Structure and predictors of repolarization disorders in patients with severe COVID-19 infection

Abstract Background COVID-19 infection can adversely affect the function of cardiac ion channels, leading to changes of the properties of conductivity and repolarization, which increases arrhythmogenesis. Purpose To determine the features of the structure and predictors of repolarization disorders in the patients with severe COVID-infection. Methods 133 patients with severe COVID-19 infection were examined, who were in the intensive care unit of the clinical hospital No. 1 in our city in the period from April to December 2020 and as a result of treatment with improved health were discharged from the hospital. Among them there were 65 (48.9%) men and 68 (51.1%) women (X2=0.068, p=0.79). The age of patients ranged from 24 to 90 years, averaging 61.38±12.96 years. Middle-aged and elderly patients were dominated at age structure (p=0.001). The total duration of staying in the hospital was 18.9±9.12 days. The duration of staying in the intensive care unit was 8.32±6.91 days. Statistical processing of the obtained data was performed using the statistical software package SPSS 12.0 for Windows. Results ECG analysis showed that most of the patients had various ischemic changes and/or myocardial repolarization disorders – in 119 (89.5%) patients. Thus, inversion of the T wave was registered – in 91 (68.4%), signs of early ventricular repolarization – in 14 (10.5%), elevation of ST segment – in 6 (4.5%), depression of ST segment – in 54 (40.6%), pathological Q wave – in 9 (6.8%). In turn, signs of an overload of a left ventricle (LV) – in 27 (20,3%), signs of an overload of a right ventricle (RV) – in 8 (6,0%), a sign of SIQIIITIII – in 7 (5,3%), prolongation of QT interval – in 6 (4.5%) patients, respectively. Also signs of LV hypertrophy – in 45 (33.8%), signs of RV hypertrophy – in 12 (9.0%), the presence of p-pulmonale – in 6 (4.5%), p-mitrale – in 7 (5.3%) patients, respectively. Predictors of ischemic changes and/or repolarization disorders in the patients with severe COVID infection are: a decrease of glomerular filtration rate (GFR) <60 ml/min/1.73 m2 – r=0.580, p=0.006; time of hospitalization r=−0,204, p=0,02; elderly patients – r=0,184; p=0.02. Conclusions The prevalence of ischemic changes and/or myocardial repolarization disorders according to ECG data is 89.5%. Presence of inversion of T wave (68.4%) and depression of ST segment (40.6%) were dominated in the structure of ischemic changes and/or myocardial repolarization disorders. Their predictors are: decrease of GFR <60 ml/min/1.73 m2; time of hospitalization; elderly patients. FUNDunding Acknowledgement Type of funding sources: None.

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Predictors of heart rhythm disorders in the patients with severe COVID-infection

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2020-24(4)-14 ◽

2020 ◽

Vol 24 (4) ◽

pp. 640-646

Author(s):

