1:e20230527. [PMID: 39813429 PMCID: PMC11726807 DOI: 10.1590/0034-7167-2023-0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 08/04/2024] [Indexed: 01/18/2025] Open
Abstract
OBJECTIVE To understand the clinical and epidemiological characteristics, outcomes, and nursing care of adult patients affected by COVID-19 in the Intensive Care Unit. METHODS This is a quantitative, retrospective, and descriptive study. The study participants were clinical and epidemiological statistical reports. Variables analyzed included age, gender, race, comorbidities, signs and symptoms, length of hospital stay, use of mechanical ventilation, medications, infections, monitoring, invasive devices, positioning, diet, comfort, and clinical outcomes. RESULTS The majority of individuals were men, of white race, with a mean age of 63 years, hypertensive, diabetic, and obese. The average length of hospital stay was 16 days. Most required invasive mechanical ventilation, vasopressor drugs, sedoanalgesia, and neuromuscular blockers. CONCLUSION Nursing care is related to monitoring, ventilation, medication administration, installation of devices, prone positioning, diet administration, and providing comfort.
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26
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Jandric M, Zlojutro B, Momcicevic D, Dragic S, Kovacevic T, Djajic V, Stojiljkovic MP, Loncar-Stojiljkovic D, Skrbic R, Djuric DM, Kovacevic P. Do dynamic changes in haematological and biochemical parameters predict mortality in critically ill COVID-19 patients? Technol Health Care 2025; 33:275-286. [PMID: 39302399 DOI: 10.3233/thc-241006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
BACKGROUND Critically ill COVID-19 patients are usually subjected to clinical, laboratory, and radiological diagnostic procedures resulting in numerous findings. Utilizing these findings as indicators for disease progression or outcome prediction is particularly intriguing. OBJECTIVES Exploring the significance of dynamic changes in haematological and biochemical parameters in predicting the mortality of critically ill COVID-19 patients. METHODS The present study was a prospective and observational study involving mechanically ventilated 75 critically ill adult COVID-19 patients with hypoxemic respiratory failure. The collected data included baseline patient characteristics, treatment options, outcome, and laboratory findings at admission and 7 days after. The dynamics of the obtained findings were compared between survivors and non-survivors. RESULTS The 28-day survival rate was 61.3%. In the group of non-survivors significant dynamic changes were found for C-reactive protein (p= 0.001), interleukin-6 (p< 0.001), lymphocyte (p= 0.003), neutrophil-lymphocyte ratio (p= 0.003), platelets (p< 0.001), haemoglobin (p< 0.001), iron (p= 0.012), and total iron-binding capacity (p< 0.001). Statistically significant changes over time were found for ferritin (p= 0.010), D-dimer (p< 0.001), hs-troponin T (p< 0.002), lactate dehydrogenase (p= 0.001), glucose (p= 0.023), unsaturated iron-binding capacity (p= 0.008), and vitamin D (p< 0.001). CONCLUSION The dynamic changes in inflammatory, haematological and biochemical parameters can predict disease severity, and outcome.
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Affiliation(s)
- Milka Jandric
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Danica Momcicevic
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Sasa Dragic
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Tijana Kovacevic
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Vlado Djajic
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Milos P Stojiljkovic
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | | | - Ranko Skrbic
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Dragan M Djuric
- Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Pedja Kovacevic
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
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27
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Oliva I, Ferré C, Daniel X, Cartanyà M, Villavicencio C, Salgado M, Vidaur L, Papiol E, de Molina FG, Bodí M, Herrera M, Rodríguez A. Risk factors and outcome of acute kidney injury in critically ill patients with SARS-CoV-2 pneumonia: a multicenter study. Med Intensiva 2025; 49:15-24. [PMID: 39003118 DOI: 10.1016/j.medine.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/06/2024] [Accepted: 06/07/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE To assess incidence, risk factors and impact of acute kidney injury(AKI) within 48 h of intensive care unit(ICU) admission on ICU mortality in patients with SARS-CoV-2 pneumonia. To assess ICU mortality and risk factors for continuous renal replacement therapy (CRRT) in AKI I and II patients. DESIGN Retrospective observational study. SETTING Sixty-seven ICU from Spain, Andorra, Ireland. PATIENTS 5399 patients March 2020 to April 2022. MAIN VARIABLES OF INTEREST Demographic variables, comorbidities, laboratory data (worst values) during the first two days of ICU admission to generate a logistic regression model describing independent risk factors for AKI and ICU mortality. AKI was defined according to current international guidelines (kidney disease improving global outcomes, KDIGO). RESULTS Of 5399 patients included 1879 (34.8%) developed AKI. These patients had higher ICU mortality and AKI was independently associated with a higher ICU mortality (HR 1.32 CI 1.17-1.48; p < 0.001). Male gender, hypertension, diabetes, obesity, chronic heart failure, myocardial dysfunction, higher severity scores, and procalcitonine were independently associated with the development of AKI. In AKI I and II patients the need for CRRT was 12.6% (217/1710). In these patients, APACHE II, need for mechanical ventilation in the first 24 h after ICU admission and myocardial dysfunction were associated with risk of needing CRRT. AKI I and II patients had a high ICU mortality (38.5%), especially if CRRT were required (64.1% vs. 34,8%; p < 0.001). CONCLUSIONS Critically ill patients with SARS-CoV-2 pneumonia and AKI have a high ICU mortality. Even AKI I and II stages are associated with high risk of needing CRRT and ICU mortality.
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Affiliation(s)
- Iban Oliva
- Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain.
| | - Cristina Ferré
- Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain
| | - Xavier Daniel
- Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain
| | - Marc Cartanyà
- Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain
| | | | - Melina Salgado
- Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain
| | - Loreto Vidaur
- Critical Care Department, Donostia University Hospital, San Sebastian, Spain
| | - Elisabeth Papiol
- Critical Care Department, Vall d'Hebron Hospital, Barcelona, Spain
| | | | - María Bodí
- Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain
| | - Manuel Herrera
- Critical Care Department, Regional University Hospital of Malaga, Malaga, Spain
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Bruno KE, Mussi H, Bruno AE, Rodrigues JB, Rezende M, Cortes VC, Gismondi RA. External Validation of the 4C (Coronavirus Clinical Characterization Consortium) Mortality Score in a Teaching Hospital in Brazil. Cureus 2025; 17:e76811. [PMID: 39897284 PMCID: PMC11786962 DOI: 10.7759/cureus.76811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2025] [Indexed: 02/04/2025] Open
Abstract
Background The 4C (Coronavirus Clinical Characterization Consortium) Mortality Score has demonstrated good discrimination in COVID-19 but has not been widely validated in Brazil. The 4C Mortality Score is a clinical tool developed during the COVID-19 pandemic to predict in-hospital mortality for patients admitted with COVID-19. It was derived from a large dataset of hospitalized patients in the United Kingdom and provides a simple yet effective way to stratify patients based on their risk of death. Objective This study aimed to determine the accuracy of the 4C Mortality Score in patients admitted with COVID-19 in a university teaching hospital. Methods The study was observational, longitudinal, and retrospective, conducted in a 180-bed university teaching hospital in Rio de Janeiro, Brazil. We included all patients admitted with COVID-19 and followed them until discharge. The 4C Mortality Score was calculated based on age, sex, Charlson index, respiratory rate, peripheral oxygen saturation (room air), Glasgow Coma Scale, serum urea, and C-reactive protein (CRP) level. The primary outcome was mortality. Results We included 208 participants, with a median age of 63 years. Among them, 111 (53%) were male; 52 (25%) had cardiovascular disease, and 83 (39%) had cancer. Mortality was 39.9%. Independent predictors of mortality were age, hemoglobin, CRP, mechanical ventilation, and the need for vasopressors. The 4C Mortality Score's area under the receiver operating characteristic curve (AUC-ROC) was 89.9%. Conclusion The 4C Mortality Score demonstrated excellent discrimination in a teaching hospital population.
