scholarly journals Recovery from Covid-19 critical illness: A secondary analysis of the ISARIC4C CCP-UK cohort study and the RECOVER trial

2021 ◽  
pp. 175114372110522
Author(s):  
Ellen Pauley ◽  
Thomas M Drake ◽  
David M Griffith ◽  
Louise Sigfrid ◽  
Nazir I Lone ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Illness ◽  
Hospital Discharge ◽  
Invasive Mechanical Ventilation ◽  
Secondary Analysis ◽  
Total Sample ◽  
Severe Fatigue ◽  
Fatigue Severity ◽  
Baseline Characteristics

Background: We aimed to compare the prevalence and severity of fatigue in survivors of Covid-19 versus non-Covid-19 critical illness, and to explore potential associations between baseline characteristics and worse recovery. Methods: We conducted a secondary analysis of two prospectively collected datasets. The population included was 92 patients who received invasive mechanical ventilation (IMV) with Covid-19, and 240 patients who received IMV with non-Covid-19 illness before the pandemic. Follow-up data were collected post-hospital discharge using self-reported questionnaires. The main outcome measures were self-reported fatigue severity and the prevalence of severe fatigue (severity >7/10) 3 and 12-months post-hospital discharge. Results: Covid-19 IMV-patients were significantly younger with less prior comorbidity, and more males, than pre-pandemic IMV-patients. At 3-months, the prevalence (38.9% [7/18] vs. 27.1% [51/188]) and severity (median 5.5/10 vs 5.0/10) of fatigue were similar between the Covid-19 and pre-pandemic populations, respectively. At 6-months, the prevalence (10.3% [3/29] vs. 32.5% [54/166]) and severity (median 2.0/10 vs. 5.7/10) of fatigue were less in the Covid-19 cohort. In the total sample of IMV-patients included (i.e. all Covid-19 and pre-pandemic patients), having Covid-19 was significantly associated with less severe fatigue (severity <7/10) after adjusting for age, sex and prior comorbidity (adjusted OR 0.35 (95%CI 0.15–0.76, p=0.01). Conclusion: Fatigue may be less severe after Covid-19 than after other critical illness.

scholarly journals Recovery from Covid-19 critical illness: a secondary analysis of the ISARIC4C CCP-UK cohort study and the RECOVER trial

2021 ◽  
Author(s):  
Ellen E Pauley ◽  
Thomas M Drake ◽  
David Griffith ◽  
Nazir I Lone ◽  
Ewen M Harrison ◽  
...  
Keyword(s):  
Critical Illness ◽  
Hospital Discharge ◽  
Invasive Mechanical Ventilation ◽  
Secondary Analysis ◽  
Total Sample ◽  
Health State ◽  
Severe Fatigue ◽  
Fatigue Severity

Background We aimed to compare the prevalence and severity of fatigue in survivors of Covid-19 versus non-Covid-19 critical illness, and to explore potential associations between baseline characteristics and worse recovery. Methods We conducted a secondary analysis of two prospectively collected datasets. The population included was 92 patients who received invasive mechanical ventilation (IMV) with Covid-19, and 240 patients who received IMV with non-Covid-19 illness before the pandemic. Follow-up data was collected post-hospital discharge using self-reported questionnaires. The main outcome measures were self-reported fatigue severity and the prevalence of severe fatigue (severity >7/10) 3 and 12-months post-hospital discharge. Results Covid-19 IMV-patients were significantly younger with less prior comorbidity, and more males, than pre-pandemic IMV-patients. At 3-months, the prevalence (38.9% [7/18] vs. 27.1% [51/188]) and severity (median 5.5/10 vs. 5.0/10) of fatigue was similar between the Covid-19 and pre-pandemic populations respectively. At 6-months, the prevalence (10.3% [3/29] vs. 32.5% [54/166]) and severity (median 2.0/10 vs. 5.7/10) of fatigue was less in the Covid-19 cohort. In the Covid-19 population, women under 50 experienced more severe fatigue, breathlessness, and worse overall health state compared to other Covid-19 IMV-patients. There were no significant sex differences in long-term outcomes in the pre-pandemic population. In the total sample of IMV-patients included (i.e. all Covid-19 and pre-pandemic patients), having Covid-19 was significantly associated with less severe fatigue (severity <7/10) after adjusting for age, sex, and prior comorbidity (adjusted OR 0.35 (95%CI 0.15-0.76, p=0.01). Conclusion. Fatigue may be less severe after Covid-19 than after other critical illness.

scholarly journals Functional status of mechanically ventilated COVID-19 survivors at ICU and hospital discharge

