Improved survival after lung transplantation for adults requiring preoperative invasive mechanical ventilation: A national cohort study

Purpose To describe the trajectory of respiratory failure in COVID-19 and explore factors associated with risk of invasive mechanical ventilation (IMV). Materials and methods A retrospective, observational cohort study of 112 inpatient adults diagnosed with COVID-19 between March 12 and April 16, 2020. Data were manually extracted from electronic medical records. Multivariable and Univariable regression were used to evaluate association between baseline characteristics, initial serum markers and the outcome of IMV. Results Our cohort had median age of 61 (IQR 45–74) and was 66% male. In-hospital mortality was 6% (7/112). ICU mortality was 12.8% (6/47), and 18% (5/28) for those requiring IMV. Obesity (OR 5.82, CI 1.74–19.48), former (OR 8.06, CI 1.51–43.06) and current smoking status (OR 10.33, CI 1.43–74.67) were associated with IMV after adjusting for age, sex, and high prevalence comorbidities by multivariable analysis. Initial absolute lymphocyte count (OR 0.33, CI 0.11–0.96), procalcitonin (OR 1.27, CI 1.02–1.57), IL-6 (OR 1.17, CI 1.03–1.33), ferritin (OR 1.05, CI 1.005–1.11), LDH (OR 1.57, 95% CI 1.13–2.17) and CRP (OR 1.13, CI 1.06–1.21), were associated with IMV by univariate analysis. Conclusions Obesity, smoking history, and elevated inflammatory markers were associated with increased need for IMV in patients with COVID-19.

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Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

Colombia Medica ◽

10.25100/cm.v44i3.1285 ◽

2013 ◽

pp. 184-188 ◽

Cited By ~ 4

Author(s):

Alvaro Sanabria ◽

Ximena Gomez ◽

Valentin Vega ◽

Luis Carlos Dominguez ◽

Camilo Osorio

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cohort Study ◽

Intensive Care ◽

Critically Ill ◽

Medical Condition ◽

Prolonged Mechanical Ventilation ◽

Invasive Mechanical Ventilation ◽

Adult Patients ◽

Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

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The role of Continuous Positive Airway Pressure (CPAP) in Delaying or Avoiding Mechanical Ventilation in COVID-19 Respiratory Failure: A Retrospective Cohort Study

10.21203/rs.3.rs-722133/v1 ◽

2021 ◽

Author(s):

Allan Cameron ◽

Sharif Fattah ◽

Laura Knox ◽

Pauline Grose

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Invasive Mechanical Ventilation ◽

Respiratory Support ◽

Royal Infirmary ◽

High Dependency ◽

Number Of Patients

Abstract Background - During the winter of 2020-2021, the second wave of the COVID19 pandemic in the United Kingdom caused increased demand for intensive care unit (ICU) beds, and in particular, for invasive mechanical ventilation (IMV). To alleviate some of this pressure, some centres offered non-invasive continuous positive airway pressure (CPAP), delivered on specialised COVID high dependency units (cHDUs). However, this practice was based largely on anecdotal reports, and it is not clear from the literature how effective CPAP is at delaying or preventing IMV. Methods - This was a retrospective observational cohort study of consecutive patients admitted to a specialised cHDU at Glasgow Royal Infirmary between November 2020 and February 2021. Each patient had a continuous record of the level of respiratory support required, and was followed up to hospital discharge or death. We examined patient outcomes according to age, sex and maximum level of respiratory support, using logistic regression and time-to-event analysis. The number of patients who could not be oxygenated by standard oxygen facemask but could be oxygenated by CPAP was counted and compared to the number of patients admitted to ICU for IMV over the same period.Results - There were 152 admissions to cHDU over the study period. Of these, 125 received CPAP treatment. Of the patients who received support in cHDU, the overall mortality rate was 37.9% (95% CI 30.3% - 46.1%)). Odds of mortality were closely correlated with increasing age and oxygen requirement. Of the 152 patients, 44 patients (28.8%, 95% CI 22.0 – 36.9%) went on to require IMV in ICU. This represents 77.2% of the 57 COVID-19 admissions to ICU during the same period. However, there were also 41 patients who received levels of respiratory support on cHDU which would normally necessitate ICU admission but who never went to ICU, potentially reducing ICU admissions by 41.8% (95% CI 32.1 – 52.2%).Conclusion - Providing respiratory support in cHDU reduced the number of potential ICU admissions by 41.8%, as well as delaying IMV for over 75% of ICU admissions. This represents a significant sparing of ICU capacity at a time when IMV beds were in high demand.