Y. M. Mostovoy ◽

T. D. Danilevych

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Sinus Bradycardia ◽

Statistical Processing ◽

Heart Rhythm ◽

Careful Examination ◽

Hospital Treatment ◽

St Segment ◽

Heart Rhythm Disorders ◽

The Right

Annotation. The severe course of COVID-19 infection often leads to complications of cardiovascular system. Among them, heart rhythm disorders are one of the main ones requiring careful examination and improvement of management of the patients with COVID-19 infection. The purpose of the work was to establish the probable predictors of cardiac rhythm disorders of the patients with severe COVID infection. In the study were examined 133 patients with severe COVID-19 infection, who were in the intensive care unit of the city clinical hospital №1 in Vinnytsia for 9 months 2020 and as a result of treatment with improved health were discharged from the hospital. Statistical processing of the obtained data was performed using the statistical software package SPSS 12.0 for Windows using parametric and non-parametric methods of statistical analysis. It was found that the prevalence of heart rhythm disorders in patients with severe COVID-19 is 86 (64.7%) patients. The predictors of arrhythmias were: the presence of stroke in anamnesis; acute thrombophlebitis during a hospital treatment; the term of being in the intensive care unit and the overall term of hospitalization. Among all rhythm disorders, tachyarrhythmias were in – 68 (51.1%), sinus tachycardia 45 (33.8%) and atrial fibrillation 19 (14.3%) were dominated in the structure of tachyarrhythmia. There were no significant predictors of tachyarrhythmias. The prevalence of bradyarrhythmias is 60 (45.1%), sinus bradycardia (12%) and the right branch of His bundle block – 30 (22.6%) were prevalent in the structure of bradyarrhythmias. Predictors of the bradyarrhythmias were: the presence of ischemic heart disease (IHD) in anamnesis; acute thrombophlebitis in anamnesis; diseases of the gastrointestinal tract; stroke while staying in a hospital; post-infarction cardiosclerosis; combination of arterial hypertension and IHD; the term of staying in the hospital and in the intensive care unit. Also, ECG predictors of bradyarrhythmia were: depression of the ST segment; pathological Q wave; hypertrophy of the left ventricle; hypertrophy of the right ventricle; extension of QT interval. The prevalence of violations of repolarization according to ECG were in 119 (89.5%) patients, among them the presence of inversion of T wave in 91 (68.4%) and depression of the ST segment – in 54 (40.6%) patients respectively. The predictors of which are: reducing of glomerular filtration rate <60 ml/min/1.73 m2; the duration of hospitalization; the old age of the patients.

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SARS-CoV-2 Persistent Viral Shedding in the Context of Hydroxychloroquine-Azithromycin Treatment

Viruses ◽

10.3390/v13050890 ◽

2021 ◽

Vol 13 (5) ◽

pp. 890

Author(s):

Michel Drancourt ◽

Sébastien Cortaredona ◽

Cléa Melenotte ◽

Sophie Amrane ◽

Carole Eldin ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Elderly Patients ◽

Rare Event ◽

Viral Shedding ◽

Qrt Pcr ◽

Viral Culture ◽

D Dimer

SARS-CoV-2 nasopharyngeal shedding contributes to the spread of the COVID-19 epidemic. Among 3271 COVID-19 patients treated at the Hospital University Institute Méditerranée Infection, Marseille, France from 3 March to 27 April 2020, tested at least twice by qRT-PCR, the median SARS-CoV-2 nasopharyngeal shedding duration was 6 days (range 2–54 days). Compared with short shedders (qRT-PCR positivity < 10 days), 34 (1.04%) persistent shedders (qRT-PCR positivity ≥ 17 days; mean ± SD: 23.3 ± 3.8 days) were significantly older, with associated comorbidities, exhibiting lymphopenia, eosinopenia, increased D-dimer and increased troponin (p < 0.05), and were hospitalized in intensive care unit in 17.7% vs. 1.1% of cases (p < 0.0001). Viral culture was positive in six persistent shedders after day 10, including in one patient after day 17, and no viral co-pathogen was detected in 33 tested patients. Persistent shedders received azithromycin plus hydroxychloroquine ≥ 3 days in 26/34 (76.5%) patients, a figure significantly lower than in short shedders (86.6%) (p = 0.042). Accordingly, mortality was 14.7% vs. 0.5% (p < 0.0001). Persistent shedding was significantly associated with persistent dyspnea and anosmia/ageusia (p < 0.05). In the context of COVID-19 treatment, including treatment with azithromycin plus hydroxychloroquine, the persistence of SARS-CoV-2 nasopharyngeal shedding was a rare event, most frequently encountered in elderly patients with comorbidities and lacking azithromycin plus hydroxychloroquine treatment.

