51: INCREASED RISK OF MENTAL DISORDERS ASSOCIATED WITH CHILDHOOD INVASIVE MECHANICAL VENTILATION

Introduction: Given the high prevalence of obesity around the globe, patients with coronavirus disease 2019 (COVID-19) are at an increased risk of devastating complications. Hypothesis: We hypothesize that morbid obesity is independently associated with increased risk of in-hospital mortality, upgrade to intensive care unit, invasive mechanical ventilation(IVM), and acute renal failure necessitating dialysis. Methods: A retrospective cohort study was performed to determine the association of basal metabolic index (BMI) with the above-mentioned outcomes. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI), respectively. Results: A total of 176 patients with confirmed COVID-19 diagnosis were included. The mean age was 62.2 years, with 51% of male patients. The mean BMI for non-surviving patients was significantly higher compared to patients surviving on the 7th day of hospitalization (35 vs. 30 kg/m2, p=0.022) and patients with a higher BMI had higher in-hospital mortality (21% vs. 9%, OR 3.2, 95% CI 1.3-8.2, p=0.01) compared to patients with a normal BMI. Similarly, patients requiring IMV had a higher BMI (33 vs. 29, p=0.002) compared to non-intubated patients. aOR of patients needing IMV (56% vs. 28%, OR 3.3, 95% CI 1.6-7.0, p=0.002) and upgrade to ICU (46% vs. 28%, OR 2.2, 1.07-4.6, p=0.04) were significantly higher compared to patients with a lower BMI. There was no significant difference between the two groups in terms of the need for dialysis (5% vs. 13%, OR 3.8, 13% vs. 4%, 1.1-14.1, p=0.07). Adjusted odds ratios controlled for baseline comorbidities and medications mirrored the overall results, except for the need to upgrade to ICU. Conclusions: In patients with confirmed COVID-19, morbid obesity serves as an independent risk factor of high in-hospital mortality and the need for invasive mechanical ventilation.

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Intensive Care Unit Admission, Mechanical Ventilation, and Mortality Among Patients With Type 1 Diabetes Hospitalized for COVID-19 in the U.S.

10.2337/figshare.14611149 ◽

2021 ◽

Author(s):

Catherine E. Barrett ◽

Joohyun Park ◽

Lyudmyla Kompaniyets ◽

James Baggs ◽

Yiling J. Cheng ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Type 1 Diabetes ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Absolute Risk ◽

Invasive Mechanical Ventilation ◽

Logistic Models ◽

Increased Risk

Objective. To assess whether risk of severe outcomes among patients with type 1 diabetes (T1DM) hospitalized for COVID-19 differs from patients without diabetes (DM) or with type 2 diabetes (T2DM). Research Design and Methods. Using the Premier Healthcare Special COVID-19 Release Database records of patients discharged after COVID-19 hospitalization from US hospitals from March to November 2020 (N=269,674, after exclusion), we estimated risk differences (RD) and risk ratios (RR) of intensive care unit admission or invasive mechanical ventilation (ICU/MV) and of death among patients with T1DM compared with patients without DM or with T2DM. Logistic models were adjusted for age, sex, and race or ethnicity. Models adjusted for additional demographic and clinical characteristics were used to examine whether other factors account for the associations between T1DM and severe COVID-19 outcomes. Results. Compared with patients without DM, T1DM was associated with a 21% higher absolute risk of ICU/MV (RD = 0.21, 95% Confidence Interval [CI]=0.19–0.24; RR=1.49, 95% CI=1.43–1.56) and a 5% higher absolute risk of mortality (RD=0.05, 95% CI=0.03–0.07; RR=1.40, 95% CI=1.24–1.57), adjusting for age, sex, and race or ethnicity. Compared with patients with T2DM, T1DM was associated with a 9% higher absolute risk of ICU/MV (RD=0.09, 95% CI=0.07–0.12; RR=1.17, 95% CI=1.12–1.22), but no difference in mortality (RD=0.00, 95% CI=-0.02–0.02; RR=1.00, 95% CI=0.89–1.13). After adjustment for diabetic ketoacidosis (DKA) occurring before or at COVID-19 diagnosis, patients with T1DM no longer had increased risk of ICU/MV (RD=0.01, 95% CI=-0.01–0.03) and had lower mortality (RD=-0.03, 95% CI=-0.05– -0.01) compared to patients with T2DM. Conclusions. Patients with T1DM hospitalized for COVID-19 are at higher risk for severe outcomes than those without DM. Higher ICU/MV risk compared with patients with T2DM was largely accounted for by the presence of DKA. These findings might further guide recommendations related to DM management and the prevention of COVID-19.

