scholarly journals Relationship between Driving Pressure and Mortality in Ventilated Patients with Heart Failure: A Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Qilin Yang ◽  
Jiezhao Zheng ◽  
Xiaohua Chen ◽  
Weiyan Chen ◽  
Deliang Wen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Medical Information ◽  
Piecewise Linear ◽  
Driving Pressure ◽  
Nonlinear Relationship ◽  
Mortality And Morbidity ◽  
Ventilated Patients

Background. Heart failure (HF) is a leading cause of mortality and morbidity worldwide, with an increasing incidence. Invasive ventilation is considered to be essential for patients with HF. Previous studies have shown that driving pressure is associated with mortality in acute respiratory distress syndrome (ARDS). However, the relationship between driving pressure and mortality has not yet been examined in ventilated patients with HF. We assessed the association of driving pressure and mortality in patients with HF. Methods. We conducted a retrospective cohort study of invasive ventilated adult patients with HF from the Medical Information Mart for Intensive Care-III database. We used multivariable logistic regression models, a generalized additive model, and a two-piecewise linear regression model to show the effect of the average driving pressure within 24 h of intensive care unit admission on in-hospital mortality. Results. Six hundred and thirty-two invasive ventilated patients with HF were enrolled. Driving pressure was independently associated with in-hospital mortality (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.06–1.18; P < 0.001 ) after adjusted potential confounders. A nonlinear relationship was found between driving pressure and in-hospital mortality, which had a threshold around 14.27 cmH2O. The effect sizes and CIs below and above the threshold were 0.89 (0.75 to 1.05) and 1.17 (1.07 to 1.30), respectively. Conclusions. There was a nonlinear relationship between driving pressure and mortality in patients with HF who were ventilated for more than 48 h, and this relationship was associated with increased in-hospital mortality when the driving pressure was more than 14.27 cmH2O.

scholarly journals Optimal Oxygen Saturation Targets in Patients with Sepsis- Associated Encephalopathy: A Cohort Study from the MIMIC-IV Database

2021 ◽  
Author(s):  
Lina Zhao ◽  
Yunying Wang ◽  
Zengzheng Ge ◽  
Huadong Zhu ◽  
Yi Li
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Oxygen Saturation ◽  
Medical Information ◽  
Generalized Additive Models ◽  
Additive Models ◽  
Optimal Range ◽  
Oxygenation Status ◽  
The Impact

Abstract Objectives: Patients with sepsis-associated encephalopathy (SAE) in the intensive care unit (ICU) are treated with supplemental oxygen. However, few studies have investigated the impact of oxygenation status on the patient with SAE, and the optimal oxygenation status target remains unclear. We aimed to investigate the relationship between optimal oxygenation status and patients with SAE.Methods: This study is a retrospective cohort study. Patients were diagnosed with sepsis3.0 at the first ICU admission between 2008 and 2019 from Medical Information Mart for Intensive Care IV (MIMIC IV). We use generalized additive models to estimate the optimal oxygen saturation targets in patients with SAE. Multivariate logistic analysis to further confirm it. Measurements and Main Results: A total of 6714 patients with SAE were included. The incidence of patients with SAE was 66.8%, and hospital mortality was 7.9%. SpO2≤92% was the independent risk factor of incidence in patients with SAE. The optimal range of SpO2 was 93%–97%, which can reduce the incidence of patients with SAE. The optimal range of SpO2 was 92%–96%, reducing the hospital mortality of patients with SAE.Conclusions: The optimal range of SpO2 was 93%–96% reduce the hospital mortality and incidence of patients with SAE. SAE patients need conservative oxygen therapy

scholarly journals Risk Factors for 28-Day in-Hospital Mortality in Mechanically Ventilated Patients with COVID-19: An International Cohort Study