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Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01842-x ◽

2021 ◽

Author(s):

Andrea Kirfel ◽

Jan Menzenbach ◽

Vera Guttenthaler ◽

Johanna Feggeler ◽

Andreas Mayr ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Elderly Patients ◽

Postoperative Delirium ◽

Confusion Assessment Method ◽

Assessment Method ◽

Hospital Length Of Stay ◽

Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

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Access to Intensive Care Unit Care for Elderly Patients with COVID-19 in Portugal

Portuguese Journal of Public Health ◽

10.1159/000511150 ◽

2020 ◽

pp. 1-3

Author(s):

Filipe S. Cardoso ◽

André Borges ◽

Isabel Botelho ◽

André Real ◽

Ana C. Araújo ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Elderly Patients ◽

Intensive Care Unit Care

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ASSISTÊNCIA DE ENFERMAGEM NOS CUIDADOS PALIATIVOS AO PACIENTE IDOSO EM UNIDADE DE TERAPIA INTENSIVA / NURSING CARE IN PALLIATIVE CARE FOR ELDERLY PATIENTS IN AN INTENSIVE CARE UNIT

Brazilian Journal of Development ◽

10.34117/bjdv6n12-648 ◽

2020 ◽

Vol 6 (12) ◽

pp. 102261-102281

Author(s):

Airton César Leite ◽

Jaiciane Jorge da Silva ◽

Maria Merciane Medeiros do nascimento Ferreira ◽

Vanessa Bonfim Mendes ◽

Lianna Emanuelli Carvalho Silva ◽

...

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Elderly Patients ◽

Nursing Care ◽

Terapia Intensiva

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Never Too Early: Parenteral Nutrition Administration in Elderly Emergency General Surgery Patients

The Journal of Nursing Home Research Sciences ◽

10.14283/jnhrs.2021.8 ◽

2021 ◽

pp. 1-8

Author(s):

A.K. Gergen ◽

P. Hosokawa ◽

C. Irwin ◽

M.J. Cohen ◽

F.L. Wright ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Enteral Nutrition ◽

Elderly Patients ◽

Parenteral Nutrition ◽

Early Initiation ◽

Unplanned Admission ◽

Emergency General Surgery ◽

Early Administration ◽

Late Initiation

Objectives: Elderly patients requiring emergency general surgery (EGS) are at high risk for complications due to preexisting malnutrition. Thus, correcting nutritional deficits perioperatively is essential to improve outcomes. However, even in patients unable to tolerate enteral nutrition, initiation of parenteral nutrition (PN) is often delayed due to concerns of associated complications. In this study, we hypothesized that in elderly EGS patients with relative short-term contraindications to enteral nutrition, early administration of PN is as safe as delayed administration. Furthermore, early PN may improve outcomes by enhancing caloric intake and combatting malnutrition in the immediate perioperative period. Design and Setting: A single-institution, retrospective review was performed at a quaternary academic medical center. Participants: Participants consisted of 58 elderly patients >65 years of age admitted to the EGS service who required PN between July 2017 and July 2020. Measurements: Postoperative outcomes of patients started on PN on hospital day 0-3 (early initiation) were compared to patients started on PN on hospital day 4 or later (late initiation). Bivariate analysis was conducted using the Chi-square or Fisher’s exact test for categorical variables and the Wilcoxon-Mann-Whitney test and F-test for continuous variables. Results: Fifty-eight patients met inclusion criteria, with 27 (46.6%) patients receiving early PN and 31 (53.4%) receiving late PN. Both groups shared similar baseline characteristics, including degree of frailty, body mass index, and nutritional status at time of admission. Complications associated with PN administration were negligible, with no instances of central venous catheter insertion-related complications, catheter-associated bloodstream infection, or factors leading to early termination of PN therapy. A significantly higher proportion of patients in the early administration group met 60% of their caloric goal within 72 hours of admission (62.9% versus 19.5%, p=0.0007). Patients receiving late PN demonstrated a significantly higher rate of unplanned admission to the intensive care unit (38.7% versus 14.8%, p=0.04). Moreover, there was a 21.5% reduction in mortality among patients in the early initiation group compared to patients in the late initiation group (33.3% versus 54.8%, p=0.10). Conclusions: Early initiation of PN in hospitalized elderly EGS patients was not associated with increased adverse events compared to patients undergoing delayed PN administration. Furthermore, patients receiving early PN demonstrated a 2.6-fold decrease in the rate of unplanned admission to the intensive care unit and trended toward improved mortality. Based on these results, further prospective studies are warranted to further explore the safety and potential benefits of early PN administration in elderly surgical patients unable to receive enteral nutrition.

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