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Association between Prolonged Intermittent Renal Replacement Therapy and All-Cause Mortality in COVID-19 Patients Undergoing Invasive Mechanical Ventilation: a Retrospective Cohort Study

10.1101/2020.03.16.20036780 ◽

2020 ◽

Cited By ~ 5

Author(s):

Yi Yang ◽

Jia Shi ◽

Shuwang Ge ◽

Shuiming Guo ◽

Xue Xing ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Invasive Mechanical Ventilation ◽

Risk Of Mortality ◽

Increased Risk ◽

Intermittent Renal Replacement Therapy

AbstractBackgroundFor the coronavirus disease 2019 (COVID-19), critically ill patients had a high mortality rate. We aimed to assess the association between prolonged intermittent renal replacement therapy (PIRRT) and mortality in patients with COVID-19 undergoing invasive mechanical ventilation.MethodsIn this retrospective cohort study, we included all patients with COVID-19 undergoing invasive mechanical ventilation from February 12nd to March 2nd, 2020. All patients were followed until death or March 28th, and all survivors were followed for at least 30 days.ResultsFor 36 hospitalized COVID-19 patients with invasive mechanical ventilation, the mean age was 69.4 (± 10.8) years, and 30 patients (83.3%) were men. Twenty-two (61.1%) patients received PIRRT (PIRRT group) and 14 cases (38.9%) were managed with conventional strategy (non-PIRRT group). There were no differences in age, sex, comorbidities, complications, treatments and most of the laboratory findings. During median follow-up period of 9.5 (interquartile range 4.3-33.5) days, 13 of 22 (59.1%) patients in the PIRRT group and 11 of 14 (78.6%) patients in the non-PIRRT group died. Kaplan-Meier analysis demonstrated prolonged survival in patients in the PIRRT group compared with that in the non-PIRRT group (P = 0.042). The association between PIRRT and a reduced risk of mortality remained significant in three different models, with adjusted hazard ratios varying from 0.332 to 0.398. Higher levels of IL-2 receptor, TNF-α, procalcitonin, prothrombin time, and NT-proBNP were significantly associated with an increased risk of mortality in patients with PIRRT.ConclusionPIRRT may be beneficial for the treatment of COVID-19 patients with invasive mechanical ventilation. Further prospective multicenter studies with larger sample sizes are required.

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Prognostic Role of Malnutrition Diagnosed by Bioelectrical Impedance Vector Analysis in Older Adults Hospitalized with COVID-19 Pneumonia: A Prospective Study

Nutrients ◽

10.3390/nu13114085 ◽

2021 ◽

Vol 13 (11) ◽

pp. 4085

Author(s):

Andrea Da Porto ◽

Carlo Tascini ◽

Maddalena Peghin ◽

Emanuela Sozio ◽

Gianluca Colussi ◽

...

Keyword(s):