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Benjamin Musheyev ◽  
Lara Borg ◽  
Rebeca Janowicz ◽  
Michael Matarlo ◽  
Hayle Boyle ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Functional Status ◽  
Hospital Discharge ◽  
Medical Equipment ◽  
Invasive Mechanical Ventilation ◽  
Chronic Obstructive ◽  
Vascular Medicine ◽  
Icu Discharge ◽  
Functional Scores

Abstract Background A significant number of COVID-19 patients have been treated using invasive mechanical ventilation (IMV). The ability to evaluate functional status of COVID-19 survivors early on at ICU and hospital discharge may enable identification of patients who may need medical and rehabilitation interventions. Methods The modified “Mental Status”, ICU Mobility, and Barthel Index scores at ICU and hospital discharge were tabulated for 118 COVID-19 survivors treated with invasive mechanical ventilation (IMV). These functional scores were compared with pre-admission functional status, discharge durable medical equipment, discharge medical follow-up recommendation, duration on IMV, duration post-IMV, demographics, comorbidities, laboratory tests, and vital signs at ICU and hospital discharge. Results The majority of COVID-19 IMV patients were not functionally independent at hospital discharge (22% discharged with cane or rolling walker, 49% discharged with durable medical equipment, and 14% admitted to a rehabilitation facility), although 94% of these patients were functionally independent prior to COVID-19 illness. Half of the patients were discharged with supplemental oxygen equipment. The most prevalent medical follow-up recommendations were cardiology, vascular medicine, pulmonology, endocrinology, and neurology with many patients receiving multiple medical follow-up recommendations. Functional status improved from ICU discharge to hospital discharge (p < 0.001). Worse functional status at hospital discharge was associated with longer IMV duration, older age, male sex, higher number of comorbidities, and the presence of pre-existing comorbidities including hypertension, diabetes, chronic obstructive pulmonary disease, and immunosuppression (p < 0.05, ANOVA). Conclusions The majority of IMV COVID-19 survivors were not functionally independent at discharge and required significant follow-up medical care. The COVID-19 circumstance has placed constraints on access to in-hospital rehabilitation. These findings underscore the need for prospective studies to ascertain the short- and long-term sequela in COVID-19 survivors.

scholarly journals Functional Status of Mechanically Ventilated COVID-19 Survivors at ICU and Hospital Discharge

2020 ◽  
Author(s):  
Benjamin Musheyev ◽  
Lara Borg ◽  
Rebeca Janowicz ◽  
Michael Matarlo ◽  
Hayle Boyle ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Functional Status ◽  
Hospital Discharge ◽  
Medical Equipment ◽  
Invasive Mechanical Ventilation ◽  
Chronic Obstructive ◽  
Vascular Medicine ◽  
Icu Discharge ◽  
Functional Scores

Abstract Background A significant number of COVID-19 patients have been treated using invasive mechanical ventilation (IMV). The ability to evaluate functional status of COVID-19 survivors early on at ICU and hospital discharge can help minimize ICU-acquired weakness, promote rapid functional recovery, and improve quality of lifeMethods The modified “Mental Status”, ICU Mobility, and Barthel Index scores at ICU and hospital discharge were tabulated for 118 COVID-19 survivors treated with invasive mechanical ventilation (IMV). These functional scores were compared with pre-admission functional status, discharge durable medical equipment, discharge medical follow-up recommendation, duration on IMV, duration post IMV, demographics, comorbidities, laboratory tests, and vital signs at ICU and hospital discharge. Results The majority of COVID-19 IMV patients were not functionally independent at hospital discharge (22% discharged with cane or rolling walker, 49% discharged with durable medical equipment, and 14% admitted to a rehabilitation facility), although they were prior to COVID-19 illness. Half of the patients were discharged with supplemental oxygen equipment. The most prevalent medical follow-up recommendations were cardiology, vascular medicine, pulmonology, endocrinology, and neurology with many patients receiving multiple medical follow-up recommendations. Functional status improved from ICU discharge to hospital discharge (p<0.001). Worse functional status at hospital discharge was associated with longer IMV duration, older age, male sex, higher number of comorbidities, and the presence of pre-existing comorbidities including hypertension, diabetes, chronic obstructive pulmonary disease, and immunosuppression (p<0.05, ANOVA). Conclusions The majority of IMV COVID-19 survivors were not functionally independent at discharge and required significant follow-up medical care. The COVID-19 circumstance has placed constraints on access to in-hospital rehabilitation. These findings underscore the need for prospective studies to ascertain the short- and long-term sequela in COVID-19 survivors.

scholarly journals COVID-IRS: A novel predictive score for risk of invasive mechanical ventilation in patients with COVID-19

