scholarly journals 375. COVID 19 infection in a Massachusetts community hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S257-S258
Author(s):  
Raul Davaro ◽  
alwyn rapose
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Essential Hypertension ◽  
Severe Acute Respiratory Syndrome ◽  
High Mortality ◽  
Case Series ◽  
World Health ◽  
Minimal Risk ◽  
The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

scholarly journals Adverse Outcomes in Pregnant Women Hospitalized With Respiratory Syncytial Virus Infection: A Case Series

2020 ◽  
Author(s):  
Anne M Hause ◽  
Lakshmi Panagiotakopoulos ◽  
Eric S Weintraub ◽  
Lina S Sy ◽  
Sungching C Glenn ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Syncytial Virus ◽  
Respiratory Failure ◽  
Virus Infection ◽  
Respiratory Syncytial Virus Infection ◽  
Case Series ◽  
Adverse Outcomes ◽  
Syncytial Virus

Abstract We identified 10 women hospitalized with respiratory syncytial virus infection during pregnancy. Diagnoses included pneumonia/atelectasis (5), respiratory failure (2), and sepsis (2). Six had obstetrical complications during hospitalization, including 1 induced preterm birth. One required intensive care unit admission and mechanical ventilation. Four infants had complications at birth.

scholarly journals Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Andrei Karpov ◽  
Anish R. Mitra ◽  
Sarah Crowe ◽  
Gregory Haljan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Respiratory Rate ◽  
Prolonged Mechanical Ventilation ◽  
Case Series ◽  
Prone Positioning ◽  
Retrospective Case ◽  
Number Of Patients

Objective and Rationale. Prone positioning of nonintubated patients has prevented intubation and mechanical ventilation in patients with respiratory failure from coronavirus disease 2019 (COVID-19). A number of patients in a recently published cohort have undergone postextubation prone positioning (PEPP) following liberation from prolonged mechanical ventilation in attempt to prevent reintubation. The objective of this study is to systematically search the literature for reports of PEPP as well as describe the feasibility and outcomes of PEPP in patients with COVID-19 respiratory failure. Design. This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team. Conclusions. The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.

The impact of time to tracheostomy on mechanical ventilation duration, length of stay, and mortality in intensive care unit patients

2009 ◽  
Vol 24 (3) ◽  
pp. 435-440 ◽  
Author(s):  
Yaseen M. Arabi ◽  
Jamal A. Alhashemi ◽  
Hani M. Tamim ◽  
Andres Esteban ◽  
Samir H. Haddad ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
The Impact

Use of a Nutrition Support Protocol to Increase Enteral Nutrition Delivery in Critically Ill Patients

2014 ◽  
Vol 23 (5) ◽  
pp. 396-403 ◽  
Author(s):  
Friederike Compton ◽  
Christian Bojarski ◽  
Britta Siegmund ◽  
Markus van der Giet
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Invasive Mechanical Ventilation ◽  
Nutrition Support ◽  
Early Enteral Nutrition ◽  
Feeding Tubes ◽  
Enteral Nutrition Support ◽  
The Impact

BackgroundEarly enteral nutrition is recommended for patients in intensive care units, but nutrition provision is often hindered by a variety of unit-specific problems.ObjectivesTo evaluate the impact of a nutrition support protocol on nutrition prescription and delivery in the intensive care unit.MethodsNutrition-related data from 73 patients receiving mechanical ventilation who were treated in an adult medical intensive care unit before introduction of an enteral nutrition support protocol were retrospectively compared with data for 87 patients admitted after implementation of the protocol.ResultsAfter implementation of the protocol, enteral nutrition was started significantly earlier (P = .007) and enteral feeding goals were reached significantly faster (6 vs 10 days, P < .001) than before. Prescription of enteral nutrition on the first day of invasive mechanical ventilation increased from 38% before to 54% after (P = .03) implementation of the protocol. Prescribed and delivered nutrition doses on the first 2 days of mechanical ventilation also increased significantly (P < .001) after the protocol was implemented. Nasojejunal feeding tubes were used in 52% of patients before and 56% of patients after protocol implementation P = .63). Jejunal tubes were placed earlier after the protocol was implemented than before (median 5 vs 6.5 days), and when a jejunal tube was in place, feeding goals were reached faster (median 2 vs 3 days, P = .002).ConclusionImplementing an enteral nutrition support protocol shortened the time to reach feeding goals. Jejunal feeding tubes were necessary in more than half of the patients, and with a jejunal feeding tube in place, feeding goals were reached rapidly.

scholarly journals The Impact of Hyperoxia on Outcome of Patients Treated with Noninvasive Respiratory Support

