EXPRESS: Elevated procalcitonin levels in severe Covid-19 may not reflect bacterial co-infection

2021 ◽  
pp. 000456322110223
Author(s):  
Randeep S Heer ◽  
Amit K J Mandal ◽  
Jason Kho ◽  
Piotr Szawarski ◽  
Peter Csabi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Disease Severity ◽  
Care Setting ◽  
Univariate Analysis ◽  
Invasive Mechanical Ventilation ◽  
Critical Care Setting ◽  
Inpatient Mortality ◽  
Laboratory Markers ◽  
Significant Difference

<u>Background</u> The variability of Covid-19 severity between patients has driven efforts to identify prognosticating laboratory markers that could aid clinical decision making. Procalcitonin (PCT) is classically used as a diagnostic marker in bacterial infections, but its role in predicting Covid-19 disease severity is emerging. We aimed to identify the association between PCT and Covid-19 disease severity in a critical care setting and whether bacterial co-infection is implicated. <u>Methods</u> We retrospectively reviewed Covid-19 patients with PCT levels measured in a critical care setting at our institution between February and September 2020. Laboratory markers including peak PCT values and a range of bacterial culture results were analysed. Outcomes were the requirement and duration of invasive mechanical ventilation as well as inpatient mortality. <u>Results</u> In total, 60 patients were included; 68% required invasive mechanical ventilation and 45% died as inpatient. Univariate analysis identified higher peak PCT levels significantly associated with both the requirement for invasive mechanical ventilation (OR: 3.2, 95% CI 1.3-9.0, p=0.02) and inpatient mortality (OR: 2.6, 95% CI 1.1-6.6, p=0.03). Higher peak PCT levels was an independent predictor of mortality on multivariate analysis (OR 3.7, 95% CI 1.1-12.4, p=0.03). There was a significant positive correlation between increased peak PCT levels and duration on invasive mechanical ventilation. No significant difference was found between peak PCT levels of patients with positive and negative bacterial cultures. <u>Conclusions</u> Elevated PCT levels in Covid-19 patients are associated with respiratory failure requiring prolonged invasive mechanical ventilation and inpatient mortality. This association may be independent of bacterial co-infection.

scholarly journals Outcomes and characteristics of COVID-19 patients treated with CPAP/ HFNO outside of the intensive care setting

2021 ◽  
pp. 00318-2021
Author(s):  
Dominic L Sykes ◽  
Michael G Crooks ◽  
Khaing Thu Thu ◽  
Oliver I Brown ◽  
Theodore J p Tyrer ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Care Setting ◽  
Treatment Options ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Intensive Care Setting ◽  
Non Invasive ◽  
Significant Difference

BackgroundContinuous Positive Airway Pressure (CPAP) and High Flow Nasal Oxygen (HFNO) have been used to manage hypoxaemic respiratory failure secondary to COVID-19 pneumonia. Limited data are available for patients treated with non-invasive respiratory support outside of the intensive care setting.MethodsIn this single-centre observational study we observed the characteristics, physiological observations, laboratory tests, and outcomes of all consecutive patients with COVID-19 pneumonia between April 2020 and March 2021 treated with non-invasive respiratory support outside of the intensive care setting.ResultsWe report the outcomes of 140 patients (Mean Age=71.2 [sd=11.1], 65% Male [n=91]) treated with CPAP/HFNO outside of the intensive care setting. Overall mortality was 59% and was higher in those deemed unsuitable for mechanical ventilation (72%). The mean age of survivors was significantly lower than those who died (66.1 versus 74.4 years, p<0.001). Those who survived their admission also had a significantly lower median Clinical Frailty Score than the non-survivor group (2 versus 4, p<0.001). We report no significant difference in mortality between those treated with CPAP (n=92, mortality: 60%) or HFNO (n=48, mortality: 56%). Treatment was well tolerated in 86% of patients receiving either CPAP or HFNO.ConclusionsCPAP and HFNO delivered outside of the intensive care setting are viable treatment options for patients with hypoxaemic respiratory failure secondary to COVID-19 pneumonia, including those considered unsuitable for invasive mechanical ventilation. This provides an opportunity to safeguard intensive care capacity for COVID-19 patients requiring invasive mechanical ventilation.

