scholarly journals Changes in utilization and outcomes of mechanical ventilation of COVID-19 during the course of the pandemic in Germany in 2020: an observational study of 7,490 patients

2021 ◽  
Author(s):  
Christian Karagiannidis ◽  
Corinna Hentschker ◽  
Michael Westhoff ◽  
Steffen Weber-Carstens ◽  
Uwe Janssens ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Local Health ◽  
Autumn Period ◽  
Spring Period ◽  
Local Health Care ◽  
Overall Mortality

Background The role of non invasive ventilation (NIV) in severe COVID-19 requiring mechanical ventilation (MV) remains a matter of debate. Methods In this observational study of confirmed COVID-19 cases claims data of the Local Health Care Funds of MV patients were comparably analysed: spring period of 2020 (February to May) versus autumn period (October/November). Findings In a nationwide cohort 7,490 cases were included: median age 70 (IQR 60to79) years, 66% male, hypertension 67%, diabetes 42%, cardiac arrhythmia 43%, congestive heart failure 34%, renal failure 27%. Overall, 3,851 (51%) patients primarily received invasive MV without NIV, 1,614 (22%) patients received NIV without having been escalated to intubation, and 1,247 (17%) patients had NIV failure (NIVF), defined by endotracheal intubation following NIV. Comparing cases of the first and second period, the proportion of patients who received invasive MV decreased from 74% to 39%. Accordingly, the proportion of patients with NIV without subsequent intubation increased from 10% to 28%, and those failing NIV increased from 9% to 21%. The overall median length of hospital stay decreased from 26 to 22 days, and the overall duration of MV decreased from 11.6 to 7.6 days. The NIV failure rate decreased from 49% (219/449) to 42% (927/2,185). Overall mortality remained unchanged (51% and 53% respectively). Mortality was 39% with NIV only, 52% with invasive MV and 66% with NIVF with mortality rates steadily increasing from 58% in early NIVF (day 1) to 75% in late NIV-F (>5 days). Interpretation The utilization of NIV rapidly increased during the autumn period compared to the spring period 2020, which was associated with a reduced duration of MV and hospital stay, but not with overall mortality. NIVF rates are high and are associated with increased mortality rates, particularly in late NIVF. In contrast, NIV success is associated with the lowest mortality rates.

scholarly journals Observational study of changes in utilization and outcomes in mechanical ventilation in COVID-19

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262315
Author(s):  
Christian Karagiannidis ◽  
Corinna Hentschker ◽  
Michael Westhoff ◽  
Steffen Weber-Carstens ◽  
Uwe Janssens ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Invasive Mechanical Ventilation ◽  
Length Of Hospital Stay ◽  
Local Health ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Local Health Care ◽  
Overall Mortality

Background The role of non-invasive ventilation (NIV) in severe COVID-19 remains a matter of debate. Therefore, the utilization and outcome of NIV in COVID-19 in an unbiased cohort was determined. Aim The aim was to provide a detailed account of hospitalized COVID-19 patients requiring non-invasive ventilation during their hospital stay. Furthermore, differences of patients treated with NIV between the first and second wave are explored. Methods Confirmed COVID-19 cases of claims data of the Local Health Care Funds with non-invasive and/or invasive mechanical ventilation (MV) in the spring and autumn pandemic period in 2020 were comparable analysed. Results Nationwide cohort of 17.023 cases (median/IQR age 71/61–80 years, 64% male) 7235 (42.5%) patients primarily received IMV without NIV, 4469 (26.3%) patients received NIV without subsequent intubation, and 3472 (20.4%) patients had NIV failure (NIV-F), defined by subsequent endotracheal intubation. The proportion of patients who received invasive MV decreased from 75% to 37% during the second period. Accordingly, the proportion of patients with NIV exclusively increased from 9% to 30%, and those failing NIV increased from 9% to 23%. Median length of hospital stay decreased from 26 to 21 days, and duration of MV decreased from 11.9 to 7.3 days. The NIV failure rate decreased from 49% to 43%. Overall mortality increased from 51% versus 54%. Mortality was 44% with NIV-only, 54% with IMV and 66% with NIV-F with mortality rates steadily increasing from 62% in early NIV-F (day 1) to 72% in late NIV-F (>4 days). Conclusions Utilization of NIV rapidly increased during the autumn period, which was associated with a reduced duration of MV, but not with overall mortality. High NIV-F rates are associated with increased mortality, particularly in late NIV-F.

scholarly journals Sex-Specific Long-Term Trends in Length of Hospital Stay, Postmenstrual Age at Discharge, and Survival in Very Low Birth Weight Infants

