scholarly journals Acute respiratory failure and inflammatory response after out-of-hospital cardiac arrest: results of the Post-Cardiac Arrest Syndrome (PCAS) pilot study

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S110-S121
Author(s):  
Katarzyna Czerwińska-Jelonkiewicz ◽  
Johannes Grand ◽  
Guido Tavazzi ◽  
Jordi Sans-Rosello ◽  
Alice Wood ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Respiratory Failure ◽  
Inflammatory Response ◽  
Acute Respiratory Failure ◽  
White Blood Cells ◽  
Short Term ◽  
Reactive Protein ◽  
Short Term Mortality ◽  
Post Cardiac Arrest Syndrome ◽  
Hospital Cardiac Arrest

Background: Although the lungs are potentially highly susceptible to post-cardiac arrest syndrome injury, the issue of acute respiratory failure after out-of-hospital cardiac arrest has not been investigated. The objectives of this analysis were to determine the prevalence of acute respiratory failure after out-of-hospital cardiac arrest, its association with post-cardiac arrest syndrome inflammatory response and to clarify its importance for early mortality. Methods: The Post-Cardiac Arrest Syndrome (PCAS) pilot study was a prospective, observational, six-centre project (Poland 2, Denmark 1, Spain 1, Italy 1, UK 1), studying patients resuscitated after out-of-hospital cardiac arrest of cardiac origin. Primary outcomes were: (a) the profile of organ failure within the first 72 hours after out-of-hospital cardiac arrest; (b) in-hospital and short-term mortality, up to 30 days of follow-up. Respiratory failure was defined using a modified version of the Berlin acute respiratory distress syndrome definition. Inflammatory response was defined using leukocytes (white blood cells), platelet count and C-reactive protein concentration. All parameters were assessed every 24 hours, from admission until 72 hours of stay. Results: Overall, 148 patients (age 62.9±15.27 years; 27.7% women) were included. Acute respiratory failure was noted in between 50 (33.8%) and 75 (50.7%) patients over the first 72 hours. In-hospital and short-term mortality was 68 (46.9%) and 72 (48.6%), respectively. Inflammation was significantly associated with the risk of acute respiratory failure, with the highest cumulative odds ratio of 748 at 72 hours (C-reactive protein 1.035 (1.001–1.070); 0.043, white blood cells 1.086 (1.039–1.136); 0.001, platelets 1.004 (1.001–1.007); <0.005). Early acute respiratory failure was related to in-hospital mortality (3.172, 95% confidence interval 1.496–6.725; 0.002) and to short-term mortality (3.335 (1.815–6.129); 0.0001). Conclusions: An inflammatory response is significantly associated with acute respiratory failure early after out-of-hospital cardiac arrest. Acute respiratory failure is associated with a worse early prognosis after out-of-hospital cardiac arrest.

scholarly journals High Platelet-Lymphocyte Ratio is a Risk Factor for 30-day Mortality In In-Hospital Cardiac Arrest Patients: A Case-Control Study

2021 ◽  
Author(s):  
Lihong Huang ◽  
Jingjing Peng ◽  
Xuefeng Wang ◽  
Feng Li
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Inflammatory Markers ◽  
Short Term ◽  
Dynamic Changes ◽  
Lymphocyte Ratio ◽  
Short Term Mortality ◽  
Independent Risk Factors ◽  
The Absolute ◽  
Hospital Cardiac Arrest