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Lung transplantation for acute respiratory distress syndrome – a retrospective European Cohort Study

European Respiratory Journal ◽

10.1183/13993003.02078-2021 ◽

2021 ◽

pp. 2102078

Author(s):

Jens Gottlieb ◽

Philipp M. Lepper ◽

Cristina Berastegui ◽

Beatriz Montull ◽

Alexandra Wald ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Cohort Study ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Lung Transplantation ◽

Distress Syndrome ◽

Selection Process ◽

Multivariable Analysis ◽

Multicenter Cohort Study

BackgroundThe published experience of lung transplantation (LTX) in acute respiratory distress syndrome (ARDS) is limited. The aim of this study was to investigate the contemporary results of LTX attempts in ARDS in major European centers.MethodsWe conducted a retrospective multicenter cohort study of all patients listed for LTX between 2011 and 2019. We surveyed 68 centers in 22 European countries. All patients admitted to the waitlist for lung transplantation with a diagnosis of “ARDS//pneumonia” were included. Patients without extracorporeal membrane oxygenation (ECMO) or mechanical ventilation were excluded. Patients were followed until October 1st 2020 or death. Multivariable analysis for 1-year survival after listing and lung transplantation were performed.ResultsForty-eight centers (74%) with a total transplant activity of 12 438 lung transplants during the 9-year period gave feedback. Forty patients with a median age of 35 years were identified. Patients were listed for LTX in 18 different centers in 10 countries. Thirty-one-patients underwent LTX (0·25% of all indications) and 9 patients died on the waitlist. Ninety percent of transplanted patients were on ECMO in combination with mechanical ventilation before LTX. On multivariable analysis, transplantation during 2015 until 2019 was independently associated with better 1-year survival after LTX (odds ratio 10.493, 95% CI 1.977, 55.705, p=0.006). Sixteen survivors out of 23 patients with known status (70%) returned to work after LTX.ConclusionLTX in highly selected ARDS patients is feasible and outcome has improved in the modern era. The selection process remains ethically and technically challenging.

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RISK OF RECURRENT RESPIRATORY FAILURE SUBSEQUENT TO SUCCESSFUL WEANING FROM INVASIVE MECHANICAL VENTILATION INITIATED FOR NON-SURGICAL REASONS: A NATIONWIDE COHORT STUDY

Respirology ◽

10.1111/resp.13420_136 ◽

2018 ◽

Vol 23 ◽

pp. 139-139

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Respiratory Failure ◽

Invasive Mechanical Ventilation ◽

Successful Weaning

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Psychiatric disorders and psychological distress in patients undergoing evaluation for lung transplantation: a national cohort study

General Hospital Psychiatry ◽

10.1016/j.genhosppsych.2016.07.001 ◽

2016 ◽

Vol 42 ◽

pp. 67-73 ◽

Cited By ~ 13

Author(s):

Torunn S. Søyseth ◽

May-Brit Lund ◽

Øystein Bjørtuft ◽

Aasta Heldal ◽

Vidar Søyseth ◽

...

Keyword(s):

Cohort Study ◽

Psychological Distress ◽

Lung Transplantation ◽

Psychiatric Disorders ◽

National Cohort

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Prognosis of patients with COVID-19 admitted to a tertiary center in Chile: A cohort study

Medwave ◽

10.5867/medwave.2020.10.8066 ◽

2020 ◽

Vol 20 (10) ◽

pp. e8066-e8066

Author(s):

Miguel Araujo ◽

Paola Ossandón ◽

Ana María Abarca ◽

Ana María Menjiba ◽

Ana María Muñoz

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Intensive Care ◽

Invasive Mechanical Ventilation ◽

Case Fatality ◽

Logistic Regression Models ◽

Reactive Protein ◽

Tertiary Center ◽

History Of ◽

Blood Gas Parameters

Introduction Since the beginning of the COVID-19 pandemic, extensive research has been done on the prognosis of patients with SARS-CoV-2 associated with age, biodemographic conditions, comorbidities, social factors, clinical parameters, inflammatory blood markers, coagulation, biochemical and blood gas parameters, among others. Few studies have addressed this problem in Latin America, so it is of interest to know how the disease plays out in this region. Objective The purpose of our study is to evaluate the course of COVID-19 in patients admitted to a tertiary center in Chile and to assess factors measured close to hospital admission that may be associated with death and the need for invasive mechanical ventilation. Methods We did a retrospective cohort study at Indisa Clinic in Santiago, Chile. We included all patients aged 15 years and older hospitalized between March 11 and July 25, 2020. Hospital mortality and severity of the cases were analyzed, and logistic regression models were applied to identify predictors of outcome variables. Results The sample included 785 subjects. The mean age was 59 years, 59% were men, and 61.3% had comorbidities. Forty five per cent required intensive care, and 24% invasive mechanical ventilation. The overall hospital fatality rate was 18.7%. In intensive care patients, the case fatality was 32.1%, and in those who received invasive mechanical ventilation, it was 59.4%. Independent risk factors for death included age (odds ratio 1.09; 95% confidence interval: 1.07 to 1.12), diabetes (1.68; 1.06 to 2.67), chronic lung disease (2.80; 1.48 to 5.28), increased C-reactive protein, creatinine, and ferritin. No association with sex, public health insurance, history of heart disease, oxygen saturation upon admission, or D-dimer was found. Similar factors were predictors of invasive mechanical ventilation. Discussion The prognosis and predictive factors in this cohort of patients hospitalized in Chile for COVID-19 were comparable to those reported in similar studies from higher-income countries. Male sex was not associated with a poor prognosis in this group of patients.

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