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0248357
Author(s):  
José Antonio Garcia-Gordillo ◽  
Antonio Camiro-Zúñiga ◽  
Mercedes Aguilar-Soto ◽  
Dalia Cuenca ◽  
Arturo Cadena-Fernández ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Systemic Disease ◽  
Invasive Mechanical Ventilation ◽  
Area Under The Curve ◽  
Lactic Dehydrogenase ◽  
Total Sample ◽  
Adverse Outcomes ◽  
Predictive Score ◽  
Neutrophil Lymphocyte Ratio ◽  
Predictive Variables

Background Coronavirus disease 2019 (COVID-19) is a systemic disease that can rapidly progress into acute respiratory failure and death. Timely identification of these patients is crucial for a proper administration of health-care resources. Objective To develop a predictive score that estimates the risk of invasive mechanical ventilation (IMV) among patients with COVID-19. Study design Retrospective cohort study of 401 COVID-19 patients diagnosed from March 12, to August 10, 2020. The score development cohort comprised 211 patients (52.62% of total sample) whereas the validation cohort included 190 patients (47.38% of total sample). We divided participants according to the need of invasive mechanical ventilation (IMV) and looked for potential predictive variables. Results We developed two predictive scores, one based on Interleukin-6 (IL-6) and the other one on the Neutrophil/Lymphocyte ratio (NLR), using the following variables: respiratory rate, SpO2/FiO2 ratio and lactic dehydrogenase (LDH). The area under the curve (AUC) in the development cohort was 0.877 (0.823–0.931) using the NLR based score and 0.891 (0.843–0.939) using the IL-6 based score. When compared with other similar scores developed for the prediction of adverse outcomes in COVID-19, the COVID-IRS scores proved to be superior in the prediction of IMV. Conclusion The COVID-IRS scores accurately predict the need for mechanical ventilation in COVID-19 patients using readily available variables taken upon admission. More studies testing the applicability of COVID-IRS in other centers and populations, as well as its performance as a triage tool for COVID-19 patients are needed.

The Association between D-dimer Levels and Thromboembolism, Worsening Severity, and Mortality among Hospitalized Adults with COVID-19

2021 ◽  
Author(s):  
Patricia Pauline M. Remalante-Rayco ◽  
Evelyn O. Salido ◽  
Joey A. Tabula ◽  
Maria Teresa S. Tolosa
Keyword(s):  
Mechanical Ventilation ◽  
Critical Illness ◽  
Open Access ◽  
Clinical Outcomes ◽  
Observational Studies ◽  
Prognostic Indicator ◽  
Cochrane Library ◽  
Increased Risk ◽  
D Dimer

Objective. To assess the association between D-dimer and clinical outcomes in adults with COVID-19. Methods. We reviewed published articles and preprints from MEDLINE, Cochrane Library, Cornell Open Access Publication (COAP), MedRxiv, and BioRxiv databases. We included cohort studies on the association between D-dimer and the outcomes of thromboembolism, mortality, and worsening severity among hospitalized adults with COVID-19. Results. We found 25 observational studies on the association between D-dimer and the outcomes of thromboembolism, mortality, or worsening severity. There was an increased risk of thromboembolism (OR 5.61 [95% CI 3.97, 7.94]) with higher D-dimer levels across different COVID-19 severities. D-dimer levels are associated with higher in-hospital mortality (OR 5.57 [95% CI 2.74, 11.31]) and worsening severity manifesting as critical illness (OR 1.91 [95% CI 1.05, 3.48] to 2.58 [95% CI 1.57, 4.24]), disease progression (HR 2.846 [95% CI 2.10, 3.85]), or need for mechanical ventilation (HR 3.28 [95% CI 1.07, 10.10]). However, some methodological flaws, such as incomplete laboratory or follow-up data and concern on varied D-dimer cut-offs and definitions of worsening disease, raise some uncertainty in the widespread use of D-dimer as a prognostic marker. Conclusion. A higher D-dimer value is associated with worse clinical outcomes among hospitalized adults with COVID-19 and may be a useful prognostic indicator.

scholarly journals Cerebral microhaemorrhage in COVID-19: a critical illness related phenomenon?

2020 ◽  
Vol 5 (4) ◽  
pp. 315-322 ◽  
Author(s):  
Luke Dixon ◽  
Cillian McNamara ◽  
Pritika Gaur ◽  
Dermot Mallon ◽  
Christopher Coughlan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Illness ◽  
Clinical Characteristics ◽  
Case Series ◽  
Severe Hypoxia ◽  
Related Phenomenon ◽  
Test Results ◽  
Secondary Effects ◽  
Preceding Period ◽  
Baseline Characteristics