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Matthias Fröhlich ◽  
Tatjana Tissen-Diabaté ◽  
Christoph Bührer ◽  
Stephanie Roll
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Hospital Stay ◽  
Very Low Birth Weight ◽  
Survival Rates ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Vlbw Infants ◽  
Postmenstrual Age ◽  
Over Time

<b><i>Introduction:</i></b> In very low birth weight (&#x3c;1,500 g, VLBW) infants, morbidity and mortality have decreased substantially during the past decades, and both are known to be lower in girls than in boys. In this study, we assessed sex-specific changes over time in length of hospital stay (LOHS) and postmenstrual age at discharge (PAD), in addition to survival in VLBW infants. <b><i>Methods:</i></b> This is a single-center retrospective cohort analysis based on quality assurance data of VLBW infants born from 1978 to 2018. Estimation of sex-specific LOHS over time was based on infants discharged home from neonatal care or deceased. Estimation of sex-specific PAD over time was based on infants discharged home exclusively. Analysis of in-hospital survival was performed for all VLBW infants. <b><i>Results:</i></b> In 4,336 of 4,499 VLBW infants admitted from 1978 to 2018 with complete data (96.4%), survival rates improved between 1978–1982 and 1993–1997 (70.8 vs. 88.3%; hazard ratio (HR) 0.20, 95% confidence interval 0.14, 0.30) and remained stable thereafter. Boys had consistently higher mortality rates than girls (15 vs. 12%, HR 1.23 [1.05, 1.45]). Nonsurviving boys died later compared to nonsurviving girls (adjusted mean survival time 23.0 [18.0, 27.9] vs. 20.7 [15.0, 26.3] days). LOHS and PAD assessed in 3,166 survivors displayed a continuous decrease over time (1978–1982 vs. 2013–2018: LOHS days 82.9 [79.3, 86.5] vs. 60.3 [58.4, 62.1] days); PAD 40.4 (39.9, 40.9) vs. 37.4 [37.1, 37.6] weeks). Girls had shorter LOHS than boys (69.4 [68.0, 70.8] vs. 73.0 [71.6, 74.4] days) and were discharged with lower PAD (38.6 [38.4, 38.8] vs. 39.2 [39.0, 39.4] weeks). <b><i>Discussion/Conclusions:</i></b> LOHS and PAD decreased over the last 40 years, while survival rates improved. Male sex was associated with longer LOHS, higher PAD, and higher mortality rates.

scholarly journals Relation between fluid balance and incidence of morbidity and mortality rates in critically ill patients prospective observational study

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M G A Gerges ◽  
H M M Elazzazi ◽  
M H S A Elsersi ◽  
S A R Mustafa ◽  
M A Saeed
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
University Hospitals ◽  
Cumulative Fluid Balance

Abstract Background While administration of fluid can be lifesaving, it has been suggested that the fluid accumulation after initial resuscitation and hemodynamic stabilization can contribute to potentially avoidable adverse effects and less favorable outcomes. Objective The aim of this study is to assess whether positive fluid balance in comparison with negative or even fluid balance is associated with increased morbidity and mortality rates in critically ill patients. Patients and Methods This prospective observational study was performed on 145 Patients older than 18 years admitted to intensive care units at Helwan university hospitals and Ain shams university hospitals during the period from November 2017 till May 2018. Results A total of 145 patients with an ICU mortality rate of 14.5% were enrolled. The median cumulative fluid balance of the 124 patients who survive was -110 ml (IQR -2.1-2.2 L) after the fourth day following randomization while the median cumulative fluid balance of the 21 patients who not survive was 3800 ml (IQR 1.7-5.2 L) after the fourth day in ICU. In our study critically ill patients with fluid balance more than 1.2 litres per day had higher ICU complications: increased risk of AKI, longer ICU and hospital stays, and mechanical ventilation, and fluid balance was independently associated with mortality. Conclusion In the view of this study, we concluded that:Zero fluid balance and negative fluid balance independently associated with decrease mortality and morbidity rates in critically ill patients after 4 days from admission in ICU.There was higher cumulative fluid balance in non survivors compared to survivors. Cumulative fluid balance after 4 days from admission was independently predictive of mortality in a heterogeneous group of critically ill patients.96 hour negative fluid balance in critically ill patients was associated with less length of stay at ICU and less mechanical ventilation duration.Positive fluid balance, mechanical ventilation, vasopressors, and high admission SAPS II, SOFA, APACHE II and KIDGO were significantly associated with high mortality.

scholarly journals Severity of hyperoxia as a risk factor in patients undergoing on-pump cardiac surgery