2021 ◽  
Author(s):  
Gianluigi Li Bassi ◽  
Jacky Y. Suen ◽  
Nicole White ◽  
Heidi J. Dalton ◽  
Jonathon Fanning ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Time Dependent ◽  
Mechanically Ventilated ◽  
Cox Regression Analysis ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Abstract Background: Risk factors associated with mortality in patients with coronavirus disease 2019 (COVID-19) on mechanical ventilation are still not fully elucidated. Thus, we aimed to identify patient-level factors, readily available at the bedside, associated with the risk of in-hospital mortality within 28 days from commencement of invasive mechanical ventilation (28-day IMV mortality) in patients with COVID-19. Methods Prospective observational cohort study in 148 intensive care units in the global COVID-19 Critical Care Consortium. Patients with clinically suspected or laboratory confirmed COVID-19 infection admitted to the intensive care unit (ICU) from February 2nd through December 29th, 2020, requiring IMV. No study-specific interventions were performed. Patient characteristics and clinical data were assessed upon ICU admission, the commencement of IMV and for 28 days thereafter. We primarily aimed to identify time-independent and time-dependent risk factors for 28-day IMV mortality. Results: A total of 1713 patients were included in the survival analysis, 588 patients died in hospital within 28 days of commencing IMV (34.3%). Cox-regression analysis identified associations between the hazard of 28-day IMV mortality with age (HR 1.27 per 10-year increase in age, 95% CI 1.17 to 1.37, P<0.001), PEEP upon commencement of IMV (HR 0.78 per 5-cmH2O increase, 95% CI 0.66-0.93, P=0.005). Time-dependent parameters associated with 28-day IMV mortality were serum creatinine (HR 1.30 per doubling, 95% CI 1.19-1.42, P<0.001), lactate (HR 1.16 per doubling, 95% CI 1.06-1.27 P=0.001), PaCO2 (HR 1.31 per doubling, 95% CI 1.05-1.64, P=0.015), pH (HR 0.82 per 0.1 increase, 95% CI 0.74-0.91, P<0.001), PaO2/FiO2 (HR 0.56 per doubling, 95% CI 0.50-0.62, P<0.001) and mean arterial pressure (HR 0.92 per 10 mmHg increase, 95% CI 0.88-0.97, P=0.002).Conclusions: This international study establishes that in mechanically ventilated patients with COVID-19, older age and clinically relevant variables monitored at the bedside are risk factors for 28-day IMV mortality. Further investigation is warranted to validate any causative roles these parameters might play in influencing clinical outcomes.

scholarly journals Incidence, Risk Factors and Outcomes of New Onset Supraventricular Arrhythmias in African American Patients with Severe Sepsis

2016 ◽  
Vol 26 (2) ◽  
pp. 205 ◽  
Author(s):  
O'Dene Lewis ◽  
Julius Ngwa ◽  
Richard F. Gillum ◽  
Alicia Thomas ◽  
Wayne Davis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Supraventricular Arrhythmias ◽  
Incidence Risk ◽  
New Onset

<p><strong>Purpose</strong>: New onset supraventricular arrhythmias (SVA) are commonly reported in mixed intensive care settings. We sought to determine the incidence, risk factors and outcomes of new onset SVA in African American (AA) patients with severe sepsis admitted to medical intensive care unit (MICU).</p><p><strong>Methods:</strong> Patients admitted to MICU between January 2012 through December 2012 were studied. Patients with a previous history of arrhythmia or with new onset of ventricular arrhythmia were excluded. Data on risk factors, critical care interventions and outcomes were obtained.</p><p><strong>Results:</strong> One hundred and thirty-one patients were identified. New onset SVA occurred in 34 (26%) patients. Of those 34, 20 (59%) had atrial fibrillation (AF), 6 (18%) had atrial flutter and 8 (24%) had other forms of SVA. Compared with patients without SVA, patients with new onset SVA were older (69 ± 12 yrs vs 59 ± 13 yrs, P=.003), had congestive heart failure (47% vs 24%, P=.015) and dyslipidemia (41% vs 15%, P=.002). Additionally, they had a higher mean mortality prediction model (MPM II) score (65 ± 25 vs 49 ± 26, P=.001) and an increased incidence of respiratory failure (85% vs 55%, P=.001). Hospital mortality in patients with new onset SVA was 18 (53%) vs 30 (31%); P=.024; however, in a multivariate analysis, new onset SVA was associated with nonsignificantly increased odds (OR 2.58, 95% CI 0.86-8.05) for in-hospital mortality.</p><p><strong>Conclusion:</strong> New onset SVA was prevalent in AA patients with severe sepsis and occurred more frequently with advanced age, increased severity of illness, congestive heart failure, and acute respiratory failure; it was associated with higher unadjusted in hospital mortality. However, after multiple adjustments, new onset SVA did not remain an independent predictor of mortality. <em>Ethn Dis.</em>2016;26(2):205-212; doi:10.18865/ ed.26.2.205</p>