BackgroundCerebral microhaemorrhages are increasingly being recognised as a complication of COVID-19. This observational retrospective study aims to further investigate the potential pathophysiology through assessing the pattern of microhaemorrhage and clinical characteristics of patients with COVID-19 and microhaemorrhage. By comparing with similar patterns of microhaemorrhage in other non-COVID-19 disease, this study aims to propose possible common pathogenic mechanisms.MethodsA retrospective observational case series was performed identifying all patients with COVID-19 complicated by cerebral microhaemorrhage on MRI. The distribution and number of microhaemorrhages were recorded using the microbleed anatomical scale, and patients’ baseline characteristics and salient test results were also recorded.ResultsCerebral microhaemorrhages were noted to have a predilection for the corpus callosum, the juxtacortical white matter and brainstem. All patients had a preceding period of critical illness with respiratory failure and severe hypoxia necessitating intubation and mechanical ventilation.DiscussionThis study demonstrates a pattern of cerebral microhaemorrhage that is similar to the pattern reported in patients with non-COVID-19 related critical illness and other causes of severe hypoxia. This raises questions regarding whether microhaemorrhage occurs from endothelial dysfunction due the direct effect of SARS-CoV-2 infection or from the secondary effects of critical illness and hypoxia.

A contextual needs assessment of families with home invasive mechanical ventilation patients: A qualitative study

2021 ◽  
pp. 174239532110263
Author(s):  
Maryam Esmaeili ◽  
Parvaneh Asgari ◽  
Nahid Dehghan Nayeri ◽  
Fatemeh Bahramnezhad ◽  
Samrand Fattah Ghazi
Keyword(s):  
Mechanical Ventilation ◽  
Home Care ◽  
Invasive Mechanical Ventilation ◽  
Multidisciplinary Treatment ◽  
Psychological Needs ◽  
Number Of Patients ◽  
Study Results ◽  
Long Term Follow Up

Objectives With the advancement of technology the number of patients surviving critical illness has increased. Home mechanical ventilation (HMV) is a growing option for patients requiring long-term mechanical ventilation. Caring for these patients is demanding and challenging. The aim of this study was to explore family caregivers’(carers) needs when providing care to adult patients under HMV from the perspective of nurses, home care attendants, and the caregivers themselves. Methods Overall, 15 participants (nine carers, three home nurses, and three home care attendants) were selected by purposive sampling. Data were collected by in-depth semi-structured interviews and structured observation. Finally, data were analyzed through conventional content analysis with MAXQDA software. Results Three categories of carers’needs were identified, including educational needs (basic and emergencies), psychological needs, and economic needs. In addition, since the needs, feelings, and views of caregivers change over time, the noted needs were divided into three periods: Pre-discharge preparation, initial transition from hospital to home, and appropriate long-term follow-up. Conclusion The study results showed that the families of patients under invasive HMV require a standard discharge plan based on their care needs, financial concerns, and psychological screening before discharge as well as a suitable long-term follow-up plan in collaboration with a multidisciplinary treatment team, insurance providers, and home care services.

scholarly journals Association between smoking cessation and post-hospitalization healthcare costs: a matched cohort analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Margaret B. Nolan ◽  
Bijan J. Borah ◽  
James P. Moriarty ◽  
David O. Warner
Keyword(s):  
Clinical Trial ◽  
Hospital Discharge ◽  
Healthcare Costs ◽  
Smoking Status ◽  
Cohort Analysis ◽  
Secondary Analysis ◽  
Population Based ◽  
Point Prevalence ◽  
Point Prevalence Abstinence

Abstract Background The potential economic benefit in terms of reduced healthcare costs when patients quit smoking after hospital discharge has not been directly measured. The aim of this study was to compare the costs for hospital admission and six-month follow-up for a cohort of patients who self-reported abstinence from cigarettes at 6 months after hospital discharge and a matched group of patients who reported continued smoking. Materials and methods This was a secondary analysis of a recent population-based clinical trial cohort (ClinicalTrials.gov ID: NCT01575145), with cohort membership determined by self-reported 7 day point prevalence abstinence at 6 months after the index hospital discharge. Participants were admitted to Mayo Clinic Hospital, Rochester, MN, between May 5, 2012 and August 10, 2014 for any indication and lived in the areas covered by postal codes included in Olmsted County, MN. Propensity score matching was used to control for differences between groups other than smoking status, and any residual imbalance was adjusted through generalized linear model with gamma distribution for cost and log-link transformation. Results Of 600 patients enrolled in the clinical trial, 144 could be contacted and self-reported 7 day point prevalence abstinence at 6 months after hospital discharge. Of these patients, 99 were successfully matched for this analysis. The cost for the index hospitalization was significantly greater in patients who abstained compared to those that did not abstain (mean difference of $3042, higher for abstainers, 95% CI $170 to $5913, P = 0.038). However, there was no difference between mean 6-month follow-up costs, number of inpatient hospitalizations, or number of emergency room visits for abstainers versus non-abstainers. Conclusion There was no evidence to support the hypothesis that abstinence at 6 months after hospital discharge is associated with a decrease in health care costs or utilization over the first 6 months after hospital discharge.

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