2017 ◽  
Vol 24 (3) ◽  
pp. 153-158
Author(s):  
Gabrielius Jakutis ◽  
Ieva Norkienė ◽  
Donata Ringaitienė ◽  
Tomas Jovaiša
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Prolonged Mechanical Ventilation ◽  
Length Of Hospital Stay ◽  
Infectious Complications ◽  
Research Database ◽  
Elective Cardiac Surgery ◽  
The Impact

Background. Hyperoxia has long been perceived as a desirable or at least an inevitable part of cardiopulmonary bypass. Recent evidence suggest that it might have multiple detrimental effects on patient homeostasis. The aim of the study was to identify the determinants of supra-physiological values of partial oxygen pressure during on-pump cardiac surgery and to assess the impact of hyperoxia on clinical outcomes. Materials and methods. Retrospective data analysis of the institutional research database was performed to evaluate the effects of hyperoxia in patients undergoing elective cardiac surgery with cardiopulmonary bypass, 246 patients were included in the final analysis. Patients were divided in three groups: mild hyperoxia (MHO, PaO2 100–199 mmHg), moderate hyperoxia (MdHO, PaO2 200–299 mmHg), and severe hyperoxia (SHO, PaO2 >300 mmHg). Postoperative complications and outcomes were defined according to standardised criteria of the Society of Thoracic Surgeons. Results. The extent of hyperoxia was more immense in patients with a lower body mass index (p = 0.001) and of female sex (p = 0.005). A significant link between severe hyperoxia and a higher incidence of infectious complications (p – 0.044), an increased length of hospital stay (p – 0.044) and extended duration of mechanical ventilation (p < 0.001) was confirmed. Conclusions. Severe hyperoxia is associated with an increased incidence of postoperative infectious complications, prolonged mechanical ventilation, and increased hospital stay.

scholarly journals MO850OUTCOMES OF COVID-19 INFECTION IN DIALYSIS PATIENTS IN QATAR: A NATIONWIDE COHORT STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Tarek Abdellatif ◽  
Abdullah Hamad ◽  
Mohamad Alkadi ◽  
Essa Abuhelaiqa ◽  
Muftah Othman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Mortality Rate ◽  
General Population ◽  
Hospital Stay ◽  
Laboratory Tests ◽  
Length Of Hospital Stay ◽  
Dialysis Patients ◽  
Risk Of Death

Abstract Background and Aims Patients on maintenance dialysis are more susceptible to COVID-19 and its severe complications. We studied outcomes of COVID-19 infection in dialysis patients in the state of Qatar. Our primary outcome was to determine the mortality rate of dialysis patients with COVID-19 infection and associated risk factors. Our secondary outcomes were to assess the severity of COVID-19 in dialysis patients and its related complications such as the incidence of hypoxia, critical care unit admission, need for mechanical ventilation or inotropes, incidence of acute respiratory distress syndrome (ARDS), and length of hospital stay. Method This was an observational, analytical, retrospective, nationwide study. We included all adult patients on dialysis who tested positive for COVID-19 (PCR assay of nasopharyngeal swab) during the period from February 1, 2020 to July 19, 2020. Patient demographics and clinical features were collected from a national electronic medical record. Laboratory tests were evaluated upon diagnosis and on day 7. Results There were 76 out of 1068 dialysis patients who were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). Eleven patients (15%) died during study period. Mortality due to COVID-19 among our dialysis cohort was 100 times higher than that in the general population for the same period (15% vs. 0.15%; OR 114.2 [95% CI: 1.53 to 2.44]; p&lt;0.001). Univariate analysis for risk factors associated with COVID-19-related death in dialysis patients showed minor but statistically significant increases in risks with age (OR 1.07), peak WBC peak level (OR 1.189), AST level at day 7 (OR 1.04), fibrinogen level at day 7 (OR 1.4), D-dimer level on day 7 (OR 1.94), and peak CRP level (OR 1.01). A major increase in the risk of death was noted with atrial fibrillation (OR, 8.7; p=0.008) and hypoxia (OR: 28; p=0.001). High severity of COVID-19 illness in dialysis manifested as 25% of patients required admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes for intractable hypotension or shock. The mean length of hospital stay was 19.2±10.4 days. Laboratory tests were remarkable for severely elevated ferritin, fibrinogen, CRP, and peak IL-6 levels and decreased albumin levels on day 7. Conclusion This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high mortality rate of COVID-19 infection compared to the general population. Dialysis patients had severe COVID-19 course complicated by prolonged hospitalization and high need for critical care, mechanical ventilation and inotropes. Special care should be done to prevent COVID-19 in dialysis patients to avoid severe complications and mortality.

Sign in / Sign up

Export Citation Format

Share Document