Outcomes of Heated High Flow Nasal Cannula in Patients With Severe or Life-Threatening COVID-19 at a Military Treatment Facility—A Retrospective Cohort Study

ABSTRACT Introduction The coronavirus-19 (COVID-19) pandemic has forced radical changes in management of healthcare in military treatment facilities (MTFs). Military treatment facilities serve unique patients that have a service connection; thus, research and data on this population are relatively sparse. The purpose of this study was to provide descriptive data on characteristics and outcomes of MTF patients with COVID-19 who are treated with heated high-flow nasal cannula (HHFNC). Materials and Methods We performed a single-center retrospective cohort study at the Wright-Patterson Medical Center, a 52-bed hospital in an urban setting. We received approval from our Institutional Review Board. The cohort included patients admitted from June 1, 2020, through May 15, 2021 with severe or life-threatening COVID-19 from a positive severe acute respiratory syndrome–related coronavirus 2 reverse transcription polymerase chain reaction test who were placed on HHFNC during their hospital stay. Severe disease was defined as dyspnea, respiratory rate ≥30/min, blood oxygen saturation ≤93% without supplemental oxygen, partial pressure of arterial oxygen to fraction of inspired oxygen ratio <300, or lung infiltrates involving >50% of lung fields within 24-48 hours. Life-threatening disease was defined as having septic shock or multiple organ dysfunction or requiring intubation. Patients meeting these criteria were retrieved from a quality improvement cohort that represents a consecutive group of patients with COVID-19 admitted to the Wright-Patterson Medical Center. Results Our MTF managed 70 cases of severe or life-threatening COVID-19 from June 1, 2020, to May 15, 2021. Of the 70 cases, 19 (27%) were placed on HHFNC. After initiation of HHFNC, median SpO2/FiO2 was 281.8 and at 24 hours 145.4. Median respiratory rate oxygenation at these times were 10.7 and 9.4, respectively. Fifty percent required mechanical ventilation during hospitalization. Median intensive care unit length of stay was 11 days, with a maximum stay of 39 days. Median hospital length of stay was 12 days, with a maximum of 39 days. Conclusion Our retrospective cohort study characterized and analyzed outcomes observed in a MTF population, with severe or life-threatening COVID-19, who were treated with HHFNC. While the study did not have the power to make concrete conclusions on the optimal form of respiratory support for COVID-19 patients, our data support HHFNC as a reasonable treatment modality despite some notable differences between our cohort and prior studied patient populations.

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Extubation to High-Flow Nasal Cannula in Infants Following Cardiac Surgery: A Retrospective Cohort Study

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1730933 ◽

2021 ◽

Author(s):

Hannah Stevens ◽

Julien Gallant ◽

Jennifer Foster ◽

David Horne ◽

Kristina Krmpotic

Keyword(s):

Cardiac Surgery ◽

Cohort Study ◽

Length Of Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Rescue Therapy ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Significant Difference

AbstractHigh-flow nasal cannula (HFNC) therapy is commonly used in the pediatric intensive care unit (PICU) for postextubation respiratory support. This hypothesis-generating retrospective cohort study aimed to compare postextubation PICU length of stay in infants extubated to HFNC and low flow oxygen (LF) in PICU following cardiac surgery. Of 136 infants (newborn to 1 year) who were intubated and mechanically ventilated in PICU following cardiac surgery, 72 (53%) were extubated to HFNC and 64 (47%) to LF. Compared with patients extubated to LF, those extubated to HFNC had significantly longer durations of cardiopulmonary bypass (152 vs. 109 minutes; p = 0.002), aortic cross-clamp (90 vs. 63 minutes; p = 0.003), and invasive mechanical ventilation (3.2 vs. 1.6 days; p < 0.001), though demographic and preoperative clinical variables were similar. No significant difference was observed in postextubation PICU length of stay between HFNC and LF groups in unadjusted analysis (3.3 vs. 2.6 days, respectively; p = 0.19) and after controlling for potential confounding variables (F [1,125] = 0.17, p = 0.68, R2 = 0.16). Escalation of therapy was similar between HFNC and LF groups (8.3 vs. 14.1%; p = 0.41). HFNC was effective as rescue therapy for six patients in the LF group requiring escalation of therapy. Need for reintubation was similar between HFNC and LF groups (8.3 vs. 4.7%; p = 0.5). Although extubation to HFNC was associated with a trend toward longer postextubation PICU length of stay and was successfully used as rescue therapy for several infants extubated to LF, our results must be interpreted with caution given the limitations of our study.

