Plasma Soluble CD14 Subtype Levels Are Associated With Clinical Outcomes in Critically Ill Subjects With Coronavirus Disease 2019

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

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Evaluation of Delirium in Critically Ill Patients Prescribed Melatonin or Ramelteon

Annals of Pharmacotherapy ◽

10.1177/10600280211002054 ◽

2021 ◽

pp. 106002802110020

Author(s):

Natasha Romero ◽

Kevin M. Dube ◽

Kenneth E. Lupi ◽

Jeremy R. DeGrado

Keyword(s):

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Receptor Agonist ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Melatonin Receptor ◽

Observational Cohort ◽

Impaired Sleep ◽

Retrospective Observational Cohort Study

Background: An impaired sleep-wake cycle may be one factor that affects the development of delirium in critically ill patients. Several small studies suggest that exogenous melatonin or ramelteon may decrease the incidence and/or duration of delirium. Objective: To compare the effect of prophylactic administration of melatonin, ramelteon, or no melatonin receptor agonist on the development of delirium in the intensive care unit (ICU). Methods: This was a single-center, retrospective, observational cohort study of nondelirious patients in the ICU who received melatonin, ramelteon, or no melatonin receptor agonist. The primary end point was the incidence of delirium. Secondary end points included assessments of daily level of sedation and daily utilization of antipsychotic, sedative, and opioid agents. Results: No difference was observed in the incidence of delirium among the melatonin, ramelteon, and placebo cohorts (18.7% vs 14.3% vs 13.8%; P = 0.77). A difference was observed in the rate of agitation and sedation among the 3 groups, with the greatest observed in the melatonin cohort. Additionally, there was a difference in the use of propofol, dexmedetomidine, and opioids. Overall, there was no difference in clinical outcomes, including duration of mechanical ventilation and ICU or hospital length of stay. Conclusion and Relevance: Therapy with melatonin, ramelteon, and no melatonin receptor agonist resulted in similar rates of delirium in a mixed ICU population. Despite significant differences in agitation, sedation, and medication utilization, there was no differences in the clinical outcomes evaluated.

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Obesity, Inflammatory and Thrombotic Markers, and Major Clinical Outcomes in Critically Ill Patients with COVID‐19 in the US

Obesity ◽

10.1002/oby.23245 ◽

2021 ◽

Author(s):

Allon N. Friedman ◽

John Guirguis ◽

Raj Kapoor ◽

Shruti Gupta ◽

David E. Leaf ◽

...

Keyword(s):

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

The Us

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Correction to: Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: infammatory response of SARS-CoV-2 patients

Annals of Intensive Care ◽

10.1186/s13613-021-00879-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jean-Rémi Lavillegrand ◽

Marc Garnier ◽

Agathe Spaeth ◽

Nathalie Mario ◽

Geofroy Hariri ◽

...

Keyword(s):

Clinical Outcomes ◽

Critically Ill ◽

Elevated Plasma

An amendment to this paper has been published and can be accessed via the original article.

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Full versus Trophic Feeds in Critically Ill Adults with High and Low Nutritional Risk Scores: A Randomized Controlled Trial

Nutrients ◽

10.3390/nu12113518 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3518

Author(s):

Chen-Yu Wang ◽

Pin-Kuei Fu ◽

Wen-Cheng Chao ◽

Wei-Ning Wang ◽

Chao-Hsiu Chen ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hospital Stay ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Controlled Trial ◽

Risk Scores ◽

Nutrition Risk ◽

Randomized Controlled ◽

Trophic Feeding

Although energy intake might be associated with clinical outcomes in critically ill patients, it remains unclear whether full or trophic feeding is suitable for critically ill patients with high or low nutrition risk. We conducted a prospective study to determine which feeding energy intakes were associated with clinical outcomes in critically ill patients with high or low nutrition risk. This was an investigator-initiated, single center, single blind, randomized controlled trial. Critically ill patients were allocated to either high or low nutrition risk based on their Nutrition Risk in the Critically Ill score, and then randomized to receive either the full or the trophic feeding. The feeding procedure was administered for six days. No significant differences were observed in hospital, 14-day and 28-day mortalities, the length of ventilator dependency, or ICU and hospital stay among the four groups. There were no associations between energy and protein intakes and hospital, 14-day and 28-day mortalities in any of the four groups. However, protein intake was positively associated with the length of hospital stay and ventilator dependency in patients with low nutrition risk receiving trophic feeding. Full or trophic feeding in critically ill patients showed no associations with clinical outcomes, regardless of nutrition risk.

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Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury

Journal of Critical Care ◽

10.1016/j.jcrc.2007.12.017 ◽

2009 ◽

Vol 24 (1) ◽

pp. 129-140 ◽

Cited By ~ 204

Author(s):

Sean M. Bagshaw ◽

Shigehiko Uchino ◽

Rinaldo Bellomo ◽

Hiroshi Morimatsu ◽

Stanislao Morgera ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury

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Association of Fluid Overload With Clinical Outcomes in Critically Ill Children With Bronchiolitis

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000001841 ◽

2019 ◽

Vol 20 (3) ◽

pp. e130-e136 ◽

Cited By ~ 6

Author(s):

Jose C. Flores-González ◽

Cristina Montero Valladares ◽

Cristina Yun Castilla ◽

Juan Mayordomo-Colunga ◽

Sonia Pérez Quesada ◽

...

Keyword(s):

Clinical Outcomes ◽

Critically Ill ◽

Fluid Overload ◽

Critically Ill Children

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Early Fever Is Associated With Clinical Outcomes in Patients With Coronavirus Disease

Frontiers in Public Health ◽

10.3389/fpubh.2021.712190 ◽

2021 ◽

Vol 9 ◽

Author(s):

Feng-ming Ding ◽

Yun Feng ◽

Lei Han ◽

Yan Zhou ◽

Yong Ji ◽

...