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Affiliation(s)
- Karima E Bruno
- Medicina Clinica, Hospital Universitário Antônio Pedro (Ebserh/Universidade Federal Fluminense), Niteroi, BRA
| | - Henrique Mussi
- Medicina Clinica, Hospital Universitário Antônio Pedro (Ebserh/Universidade Federal Fluminense), Niteroi, BRA
| | - Amanda E Bruno
- Medicina Clinica, Hospital Universitário Antônio Pedro (Ebserh/Universidade Federal Fluminense), Niteroi, BRA
| | - Juliana B Rodrigues
- Medicina Clinica, Hospital Universitário Antônio Pedro (Ebserh/Universidade Federal Fluminense), Niteroi, BRA
| | - Manuella Rezende
- Medicina Clinica, Hospital Universitário Antônio Pedro (Ebserh/Universidade Federal Fluminense), Niteroi, BRA
| | - Victor C Cortes
- Medicina Clinica, Hospital Universitário Antônio Pedro (Ebserh/Universidade Federal Fluminense), Niteroi, BRA
| | - Ronaldo A Gismondi
- Medicina Clinica, Hospital Universitário Antônio Pedro (Ebserh/Universidade Federal Fluminense), Niteroi, BRA
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Meyer HJ, Mödl L, Unruh O, Xiang W, Berger S, Müller-Plathe M, Rohde G, Pletz MW, Rupp J, Suttorp N, Witzenrath M, Zoller T, Mittermaier M, Steinbeis F. Comparison of clinical outcomes in hospitalized patients with COVID-19 or non-COVID-19 community-acquired pneumonia in a prospective observational cohort study. Infection 2024; 52:2359-2370. [PMID: 38761325 PMCID: PMC11621138 DOI: 10.1007/s15010-024-02292-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE Coronavirus disease 2019 (COVID-19) and non-COVID-19 community-acquired pneumonia (NC-CAP) often result in hospitalization with considerable risks of mortality, ICU treatment, and long-term morbidity. A comparative analysis of clinical outcomes in COVID-19 CAP (C-CAP) and NC-CAP may improve clinical management. METHODS Using prospectively collected CAPNETZ study data (January 2017 to June 2021, 35 study centers), we conducted a comprehensive analysis of clinical outcomes including in-hospital death, ICU treatment, length of hospital stay (LOHS), 180-day survival, and post-discharge re-hospitalization rate. Logistic regression models were used to examine group differences between C-CAP and NC-CAP patients and associations with patient demography, recruitment period, comorbidity, and treatment. RESULTS Among 1368 patients (C-CAP: n = 344; NC-CAP: n = 1024), C-CAP showed elevated adjusted probabilities for in-hospital death (aOR 4.48 [95% CI 2.38-8.53]) and ICU treatment (aOR 8.08 [95% CI 5.31-12.52]) compared to NC-CAP. C-CAP patients were at increased risk of LOHS over seven days (aOR 1.88 [95% CI 1.47-2.42]). Although ICU patients had similar in-hospital mortality risk, C-CAP was associated with length of ICU stay over seven days (aOR 3.59 [95% CI 1.65-8.38]). Recruitment period influenced outcomes in C-CAP but not in NC-CAP. During follow-up, C-CAP was linked to a reduced risk of re-hospitalization and mortality post-discharge (aOR 0.43 [95% CI 0.27-0.70]). CONCLUSION Distinct clinical trajectories of C-CAP and NC-CAP underscore the need for adapted management to avoid acute and long-term morbidity and mortality amid the evolving landscape of CAP pathogens.
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Affiliation(s)
- Hans-Jakob Meyer
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Pneumology, Helios Klinikum Emil Von Behring, Lungenklinik Heckeshorn, Berlin, Germany
| | - Lukas Mödl
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | | | - Weiwei Xiang
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Berger
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Moritz Müller-Plathe
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Gernot Rohde
- CAPNETZ STIFTUNG, Hannover, Germany
- Department of Respiratory Medicine, Goethe University, University Hospital, Medical Clinic I, Frankfurt/Main, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Mathias W Pletz
- CAPNETZ STIFTUNG, Hannover, Germany
- Institute of Infectious Diseases and Infection Control, Jena University Hospital /Friedrich Schiller University, Jena, Germany
| | - Jan Rupp
- CAPNETZ STIFTUNG, Hannover, Germany
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
- German Center for Lung Research (DZL), Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
- German Center for Lung Research (DZL), Berlin, Germany
| | - Thomas Zoller
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Mirja Mittermaier
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Fridolin Steinbeis
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Alnemri A, Ricciardelli K, Wang S, Baumgartner M, Chao TN. Tracheostomy is associated with decreased in-hospital mortality during severe COVID-19 infection. World J Otorhinolaryngol Head Neck Surg 2024; 10:253-260. [PMID: 39677053 PMCID: PMC11634706 DOI: 10.1002/wjo2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 12/17/2024] Open
Abstract
Objective Tracheostomy is often performed in patients with a prolonged course of endotracheal intubation. This study sought to examine the clinical utility of tracheostomy during severe Coronavirus disease 2019 (COVID-19) infection. Study Design A retrospective single-system, multicenter observational cohort study was performed on patients intubated for COVID-19 infection. Patients who received intubation alone were compared with patients who received intubation and subsequent tracheostomy. Patient demographics, comorbidities, and hospital courses were analyzed. Setting The University of Pennsylvania Health System from 2020 to 2021. Methods Logistic regression analysis was performed on patient demographics and comorbidities. Kaplan-Meier survival curves were generated depending on whether patients received a tracheostomy. Results Of 777 intubated patients, 452 were male (58.2%) and 325 were female (41.8%) with a median age of 63 (interquartile range [IQR]: 54-73) years. One-hundred and eighty-five (23.8%) patients underwent tracheostomy. The mean time from intubation to tracheostomy was (17.3 ± 9.7) days. Patients who underwent tracheostomy were less likely to expire during their hospitalization than those who did not undergo tracheostomy (odds ratio [OR] = 0.31, P < 0.001), and patient age was positively associated with mortality (OR = 1.04 per year, P < 0.001). Likelihood of receiving tracheostomy was positively associated with being on extra-corporeal membranous oxygenation (ECMO) (OR = 101.10, P < 0.001), immunocompromised status (OR = 3.61, P = 0.002), and current tobacco smoking (OR = 4.81, P = 0.041). Tracheostomy was also associated with a significantly longer hospital length of stay ([57.5 ± 32.2] days vs. [19.9 ± 18.1] days, P < 0.001). Conclusions Tracheostomy was associated with reduced in-hospital mortality, despite also being associated with increased comorbidities. Tracheostomy should not be held back from patients with comorbidities for this reason alone and may even improve survival in high-risk patients.
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Affiliation(s)
- Ahab Alnemri
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kaley Ricciardelli
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Stephanie Wang
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Michael Baumgartner
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Tiffany N. Chao
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Alemany A, Balanza N, Millat-Martinez P, Ouchi D, Corbacho-Monné M, Morales-Indiano C, Fernández Rivas G, Blanco I, Mitjà O, Aguilar R, Dobaño C, Bassat Q, Moncunill G, Baro B, COnV-ert BMK STUDY GROUP. Prognostic performance of early immune and endothelial activation markers in mild-to-moderate COVID-19 outpatients: a nested case-control study. Front Immunol 2024; 15:1501872. [PMID: 39664394 PMCID: PMC11631913 DOI: 10.3389/fimmu.2024.1501872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 11/06/2024] [Indexed: 12/13/2024] Open
Abstract
Introduction Evidence on the association of biomarkers of host response to infection with COVID-19 clinical outcomes has focused mainly on hospitalized patients. We investigated the prognostic performance of 39 immune and endothelial activation markers measured early in the course of disease to predict the development of severe COVID-19 and hospitalization. Methods We conducted a nested case-control study from a randomized clinical trial evaluating the efficacy of COVID-19 convalescent plasma in outpatients aged 50 years or older presenting with mild-to-moderate COVID-19. We selected participants who were hospitalized within 28 days (cases) and who were not (controls) to compare their biomarker levels in plasma samples collected at enrolment. Results A total of 42 cases and 42 controls were included in this study. The levels of CRP, IL6, IP10, ferritin, IFNα, IL8, IL1RA, MCP1, and RANTES, determined within 7 days of symptoms onset, showed good individual prognostic performance for COVID-19 associated hospitalization by day 28. The biomarkers CRP, IL6, IP10, IL8, IL1RA, and suPAR showed good individual prognostic performance for severe COVID-19. CRP, IL6 and IP10 had the most robust association with both hospitalization and severe COVID-19, with CRP having the highest discriminatory capacity with hospitalization, and IL6 for severe COVID-19. Discussion Our study shows good prognostic performance of CRP and IL6 for 28-day hospitalization in patients with mild-to-moderate COVID-19, in the absence of clinical criteria for admission upon enrolment. These findings confirm the value of these biomarkers at early stages of COVID-19 disease in the outpatient setting to support management decisions.