Abstract Background: Early identification of risk factors for short-term mortality in patients with in-hospital cardiac arrest (IHCA) is crucial for early prognostication. This study aimed to explore the association of early dynamic changes in inflammatory markers with 30-day mortality in IHCA patients.Methods: This study retrospectively collected demographic and clinical characteristics and relevant laboratory indicators within 72 h after recovery of spontaneous circulation (ROSC) of IHCA patients from December 2015 to December 2020 at the First Affiliated Hospital of Chongqing Medical University. The outcome was 30-day mortality. A linear mixed model was used to analyze the dynamic changes in laboratory indicators within 72 h after ROSC, and Cox regression was used to identify the independent risk factors for 30-day mortality.Results: Overall, 85 IHCA patients were included. The 0-72h and 0-30day cumulative mortality rates were 25.88% and 57.65%, respectively, and the median survival time was 13.79 days. There was no association of inflammatory markers before IHCA with mortality. Within 72 h after ROSC, inflammatory markers showed various changes: the absolute monocyte count (AMC) showed no significant change trend, and the absolute lymphocyte count (ALC) showed an overall upward trend, while the absolute neutral count (ANC), white blood cell (WBC) count, platelet (PLT) count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) showed an overall downward trend. Cox multivariate analysis showed that Charlson comorbidity index (CCI) (HR = 2.366, 95%CI (1.084, 5.168)), APACHE II score (HR = 2.550, 95% CI (1.001, 6.498)), abnormal Cr before IHCA (HR = 3.417, 95% CI (1.441, 8.104)) and PLR within 72 h after ROSC (HR = 2.993, 95% CI (1.442, 6.214)) were independent risk factors for 30-day mortality. When PLR ≥ 180, the risk of 30-day mortality increased by 199.3%.Conclusions: This study clarified the dynamic change trends of inflammatory markers within 72 h after ROSC. The PLR was an independent risk factor for 30-day mortality in IHCA patients; it can be used as a predictor of short-term mortality and provide a reference for early prognostication.Trial registration: ChiCTR1800014324

scholarly journals Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Hideto Yasuda ◽  
Hiromu Okano ◽  
Takuya Mayumi ◽  
Chihiro Narita ◽  
Yu Onodera ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Relative Risk ◽  
Confidence Interval ◽  
Acute Respiratory Failure ◽  
Meta Analysis ◽  
Positive Pressure ◽  
Cochrane Central Register ◽  
Short Term ◽  
Short Term Mortality ◽  
Registration Number

Abstract Background High-flow nasal cannula oxygenation (HFNC) and noninvasive positive-pressure ventilation (NPPV) possibly decrease tracheal reintubation rates better than conventional oxygen therapy (COT); however, few large-scale studies have compared HFNC and NPPV. We conducted a network meta-analysis (NMA) to compare the effectiveness of three post-extubation respiratory support devices (HFNC, NPPV, and COT) in reducing the mortality and reintubation risk. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. COT, NPPV, and HFNC use were assessed in patients who were aged ≥ 16 years, underwent invasive mechanical ventilation for > 12 h for acute respiratory failure, and were scheduled for extubation after spontaneous breathing trials. The GRADE Working Group Approach was performed using a frequentist-based approach with multivariate random-effect meta-analysis. Short-term mortality and reintubation and post-extubation respiratory failure rates were compared. Results After evaluating 4631 records, 15 studies and 2600 patients were included. The main cause of acute hypoxic respiratory failure was pneumonia. Although NPPV/HFNC use did not significantly lower the mortality risk (relative risk [95% confidence interval] 0.75 [0.53–1.06] and 0.92 [0.67–1.27]; low and moderate certainty, respectively), HFNC use significantly lowered the reintubation risk (0.54 [0.32–0.89]; high certainty) compared to COT use. The associations of mortality with NPPV and HFNC use with respect to either outcome did not differ significantly (short-term mortality and reintubation, relative risk [95% confidence interval] 0.81 [0.61–1.08] and 1.02 [0.53–1.97]; moderate and very low certainty, respectively). Conclusion NPPV or HFNC use may not reduce the risk of short-term mortality; however, they may reduce the risk of endotracheal reintubation. Trial registration number and date of registration PROSPERO (registration number: CRD42020139112, 01/21/2020).

scholarly journals Post-extubation Oxygenation Strategies and Mortality and Reintubation Rates in Acute Respiratory Failure: A Systematic Review and Network Meta-Analysis

2021 ◽  
Author(s):  
Hideto Yasuda ◽  
Hiromu Okano ◽  
Takuya Mayumi ◽  
Chihiro Narita ◽  
Yu Onodera ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Relative Risk ◽  
Confidence Interval ◽  
Acute Respiratory Failure ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Positive Pressure ◽  
Short Term ◽  
Short Term Mortality ◽  
Registration Number