scholarly journals Association Between Oxygen Partial Pressure Trajectories and Short-Term Outcomes in Patients With Hemorrhagic Brain Injury

2021 ◽  
Vol 8 ◽  
Author(s):  
Guolong Cai ◽  
Weizhe Ru ◽  
Qianghong Xu ◽  
Jiong Wu ◽  
Shijin Gong ◽  
...  
Keyword(s):  
Intensive Care ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Oxygen Partial Pressure ◽  
Partial Pressure ◽  
Medical Information ◽  
Logistic Models ◽  
Neurological Outcomes ◽  
Risk Of Death ◽  
Logistic Analysis

Objectives: Arterial hyperoxia is reportedly a risk factor for poor outcomes in patients with hemorrhagic brain injury (HBI). However, most previous studies have only evaluated the effects of hyperoxia using static oxygen partial pressure (PaO2) values. This study aimed to investigate the association between overall dynamic oxygenation status and HBI outcomes, using longitudinal PaO2 data.Methods: Data were extracted from the Medical Information Mart for Intensive Care III database. Longitudinal PaO2 data obtained within 72 h of admission to an intensive care unit were analyzed, using a group-based trajectory approach. In-hospital mortality was used as the primary outcomes. Multivariable logistic models were used to explore the association between PaO2 trajectory and outcomes.Results: Data of 2,028 patients with HBI were analyzed. Three PaO2 trajectory types were identified: Traj-1 (mild hyperoxia), Traj-2 (transient severe hyperoxia), and Traj-3 (persistent severe hyperoxia). The initial and maximum PaO2 of patients with Traj-2 and Traj-3 were similar and significantly higher than those of patients with Traj-1. However, PaO2 in patients with Traj-2 decreased more rapidly than in patients with Traj-3. The crude in-hospital mortality was the lowest for patients with Traj-1 and highest for patients with Traj-3 (365/1,303, 209/640, and 43/85 for Traj-1, Traj-2, and Traj-3, respectively; p &lt; 0.001), and the mean Glasgow Coma Scale score at discharge (GCSdis) was highest for patients with Traj-1 and lowest in patients with Traj-3 (13 [7–15], 11 [6–15], and 7 [3–14] for Traj-1, Traj-2, and Traj-3, respectively; p &lt; 0.001). The multivariable model revealed that the risk of death was higher in patients with Traj-3 than in patients with Traj-1 (odds ratio [OR]: 3.3, 95% confidence interval [CI]: 1.9–5.8) but similar for patients with Traj-1 and Traj-2. Similarly, the logistic analysis indicated the worst neurological outcomes in patients with Traj-3 (OR: 3.6, 95% CI: 2.0–6.4, relative to Traj-1), but similar neurological outcomes for patients in Traj-1 and Traj-2.Conclusion: Persistent, but not transient severe arterial hyperoxia, was associated with poor outcome in patients with HBI.

scholarly journals The Value of Admission Serological Indicators for Predicting 28-Day Mortality in Intensive Care Patients With Acute Heart Failure: Construction and Validation of a Nomogram