Mechanical Ventilation ◽

Nutritional Status ◽

Hospital Stay ◽

Invasive Mechanical Ventilation ◽

Bioelectrical Impedance ◽

Vector Analysis ◽

Bioelectrical Impedance Vector Analysis ◽

Increased Risk ◽

Impedance Vector ◽

A Prospective Study

Background: Little is known on the clinical relevance of the nutritional status and body composition of patients hospitalized with SARS-CoV-2 infection. The aim of our study was to assess the prevalence of malnutrition in patients with COVID-19 pneumonia using bioelectrical impedance vector analysis (BIVA), and to evaluate the relationship of their nutritional status with the severity and outcome of disease. Methods: Among 150 consecutive patients who were hospitalized with COVID-19 pneumonia, 37 (24.3%) were classified as malnourished by BIVA, and were followed-up for 60 days from admission. Outcome measures were differences in the need for invasive mechanical ventilation, in-hospital mortality, and the duration of hospital stay in survivors. Results: During 60 days of follow-up, 10 (27%) malnourished patients and 13 (12%) non-malnourished patients required invasive mechanical ventilation (p = 0.023), and 13 (35%) malnourished patients and 9 (8%) non-malnourished patients died (p < 0.001). The average duration of the hospital stay in survivors was longer in patients with malnutrition (18.2 ± 15.7 vs. 13.2 ± 14.8 days, p < 0.001). In survival analyses, mechanical ventilation free (log-rank 7.887, p = 0.050) and overall (log-rank 17.886, p < 0.001) survival were significantly longer in non-malnourished than malnourished patients. The Cox proportional ratio showed that malnutrition was associated with an increased risk of mechanical ventilation (HR 4.375, p = 0.004) and death (HR 4.478, p = 0.004) after adjusting for major confounders such as age, sex, and BMI. Conclusions: Malnutrition diagnosed with BIVA was associated with worse outcomes in hospitalized patients with COVID-19 pneumonia.

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Non-invasive ventilation in the treatment of severe polymicrobial community-acquired pneumonia

Italian Journal of Medicine ◽

10.4081/itjm.2017.675 ◽

2017 ◽

Vol 11 (1) ◽

pp. 57

Author(s):

Enrico Cinque ◽

Ines Maria Grazia Piroddi ◽

Cornelius Barlascini ◽

Alessandro Perazzo ◽

Antonello Nicolini

Keyword(s):

Mechanical Ventilation ◽

Severe Disease ◽

Invasive Mechanical Ventilation ◽

Clinical Signs ◽

Case Series ◽

Community Acquired Pneumonia ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Increased Risk

Polymicrobial pneumonia may be caused by the combination of respiratory viruses, bacteria and fungi in a host. Colonization by Streptococcus pneumoniae was associated with increased risk of Intensive Care Unit admission or death in the setting of influenza infection, whereas the colonization by methicillin sensible Staphylococcus aureus co-infection was associated with severe disease and death in adults and children. The principal association of pathogens in community-acquired pneumonia (CAP) is bacteria and viral co-infection, and accounts approximately for 39% of microbiological diagnosed cases of CAP. The differential clinical diagnosis between a viral and a bacterial CAP is not easy: no clinical signs or radiological findings help the clinician to suspect to the diagnosis. Patients with polymicrobial infections are more likely to have underlying medical conditions and have more severe outcome. Severe respiratory failure and need of mechanical ventilation occur in several cases. Non invasive ventilation (NIV) use aims to avoid invasive mechanical ventilation. NIV treatment is controversial owing to high reported treatment failure. In this case series we report three cases of severe polymicrobial CAP: all of them required NIV with a good outcome.

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Invasive mechanical ventilation for people with severe mental disorders: recent trends in incidence and in-hospital mortality

Intensive Care Medicine ◽

10.1007/s00134-019-05850-4 ◽

2019 ◽

Vol 46 (1) ◽

pp. 143-144

Author(s):

Gonzalo Martínez-Alés ◽

Teresa López-Cuadrado ◽

Mark Olfson ◽

Carmen Bouza

Keyword(s):

Mechanical Ventilation ◽

Mental Disorders ◽

Hospital Mortality ◽

Invasive Mechanical Ventilation ◽

Severe Mental Disorders ◽

Recent Trends

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Higher Levels of C-Reactive Protein and Ferritin in Patients with Overweight and Obesity and SARS-CoV-2-Related Pneumonia

Obesity Facts ◽

10.1159/000517851 ◽

2021 ◽

pp. 1-7

Author(s):

Silvia Bettini ◽

Giovanni Bucca ◽

Caterina Sensi ◽

Chiara Dal Prà ◽

Roberto Fabris ◽

...