Outcomes After Long-term Mechanical Ventilation of Cancer Patients Outside of the Critical Care Setting

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 480A
Author(s):  
Kelly Haviland ◽  
kay see tan ◽  
Manju Pillai ◽  
Diane Stover ◽  
Robert Downey
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Cancer Patients ◽  
Care Setting ◽  
Critical Care Setting

scholarly journals Evaluation of cognitive load and emotional states during multidisciplinary critical care simulation sessions

2017 ◽  
Vol 4 (2) ◽  
pp. 87-91 ◽  
Author(s):  
Swapnil Pawar ◽  
Theresa Jacques ◽  
Kush Deshpande ◽  
Raju Pusapati ◽  
Michael J Meguerdichian
Keyword(s):  
Critical Care ◽  
Cognitive Load ◽  
Nursing Staff ◽  
Care Setting ◽  
Emotional State ◽  
Critical Care Setting ◽  
Subjective Rating ◽  
Significant Difference ◽  
Simulation Scenario ◽  
The Mean

BackgroundThe simulation in critical care setting involves a heterogeneous group of participants with varied background and experience. Measuring the impacts of simulation on emotional state and cognitive load in this setting is not often performed. The feasibility of such measurement in the critical care setting needs further exploration.MethodsMedical and nursing staff with varying levels of experience from a tertiary intensive care unit participated in a standardised clinical simulation scenario. The emotional state of each participant was assessed before and after completion of the scenario using a validated eight-item scale containing bipolar oppositional descriptors of emotion. The cognitive load of each participant was assessed after the completion of the scenario using a validated subjective rating tool.ResultsA total of 103 medical and nursing staff participated in the study. The participants felt more relaxed (−0.28±1.15 vs 0.14±1, P<0.005; d=0.39), excited (0.25±0.89 vs 0.55±0.92, P<0.005, d=0.35) and alert (0.85±0.87 vs 1.28±0.73, P<0.00001, d=0.54) following simulation. There was no difference in the mean scores for the remaining five items. The mean cognitive load for all participants was 6.67±1.41. There was no significant difference in the cognitive loads among medical staff versus nursing staff (6.61±2.3 vs 6.62±1.7; P>0.05).ConclusionA well-designed complex high fidelity critical care simulation scenario can be evaluated to identify the relative cognitive load of the participants’ experience and their emotional state. The movement of learners emotionally from a more negative state to a positive state suggests that simulation can be an effective tool for improved knowledge transfer and offers more opportunity for dynamic thinking.

scholarly journals Empiric use of anticoagulation in hospitalized patients with COVID-19: a propensity score-matched study of risks and benefits

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Bo Yu ◽  
Victor Perez Gutierrez ◽  
Alex Carlos ◽  
Gregory Hoge ◽  
Anjana Pillai ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Major Bleeding ◽  
Risk Estimation ◽  
Large Population ◽  
Invasive Mechanical Ventilation ◽  
Bleeding Risk ◽  
Hospitalized Patients ◽  
Significant Difference

Abstract Background Hospitalized patients with COVID-19 demonstrate a higher risk of developing thromboembolism. Anticoagulation (AC) has been proposed for high-risk patients, even without confirmed thromboembolism. However, benefits and risks of AC are not well assessed due to insufficient clinical data. We performed a retrospective analysis of outcomes from AC in a large population of COVID-19 patients. Methods We retrospectively reviewed 1189 patients hospitalized for COVID-19 between March 5 and May 15, 2020, with primary outcomes of mortality, invasive mechanical ventilation, and major bleeding. Patients who received therapeutic AC for known indications were excluded. Propensity score matching of baseline characteristics and admission parameters was performed to minimize bias between cohorts. Results The analysis cohort included 973 patients. Forty-four patients who received therapeutic AC for confirmed thromboembolic events and atrial fibrillation were excluded. After propensity score matching, 133 patients received empiric therapeutic AC while 215 received low dose prophylactic AC. Overall, there was no difference in the rate of invasive mechanical ventilation (73.7% versus 65.6%, p = 0.133) or mortality (60.2% versus 60.9%, p = 0.885). However, among patients requiring invasive mechanical ventilation, empiric therapeutic AC was an independent predictor of lower mortality (hazard ratio [HR] 0.476, 95% confidence interval [CI] 0.345–0.657, p < 0.001) with longer median survival (14 days vs 8 days, p < 0.001), but these associations were not observed in the overall cohort (p = 0.063). Additionally, no significant difference in mortality was found between patients receiving empiric therapeutic AC versus prophylactic AC in various subgroups with different D-dimer level cutoffs. Patients who received therapeutic AC showed a higher incidence of major bleeding (13.8% vs 3.9%, p < 0.001). Furthermore, patients with a HAS-BLED score of ≥2 had a higher risk of mortality (HR 1.482, 95% CI 1.110–1.980, p = 0.008), while those with a score of ≥3 had a higher risk of major bleeding (Odds ratio: 1.883, CI: 1.114–3.729, p = 0.016). Conclusion Empiric use of therapeutic AC conferred survival benefit to patients requiring invasive mechanical ventilation, but did not show benefit in non-critically ill patients hospitalized for COVID-19. Careful bleeding risk estimation should be pursued before considering escalation of AC intensity.

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