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Association of patient-to-emergency department staff ratio with the incidence of cardiac arrest: A retrospective cohort study

10.22514/sv.2021.029 ◽

2021 ◽

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Cohort Study ◽

Length Of Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Medical Center ◽

Occupancy Rate ◽

Number Of Patients ◽

Ed Overcrowding

Background: Emergency department (ED) overcrowding and overuse are global healthcare problems. Despite that substantial pieces of literature have explored quality parameters to monitor the patients’ safety and quality of care in the ED, to the best of our knowledge, no reasonable patient-to-ED staff ratios were established. Objectives: This study aimed to find the association between unexpected emergency department cardiac arrest (EDCA) and the patient-to-ED staff ratio. Methods: A retrospective cohort study was conducted in a medical center in Taiwan. Non-trauma patients (age > 18) who visited the ED from January 1, 2016 to November 30, 2018 were included. The total number of patients in ED, number of patients waiting for boarding, length of stay over 48 hours, and physician/nurse number in ED were collected and analyzed. The primary outcome was the association of each parameter with the incidence of EDCA. Results: A total of 508 patients were included. The total number of patients in ED ( > 361, RR: 1.54; 95% CI {1.239-1.917}), ED occupancy rate (> 280, RR: 1.54; 95% CI {1.245-1.898}), ED bed occupancy rate (> 184, RR: 1.63; 95% CI {1.308-2.034}), number of patients waiting for boarding (> 134, RR: 1.45; 95% CI {1.164-1.805}), number of patients in ED with length of stay over 48 hours (> 36, RR: 1.27; 95% CI {1.029-1.558}) and patient-to-nurse ratio (> 8.5, adjusted RR: 1.33; 95% CI {1.054-1.672}) had significant associations with higher incidence of EDCA. However, the patient-to-physician ratio was not associated with EDCA incidence. Discussions: Regarding loading parameters, the patient-to-nurse ratio is more representative than the patient-to-physician ratio as regards association with higher EDCA incidence. Conclusions: A higher patient-to-nurse ratio (> 8.5) was associated with an increment in the incidence of EDCA. Our findings provide a basis for setting different thresholds for different ED settings to adjust ED staff and develop individually tailored approaches corresponding to the level of ED overcrowding.

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Safety and Long Term Outcomes with High Flow Nasal Cannula Therapy in Neonatology: A Large Retrospective Cohort Study

Journal of Pulmonary & Respiratory Medicine ◽

10.4172/2161-105x.1000216 ◽

2014 ◽

Vol 04 (06) ◽

Cited By ~ 7

Author(s):

Michael McQueen

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Long Term Outcomes

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High-flow nasal cannula oxygen therapy in hypoxic patients with COVID-19 pneumonia: a retrospective cohort study confirming the utility of respiratory rate index

Respiratory Investigation ◽

10.1016/j.resinv.2021.10.005 ◽

2021 ◽

Author(s):

Yuichiro Takeshita ◽

Jiro Terada ◽

Yasutaka Hirasawa ◽

Taku Kinoshita ◽

Hiroshi Tajima ◽

...