Keyword(s):

Mechanical Ventilation ◽

Adipose Tissue ◽

Hospital Stay ◽

Invasive Mechanical Ventilation ◽

Normal Weight ◽

Overweight And Obesity ◽

Cytokine Storm ◽

C Reactive Protein ◽

Reactive Protein ◽

Increased Risk

Introduction: Overweight and obesity are associated with a more severe COronaVirus Disease 19 (COVID-19). Adipose tissue-related chronic inflammation could be a promoter for the occurrence of the cytokine storm that predicts aggravation of COVID-19. The primary aim was to investigate if this increased risk for more severe COVID-19 was associated with a higher inflammatory response. Methods: We enrolled patients <75 years old hospitalized in a medical COVID-19 ward with SARS-CoV-2-related pneumonia. Patients were classified according to BMI as normal weight, overweight, and obesity. Laboratory parameters were measured at admission and every second day during the hospital stay. Results: Ninety patients (64.4% males; median age 61 years) were enrolled. Invasive mechanical ventilation (IMV) was needed in 9% of the patients with normal weight, in 32.4% of the patients with overweight, and in 12.9% of the patients with obesity (p = 0.045). Maximal C-reactive protein (CRP) level during hospital stay was 92 (48–122) mg/L in patients with normal weight, 140 (82–265) mg/L in patients with overweight, and 117 (67–160) mg/L in patients with obesity (p = 0.037). Maximal ferritin values were 564 (403–1,379) μg/L in patients with a normal weight, 1,253 (754–2,532) μg/L in patients with overweight, and 828 (279–1,582) μg/L in patients with obesity (p = 0.015). Conclusion: Patients with overweight and obesity required more IMV and had higher peaks of CRP and ferritin than patients with normal weight during COVID-19.

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The effect of the physiological reserve surrogate characteristics on non-airway extubation failure in patients with pneumonia with high Burns wean assessment program scores

10.22514/sv.2021.094 ◽

2021 ◽

Keyword(s):

Mechanical Ventilation ◽

Invasive Mechanical Ventilation ◽

Extubation Failure ◽

Airway Extubation ◽

Assessment Program ◽

Increased Risk ◽

Successful Weaning ◽

History Of ◽

Physiological Reserve ◽

Baseline Characteristics

Objectives: A successful weaning prediction score could be a useful tool to predict non-airway extubation failure. However, it may carry some challenges without considering the effect of the physiological reserve on the sustainability of extubation. This study investigated the possible correlation between the physiological reserve surrogate characteristics including acute, baseline, and biochemical patients’ factors and non-airway extubation failure in patients with pneumonia. Methods: A retrospective cohort study at two academic teaching hospitals was conducted between January 2019 and January 2020 with patients with pneumonia requiring invasive mechanical ventilation and with Burns Wean Assessment Program (BWAP) scores equal to or exceeding 50. Acute clinical, biochemical, and baseline characteristics were collected for both successful and failed non-airway extubation patients. Results: Among 313 patients, the mean age was 63.63 ± 10.44 years and most of the patients were males (60.7%). The median invasive mechanical duration was 7 days [Interquartile range (IQR): 5–12], the median length of ICU stay was 12 [IQR: 6–23] and the in-hospital mortality was 16.9%. Among this cohort of patients with pneumonia, 37.7% had non-airway extubation failure. Multivariate logistic regression analyses showed that higher CURB-65 score, longer duration of invasive mechanical ventilation, hemodynamic instability, healthcare-associated pneumonia, older men, history of diabetes mellitus, history of cardiac disease, hypophosphatemia, hypocalcemia, and higher admission serum sodium were associated with increased risk of non-airway extubation failure in patients with pneumonia with high BWAP score. Conclusion: A distinct successful weaning score for patients with pneumonia that considers patients’ acute clinical, biochemical, and baseline characteristics may be effective, and these factors could be reflective of the underlying physiological reserve. Sustainability score from IMV rather than weaning score is needed and may be more predictive for the extubation outcome.