Abstract Background: High-flow nasal cannula oxygenation (HFNC) and noninvasive positive-pressure ventilation (NPPV) possibly decrease tracheal reintubation rates better than conventional oxygen therapy (COT); however, few large-scale studies have compared HFNC and NPPV. We conducted a network meta-analysis (NMA) to compare the effectiveness of three post-extubation respiratory support devices (HFNC, NPPV, COT) in reducing the mortality and reintubation risk.Methods: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. COT, NPPV, and HFNC use were assessed in patients aged ≥16 years who underwent invasive mechanical ventilation for >12 hours for acute respiratory failure and were scheduled for extubation after spontaneous breathing trials. The GRADE Working Group Approach was performed using a frequentist-based approach with multivariate random-effects meta-analysis. Short-term mortality and reintubation and post-extubation respiratory failure rates were compared. Results: After evaluating 4,631 records, 15 studies and 2,600 patients were included. The main cause of acute hypoxic respiratory failure was pneumonia. Although NPPV/HFNC use did not significantly lower the mortality risk (relative risk [95% confidence interval], 0.75 [0.53–1.06] and 0.92 [0.67–1.27]; low and moderate certainty, respectively), HFNC use significantly lowered the reintubation risk (0.54 [0.32–0.89]; high certainty) compared with COT use. The associations of mortality with NPPV and HFNC in either outcome did not differ significantly (short-term mortality and reintubation, relative risk [95% confidence interval], 0.81 [0.61–1.08] and 1.02 [0.53–1.97]; moderate and very low certainty, respectively).Conclusion: NPPV or HFNC use may reduce endotracheal reintubation risk, but not short-term mortality risk.Trial registration number and date of registrationPROSPERO (registration number: CRD42020139112, 01/21/2020).

scholarly journals A Novel Prediction Prognosis Model of sepsis with acute respiratory failure: A cohort study from the MIMIC-IV database

2021 ◽  
Author(s):  
Lina Zhao ◽  
Jing Yang ◽  
Yunying Wang ◽  
Zheng Ge. Zeng ◽  
Tao Liu ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Medical Information ◽  
Cox Regression ◽  
Abdominal Cavity ◽  
Simplified Acute Physiology Score ◽  
Hospital Death ◽  
Short Term ◽  
Short Term Mortality ◽  
Prognosis Model

Abstract Objectives: Acute respiratory failure is significantly related to increased short-term mortality in sepsis patients. We aimed to develop a novel prognosis model for predicting the risk for hospital mortality in sepsis patients with acute respiratory failure.Methods: We researched the Medical Information Mart for Intensive Care (MIMIC)-IV database, and developed a matched cohort of adult sepsis with acute respiratory failure. After applying multivariate Cox regression, a nomogram was developed based on identified risk factors of the mortality in the cohort. Besides, the discrimination of the nomogram in predicting individual hospital death was evaluated by the area under o the characteristic operating curve (ROC).Results: A total of 663 sepsis patients with acute respiratory failure were included in this study. Systolic blood pressure, white blood cell count, neutrophils, mechanical ventilation, PaO2 < 60mmHg, abdominal cavity infection, Klebsiella pneumoniae, Acinetobacter baumannii, and immunosuppressive disease were the independent risk predictors of the mortality in sepsis patients with acute respiratory failure. The area under curve of the nomogram in the ROC was 0.880 (95% CI: 0.851-0.908) that provided significantly higher discrimination compared with simplified acute physiology score II [0.656 (95% CI: 0.612-0.701)].Conclusion: The model has good performance in predicting the mortality risk of sepsis patients with acute respiratory failure, and it can be clinically useful to evaluate the short-term prognosis in critically ill patients with sepsis and acute respiratory failure.

scholarly journals In-hospital Cardiac Arrest in Patients With Sepsis: A National Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Catherine Duazo ◽  
Jo-Ching Hsiung ◽  
Frank Qian ◽  
Charles Fox Sherrod ◽  
Dean-An Ling ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Cohort Study ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Organ Dysfunction ◽  
Risk Index ◽  
Cardiac Risk ◽  
Tract Infections ◽  
Hospital Cardiac Arrest