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoyuan Wei ◽  
Yu Min ◽  
Jiangchuan Yu ◽  
Qianli Wang ◽  
Han Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care ◽  
Acute Heart Failure ◽  
Sofa Score ◽  
Medical Information ◽  
Troponin T ◽  
Adequate Treatment ◽  
Intensive Care Patients ◽  
Creatine Kinase Mb ◽  
Death Group

Background: Acute heart failure (AHF) is a severe clinical syndrome characterized as rapid onset or worsening of symptoms of chronic heart failure (CHF). Risk stratification for patients with AHF in the intensive care unit (ICU) may help clinicians to predict the 28-day mortality risk in this subpopulation and further raise the quality of care.Methods: We retrospectively reviewed and analyzed the demographic characteristics and serological indicators of patients with AHF in the Medical Information Mart for Intensive Care III (MIMIC III) (version 1.4) between June 2001 and October 2012 and our medical center between January 2019 and April 2021. The chi-squared test and the Fisher's exact test were used for comparison of qualitative variables among the AHF death group and non-death group. The clinical variables were selected by using the least absolute shrinkage and selection operator (LASSO) regression. A clinical nomogram for predicting the 28-day mortality was constructed based on the multivariate Cox proportional hazard regression analysis and further validated by the internal and external cohorts.Results: Age &gt; 65 years [hazard ratio (HR) = 2.47], the high Sequential Organ Failure Assessment (SOFA) score (≥3 and ≤8, HR = 2.21; ≥9 and ≤20, HR = 3.29), lactic acid (Lac) (&gt;2 mmol/l, HR = 1.40), bicarbonate (HCO3-) (&gt;28 mmol/l, HR = 1.59), blood urea nitrogen (BUN) (&gt;21 mg/dl, HR = 1.75), albumin (&lt;3.5 g/dl, HR = 2.02), troponin T (TnT) (&gt;0.04 ng/ml, HR = 4.02), and creatine kinase-MB (CK-MB) (&gt;5 ng/ml, HR = 1.64) were the independent risk factors for predicting 28-day mortality of intensive care patients with AHF (p &lt; 0.05). The novel nomogram was developed and validated with a promising C-index of 0.814 (95% CI: 0.754–0.882), 0.820 (95% CI: 0.721–0.897), and 0.828 (95% CI: 0.743–0.917), respectively.Conclusion: This study provides a new insight in early predicting the risk of 28-day mortality in intensive care patients with AHF. The age, the SOFA score, and serum TnT level are the leading three predictors in evaluating the short-term outcome of intensive care patients with AHF. Based on the nomogram, clinicians could better stratify patients with AHF at high risk and make adequate treatment plans.

The Chasm in Neonatal Outcomes in Relation to Time of Birth in Lebanon

2007 ◽  
Vol 26 (2) ◽  
pp. 97-102 ◽  
Author(s):  
Lina Kurdahi Badr ◽  
Bahia Abdallah ◽  
Sossi Balian ◽  
Hala Tamim ◽  
Mirvat Hawari
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Night Shift ◽  
Neonatal Intensive Care Units ◽  
Maternal Risk Factors ◽  
Mortality And Morbidity ◽  
Maternal Risk ◽  
The Relationship

Purpose:The purpose of this study was to investigate the relationship between the time of birth and the mortality and morbidity of infants admitted to neonatal intensive care units.Design:This prospective, cohort study examined the records of women and infants admitted to the NICUs of four hospitals in Beirut, Lebanon, between July 1, 2002, and June 30, 2003. The hospitals selected were university affiliated and had a large number of deliveries (5,152 total for the year 2002–2003).Main Outcome Variables:Neonatal mortality and morbidity for infants admitted to the NICU were evaluated in relation to time of birth.Results:For the whole sample, mortality was higher for infants born during the night shift than for those born during the day shift. Mortality, morbidity, and brain asphyxia rates were also higher for infants born during the night shift and admitted to the NICU. Maternal risk factors and delivery complications were not consistently higher on the night shift.

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