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Affiliation(s)
- Andrea Alemany
- ISGlobal, Barcelona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Núria Balanza
- ISGlobal, Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | | | - Dan Ouchi
- ISGlobal, Barcelona, Spain
- Fight Infectious Diseases Foundation, Badalona, Spain
| | - Marc Corbacho-Monné
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Cristian Morales-Indiano
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Clinical Laboratory Metropolitana Nord, Badalona, Spain
| | - Gema Fernández Rivas
- Microbiology Department, Clinical Laboratory Metropolitana Nord, Barcelona, Spain
| | - Ignacio Blanco
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Clinical Laboratory Metropolitana Nord, Badalona, Spain
| | - Oriol Mitjà
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ruth Aguilar
- ISGlobal, Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlota Dobaño
- ISGlobal, Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Quique Bassat
- ISGlobal, Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- ICREA, Pg Lluís Companys 23, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Gemma Moncunill
- ISGlobal, Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Dalne C, Biston P, Piagnerelli M. Evolution of the oxyhemoglobin dissociation curve in COVID-19 related ARDS patients. Front Physiol 2024; 15:1463775. [PMID: 39588270 PMCID: PMC11586354 DOI: 10.3389/fphys.2024.1463775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 10/22/2024] [Indexed: 11/27/2024] Open
Abstract
Introduction Severe hypoxemia is the leading cause of admission in intensive care (ICU) in patients with COVID-19 related acute respiratory distress syndrome (ARDS). In these patients, several studies reported a left shift of the oxyhemoglobin dissociation curve associated with a lower mortality. However, these results are conflicting, as these studies include few patients and often no control groups. Moreover, the calculation of P50, representing the PaO2 value at which 50% of hemoglobin is saturated, is not corrected for factors known to influence it (pH, PaCO2 or temperature). For all of these reasons, we compared the corrected P50 between ICU patients with severe COVID-19 related ARDS on mechanical ventilation or not, and ARDS from other causes. We investigated the evolution of the corrected P50 during the first 3 days of ICU and its relationship with ICU mortality. Methods and Patients We retrospectively calculated the corrected P50 in three groups of patients: intubated and mechanically ventilated COVID-19 related ARDS, non-intubated COVID-19 related ARDS and intubated patients with ARDS due to other infectious causes. The corrected P50 was calculated, on the worst blood gas analysis on days 1 and 3 of ICU admission, by the formula of Hill but modified by Dash et al., controlled for pH, PaCO2 and temperature. We collected ICU mortality. Results 463 blood gas analysis at days 1 and 3 from 214 ICU COVID-19 related ARDS patients (114 with intubation and 100 without) and 35 ICU patients with ARDS from other causes were analyzed. All patients were severely hypoxemic: PaO2/FiO2 of 76 [58-108] mmHg for intubated COVID-19, 79 [60-108] mmHg for non-intubated COVID-19 and 142 [78-197] mmHg for the third group (p < 0.001). The mortality rate was higher in intubated COVID-19 related ARDS patients (44.7 versus 14 versus 37% in ARDS from other causes; p < 0.001). The corrected P50 was significantly lower in COVID-19 patients, especially in non- intubated patients (21.2 [18.8-25.2] mmHg vs. 25.5 [19.2-30.3] mmHg in intubated patients; compared to ARDS from other causes: 27.2 [23.3-35.4] mmHg; p < 0.001. The corrected P50 does not change over the first 3 days, except for the non intubated COVID-19 related ARDS and is not correlated with ICU mortality (odds ratio = 0.98 [0.95-1.03]; p = 0.51), in contrast of PaO2/FiO2 and ICU gravity scores. Conclusion The oxyhemoglobin dissociation curve at ICU admission was left shifting in severe COVID-19 related ARDS patients regardless of the type of ventilation. This deviation increases the third day only in non-intubated COVID-19 related ARDS and was not related to the outcome.
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Affiliation(s)
- Charlotte Dalne
- Intensive Care. CHU-Charleroi Chimay, Université Libre de Bruxelles, Charleroi, Belgium
| | - Patrick Biston
- Intensive Care. CHU-Charleroi Chimay, Université Libre de Bruxelles, Charleroi, Belgium
| | - Michaël Piagnerelli
- Intensive Care. CHU-Charleroi Chimay, Université Libre de Bruxelles, Charleroi, Belgium
- Experimental Medicine Laboratory, ULB 222 Unit, CHU-Charleroi Chimay, Université Libre de Bruxelles, Montigny-le-Tilleul, Belgium
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Elbaz M, Moshkovits I, Bar-On T, Goder N, Lichter Y, Ben-Ami R. Clinical prediction model for bacterial co-infection in hospitalized COVID-19 patients during four waves of the pandemic. Microbiol Spectr 2024; 12:e0025124. [PMID: 39315820 PMCID: PMC11537039 DOI: 10.1128/spectrum.00251-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 08/14/2024] [Indexed: 09/25/2024] Open
Abstract
The reported estimates of bacterial co-infection in COVID-19 patients are highly variable. We aimed to determine the rates and risk factors of bacterial co-infection and develop a clinical prediction model to support early decision-making on antibiotic use. This is a retrospective cohort study conducted in a tertiary-level academic hospital in Israel between March 2020 and May 2022. All adult patients with severe COVID-19 who had a blood or lower respiratory specimen sent for microbiological analyses within 48 h of admission were included. The primary study endpoint was the prevalence of bacterial co-infection at the time of hospital admission. We created a prediction model using the R XGBoost package. The study cohort included 1,050 patients admitted with severe or critical COVID-19. Sixty-two patients (5.9%) had a microbiologically proven bacterial infection on admission. The variables with the greatest impact on the prediction model were age, comorbidities, functional capacity, and laboratory parameters. The model achieved perfect prediction on the training set (area under the curve = 1.0). When applied to the test dataset, the model achieved 56% and 78% specificity with the area under the receiver operating curve of 0.784. The negative and positive predictive values were 0.975 and 0.105, respectively. Applying the prediction model would have resulted in a 2.5-fold increase in appropriate antibiotic use and an 18% reduction in inappropriate use in patients with severe and critical COVID-19. The use of a clinical prediction model can support decisions to withhold empiric antimicrobial treatment at the time of hospital admission without adversely affecting patient outcomes. IMPORTANCE Estimates of bacterial coinfection in COVID-19 patients are highly variable and depend on many factors. Patients with severe or critical COVID-19 requiring intensive care unit admission have the highest risk of infection-related complications and death. Thus, the study of the incidence and risk factors for bacterial coinfection in this population is of special interest and may help guide empiric antibiotic therapy and avoid unnecessary antimicrobial treatment. The prediction model based on clinical criteria and simple laboratory tests may be a useful tool to predict bacterial co-infection in patients hospitalized with severe COVID-19.
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Affiliation(s)
- Meital Elbaz
- Infectious Disease Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itay Moshkovits
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Division of Anesthesia, Pain Management and Intensive Care, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Internal Medicine Department, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Tali Bar-On
- Internal Medicine Department, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Noam Goder
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Division of Anesthesia, Pain Management and Intensive Care, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Yael Lichter
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Division of Anesthesia, Pain Management and Intensive Care, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ronen Ben-Ami
- Infectious Disease Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Tchakerian S, Besnard N, Brunot V, Moulaire V, Benchabane N, Platon L, Daubin D, Corne P, Machado S, Jung B, Bendiab E, Landreau L, Pelle C, Larcher R, Klouche K. Epidemiology, clinical and biological characteristics, and prognosis of critically ill COVID 19 patients: a single-center experience through 4 successive waves. Pneumonia (Nathan) 2024; 16:27. [PMID: 39497221 PMCID: PMC11536821 DOI: 10.1186/s41479-024-00144-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/26/2024] [Indexed: 11/07/2024] Open
Abstract
OBJECTIVE The aim of this study was to describe the characteristics of patients admitted to the intensive care unit with severe pneumonia due to SARS-CoV-2, comparing them according to successive waves, and to identify prognostic factors for morbidity and mortality. MATERIALS AND METHODS This single-center retrospective observational descriptive study was conducted from March 10, 2020, to October 17, 2021. All adult patients admitted with SARS-CoV-2 pneumonia presenting acute respiratory failure were included. COVID 19 diagnosis was confirmed by RT-PCR testing of respiratory specimens. The primary endpoint was ICU mortality. Secondary endpoints were the occurrence of ventilator-associated pneumonia (VAP) or bronchopulmonary aspergillosis. RESULTS Over the study period, 437 patients were included of whom 282 (65%) patients were ventilated for 9 [5;20] days. Among the studied population, 38% were treated for one or more episodes of VAP, and 22 (5%) for bronchopulmonary aspergillosis. ICU mortality was 26% in the first wave, then fell and stabilized at around 10% in subsequent waves (p = 0.02). Increased age, Charlson index, SOFA score and lactatemia on admission were predictive of mortality. Survival at 90 days was 85% (95% CI 82-88) and was unaffected by the presence of VAP. However, the occurrence of bronchopulmonary aspergillosis increased mortality to 36%. CONCLUSION In this study, we observed mortality in the lower range of those previously reported. Risk factors for mortality mainly included age and previous comorbidities. The prognosis of these critically ill Covid 19 patients improved over the four waves, underlining the likely beneficial effect of vaccination and dexamethasone.
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Affiliation(s)
- Sonia Tchakerian
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Noémie Besnard
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Vincent Brunot
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Valérie Moulaire
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Nacim Benchabane
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Laura Platon
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Delphine Daubin
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Philippe Corne
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Sonia Machado
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Boris Jung
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
- PhyMedExp, INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, School of Medicine, Montpellier, France
| | - Eddine Bendiab
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Liliane Landreau
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Corrine Pelle
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Romaric Larcher
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Kada Klouche
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
- PhyMedExp, INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, School of Medicine, Montpellier, France.
