Timing of tracheal intubation on mortality and duration of mechanical ventilation in critically ill children: A propensity score analysis

Abstract Background and objectives: The timing of invasive mechanical ventilation (IMV) is controversial in COVID-19 patients with acute respiratory hypoxemia. The study aimed to develop a novel biomarker called cumulative oxygen deficit (COD) for the initiation of IMV.Methods: The study was conducted in four designated hospitals for treating COVID-19 patients in Jingmen, Wuhan, from January to March 2020. COD was defined to account for both the magnitude and duration of hypoxemia. A higher value of COD indicated more oxygen deficit. The predictive performance of COD was calculated in multivariable Cox regression models. Time-dependent propensity score matching was performed to explore the effectiveness of IMV versus other non-invasive respiratory supports on survival outcome.Results: A number of 111 patients including 80 in the non-IMV group and 31 in the IMV group were included. Patients with IMV had significantly lower PaO2 (62 (49, 89) vs. 90.5 (68, 125.25) mmHg; p < 0.001), and higher COD (-6.87 (-29.36, 52.38) vs. -231.68 (-1040.78, 119.83)) than patients without IMV. As compared to patients with COD < 0, patients with COD > 30 had higher risk of fatality (HR: 3.79, 95% CI: 2.57 to 16.93; p = 0.037) , and those with COD > 50 were 10 times more likely to die (HR: 10.45, 95% CI: 1.28 to 85.37; p = 0.029). The Cox regression model performed in the time-dependent propensity score matched cohort showed that IMV was associated with half of the hazard of death than those without IMV (HR: 0.56; 95% CI: 0.16 to 1.93; p = 0.358).Conclusions: The study developed a novel biomarker COD which considered both magnitude and duration of hypoxemia, to assist the timing of IMV in patients with COVID-19. We suggest IMV should be the preferred ventilatory support once the COD reaches 30.

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Association of prophylactic synbiotics with reduction in diarrhea and pneumonia in mechanically ventilated critically ill patients: A propensity score analysis

Journal of Infection and Chemotherapy ◽

10.1016/j.jiac.2018.06.006 ◽

2018 ◽

Vol 24 (10) ◽

pp. 795-801 ◽

Cited By ~ 1

Author(s):

Kentaro Shimizu ◽

Hiroshi Ogura ◽

Daijiro Kabata ◽

Ayumi Shintani ◽

Osamu Tasaki ◽

...

Keyword(s):

Propensity Score ◽

Critically Ill ◽

Critically Ill Patients ◽

Propensity Score Analysis ◽

Mechanically Ventilated ◽

Score Analysis

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Prophylactic Antibiotics May Improve Outcome in Patients With Severe Burns Requiring Mechanical Ventilation: Propensity Score Analysis of a Japanese Nationwide Database

Clinical Infectious Diseases ◽

10.1093/cid/civ763 ◽

2015 ◽

Vol 62 (1) ◽

pp. 60-66 ◽

Cited By ~ 36

Author(s):

Takashi Tagami ◽

Hiroki Matsui ◽

Kiyohide Fushimi ◽

Hideo Yasunaga

Keyword(s):

Mechanical Ventilation ◽

Propensity Score ◽

Propensity Score Analysis ◽

Prophylactic Antibiotics ◽

Improve Outcome ◽

Nationwide Database ◽

Severe Burns ◽

Score Analysis

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Prognostic impact of early adjunctive corticosteroid therapy in non-HIV oncology or haematology patients with Pneumocystis jirovecii pneumonia: A propensity score analysis

PLoS ONE ◽

10.1371/journal.pone.0250611 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250611

Author(s):

Mehdi Assal ◽

Jérôme Lambert ◽

Laurent Chow-Chine ◽

Magali Bisbal ◽

Luca Servan ◽

...

Keyword(s):

Mortality Rate ◽

Propensity Score ◽

Tracheal Intubation ◽

Corticosteroid Therapy ◽

Propensity Score Analysis ◽

Pneumocystis Jirovecii ◽

Pneumocystis Jirovecii Pneumonia ◽

Prognostic Impact ◽

Score Analysis ◽

Haematology Patients

Purpose While early adjunctive corticosteroid therapy (EACST) has been proven effective in HIV patients with Pneumocystis Jirovecii Pneumonia (PJP), data remains controversial concerning non-HIV oncology or haematology patients. Methods This retrospective study included cancer patients without HIV and with diagnosis of PJP admitted in a cancer referral centre, from January-1-2010 to March-31-2017. We compared 30-day and 1-year mortality rate, change in the respiratory item of the Sequential Organ Failure Assessment score(SOFA-resp worsening), use of tracheal intubation between day-1 and day-5 of anti-pneumocystis therapy and occurrence of coinfections between patients with EACST and those with no or late corticosteroid therapy, using an inverse probability weighting propensity score-based (IPW) analysis. Results 133 non-HIV oncology or haematology PJP patients were included (EACST n = 58, others n = 75). The main underlying conditions were haematological malignancies (n = 107, 80,5%), solid tumour (n = 27, 20,3%) and allogeneic stem cell transplantation (n = 17, 12,8%). Overall 30-day and 1-year mortality rate was 24,1% and 56,4%, respectively. IPW analysis found no difference on 30-day (HR = 1.45, 95% CI [0.7–3.04], p = 0.321) and 1-year (HR = 1.25, CI 95% [0.75–2.09], p = 0.39) mortality rate between groups. Conclusion No difference in SOFA-resp worsening, tracheal intubation and coinfections was found between groups. Combination of EACST with anti-pneumocystis therapy in non-HIV onco-haematology PJP-patients was not associated with clinical improvement.

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