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Seyhan Pala Cifci ◽  
Yasemin Urcan Tapan ◽  
Bengu Turemis Erkul ◽  
Yusuf Savran ◽  
Bilgin Comert
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
High Flow Oxygen ◽  
The Impact

Objective. Oxygen therapy is one of the most common treatment modalities for hypoxemic patients, but target goals for normoxemia are not clearly defined. Therefore, iatrogenic hyperoxia is a very common situation. The results from the recent clinical researches about hyperoxia indicate that hyperoxia can be related to worse outcomes than expected in some critically ill patients. According to our literature knowledge, there are not any reports researching the effect of hyperoxia on clinical course of patients who are not treated with invasive mechanical ventilation. In this study, we aimed to determine the effect of hyperoxia on mortality, and length of stay and also possible side effects of hyperoxia on the patients who are treated with oxygen by noninvasive devices. Materials and Methods. One hundred and eighty-seven patients who met inclusion criteria, treated in Dokuz Eylul University Medical Intensive Care Unit between January 1, 2016, and October 31, 2018, were examined retrospectively. These patients’ demographic data, oxygen saturation (SpO2) values for the first 24 hours, APACHE II (Acute Physiology and Chronic Health Evaluation II) scores, whether they needed intubation, if they did how many days they got ventilated, length of stay in intensive care unit and hospital, maximum PaO2 values of the first day, oxygen treatment method of the first 24 hours, and the rates of mortality were recorded. Results. Hyperoxemia was determined in 62 of 187 patients who were not treated with invasive mechanic ventilation in the first 24 hours of admission. Upon further investigation of the relation between comorbid situations and hyperoxia, hyperoxia frequency in patients with COPD was detected to be statistically low (16% vs. 35%, p<0.008). Hospital mortality was significantly high (51.6% vs. 35.2%, p<0.04) in patients with hyperoxia. When the types of oxygen support therapies were investigated, hyperoxia frequency was found higher in patients treated with supplemental oxygen (nasal cannula, oronasal mask, high flow oxygen therapy) than patients treated with NIMV (44.2% vs. 25.5%, p<0.008). After exclusion of 56 patients who were intubated and treated with invasive mechanical ventilation after the first 24 hours, hyperoxemia was determined in 46 of 131 patients. Mortality in patients with hyperoxemia who were not treated with invasive mechanical ventilation during hospital stay was statistically higher when compared to normoxemic patients (41.3% vs 15.3%, p<0.001). Conclusion. We report that hyperoxemia increases the hospital mortality in patients treated with noninvasive respiratory support. At the same time, we determined that hyperoxemia frequency was lower in COPD patients and the ones treated with NIMV. Conservative oxygen therapy strategy can be suggested to decrease the hyperoxia prevalence and mortality rates.

The swallowing telerehabilitation in COVID-19 (Preprint)

2020 ◽  
Author(s):  
Tomoo Mano ◽  
Shigeto Soyama
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Protective Equipment ◽  
Video Conference ◽  
Rehabilitation Professionals ◽  
Swallowing Rehabilitation ◽  
Swallowing Difficulty ◽  
The Individual

UNSTRUCTURED Direct swallowing rehabilitation is not recommended for patients who is positive or suspected for the severe acute respiratory syndrome coronavirus 2（SARS-CoV-2），because SARS-CoV-2 is extremely infectious and may transmit to the individual performing rehabilitation. Some of patients in the intensive care unit and on mechanical ventilation undergo the swallowing difficulty. To feed normally again and be discharged, an assessment of dysphagia and eventual targeted swallowing training by specialized rehabilitation professionals are provided. We analysis the benefit of telerehabilitation, and we experienced the case with COVID-19 of contactless swallowing rehabilitation using video conference software on the tablet-type devices. Telerehabilitation offers the risk reduction of infection and the prevention the shortage of personal protective equipment. Protecting the medical staff from nosocomial infection of COVID-19 is therefore extremely important, and we suggest telerehabilitation as a useful approach in the swallowing rehabilitation.

scholarly journals Epidemiology, Prognosis, and Evolution of Management of Septic Shock in a French Intensive Care Unit: A Five Years Survey

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Nicolas Boussekey ◽  
Juliette Cantrel ◽  
Lise Dorchin Debrabant ◽  
Joachim Langlois ◽  
Patick Devos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
High Mortality ◽  
Mortality Risk ◽  
Simplify Acute Physiology Score ◽  
Chronic Alcoholism ◽  
New Approach