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Yoo JW, Kim WY, Chung CR, Cho YJ, Lee J, Jegal Y, Kim J, Joh JS, Park TY, Baek AR, Park JH, Chae G, Hwang JH, Song JW. Early pulmonary fibrosis-like changes between delta and pre-delta periods in patients with severe COVID-19 pneumonia on mechanical ventilation. Sci Rep 2024; 14:26101. [PMID: 39478105 PMCID: PMC11525473 DOI: 10.1038/s41598-024-77405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 10/22/2024] [Indexed: 11/02/2024] Open
Abstract
It remains unclear whether pulmonary fibrosis-like changes differ in patients with different SARS-CoV-2 variants. This study aimed to compare pulmonary fibrotic changes between two SARS-CoV-2 variant periods (delta vs. pre-delta) in critically ill patients with SARS-CoV-2 pneumonia. Clinical data and chest CT images of patients with SARS-CoV-2 pneumonia receiving mechanical ventilation were collected from 10 hospitals in South Korea over two periods: delta (July-December, 2021; n = 64) and pre-delta (February, 2020-June, 2021; n = 120). Fibrotic changes on chest CT were evaluated through visual assessment. Of 184 patients, the mean age was 64.6 years, and 60.5% were ale. Fibrosis-like changes on chest CT (median 51 days from enrollment to follow up CT scan, interquartile range 27-76 days) were identified in 75.3%. Delta group showed more fibrosis-like changes (≥ 2) (69.8% vs. 43.1%, P = 0.001) and more frequent reticulation and architectural distortion+/-parenchymal band than pre-delta group. Even after propensity score matching with clinical variables, delta group had more severe (≥ 2) fibrosis-like changes (71.4% vs. 38.8%, P = 0.001), and more frequent reticulation and architectural distortion+/-parenchymal band than pre-delta group. Our data suggest that critically ill patients with SARS-CoV-2 in delta period had more severe pulmonary fibrosis-like changes than those in pre-delta period.
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Affiliation(s)
- Jung-Wan Yoo
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Won-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yangjin Jegal
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Junghyun Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Joon-Sung Joh
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Tae Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ganghee Chae
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jung Hwa Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu 05505, Seoul, Republic of Korea.
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Abstract
The understanding of acute respiratory distress syndrome (ARDS) has evolved greatly since it was first described in a 1967 case series, with several subsequent updates to the definition of the syndrome. Basic science advances and clinical trials have provided insight into the mechanisms of lung injury in ARDS and led to reduced mortality through comprehensive critical care interventions. This review summarizes the current understanding of the epidemiology, pathophysiology, and management of ARDS. Key highlights include a recommended new global definition of ARDS and updated guidelines for managing ARDS on a backbone of established interventions such as low tidal volume ventilation, prone positioning, and a conservative fluid strategy. Future priorities for investigation of ARDS are also highlighted.
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Affiliation(s)
- Katherine D Wick
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Lorraine B Ware
- Departments of Medicine and Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, University of California San Francisco, San Francisco, CA, USA
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
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Rodriguez Lima DR, Anzueta Duarte JH, Rubio Ramos C, Otálora González L, Pinilla Rojas DI, Gómez Cortés LA, Rodríguez Aparicio EE, Yepes Velasco AF, Devia Jaramillo G. Risk factors for in-hospital mortality in older patients with acute respiratory distress syndrome due to COVID-19: a retrospective cohort study. BMC Geriatr 2024; 24:878. [PMID: 39462358 PMCID: PMC11515189 DOI: 10.1186/s12877-024-05411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/25/2024] [Indexed: 10/29/2024] Open
Abstract
BACKGROUND Advancing age is associated with an increase in mortality among patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed to determine risk factors for in-hospital mortality in patients over 60 years old with COVID-19-related ARDS (C-ARDS). METHODS This was an observational, analytical, retrospective study conducted on a cohort that included all patients aged 60 years or older diagnosed with COVID-ARDSwho were admitted to a high-complexity hospital in Bogotá, Colombia, between March 2020 and July 2021. RESULTS A total of 1563 patients were included in the analysis, with a median age of 73 years (interquartile range [IQR]: 67-80) and 811 deaths (51.8%). Independent risk factors for in-hospital mortality were identified as follows: patients aged 71-80 [OR 1.87 (95% CI 1.33-2.64)], age > 80 [OR 8.74 (95% CI 5.34-14.31)], lactate dehydrogenase (LDH) [OR 1.009 (95% CI 1.003-1.0015)], severe C-ARDS [OR 2.16 (95% CI 1.50-3.11)], use of invasive mechanical ventilation (IMV) [OR 12.94 (95% CI 9.52-17.60)], and use of steroids [OR 1.49 (95% CI 1.09-2.03)]. In patients over 80 years of age (n = 388), the primary risk factor associated with in-hospital mortality was the use of IMV (n = 76) [OR 6.26 (95% CI 2.67-14.69)], resulting in an in-hospital mortality rate of 89.4% (n = 68) when this therapy was implemented. CONCLUSIONS The primary risk factors for in-hospital mortality in patients older than 60 years were age, the use of IMV, the severity of C-ARDS, use of steroids and elevated LDH values. Among patients older than 80 years, the main risk factor for in-hospital mortality was the use of IMV. In cases of C-ARDS in older patients, the decision to initiate IMV should always be individualized; therefore, the use of alternative oxygen delivery systems as the first-line approach can be considered.
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Affiliation(s)
- David Rene Rodriguez Lima
- Critical and Intensive Care Medicine, Hospital Universitario Mayor-Méderi, Bogotá, Colombia.
- Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá́, Colombia.
| | - Jimmy Hadid Anzueta Duarte
- Critical and Intensive Care Medicine, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Cristhian Rubio Ramos
- Critical and Intensive Care Medicine, Hospital Universitario Mayor-Méderi, Bogotá, Colombia
| | | | | | | | | | - Andrés Felipe Yepes Velasco
- Critical and Intensive Care Medicine, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - German Devia Jaramillo
- Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá́, Colombia
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Frat JP, Coudroy R, Quenot JP, Guitton C, Badie J, Gacouin A, Ehrmann S, Demoule A, Jarousseau F, Carteaux G, Rigaud JP, Reignier J, Sedillot N, Contou D, Beloncle F, Daubin C, Dureau AF, Fatah A, Besse MC, Ferre A, Turbil E, Merdji H, Galerneau LM, Lacombe B, Richard JC, Romen A, Delbove A, Prat G, Lautrette A, Colin G, Soum E, Bourdin G, Hernández G, Ragot S, Thille AW. Effect of high-flow nasal cannula oxygen versus standard oxygen on mortality in patients with acute hypoxaemic respiratory failure: protocol for a multicentre, randomised controlled trial (SOHO). BMJ Open 2024; 14:e083232. [PMID: 39448217 PMCID: PMC11499756 DOI: 10.1136/bmjopen-2023-083232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 09/30/2024] [Indexed: 10/26/2024] Open
Abstract
INTRODUCTION First-line oxygenation strategy in patients with acute hypoxaemic respiratory failure consists in standard oxygen or high-flow nasal oxygen therapy. Clinical practice guidelines suggest the use of high-flow nasal oxygen rather than standard oxygen. However, findings remain contradictory with a low level of certainty. We hypothesise that compared with standard oxygen, high-flow nasal oxygen may reduce mortality in patients with acute hypoxaemic respiratory failure. METHOD AND ANALYSIS The Standard Oxygen versus High-flow nasal Oxygen-trial is an investigator-initiated, multicentre, open-label, randomised controlled trial comparing high-flow nasal oxygen versus standard oxygen in patients admitted to an intensive care unit (ICU) for acute respiratory failure with moderate-to-severe hypoxaemia. 1110 patients will be randomly assigned to one of the two groups with a ratio of 1:1. The primary outcome is the number of patients who died 28 days after randomisation. Secondary outcomes include comfort, dyspnoea and oxygenation 1 hour after treatment initiation, the number of patients intubated at day 28, mortality in ICU, in hospital and until day 90, and complications during ICU stay. ETHICS AND DISSEMINATION The study has been approved by the central Ethics Committee 'Sud Méditerranée III' (2020-07-05) and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04468126.