Keyword(s):

Clinical Outcomes ◽

Critically Ill ◽

Symptom Onset ◽

Critically Ill Patients ◽

Severe Disease ◽

Multivariable Analysis ◽

Reactive Protein ◽

Increased Temperature ◽

Kaplan Meier ◽

Image Improvement

Fever is one of the typical symptoms of coronavirus disease (COVID-19). We aimed to investigate the association between early fever (EF) and clinical outcomes in COVID-19 patients. A total of 1,014 COVID-19 patients at the Leishenshan Hospital were enrolled and classified into the EF and non-EF groups based on whether they had fever within 5 days of symptom onset. Risk factors for clinical outcomes in patients with different levels of disease severity were analyzed using multivariable analyses. Time from symptom onset to symptom alleviation, CT image improvement, and discharge were longer for patients with moderate and severe disease in the EF group than in the non-EF group. Multivariable analysis showed that sex, EF, eosinophil number, C-reactive protein, and IL-6 levels were positively correlated with the time from symptom onset to hospital discharge in moderate cases. The EF patients showed no significant differences in the development of acute respiratory distress syndrome, compared with the non-EF patients. The Kaplan–Meier curve showed no obvious differences in survival between the EF and non-EF patients. However, EF patients with increased temperature showed markedly lower survival than the non-EF patients with increased temperature. EF had no significant impact on the survival of critically ill patients, while an increase in temperature was identified as an independent risk factor. EF appears to be a predictor of longer recovery time in moderate/severe COVID-19 infections. However, its value in predicting mortality needs to be considered for critically ill patients with EF showing increasing temperature.

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Effects of fenugreek seed powder on enteral nutrition tolerance and clinical outcomes in critically ill patients: A randomized clinical trial

Biomedical Research and Therapy ◽

10.15419/bmrat.v5i7.462 ◽

2018 ◽

Vol 5 (7) ◽

pp. 2528-2537

Author(s):

Akram Kooshki ◽

Zaher Khazaei ◽

Azam Zarghi ◽

Mojtaba Rad ◽

Hadi Gholam Mohammadi ◽

...

Keyword(s):

Enteral Nutrition ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Routine Care ◽

Fenugreek Seeds ◽

Mechanically Ventilated ◽

Fenugreek Seed ◽

Group 2 ◽

Group 1

Background: Enteral nutrition (EN) intolerance is a common complication in critically ill patients that contributes to morbidity and mortality. Based on the evidence of curing effects of fenugreek seeds in some gastrointestinal disorders, this study aimed to determine the effects of fenugreek seed powder on enteral nutrition tolerance and clinical outcomes in critically ill patients. Materials & Methods: A randomized, double-blinded clinical trial of 5-day duration was conducted on 60 mechanically ventilated patients divided in 2 groups (n=30). Group 1 was given fenugreek seed powder by gavage, twice a day in addition to routine care, while Group 2 received only routine care. Enteral nutrition tolerance and clinical outcomes were measured throughout the study. Demographic and clinical data were recorded and clinical responses to the primary outcome (enteral nutrition tolerance) and secondary outcome (other clinical factors) were interpreted. Data were analyzed using the independent t-test, Chi-squared test, covariance analysis, and repeated measure ANOVA via SPSS statistical software (v. 20); statistical significance was set at p< 0.05. Results: Patients who were fed with the fenugreek seed powder showed a significant improvement in enteral nutrition tolerance, as well as some complications of mechanical ventilation for Group 1, as compared with Group 2. The mortality rates were not different between the two groups. Conclusion: This study shows the beneficial effects of fenugreek seeds on food intolerance in critically ill patients and that the seed powder can be used as an add-on therapy with other medications. Thus, the use of fenugreek seeds to treat mechanically ventilated patients is recommended.

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Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

10.21203/rs.3.rs-923773/v1 ◽

2021 ◽

Author(s):

Zi-Hong Xiong ◽

Xue-Mei Zheng ◽

Guo-Ying Zhang ◽

Meng-Jun Wu ◽

Yi Qu

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nutritional Status ◽

Clinical Outcomes ◽

Critically Ill ◽

Pediatric Intensive Care Unit ◽

Phase Angle ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Duration Time

Abstract BackgroundMalnutrition is highly prevalent in critically ill children in the pediatric intensive care unit .We aimed to investigate the efficiency of bioelectrical impedance analysis (BIA) measurements and phase angle (PhA) analysis for the assessment of nutritional risk and clinical outcomes in critically ill children.MethodsThis single-center observational study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Chengdu Women’s and Children’s Central Hospital. All patients underwent anthropometric measurement in the first 24 h of admission and underwent BIA measurements within 3 days after the admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistics method.ResultsThere were 204 patients enrolled in our study, of which 32.4% were diagnosed with malnutrition. We found that BMI, arm muscle circumference, fat mass, and %body fat were lower in the group with poorer nutritional status (P < 0.05). Evident differences in the score of the Pediatric Risk of Mortality and the duration of mechanical ventilation (MV) among the three groups with different nutritional statuses were observed (P < 0.05). Patients in the severely malnourished group had the longest duration of MV. In the MV groups, there were significant differences (P < 0.05) in albumin level, PhA, and extracellular water/total body water (ECW/TBW ratio). The ECW/TBW ratio and the time for PICU stay had a weak degree of correlation (Pearson correlation coefficient = 0.375). PhA showed a weak degree of correlation with the duration time of medical ventilation (coefficient of correlation = 0.398).ConclusionBIA can be considered an alternative way to assess nutritional status in critically ill children. ECW/TBW ratio and PhA were correlated with PICU stay and duration time of medical ventilation, respectively.

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