Keyword(s):

Cohort Study ◽

Respiratory Rate ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Oxygen Therapy ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula

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A Retrospective Comparison of the Effectiveness and Safety of Intravenous Olanzapine Versus Intravenous Haloperidol for Agitation in Adult Intensive Care Unit Patients

Journal of Intensive Care Medicine ◽

10.1177/0885066620984450 ◽

2021 ◽

pp. 088506662098445

Author(s):

Michelle Wang ◽

Tuyen T. Yankama ◽

George T. Abdallah ◽

Ijeoma Julie Eche ◽

Kristen N. Knoph ◽

...

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Length Of Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Medical Center ◽

Academic Medical Center ◽

Icu Length Of Stay ◽

Haloperidol Group

Objective: Intravenous (IV) olanzapine could be an alternative to first-generation antipsychotics for the management of agitation in intensive care unit (ICU) patients. We compared the effectiveness and safety of IV olanzapine to IV haloperidol for agitation management in adult patients in the ICU at a tertiary academic medical center. Methods: A retrospective cohort study was conducted. The primary outcome was the proportion of patients who achieved a Richmond Agitation Sedation Scale (RASS) score of < +1 within 4 hours of IV olanzapine or IV haloperidol administration. Secondary outcomes included the proportion of patients who required rescue medications for agitation within 4 hours of initial IV olanzapine or IV haloperidol administration, incidence of adverse events and ICU length of stay. Results: In the 192 patient analytic cohort, there was no difference in the proportion of patients who achieved a RASS score of < +1 within 4 hours of receiving IV olanzapine or IV haloperidol (49% vs. 42%, p = 0.31). Patients in the IV haloperidol group were more likely to receive rescue medications (28% vs 55%, p < 0.01). There was no difference in the incidence of respiratory events or hypotension between IV olanzapine and IV haloperidol. Patients in the IV olanzapine group experienced more bradycardia (11% vs. 3%, p = 0.04) and somnolence (9% vs. 1%, p = 0.02) compared to the IV haloperidol group. Patients in the IV olanzapine group had a longer median ICU length of stay (7.5 days vs. 5 days, p = 0.04). Conclusion: In this retrospective cohort study, there was no difference in the effectiveness of IV olanzapine compared to IV haloperidol for the management of agitation. IV olanzapine was associated with an increased incidence of bradycardia and somnolence.

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Using nursing notes to improve clinical outcome prediction in intensive care patients: A retrospective cohort study

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocab051 ◽

2021 ◽

Author(s):

Kexin Huang ◽

Tamryn F Gray ◽

Santiago Romero-Brufau ◽

James A Tulsky ◽

Charlotta Lindvall

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Length Of Stay ◽

Patient Outcomes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Medical Center ◽

Gradient Boosting ◽

Short Term ◽

Icu Length Of Stay

Abstract Objective Electronic health record documentation by intensive care unit (ICU) clinicians may predict patient outcomes. However, it is unclear whether physician and nursing notes differ in their ability to predict short-term ICU prognosis. We aimed to investigate and compare the ability of physician and nursing notes, written in the first 48 hours of admission, to predict ICU length of stay and mortality using 3 analytical methods. Materials and Methods This was a retrospective cohort study with split sampling for model training and testing. We included patients ≥18 years of age admitted to the ICU at Beth Israel Deaconess Medical Center in Boston, Massachusetts, from 2008 to 2012. Physician or nursing notes generated within the first 48 hours of admission were used with standard machine learning methods to predict outcomes. Results For the primary outcome of composite score of ICU length of stay ≥7 days or in-hospital mortality, the gradient boosting model had better performance than the logistic regression and random forest models. Nursing and physician notes achieved area under the curves (AUCs) of 0.826 and 0.796, respectively, with even better predictive power when combined (AUC, 0.839). Discussion Models using only nursing notes more accurately predicted short-term prognosis than did models using only physician notes, but in combination, the models achieved the greatest accuracy in prediction. Conclusions Our findings demonstrate that statistical models derived from text analysis in the first 48 hours of ICU admission can predict patient outcomes. Physicians’ and nurses’ notes are both uniquely important in mortality prediction and combining these notes can produce a better predictive model.

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