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Affiliation(s)
- Jean-Pierre Frat
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Remi Coudroy
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Jean-Pierre Quenot
- Réanimation médicale, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Christophe Guitton
- Médecine intensive réanimation, Centre Hospitalier de Mans, Le Mans, France
| | - Julio Badie
- Réanimation, Centre Hospitalier Belfort-Montbéliard - Site de Belfort, Belfort, France
| | - Arnaud Gacouin
- Service des maladies infectieuses et réanimation médicale, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Stephan Ehrmann
- Médecin Intensive Réanimation, CIC 1415, CRICS-TriggerSEP, Centre d'étude des pathologies respiratoires, INSERM U1100, Université de Tours, Centre Hospitalier Régional Universitaire de Tours, Tours, France
- Médecine Intensive Réanimation, Centre Hospitalier Régional Universitaire de Tours, Tours, Centre-Val de Loire, France
| | - Alexandre Demoule
- Service de Pneumologie et Réanimation Médicale du Département R3S, AP-HP, INSERM, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne Université, Assistance Publique - Hopitaux de Paris, Paris, France
| | | | | | | | - Jean Reignier
- Médecine intensive réanimation, CHU Nantes, Nantes, France
| | - Nicholas Sedillot
- Hôpital Fleyriat, Réanimation Polyvalente, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, France
| | - Damien Contou
- Service de Réanimation Polyvalente, Centre Hospitalier d'Argenteuil, Argenteuil, France
| | - François Beloncle
- Département de Médecine Intensive - Réanimation, Université d’Angers, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Cédric Daubin
- Department of Medical Intensive Care, CHRU de Caen, Caen, France
| | - Anne-Florence Dureau
- Médecine Intensive Réanimation, Groupe Hospitalier de la Région de Mulhouse et Sud Alsace, Mulhouse, France
| | - Abdelhamid Fatah
- Réanimation Polyvalente, Groupement Hospitalier Nord-Dauphine, Bourgoin-Jallieu, France
| | | | - Alexis Ferre
- Réanimation, CH de Versailles, Le Chesnay, France
| | - Emanuele Turbil
- Service de Réanimation, CH Henri Mondor d’Aurillac, Aurillac, France
| | - Hamid Merdji
- Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg,France; , Strasbourg, France
| | | | - Béatrice Lacombe
- Service de Réanimation polyvalente, Groupe Hospitalier Bretagne Sud, Lorient , France
| | - Jean-Christophe Richard
- Médecine Intensive Réanimation, Hôpital de La Croix Rousse, Hospices civils de Lyon, Lyon , France
| | | | - Agathe Delbove
- Réanimation, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Gwenael Prat
- Médecine Intensive Réanimation, CHU de Brest, Brest, France
| | - Alexandre Lautrette
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Clermont-Ferrand Site Gabriel-Montpied, Clermont-Ferrand, France
| | - Gwenhaël Colin
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Departmental La Roche-sur-Yon, La Roche-sur-Yon, France
| | - Edouard Soum
- Réanimation Polyvalente, Centre Hospitalier de Périgueux, Perigueux, France
| | - Gaël Bourdin
- Réanimation Polyvalente, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | - Gonzalo Hernández
- Department of Critical Care Medicine, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | | | - Arnaud W Thille
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
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Hintersteininger M, Haselwanter P, Maleczek M, Laxar D, Hermann M, Hermann A, Buchtele N, Staudinger T, Zauner C, Schneeweiss-Gleixner M. The Influence of Prone Positioning on Energy and Protein Delivery in COVID-19 Patients Requiring ECMO Support. Nutrients 2024; 16:3534. [PMID: 39458527 PMCID: PMC11510455 DOI: 10.3390/nu16203534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 10/08/2024] [Accepted: 10/15/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND Gastrointestinal dysfunction is a common complication of medical nutrition therapy in critically ill patients. Whether prone positioning leads to a deterioration in gastrointestinal function has not been fully clarified. Thus, we aimed to analyze the influence of prone positioning on the tolerance of medical nutrition therapy. METHODS We conducted a retrospective analysis of 102 SARS-CoV-2 infected patients with venovenous extracorporeal membrane oxygenation support (VV ECMO). Gastric residual volume (GRV) was used to assess the tolerance of enteral nutrition. RESULTS Nutritional data were collected for 2344 days. Undernutrition was observed in 40.8%, with a significantly higher incidence on days in prone position (48.4% versus 38.6%, p < 0.001). On days in supine position, significantly more calories were administered enterally than on days in prone position (p < 0.001). The mean GRV/24 h was 111.1 mL on days in supine position and 187.3 mL on days in prone position (p < 0.001). Prone positioning was associated with higher rates of GRV of ≥500 mL/24 h independent of age, disease severity at ECMO start, ECMO runtime and ICU length of stay (adjusted hazard ratio: 4.06; 95%CI: 3.0-5.5; p < 0.001). CONCLUSIONS Prone position was associated with lower tolerance of enteral nutrition, as indicated by an increased GRV. As a result, reduced enteral nutritional support was administered.
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Affiliation(s)
- Marlene Hintersteininger
- Department of Medicine III, Clinical Division of Gastroenterology and Hepatology, Medical University of Vienna, 1090 Vienna, Austria; (M.H.); (P.H.); (C.Z.)
| | - Patrick Haselwanter
- Department of Medicine III, Clinical Division of Gastroenterology and Hepatology, Medical University of Vienna, 1090 Vienna, Austria; (M.H.); (P.H.); (C.Z.)
| | - Mathias Maleczek
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (D.L.); (M.H.)
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, 1090 Vienna, Austria
| | - Daniel Laxar
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (D.L.); (M.H.)
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, 1090 Vienna, Austria
| | - Martina Hermann
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (D.L.); (M.H.)
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, 1090 Vienna, Austria
| | - Alexander Hermann
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, 1090 Vienna, Austria; (A.H.); (N.B.); (T.S.)
| | - Nina Buchtele
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, 1090 Vienna, Austria; (A.H.); (N.B.); (T.S.)
| | - Thomas Staudinger
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, 1090 Vienna, Austria; (A.H.); (N.B.); (T.S.)
| | - Christian Zauner
- Department of Medicine III, Clinical Division of Gastroenterology and Hepatology, Medical University of Vienna, 1090 Vienna, Austria; (M.H.); (P.H.); (C.Z.)
| | - Mathias Schneeweiss-Gleixner
- Department of Medicine III, Clinical Division of Gastroenterology and Hepatology, Medical University of Vienna, 1090 Vienna, Austria; (M.H.); (P.H.); (C.Z.)
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Gebremeskel GG, Tadesse DB, Haile TG. Mortality and morbidity in critically ill COVID-19 patients: A systematic review and meta-analysis. J Infect Public Health 2024; 17:102533. [PMID: 39243690 DOI: 10.1016/j.jiph.2024.102533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/13/2024] [Accepted: 08/25/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused 14.83 million deaths globally. This systematic review and meta-analysis aimed to provide a pooled estimate of the overall mortality and morbidity of critically ill COVID-19 patients. METHOD Four electronic databases, Medline/PubMed, the Cochrane Library, the WHO COVID-19 database, and the Web of Science, were used to identify relevant studies. Two authors independently screened the studies, evaluated the eligibility criteria and resolved discrepancies through discussion with the third author. The pooled effect size was computed using STATA software version 14. The Cochran Q test and I2 test were utilized to assess heterogeneity across the studies. Additionally, subgroup analysis, sensitivity analysis, and publication bias were evaluated. It is registered in Prospero with Prospero ID CRD42020212146. RESULTS A total of 1003 published articles were screened from various databases, and 24 studies involving a total of 142,291 critically ill COVID-19 participants were selected for inclusion in the review. Among the participants, 67 % were male, and the mean age was 63.43 + SD3.33 years. The mortality rate reported in the individual studies ranged from 4.5 % to 69.5 %. The findings from the analysis revealed that the overall pooled mortality rate was 34 % (95 % confidence interval: 31 %-37 %). Additionally, the findings showed that 62 % of critically ill COVID-19 patients required mechanical ventilation, while 68.7 % of these patients had chronic disease comorbidities. CONCLUSION Critically ill COVID-19 patients face a high-risk risk of death, with an estimate of about one in three patients dying from the virus. Notably, a substantial portion of critically ill COVID-19 patients (62 %) require mechanical ventilation; surprisingly, more than two-thirds of patients with COVID-19 have chronic disease comorbidities, highlighting the importance of managing comorbidities in this population.
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Affiliation(s)
| | - Degena Bahrey Tadesse
- Department of adult health nursing, school of nursing, college of health science, Aksum university, Axum, Tigray, Ethiopia
| | - Teklehaimanot Gereziher Haile
- Department of maternity and neonatal nursing, school of nursing, college of health science, Aksum university, Axum, Tigray, Ethiopia
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Jeong JH, Heo M, Park S, Lee SH, Park O, Kim T, Yeo HJ, Jang JH, Cho WH, Yoo JW, on behalf of the Korean Intensive Care Study Group. Association between Age-Adjusted Endothelial Activation and Stress Index and Intensive Care Unit Mortality in Patients with Severe COVID-19. Tuberc Respir Dis (Seoul) 2024; 87:524-531. [PMID: 39044336 PMCID: PMC11468444 DOI: 10.4046/trd.2024.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/27/2024] [Accepted: 07/21/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Endothelial activation and stress index (EASIX) reflects endothelial dysfunction or damage. Because endothelial dysfunction is one of the key mechanisms, a few studies have shown the clinical usefulness of original and age-adjusted EASIX (age-EASIX) in patients with coronavirus disease 2019 (COVID-19). We aimed to evaluate the clinical utility of age-EASIX in predicting intensive care unit (ICU) mortality in critically ill patients with COVID-19 in South Korea. METHODS Secondary analysis was performed using clinical data retrospectively collected from 22 nationwide hospitals in South Korea between January 1, 2020, and August 31, 2021. Patients were at least 19 years old and admitted to the ICU for severe COVID-19, demanding at least high-flow nasal cannula oxygen therapy. EASIX [lactate dehydrogenase (U/L)×creatinine (mg/dL)/platelet count (109 cells/L)] and age-EASIX (EASIX×age) were calculated and log2-transformed. RESULTS The mean age of 908 critically ill patients with COVID-19 was 67.4 years with 59.7% male sex. The mean log2 age-EASIX was 7.38±1.45. Non-survivors (n=222, 24.4%) in the ICU had a significantly higher log2 age-EASIX than of survivors (8.2±1.52 vs. 7.1±1.32, p<0.001). log2 age-EASIX was significantly associated with ICU mortality (odds ratio, 1.541; 95% confidence interval, 1.322 to 1.796; p<0.001) and had a better area under the receiver operating characteristic curve than of the sequential organ failure assessment (SOFA) score in predicting ICU mortality (0.730 vs. 0.660, p=0.001). CONCLUSION Age-EASIX is significantly associated with ICU mortality and has better discriminatory ability than the SOFA score in predicting ICU mortality.
