Practice Variation In Weaning Critically Ill Adults From Invasive Mechanical Ventilation: Preliminary Results Of An International Survey

AbstractBackgroundNearly 30,000 patients with coronavirus disease-2019 (COVID-19) have been hospitalized in New York City as of April 14th, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed.MethodsWe prospectively collected clinical, biomarker, and treatment data on critically ill adults with laboratory-confirmed-COVID-19 admitted to two hospitals in northern Manhattan between March 2nd and April 1st, 2020. The primary outcome was in-hospital mortality.Secondary outcomes included frequency and duration of invasive mechanical ventilation, frequency of vasopressor use and renal-replacement-therapy, and time to clinical deterioration following hospital admission. The relationship between clinical risk factors, biomarkers, and in-hospital mortality was modeled using Cox-proportional-hazards regression. Each patient had at least 14 days of observation.ResultsOf 1,150 adults hospitalized with COVID-19 during the study period, 257 (22%) were critically ill. The median age was 62 years (interquartile range [IQR] 51-72); 170 (66%) were male. Two-hundred twelve (82%) had at least one chronic illness, the most common of which were hypertension (63%; 162/257) and diabetes mellitus (36%; 92/257). One-hundred-thirty-eight patients (54%) were obese, and 13 (5%) were healthcare workers. As of April 14th, 2020, in-hospital mortality was 33% (86/257); 47% (122/257) of patients remained hospitalized. Two-hundred-one (79%) patients received invasive mechanical ventilation (median 13 days [IQR 9-17]), and 54% (138/257) and 29% (75/257) required vasopressors and renal-replacement-therapy, respectively. The median time to clinical deterioration following hospital admission was 3 days (IQR 1-6). Older age, hypertension, chronic lung disease, and higher concentrations of interleukin-6 and d-dimer at admission were independently associated with in-hospital mortality.ConclusionsCritical illness among patients hospitalized with COVID-19 in New York City is common and associated with a high frequency of invasive mechanical ventilation, extra-pulmonary organ dysfunction, and substantial in-hospital mortality.

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Automated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd009235.pub3 ◽

2014 ◽

Cited By ~ 8

Author(s):

Louise Rose ◽

Marcus J Schultz ◽

Chris R Cardwell ◽

Philippe Jouvet ◽

Danny F McAuley ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Adults And Children ◽

Critically Ill Adults ◽

Ill Adults

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Liberation From Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline

CHEST Journal ◽

10.1016/j.chest.2016.10.036 ◽

2017 ◽

Vol 151 (1) ◽

pp. 166-180 ◽

Cited By ~ 97

Author(s):

Daniel R. Ouellette ◽

Sheena Patel ◽

Timothy D. Girard ◽

Peter E. Morris ◽

Gregory A. Schmidt ◽

...

Keyword(s):

Mechanical Ventilation ◽

Clinical Practice ◽

Critically Ill ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

American Thoracic Society ◽

Critically Ill Adults ◽

Ill Adults

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ICU and ventilator mortality among critically ill adults with COVID-19

10.1101/2020.04.23.20076737 ◽

2020 ◽

Cited By ~ 7

Author(s):

Sara C. Auld ◽

Mark Caridi-Scheible ◽

James M. Blum ◽

Chad Robichaux ◽

Colleen Kraft ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Critical Illness ◽

Critically Ill ◽

Preliminary Data ◽

Early Experience ◽

Mortality Rates ◽

Critically Ill Adults ◽

Ill Adults ◽

Overall Mortality

SummaryWe report preliminary data from a cohort of adults admitted to COVID-designated intensive care units from March 6 through April 17, 2020 across an academic healthcare system. Among 217 critically ill patients, mortality for those who required mechanical ventilation was 29.7% (49/165), with 8.5% (14/165) of patients still on the ventilator at the time of this report. Overall mortality to date in this critically ill cohort is 25.8% (56/217), and 40.1% (87/217) patients have survived to hospital discharge. Despite multiple reports of mortality rates exceeding 50% among critically ill adults with COVID-19, particularly among those requiring mechanical ventilation, our early experience indicates that many patients survive their critical illness.

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Association of multiple glycemic parameters at intensive care unit admission with mortality and clinical outcomes in critically ill patients

Scientific Reports ◽

10.1038/s41598-019-55080-3 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 6

Author(s):

Priscila Bellaver ◽

Ariell F. Schaeffer ◽

Diego P. Dullius ◽

Marina V. Viana ◽

Cristiane B. Leitão ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Glycemic Variability ◽

Stress Hyperglycemia ◽

Critically Ill Adults ◽

Ill Adults

AbstractThe aim of the present study was to investigate the association of multiple glycemic parameters at intensive care unit (ICU) admission with outcomes in critically ill patients. Critically ill adults admitted to ICU were included prospectively in the study and followed for 180 days until hospital discharge or death. Patients were assessed for glycemic gap, hypoglycemia, hyperglycemia, glycemic variability, and stress hyperglycemia ratio (SHR). A total of 542 patients were enrolled (30% with preexisting diabetes). Patients with glycemic gap >80 mg/dL had increased need for renal replacement therapy (RRT; 37.7% vs. 23.7%, p = 0.025) and shock incidence (54.7% vs. 37.4%, p = 0.014). Hypoglycemia was associated with increased mortality (54.8% vs. 35.8%, p = 0.004), need for RRT (45.1% vs. 22.3%, p < 0.001), mechanical ventilation (MV; 72.6% vs. 57.5%, p = 0.024), and shock incidence (62.9% vs. 35.8%, p < 0.001). Hyperglycemia increased mortality (44.3% vs. 34.9%, p = 0.031). Glycemic variability >40 mg/dL was associated with increased need for RRT (28.3% vs. 14.4%, p = 0.002) and shock incidence (41.4% vs.31.2%, p = 0.039). In this mixed sample of critically ill subjects, including patients with and without preexisting diabetes, glycemic gap, glycemic variability, and SHR were associated with worse outcomes, but not with mortality. Hypoglycemia and hyperglycemia were independently associated with increased mortality.

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