Background: Little is known about the risk of in-hospital cardiac arrest (IHCA) among patients with sepsis. We aimed to characterize the incidence and outcome of IHCA among patients with sepsis in a national database. We then determined the major risk factors associated with IHCA among sepsis patients.Methods: We used data from a population-based cohort study based on the National Health Insurance Research Database of Taiwan (NHRID) between 2000 and 2013. We used Martin's implementation that combined the explicit ICD-9 CM codes for sepsis and six major organ dysfunction categories. IHCA among sepsis patients was identified by the presence of cardiopulmonary resuscitation procedures. The survival impact was analyzed with the Cox proportional-hazards model using inverse probability of treatment weighting (IPTW). The risk factors were identified by logistic regression models with 10-fold cross-validation, adjusting for competing risks.Results: We identified a total of 20,022 patients with sepsis, among whom 2,168 developed in-hospital cardiac arrest. Sepsis patients with a higher burden of comorbidities and organ dysfunction were more likely to develop in-hospital cardiac arrest. Acute respiratory failure, hematological dysfunction, renal dysfunction, and hepatic dysfunction were associated with increased risk of IHCA. Regarding the source of infection, patients with respiratory tract infections were at the highest risk, whereas patients with urinary tract infections and primary bacteremia were less likely to develop IHCA. The risk of IHCA correlated well with age and revised cardiac risk index (RCRI). The final competing risk model concluded that acute respiratory failure, male gender, and diabetes are the three strongest predictors for IHCA. The effect of IHCA on survival can last 1 year after hospital discharge, with an IPTW-weighted hazard ratio of 5.19 (95% CI: 5.06, 5.35) compared to patients who did not develop IHCA.Conclusion: IHCA in sepsis patients had a negative effect on both short- and long-term survival. The risk of IHCA among hospitalized sepsis patients was strongly correlated with age and cardiac risk index. The three identified risk factors can help clinicians to identify patients at higher risk for IHCA.

scholarly journals Correlation between CT findings and outcomes in 46 patients with coronavirus disease 2019

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Qiang Lei ◽  
Guangming Li ◽  
Xiaofen Ma ◽  
Junzhang Tian ◽  
Yun fan Wu ◽  
...  
Keyword(s):  
Ground Glass Opacity ◽  
Ground Glass ◽  
Short Term ◽  
Lung Lobe ◽  
Reactive Protein ◽  
Ct Findings ◽  
Short Term Mortality ◽  
Recovery Group ◽  
Diffuse Distribution ◽  
Death Group

AbstractThe aim of this study was to analyze initial chest computed tomography (CT) findings in COVID-19 pneumonia and identify features associated with poor prognosis. Patients with RT-PCR-confirmed COVID-19 infection were assigned to recovery group if they made a full recovery and to death group if they died within 2 months of hospitalization. Chest CT examinations for ground-glass opacity, crazy-paving pattern, consolidation, and fibrosis were scored by two reviewers. The total CT score comprised the sum of lung involvement (5 lobes, scores 1–5 for each lobe, range; 0, none; 25, maximum). 40 patients who recovered from COVID-19 and six patients who died were enrolled. The initial chest CTs showed 27 (58.7%) patients had ground-glass opacity, 19 (41.3%) had ground glass and consolidation, and 35 (76.1%) patients had crazy-paving pattern. None of the patients who died had fibrosis in contrast to six (15%) patients who recovered from COVID-19. Most patients had subpleural lesions (89.0%) as well as bilateral (87.0%) and lower (93.0%) lung lobe involvement. Diffuse lesions were present in four (67%) patients who succumbed to coronavirus but only one (2.5%) patient who recovered (p < 0.001). In the death group of patients, the total CT score was higher than that of the recovery group (p = 0.005). Patients in the death group had lower lymphocyte count and higher C-reactive protein than those in the recovery group (p = 0.011 and p = 0.041, respectively). A high CT score and diffuse distribution of lung lesions in COVID-19 are indicative of disease severity and short-term mortality.

Association of post-resuscitation inflammatory response with favorable neurologic outcomes in adults with in-hospital cardiac arrest

Resuscitation ◽  
2021 ◽  
Vol 159 ◽  
pp. 54-59
Author(s):  
Jignesh K. Patel ◽  
Niraj Sinha ◽  
Wei Hou ◽  
Rian Shah ◽  
Asem Qadeer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Inflammatory Response ◽  
Neurologic Outcomes ◽  
Hospital Cardiac Arrest
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