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Affiliation(s)
- Jong Hwan Jeong
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Manbong Heo
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Su Hwan Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Onyu Park
- BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Taehwa Kim
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Hye Ju Yeo
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jin Ho Jang
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Woo Hyun Cho
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jung-Wan Yoo
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - on behalf of the Korean Intensive Care Study Group
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
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Zhao Y, Yao Z, Xu S, Yao L, Yu Z. Glucocorticoid therapy for acute respiratory distress syndrome: Current concepts. JOURNAL OF INTENSIVE MEDICINE 2024; 4:417-432. [PMID: 39310055 PMCID: PMC11411438 DOI: 10.1016/j.jointm.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 09/25/2024]
Abstract
Acute respiratory distress syndrome (ARDS), a fatal critical disease, is induced by various insults. ARDS represents a major global public health burden, and the management of ARDS continues to challenge healthcare systems globally, especially during the pandemic of the coronavirus disease 2019 (COVID-19). There remains no confirmed specific pharmacotherapy for ARDS, despite advances in understanding its pathophysiology. Debate continues about the potential role of glucocorticoids (GCs) as a promising ARDS clinical therapy. Questions regarding GC agent, dose, and duration in patients with ARDS need to be answered, because of substantial variations in GC administration regimens across studies. ARDS heterogeneity likely affects the therapeutic actions of exogenous GCs. This review includes progress in determining the GC mechanisms of action and clinical applications in ARDS, especially during the COVID-19 pandemic.
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Affiliation(s)
- Yuanrui Zhao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhun Yao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Song Xu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Lan Yao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhui Yu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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43
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Goossen RL, van Vliet R, Bos LDJ, Buiteman-Kruizinga LA, Hollman MW, Myatra SN, Neto AS, Spronk PE, van der Woude MCE, van Meenen DMP, Paulus F, Schultz MJ. High PEEP/low FiO 2 ventilation is associated with lower mortality in COVID-19. J Crit Care 2024; 83:154854. [PMID: 38996499 DOI: 10.1016/j.jcrc.2024.154854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/07/2024] [Accepted: 06/23/2024] [Indexed: 07/14/2024]
Abstract
RATIONALE The positive end-expiratory pressure (PEEP) strategy in patients with coronavirus 2019 (COVID-19) acute respiratory distress syndrome (ARDS) remains debated. Most studies originate from the initial waves of the pandemic. Here we aimed to assess the impact of high PEEP/low FiO2 ventilation on outcomes during the second wave in the Netherlands. METHODS Retrospective observational study of invasively ventilated COVID-19 patients during the second wave. Patients were categorized based on whether they received high PEEP or low PEEP ventilation according to the ARDS Network tables. The primary outcome was ICU mortality, and secondary outcomes included hospital and 90-day mortality, duration of ventilation and length of stay, and the occurrence of kidney injury. Propensity matching was performed to correct for factors with a known relationship to ICU mortality. RESULTS This analysis included 790 COVID-ARDS patients. At ICU discharge, 32 (22.5%) out of 142 high PEEP patients and 254 (39.2%) out of 848 low PEEP patients had died (HR 0.66 [0.46-0.96]; P = 0.03). High PEEP was linked to improved secondary outcomes. Matched analysis did not change findings. CONCLUSIONS High PEEP ventilation was associated with improved ICU survival in patients with COVID-ARDS.
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Affiliation(s)
- Robin L Goossen
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands.
| | - Relin van Vliet
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Lieuwe D J Bos
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Laura A Buiteman-Kruizinga
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Department of Intensive Care, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Markus W Hollman
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Sheila N Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Peter E Spronk
- Department of Intensive Care, Gelre Hospitals, Apeldoorn, the Netherlands
| | | | - David M P van Meenen
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Faculty of Health, ACHIEVE, center of applied research, University of Applied Research, Amsterdam, the Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Medical University of Vienna, Vienna, Austria
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Maurizot A, Chabay S, Roger G, Tapiero S, Georges JL, Flaujac C, Paul M, Roche A, Bruneel F, Ferré A. Incidence of deep venous thrombosis in COVID-19 critically ill patients treated with intermediate-dose of heparin for thromboprophylaxis: The COVIDOP-DVT observational study. Vascular 2024; 32:1099-1106. [PMID: 37009990 PMCID: PMC10071186 DOI: 10.1177/17085381231165083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
INTRODUCTION The high prevalence of deep vein thrombosis (DVT) in patients admitted to intensive care unit (ICU) for COVID-19-related acute respiratory distress syndrome (ARDS) would justify systematic screening of these patients or higher therapeutic dose of heparin for thromboprophylaxis. MATERIAL AND METHOD We performed a systematic echo-Doppler of the lower limb proximal veins during the first 48 h (visit 1) and from 7 to 9 days after visit 1 (visit 2) in consecutive patients admitted to the ICU of a university-affiliated tertiary hospital for severe proven COVID-19 during the second wave. All patients received intermediate-dose heparin (IDH). The primary objective was to determine DVT incidence on venous Doppler ultrasound. Secondary objectives were to determine whether the presence of DVT modifies the anticoagulation regimen, the incidence of major bleeding according to International Society on Thrombosis and Haemostasis (ISTH) criteria, and the mortality rate of patients with and without DVT. RESULTS We included 48 patients (30 [62.5%] men) with a median age of 63 years [IQR, 54-70]. The prevalence of proximal deep vein thrombosis was 4.2% (2/48). In these two patients, after DVT diagnosis, anticoagulation was changed from intermediate to curative dose. Two patients (4.2%) had a major bleeding complication according to ISTH criteria. Among the 48 patients, 9 (18.8%) died before hospital discharge. No DVT or pulmonary embolism was diagnosed in these deceased patients during their hospital stay. CONCLUSION In critically ill patients with COVID-19, management with IDH results in a low incidence of DVT. Although our study is not designed to demonstrate any difference in outcome, our results do not suggest any signal of harm when using intermediate-dose heparin (IDH) COVID-19 with a frequency of major bleeding complications less than 5%.
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Affiliation(s)
- Aurélien Maurizot
- Vascular Medicine Unit, Cardiology Department, Versailles Hospital, Le Chesnay, France
| | - Simon Chabay
- Vascular Medicine Unit, Cardiology Department, Versailles Hospital, Le Chesnay, France
| | - Guillaume Roger
- Vascular Medicine Unit, Cardiology Department, Versailles Hospital, Le Chesnay, France
| | - Stéphanie Tapiero
- Vascular Medicine Unit, Cardiology Department, Versailles Hospital, Le Chesnay, France
| | | | - Claire Flaujac
- Haemostasis Unit, Medical Biology Department, Versailles Hospital, Le Chesnay, France
| | - Marine Paul
- Intensive Care Unit, Versailles Hospital, Le Chesnay, France
| | - Anne Roche
- Intensive Care Unit, Versailles Hospital, Le Chesnay, France
| | - Fabrice Bruneel
- Intensive Care Unit, Versailles Hospital, Le Chesnay, France
| | - Alexis Ferré
- Intensive Care Unit, Versailles Hospital, Le Chesnay, France
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45
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Reizine F, Massart N, Mansour A, Fedun Y, Machut A, Vacheron CH, Savey A, Friggeri A, Lepape A. Relationship between SARS-CoV-2 infection and ICU-acquired candidemia in critically ill medical patients: a multicenter prospective cohort study. Crit Care 2024; 28:320. [PMID: 39334254 PMCID: PMC11429030 DOI: 10.1186/s13054-024-05104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND While SARS-CoV2 infection has been shown to be a significant risk-factor for several secondary bacterial, viral and Aspergillus infections, its impact on intensive care unit (ICU)-acquired candidemia (ICAC) remains poorly explored. METHOD Using the REA-REZO network (French surveillance network of ICU-acquired infections), we included all adult patients hospitalized for a medical reason of admission in participating ICUs for at least 48 h from January 2020 to January 2023. To account for confounders, a non-parsimonious propensity score matching was performed. Rates of ICAC according to SARS-CoV2 status were compared in matched patients. Factors associated with ICAC in COVID-19 patients were also assessed using a Fine-Gray model. RESULTS A total of 55,268 patients hospitalized at least 48 h for a medical reason in 101 ICUs were included along the study period. Of those, 13,472 were tested positive for a SARS-CoV2 infection while 284 patients developed an ICAC. ICAC rate was higher in COVID-19 patients in both the overall population and the matched patients' cohort (0.8% (107/13,472) versus 0.4% (173/41,796); p < 0.001 and 0.8% (93/12,241) versus 0.5% (57/12,241); p = 0.004, respectively). ICAC incidence rate was also higher in those patients (incidence rate 0.51 per 1000 patients-days in COVID-19 patients versus 0.32 per 1000 patients-days; incidence rate ratio: 1.58 [95% CI:1.08-2.35]; p = 0.018). Finally, patients with ICAC had a higher ICU mortality rate (49.6% versus 20.2%; p < 0.001). CONCLUSION In this large multicenter cohort of ICU patients, although remaining low, the rate of ICAC was higher among COVID-19 patients.