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Increased Risk of Severe COVID-19 Disease in Pregnancy in a Multicenter Propensity Score-Matched Study.

10.1101/2021.06.18.21258899 ◽

2021 ◽

Author(s):

Liviu Cojocaru ◽

Myint Noe ◽

Autusa Pahlavan ◽

Alissa Werzen ◽

Hyunuk Seung ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Propensity Score ◽

Disease Severity ◽

Clinical Course ◽

Invasive Mechanical Ventilation ◽

Oxygen Supplementation ◽

Increased Risk ◽

Matched Study ◽

In Pregnancy

Background: Respiratory infections have long been associated with higher maternal and perinatal morbidity. Early data did not report an increased risk of SARS-CoV-2 infection or disease severity in pregnancy. However, surveillance data from the Center for Disease Control and Prevention (CDC) indicates a higher risk of severe disease and death in pregnant women with symptomatic SARS-CoV-2 infection, although this data is subject to ascertainment bias. Objective: To explore the association between COVID-19 disease severity and pregnancy in our university-based hospital system using measures such as COVID-19 ordinal scale severity score, hospitalization, intensive care unit admission, oxygen supplementation, invasive mechanical ventilation, and death. Study design: We conducted a retrospective, multicenter case-control study to understand the association between COVID-19 disease severity and pregnancy. We reviewed consecutive charts of adult females, ages 18-45, with laboratory-confirmed SARS-CoV-2 infection in six months between March 1, 2020, and August 31, 2020. Cases were patients diagnosed with COVID-19 during pregnancy, whereas controls were not pregnant at the time of COVID-19 diagnosis. Primary endpoints were the COVID-19 severity score at presentation (within four hours) and the nadir of the clinical course. The secondary endpoints were the proportion of patients requiring hospitalization, intensive care unit admission, oxygen supplementation, invasive mechanical ventilation, and death. Results: A higher proportion of pregnant women had moderate to severe COVID-19 disease at the nadir of the clinical course than nonpregnant women (25% vs. 16.1%, p=0.04, respectively). While there was a higher rate of hospitalization (25.6% vs. 17.2%), ICU admission (8.9% vs. 4.4%), need for vasoactive substances (5.0% vs. 2.8%), and invasive mechanical ventilation (5.6% vs. 2.8%) in the pregnant group, this difference was not significant after the propensity score matching was applied. We found a high rate of pregnancy complications in our population (40.7%). The most worrisome is the rate of hypertensive disorders of pregnancy (20.1%). Conclusions: In our propensity score-matched study, COVID-19 in pregnancy is associated with an increased risk of disease severity and an increased risk of pregnancy complications.

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Ventilator Liberation Strategies

10.1093/med/9780199653461.003.0039 ◽

2014 ◽

Author(s):

Stefano Nava ◽

Luca Fasano

Keyword(s):

Mechanical Ventilation ◽

Clinical Decision Making ◽

Prolonged Mechanical Ventilation ◽

Invasive Mechanical Ventilation ◽

Respiratory Muscles ◽

Clinical Decision ◽

Fully Integrated ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Increased Risk

The weaning process should ideally begin as soon as the patient is intubated and continue through the treatment of the cause inducing acute respiratory failure. Weaning includes the assessment of readiness to extubate, extubation, and post-extubation monitoring; it also includes consideration of non-invasive ventilation which has been shown to reduce the duration of invasive mechanical ventilation in selected patients. Weaning accounts for approximately 40% of the total time spent on mechanical ventilation and should be achieved rapidly, since prolonged mechanical ventilation is associated with increased risk of complications and mortality and with increased costs. During mechanical ventilation, medical management should seek to correct the imbalance between respiratory load and ventilatory capacity (reducing the respiratory and cardiac workload, improving gas exchange and the ventilatory pump power). Ventilator settings delivering partial ventilatory pump support may help prevent ventilator-induced respiratory muscles dysfunction. Daily interruption of sedation has been associated with earlier extubation. Critically ill patients should be repeatedly and carefully screened for readiness to wean and readiness to extubate, and objective screening variables should be fully integrated in clinical decision making.

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