Purpose. To evaluate the epidemiology, prognosis, and management of septic shock patients hospitalized in our intensive care unit (ICU).Materiel and Methods. Five-year monocenter observational study including 320 patients.Results. ICU mortality was 54.4%. Independent mortality risk factors were mechanical ventilation (), Simplify Acute Physiology Score (SAPS) II > 60 (), chronic alcoholism (), age >65 years (), prothrombin ratio <40% (), and ratio <150 (). These six mortality risk factors recovered allow screening immediately septic shock patients with a high mortality risk. Morbidity improved with time (diminution of septic shock complications, increase of the number of days alive free from mechanical ventilation and vasopressors on day 28), concomitant to an evolution of the management (earlier institution of all replacement and medical therapies and more initial volume expansion). There was no difference in mortality.Conclusion. Our study confirms a high mortality rate in septic shock patients despite a new approach of treatment.

scholarly journals Optimal Nutritional Factors Influencing the Duration of Mechanical Ventilation Among Adult Patients with Critical Illnesses in an Intensive Care Unit

2021 ◽  
Author(s):  
Apinya Koontalay ◽  
Wanich Suksatan ◽  
Jonaid M Sadang ◽  
Kantapong Prabsangob
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Nutritional Status ◽  
Nutritional Factors ◽  
Factors Influencing ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
Critical Patients ◽  
The Impact

Objective: This study aims to identify the impact of nutritional factors on mechanical ventilation duration for critical patients. Patients and Methods: The current study was a single-center, prospective observational design which enrolled one-hundred critically ill patients who were admitted to an intensive care unit (ICU). It demonstrates purposive sampling and also performs the descriptive nutritional factors influencing the mechanical ventilation duration. Daily calories target requirement scale (DCRS), subjective global assessment form (SGA), dyspnea assessment form, and APACHE II have been used as methods in the study along with time to initial enteral nutrition (EN) after 24-hour admission and daily calories target requirement over 7 days to assess patients. Data is analyzed using the multiple regressions. Results: As a result, nutritional status monitoring, time to initial EN, calories and target requirements are statistically positive significance associated with the mechanical ventilation duration respectively (R = 0.54, R = 0.30, R= 0.40, p &lt; 0.05). However, age, illness severity, and dyspnea scales are not associated with the mechanical ventilation duration (p&gt; 0.05). Therefore, the nutritional status, malnutrition scores and calorie target requirements can be used to significantly predict the mechanical ventilation duration. The predictive power is 58 and 28.0% of variance. The most proper influencer to predict the mechanical ventilation duration is nutritional status or malnutrition scores. Conclusion: The research findings show that the nutritional status, time to initial EN, and calorie target requirement within 7 days of admission are associated with the mechanical ventilation duration in the critical patients. Therefore, it can be used to develop guidelines reducing the mechanical ventilation duration and to promote the ventilator halting for critical patients.

Sound Levels, Staff Perceptions, and Patient Outcomes During Renovation Near the Neonatal Intensive Care Unit

2012 ◽  
Vol 5 (4) ◽  
pp. 76-87 ◽  
Author(s):  
Amber W. Trickey ◽  
Cody C. Arnold ◽  
Ankit Parmar ◽  
Robert E. Lasky
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Patient Outcomes ◽  
Neonatal Intensive Care ◽  
Staff Perceptions ◽  
Total Period ◽  
Sound Levels ◽  
The Impact

Objective: Sound levels, staff perceptions, and patient outcomes were evaluated during a year-long hospital renovation project on the floor above a neonatal intensive care unit (NICU). Background: Construction noise may be detrimental to NICU patients and healthcare professionals. There are no comprehensive studies evaluating the impact of hospital construction on sound levels, staff, and patients. Methods: Prospective observational study comparing sound measures and patient outcomes before, during, and after construction. Staff were surveyed about the construction noise, and hospital employee satisfaction scores are reported. Results: Equivalent sound levels were not significantly higher during construction. Most staff members (89%) perceived the renovation period as louder, and 83% reported interruptions of their work. Patient outcomes were the same or more positive during construction. Very low birth weight (VLBW infants were less likely to require 24+ hours' mechanical ventilation during construction: 54% vs. 59% before ( OR = 1.6, p = 0.018) and 62% after ( OR = 1.48, p = 0.065); and they required a shorter total period of mechanical ventilation: 3.6 days vs. 8.0 before ( p = 0.011) and 9.5 after ( p = 0.001). VLBW newborns' differences in ventilation days were mostly in the upper extremes; medians were similar in all periods: 0.6 days vs. 1 day preconstruction and 2 days postconstruction. Conclusions: Construction above the NICU did not cause substantially louder sound levels, but staff perceived important changes in noise and work routines. No evidence suggested that patients were negatively affected by the renovation period. Meticulous construction planning remains necessary to avoid interference with patient care and caregiver work environments.

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