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Affiliation(s)
- Florian Reizine
- Service de Réanimation Polyvalente, Centre Hospitalier de Vannes, 56000, Vannes, France.
| | - Nicolas Massart
- Service de Réanimation Polyvalente, Centre Hospitalier de Saint Brieuc, Saint-Brieuc, France
| | - Alexandre Mansour
- Service d'Anesthésie-Réanimation, CHU de Rennes, CHU Rennes, Rennes, France
| | - Yannick Fedun
- Service de Réanimation Polyvalente, Centre Hospitalier de Vannes, 56000, Vannes, France
| | - Anaïs Machut
- REA-REZO Infections Et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
| | - Charles-Hervé Vacheron
- REA-REZO Infections Et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
- Département d'Anesthésie Médecine Intensive Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
- PHE3ID, Centre International de Recherche en Infectiologie, Institut National de La Santé Et de La Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Anne Savey
- REA-REZO Infections Et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
- PHE3ID, Centre International de Recherche en Infectiologie, Institut National de La Santé Et de La Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Arnaud Friggeri
- REA-REZO Infections Et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
- Département d'Anesthésie Médecine Intensive Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
- PHE3ID, Centre International de Recherche en Infectiologie, Institut National de La Santé Et de La Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Alain Lepape
- REA-REZO Infections Et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
- Département d'Anesthésie Médecine Intensive Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
- PHE3ID, Centre International de Recherche en Infectiologie, Institut National de La Santé Et de La Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
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Krisht AAH, Grapin K, de Beauchene RC, Bonnet B, Cassagnes L, Evrard B, Adda M, Souweine B, Dupuis C. SARS-CoV2 pneumonia patients admitted to the ICU: Analysis according to clinical and biological parameters and the extent of lung parenchymal lesions on chest CT scan, a monocentric observational study. PLoS One 2024; 19:e0308014. [PMID: 39298399 PMCID: PMC11412649 DOI: 10.1371/journal.pone.0308014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/16/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND CT-scan and inflammatory and coagulation biomarkers could help in prognostication of COVID-19 in patients on ICU admission. OBJECTIVE The objectives of this study were to measure the prognostic value of the extent of lung parenchymal lesions on computed tomography (CT) and of several coagulation and inflammatory biomarkers, and to explore the characteristics of the patients depending on the extent of lung parenchymal lesions. DESIGN Retrospective monocentric observational study achieved on a dataset collected prospectively. SETTING Medical ICU of the university hospital of Clermont-Ferrand, France. PATIENTS All consecutive adult patients aged ≥18 years admitted between 20 March, 2020 and 31 August, 2021 for COVID-19 pneumonia. INTERVENTIONS Characteristics at baseline and during ICU stay, and outcomes at day 60 were recorded. The extent of lung parenchyma lesions observed on the chest CT performed on admission was established by artificial intelligence software. MEASUREMENTS Several clinical characteristics and laboratory features were collected on admission including plasma interleukin-6, HLA-DR monocytic-expression rate (mHLA-DR), and the extent of lung parenchymal lesions. Factors associated with day-60 mortality were investigated by uni- and multivariate survival analyses. RESULTS 270 patients were included. Inflammation biomarkers including the levels of neutrophils, CRP, ferritin and Il10 were the indices the most associated with the severity of the extent of the lung lesions. Patients with more extensive lung parenchymal lesions (≥ 75%) on admission had higher CRP serum levels. The extent of lung parenchymal lesions was associated with a decrease in the PaO2/FiO2 ratio(p<0.01), fewer ventilatory-free days (p = 0.03), and a higher death rate at day 60(p = 0.01). Extent of the lesion of more than 75% was independently associated with day-60 mortality (aHR = 1.72[1.06; 2.78], p = 0.03). The prediction of death at day 60 was improved when considering simultaneously biological and radiological markers obtained on ICU admission (AUC = 0.78). CONCLUSIONS The extent of lung parenchyma lesions on CT was associated with inflammation, and the combination of coagulation and inflammatory biomarkers and the extent of the lesions predicted the poorest outcomes.
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Affiliation(s)
- Abed al Hadi Krisht
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | - Kévin Grapin
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | | | - Benjamin Bonnet
- CHU Clermont-Ferrand, Service d’Immunologie, Clermont-Ferrand, France
- Université Clermont Auvergne, Laboratoire d’Immunologie, ECREIN, UMR1019 UNH, UFR Médecine de Clermont-Ferrand, Clermont-Ferrand, France
| | - Lucie Cassagnes
- CHU Clermont-Ferrand, Service de Radiologie, Clermont-Ferrand, France
- Université Clermont Auvergne, Unité de Nutrition Humaine, INRAe, CRNH Auvergne, Clermont Ferrand, France
| | - Bertrand Evrard
- CHU Clermont-Ferrand, Service d’Immunologie, Clermont-Ferrand, France
- Université Clermont Auvergne, Laboratoire d’Immunologie, ECREIN, UMR1019 UNH, UFR Médecine de Clermont-Ferrand, Clermont-Ferrand, France
| | - Mireille Adda
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | - Bertrand Souweine
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS, LMGE, Clermont-Ferrand, France
| | - Claire Dupuis
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
- Université Clermont Auvergne, Unité de Nutrition Humaine, INRAe, CRNH Auvergne, Clermont Ferrand, France
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Liu S, Yu C, Tu Q, Zhang Q, Fu Z, Huang Y, He C, Yao L. Bacterial co-infection in COVID-19: a call to stay vigilant. PeerJ 2024; 12:e18041. [PMID: 39308818 PMCID: PMC11416760 DOI: 10.7717/peerj.18041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 08/13/2024] [Indexed: 09/25/2024] Open
Abstract
Co-infection with diverse bacteria is commonly seen in patients infected with the novel coronavirus, SARS-CoV-2. This type of co-infection significantly impacts the occurrence and development of novel coronavirus infection. Bacterial co-pathogens are typically identified in the respiratory system and blood culture, which complicates the diagnosis, treatment, and prognosis of COVID-19, and even exacerbates the severity of disease symptoms and increases mortality rates. However, the status and impact of bacterial co-infections during the COVID-19 pandemic have not been properly studied. Recently, the amount of literature on the co-infection of SARS-CoV-2 and bacteria has gradually increased, enabling a comprehensive discussion on this type of co-infection. In this study, we focus on bacterial infections in the respiratory system and blood of patients with COVID-19 because these infection types significantly affect the severity and mortality of COVID-19. Furthermore, the progression of COVID-19 has markedly elevated the antimicrobial resistance among specific bacteria, such as Klebsiella pneumoniae, in clinical settings including intensive care units (ICUs). Grasping these resistance patterns is pivotal for the optimal utilization and stewardship of antibiotics, including fluoroquinolones. Our study offers insights into these aspects and serves as a fundamental basis for devising effective therapeutic strategies. We primarily sourced our articles from PubMed, ScienceDirect, Scopus, and Google Scholar. We queried these databases using specific search terms related to COVID-19 and its co-infections with bacteria or fungi, and selectively chose relevant articles for inclusion in our review.
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Affiliation(s)
- Shengbi Liu
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Chao Yu
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Qin Tu
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Qianming Zhang
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Zuowei Fu
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Yifeng Huang
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Chuan He
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Lei Yao
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
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Lai C, Shi R, Jelinski L, Lardet F, Fasan M, Ayed S, Belotti H, Biard N, Guérin L, Fage N, Fossé Q, Gobé T, Pavot A, Roger G, Yhuel A, Teboul JL, Pham T, Monnet X. Respiratory effects of prone position in COVID-19 acute respiratory distress syndrome differ according to the recruitment-to-inflation ratio: a prospective observational study. Ann Intensive Care 2024; 14:146. [PMID: 39292429 PMCID: PMC11411043 DOI: 10.1186/s13613-024-01375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 09/01/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Improvements in oxygenation and lung mechanics with prone position (PP) in patients with acute respiratory distress syndrome (ARDS) are inconstant. The objectives of the study were (i) to identify baseline variables, including the recruitment-to-inflation ratio (R/I), associated with a positive response to PP in terms of oxygenation (improvement of the ratio of arterial oxygen partial pressure over the inspired oxygen fraction (PaO2/FiO2) ≥ 20 mmHg) and lung mechanics; (ii) to evaluate whether the response to the previous PP session is associated with the response to the next session. METHODS In this prospective, observational, single-center study in patients who underwent PP for ARDS due to COVID-19, respiratory variables were assessed just before PP and at the end of the session. Respiratory variables included mechanical ventilation settings and respiratory mechanics variables, including R/I, an estimate of the potential for lung recruitment compared to lung overinflation. RESULTS In 50 patients, 201 PP sessions lasting 19 ± 3 h were evaluated. Neuromuscular blockades were used in 116 (58%) sessions. The PaO2/FiO2 ratio increased from 109 ± 31 mmHg to 165 ± 65 mmHg, with an increase ≥ 20 mmHg in 142 (71%) sessions. In a mixed effect logistic regression, only pre-PP PaO2/FiO2 (OR 1.12 (95% CI [1.01-1.24])/every decrease of 10 mmHg, p = 0.034) in a first model and improvement in oxygenation at the previous PP session (OR 3.69 (95% CI [1.27-10.72]), p = 0.017) in a second model were associated with an improvement in oxygenation with PP. The R/I ratio (n = 156 sessions) was 0.53 (0.30-0.76), separating lower- and higher-recruiters. Whereas PaO2/FiO2 improved to the same level in both subgroups, driving pressure and respiratory system compliance improved only in higher-recruiters (from 14 ± 4 to 12 ± 4 cmH2O, p = 0.027, and from 34 ± 11 to 38 ± 13 mL/cmH2O, respectively, p = 0.014). CONCLUSIONS A lower PaO2/FiO2 at baseline and a positive O2-response at the previous PP session are associated with a PP-induced improvement in oxygenation. In higher-recruiters, lung mechanics improved along with oxygenation. Benefits of PP could thus be greater in these patients.
