Cardiovascular profile in critically ill elderly medical patients: Prevalence, mortality and length of stay

Summary Background Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. Methods The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. Results A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2–6) compared to 2020: 4 days (IQR 2–7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. Conclusion In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.

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Impact of dexamethasone on the incidence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective study

Annals of Intensive Care ◽

10.1186/s13613-021-00876-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ines Gragueb-Chatti ◽

Alexandre Lopez ◽

Dany Hamidi ◽

Christophe Guervilly ◽

Anderson Loundou ◽

...

Keyword(s):

Mechanical Ventilation ◽

Retrospective Study ◽

Length Of Stay ◽

Critically Ill ◽

Invasive Mechanical Ventilation ◽

Blood Stream ◽

Hospital Length Of Stay ◽

Ventilator Associated Pneumonia ◽

Blood Stream Infections ◽

Second Wave

Abstract Background Dexamethasone decreases mortality in patients with severe coronavirus disease 2019 (COVID-19) and has become the standard of care during the second wave of pandemic. Dexamethasone is an immunosuppressive treatment potentially increasing the risk of secondary hospital acquired infections in critically ill patients. We conducted an observational retrospective study in three French intensive care units (ICUs) comparing the first and second waves of pandemic to investigate the role of dexamethasone in the occurrence of ventilator-associated pneumonia (VAP) and blood stream infections (BSI). Patients admitted from March to November 2020 with a documented COVID-19 and requiring mechanical ventilation (MV) for ≥ 48 h were included. The main study outcomes were the incidence of VAP and BSI according to the use of dexamethasone. Secondary outcomes were the ventilator-free days (VFD) at day-28 and day-60, ICU and hospital length of stay and mortality. Results Among the 151 patients included, 84 received dexamethasone, all but one during the second wave. VAP occurred in 63% of patients treated with dexamethasone (DEXA+) and 57% in those not receiving dexamethasone (DEXA−) (p = 0.43). The cumulative incidence of VAP, considering death, duration of MV and late immunosuppression as competing factors was not different between groups (p = 0.59). A multivariate analysis did not identify dexamethasone as an independent risk factor for VAP occurrence. The occurrence of BSI was not different between groups (29 vs. 30%; p = 0.86). DEXA+ patients had more VFD at day-28 (9 (0–21) vs. 0 (0–11) days; p = 0.009) and a reduced ICU length of stay (20 (11–44) vs. 32 (17–46) days; p = 0.01). Mortality did not differ between groups. Conclusions In this cohort of COVID-19 patients requiring invasive MV, dexamethasone was not associated with an increased incidence of VAP or BSI. Dexamethasone might not explain the high rates of VAP and BSI observed in critically ill COVID-19 patients.

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PSYCHOLOGICAL FACTORS PREDICT SEDATION REQUIREMENT IN CRITICALLY ILL MEDICAL PATIENTS

Critical Care Medicine ◽

10.1097/00003246-200212001-00325 ◽

2002 ◽

Vol 30 (Supplement) ◽

pp. A95

Author(s):

Tamar Green

Keyword(s):

Critically Ill ◽

Psychological Factors ◽

Medical Patients

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Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes

JAMA ◽

10.1001/jama.2011.697 ◽

2011 ◽

Vol 305 (21) ◽

pp. 2175 ◽

Cited By ~ 285

Author(s):

Craig M. Lilly

Keyword(s):

Critical Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Care Processes ◽

Before And After

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Comparative thrombosis risk of vascular access devices among critically ill medical patients

Thrombosis Research ◽

10.1016/j.thromres.2018.10.013 ◽

2018 ◽

Vol 172 ◽

pp. 54-60 ◽

Cited By ~ 8

Author(s):

Darren White ◽

Scott C. Woller ◽

Scott M. Stevens ◽

Dave S. Collingridge ◽

Vineet Chopra ◽

...

Keyword(s):

Critically Ill ◽

Vascular Access ◽

Medical Patients ◽

Vascular Access Devices ◽

Thrombosis Risk

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Effect of Length of Stay in Intensive Care Unit on Hospital and Long-Term Mortality of Critically Ill Adult Patients

Survey of Anesthesiology ◽

10.1097/sa.0b013e3181fac944 ◽

2010 ◽

Vol 54 (6) ◽

pp. 269

Author(s):

&NA;

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Critically Ill ◽

Adult Patients ◽

Long Term Mortality

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HOSPITAL Score, LACE Index and LACE+ Index as predictors of 30-day readmission in patients with heart failure

BMJ evidence-based medicine ◽

10.1136/bmjebm-2019-111271 ◽

2019 ◽

Vol 25 (5) ◽

pp. 166-167 ◽

Cited By ~ 3

Author(s):

Abdisamad M Ibrahim ◽

Cameron Koester ◽

Mohammad Al-Akchar ◽

Nitin Tandan ◽

Manjari Regmi ◽

...

Keyword(s):

Heart Failure ◽

Length Of Stay ◽

Patient Population ◽

Prediction Models ◽

Hospital Admissions ◽

Diastolic Heart Failure ◽

Hospital Readmissions ◽

Medical Patients ◽

Readmission Rates ◽

C Statistic

This study aimed to evaluate the accuracy of the HOSPITAL Score (Haemoglobin level at discharge, Oncology at discharge, Sodium level at discharge, Procedure during hospitalization, Index admission, number of hospital admissions, Length of stay) LACE index (Length of stay, Acute/emergent admission, Charlson comorbidy index score, Emerency department visits in previous 6 months) and LACE+ index in predicting 30-day readmission in patients with diastolic dysfunction. Heart failure remains one of the most common hospital readmissions in adults, leading to significant morbidity and mortality. Different models have been used to predict 30-day hospital readmissions. All adult medical patients discharged from the SIU School of Medicine Hospitalist service from 12 June 2016 to 12 June 2018 with an International Classification of Disease, 10th Revision, Clinical Modification diagnosis of diastolic heart failure were studied retrospectively to evaluate the performance of the HOSPITAL Score, LACE index and LACE+ index readmission risk prediction tools in this patient population. Of the 730 patient discharges with a diagnosis of heart failure with preserved ejection fraction (HFpEF), 692 discharges met the inclusion criteria. Of these discharges, 189 (27%) were readmitted to the same hospital within 30 days. A receiver operating characteristic evaluation showed C-statistic values to be 0.595 (95% CI 0.549 to 0.641) for the HOSPITAL Score, 0.551 (95% CI 0.503 to 0.598) for the LACE index and 0.568 (95% CI 0.522 to 0.615) for the LACE+ index, indicating poor specificity in predicting 30-day readmission. The result of this study demonstrates that the HOSPITAL Score, LACE index and LACE+ index are not effective predictors of 30-day readmission for patients with HFpEF. Further analysis and development of new prediction models are needed to better estimate the 30-day readmission rates in this patient population.

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