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Affiliation(s)
- Christopher Lai
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
- Inserm UMR S_999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, University Paris-Saclay, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.
| | - Rui Shi
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR S_999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, University Paris-Saclay, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Ludwig Jelinski
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Florian Lardet
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Marta Fasan
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Department of Surgery, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Veneto, Italy
| | - Soufia Ayed
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Hugo Belotti
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Nicolas Biard
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Laurent Guérin
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Nicolas Fage
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Quentin Fossé
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Thibaut Gobé
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Arthur Pavot
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Guillaume Roger
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Alex Yhuel
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Jean-Louis Teboul
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR S_999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, University Paris-Saclay, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Tai Pham
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP,, Université Paris-Saclay (UVSQ)-Université Paris-Sud, Villejuif, 94807, France
| | - Xavier Monnet
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR S_999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, University Paris-Saclay, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
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Helms J, Catoire P, Abensur Vuillaume L, Bannelier H, Douillet D, Dupuis C, Federici L, Jezequel M, Jozwiak M, Kuteifan K, Labro G, Latournerie G, Michelet F, Monnet X, Persichini R, Polge F, Savary D, Vromant A, Adda I, Hraiech S. Oxygen therapy in acute hypoxemic respiratory failure: guidelines from the SRLF-SFMU consensus conference. Ann Intensive Care 2024; 14:140. [PMID: 39235690 PMCID: PMC11377397 DOI: 10.1186/s13613-024-01367-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/09/2024] [Indexed: 09/06/2024] Open
Abstract
INTRODUCTION Although largely used, the place of oxygen therapy and its devices in patients with acute hypoxemic respiratory failure (ARF) deserves to be clarified. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and the French Emergency Medicine Society (Société Française de Médecine d'Urgence, SFMU) organized a consensus conference on oxygen therapy in ARF (excluding acute cardiogenic pulmonary oedema and hypercapnic exacerbation of chronic obstructive diseases) in December 2023. METHODS A committee without any conflict of interest (CoI) with the subject defined 7 generic questions and drew up a list of sub questions according to the population, intervention, comparison and outcomes (PICO) model. An independent work group reviewed the literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Fifteen experts in the field from both societies proposed their own answers in a public session and answered questions from the jury (a panel of 16 critical-care and emergency medicine physicians, nurses and physiotherapists without any CoI) and the public. The jury then met alone for 48 h to write its recommendations. RESULTS The jury provided 22 statements answering 11 questions: in patients with ARF (1) What are the criteria for initiating oxygen therapy? (2) What are the targets of oxygen saturation? (3) What is the role of blood gas analysis? (4) When should an arterial catheter be inserted? (5) Should standard oxygen therapy, high-flow nasal cannula oxygen therapy (HFNC) or continuous positive airway pressure (CPAP) be preferred? (6) What are the indications for non-invasive ventilation (NIV)? (7) What are the indications for invasive mechanical ventilation? (8) Should awake prone position be used? (9) What is the role of physiotherapy? (10) Which criteria necessarily lead to ICU admission? (11) Which oxygenation device should be preferred for patients for whom a do-not-intubate decision has been made? CONCLUSION These recommendations should optimize the use of oxygen during ARF.
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Affiliation(s)
- Julie Helms
- Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France.
- UMR 1260, Regenerative Nanomedicine (RNM), FMTS, INSERM (French National Institute of Health and Medical Research), Strasbourg, France.
| | - Pierre Catoire
- Emergency Medicine Department, University Hospital of Bordeaux, 1 Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Laure Abensur Vuillaume
- SAMU57, Service d'Accueil des Urgences, Centre Hospitalier Régional Metz-Thionville, 57530, Ars-Laquenexy, France
| | - Héloise Bannelier
- Service d'Accueil des Urgences - SMUR Hôpital Pitié Salpêtrière Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Delphine Douillet
- Department of Emergency Medicine, University Hospital of Angers, Angers, France
- UNIV Angers, UMR MitoVasc CNRS 6215 INSERM 1083, Angers, France
| | - Claire Dupuis
- CHU Clermont-Ferrand, Service de Réanimation Médicale, Clermont-Ferrand, France
- Unité de Nutrition Humaine, Université Clermont Auvergne, INRAe, CRNH Auvergne, 63000, Clermont-Ferrand, France
| | - Laura Federici
- Service d'Anesthésie Réanimation, Centre Hospitalier D'Ajaccio, Ajaccio, France
| | - Melissa Jezequel
- Unité de Soins Intensifs Cardiologiques, Hôpital de Saint Brieuc, Saint-Brieuc, France
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, CHU de Nice, 151 Route Saint Antoine de Ginestière, 06200, Nice, France
- UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | | | - Guylaine Labro
- Service de Réanimation Médicale GHRMSA, 68100, Mulhouse, France
| | - Gwendoline Latournerie
- Pole de Médecine d'Urgence- CHU Toulouse, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
| | - Fabrice Michelet
- Service de Réanimation, Hôpital de Saint Brieuc, Saint-Brieuc, France
| | - Xavier Monnet
- AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU 4 CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMAS, Université Paris-Saclay, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Romain Persichini
- Service de Réanimation et Soins Continus, CH de Saintes, Saintes, France
| | - Fabien Polge
- Hôpitaux Universitaires de Paris Centre Site Cochin APHP, Paris, France
| | - Dominique Savary
- Département de Médecine d'Urgences, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France
- IRSET Institut de Recherche en Santé, Environnement et Travail/Inserm EHESP - UMR_S1085, CAPTV CDC, 49000, Angers, France
| | - Amélie Vromant
- Service d'Accueil des Urgences, Hôpital La Pitié Salpetrière, Paris, France
| | - Imane Adda
- Department of Research, One Clinic, Paris, France
- PointGyn, Paris, France
| | - Sami Hraiech
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
- Faculté de Médecine, Centre d'Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
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50
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Beurton A, Kooistra EJ, De Jong A, Schiffl H, Jourdain M, Garcia B, Vimpère D, Jaber S, Pickkers P, Papazian L. Specific and Non-specific Aspects and Future Challenges of ICU Care Among COVID-19 Patients with Obesity: A Narrative Review. Curr Obes Rep 2024; 13:545-563. [PMID: 38573465 DOI: 10.1007/s13679-024-00562-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Since the end of 2019, the coronavirus disease 2019 (COVID-19) pandemic has infected nearly 800 million people and caused almost seven million deaths. Obesity was quickly identified as a risk factor for severe COVID-19, ICU admission, acute respiratory distress syndrome, organ support including mechanical ventilation and prolonged length of stay. The relationship among obesity; COVID-19; and respiratory, thrombotic, and renal complications upon admission to the ICU is unclear. RECENT FINDINGS The predominant effect of a hyperinflammatory status or a cytokine storm has been suggested in patients with obesity, but more recent studies have challenged this hypothesis. Numerous studies have also shown increased mortality among critically ill patients with obesity and COVID-19, casting doubt on the obesity paradox, with survival advantages with overweight and mild obesity being reported in other ICU syndromes. Finally, it is now clear that the increase in the global prevalence of overweight and obesity is a major public health issue that must be accompanied by a transformation of our ICUs, both in terms of equipment and human resources. Research must also focus more on these patients to improve their care. In this review, we focused on the central role of obesity in critically ill patients during this pandemic, highlighting its specificities during their stay in the ICU, identifying the lessons we have learned, and identifying areas for future research as well as the future challenges for ICU activity.
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Affiliation(s)
- Alexandra Beurton
- Department of Intensive Care, Hôpital Tenon, APHP, Paris, France.
- UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France.
| | - Emma J Kooistra
- Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
| | - Audrey De Jong
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, Montpellier, France
- Phymed Exp INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Helmut Schiffl
- Division of Nephrology, Department of Internal Medicine IV, University Hospital LMU Munich, Munich, Germany
| | - Mercedes Jourdain
- CHU Lille, Univ-Lille, INSERM UMR 1190, ICU Department, F-59037, Lille, France
| | - Bruno Garcia
- CHU Lille, Univ-Lille, INSERM UMR 1190, ICU Department, F-59037, Lille, France
| | - Damien Vimpère
- Anesthesia and Critical Care Department, Hôpital Necker, APHP, Paris, France
| | - Samir Jaber
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, Montpellier, France
- Phymed Exp INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
| | - Laurent Papazian
- Intensive Care Unit, Centre Hospitalier de Bastia, Bastia, Corsica, France
- Aix-Marseille University, Marseille, France
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