Influenza in patients with respiratory failure admitted to intensive care units in Poland and the use of extracorporeal respiratory support: a survey-based multicenter study

Abstract Background In Poland, little is known about the most serious cases of influenza that need admittance to the intensive care unit (ICU), as well as the use of extracorporeal respiratory support. Methods This was an electronic survey comprising ICUs in two administrative regions of Poland. The aim of the study was to determine the number of influenza patients with respiratory failure admitted to the ICU in the autumn–winter season of 2018/2019. Furthermore, respiratory support, outcome and other pathogens detected in the airways were investigated. Results Influenza infection was confirmed in 76 patients. The A(H1N1)pdm09 strain was the most common. 34 patients died (44.7%). The median age was 62 years, the median sequential organ failure assessment (SOFA) score was 11 and was higher in patients who died (12 vs. 10, p = 0.017). Mechanical ventilation was used in 75 patients and high flow nasal oxygen therapy in 1 patient. Extracorporeal membrane oxygenation (ECMO) was used in 7 patients (6 survived), and extracorporeal carbon dioxide removal (ECCO2R) in 2 (1 survived). The prone position was used in 16 patients. In addition, other pathogens were detected in the airways on admittance to the ICU. Conclusion A substantial number of influenza infections occurred in the autumn–winter season of 2018/2019 that required costly treatment in the intensive care units. Upon admission to the ICU, influenza patients had a high degree of organ failure as assessed by the SOFA score, and the mortality rate was 44.7%. Advanced extracorporeal respiratory techniques offer real survival opportunities to patients with severe influenza-related ARDS. The presence of coinfection should be considered in patients with influenza and respiratory failure.

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Baseline characteristics and outcomes of COVID-19 patients admitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2020.704 ◽

2020 ◽

Vol 15 ◽

Author(s):

Valentina Di Lecce ◽

Giovanna Elisiana Carpagnano ◽

Paola Pierucci ◽

Vitaliano Nicola Quaranta ◽

Federica Barratta ◽

...

Keyword(s):

Intensive Care ◽

Respiratory Failure ◽

Clinical Outcomes ◽

Intensive Care Units ◽

Invasive Mechanical Ventilation ◽

Respiratory Support ◽

Severe Respiratory Failure ◽

Non Invasive ◽

Baseline Characteristics ◽

Almost All

The recent Coronavirus disease 19 (COVID-19) pandemic, first in China and then also in Italy, brought to the attention the problem of the saturation of Intensive Care Units (ICUs). Almost all previous reports showed that in ICU less than half of patients were treated with invasive mechanical ventilation (IMV) and the rest of them with non-invasive respiratory support. This highlighted the role of respiratory intensive care units (RICUs), where patients with moderate to severe respiratory failure can be treated with non-invasive respiratory support, avoiding ICU admission. In this report, we describe baseline characteristics and clinical outcomes of 97 patients with moderate to severe respiratory failure due to COVID-19 admitted to the RICU of the Policlinico of Bari from March 11th to May 31st 2020. In our population, most of the subjects were male (72%), non-smokers (76%), with a mean age of 69.65±14 years. Ninety-one percent of patients presented at least one comorbidity and 60% had more than two comorbidities. At admission, 40% of patients showed PaO2/FiO2 ratio between 100 and 200 and 17% showed Pa02/FiO2 ratio <100. Mean Pa02/FiO2 ratio at admission was 186.4±80. These patients were treated with non-invasive respiratory support 40% with CPAP, 38% with BPAP, 3% with HFNC, 11% with standard oxygen therapy or with IMV through tracheostomy (patients in step down from ICU, 8%). Patients discharged to general ward (GW) were 51%, 30% was transferred to ICU and 19% died. To the best of our knowledge, this is one of the few described experiences of patients with respiratory failure due to COVID-19 treated outside the ICU, in a RICU. Outcomes of our patients, characterized by several risk factors for disease progression, were satisfactory compared with other experiences regarding patients treated with non-invasive respiratory support in ICU. The strategical allocation of our RICU, between ED and ICU, might have positively influenced clinical outcomes of our patients.

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Establishment of a prognostic model based on the Sequential Organ Failure Assessment score for patients with first-time acute myocardial infarction

Journal of International Medical Research ◽

10.1177/03000605211011976 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110119

Author(s):

Shuai Zheng ◽

Jun Lyu ◽

Didi Han ◽

Fengshuo Xu ◽

Chengzhuo Li ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Intensive Care Unit ◽

Intensive Care ◽

Sequential Organ Failure Assessment ◽

Organ Failure ◽

Sofa Score ◽

Cardiovascular Events ◽

Failure Assessment ◽

First Time

Objective This study aimed to identify the prognostic factors of patients with first-time acute myocardial infarction (AMI) and to establish a nomogram for prognostic modeling. Methods We studied 985 patients with first-time AMI using data from the Multi-parameter Intelligent Monitoring for Intensive Care database and extracted their demographic data. Cox proportional hazards regression was used to examine outcome-related variables. We also tested a new predictive model that includes the Sequential Organ Failure Assessment (SOFA) score and compared it with the SOFA-only model. Results An older age, higher SOFA score, and higher Acute Physiology III score were risk factors for the prognosis of AMI. The risk of further cardiovascular events was 1.54-fold higher in women than in men. Patients in the cardiac surgery intensive care unit had a better prognosis than those in the coronary heart disease intensive care unit. Pressurized drug use was a protective factor and the risk of further cardiovascular events was 1.36-fold higher in nonusers. Conclusion The prognosis of AMI is affected by age, the SOFA score, the Acute Physiology III score, sex, admission location, type of care unit, and vasopressin use. Our new predictive model for AMI has better performance than the SOFA model alone.

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Sequential Organ Failure Assessment (SOFA) Score Is Superior to Classical Prognostic Indices in Prediction of Severity, Intensive Care Unit Admissions and Mortality in Acute Pancreatitis

HPB ◽

10.1016/j.hpb.2020.11.116 ◽

2021 ◽

Vol 23 ◽

pp. S48-S49

Author(s):

S. Baey ◽

T. Tan ◽

S.K. Gunasekaran ◽

S.P. Junnarkar ◽

J.K. Low ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Pancreatitis ◽

Intensive Care ◽

Sequential Organ Failure Assessment ◽

Organ Failure ◽

Sofa Score ◽

Failure Assessment ◽

Prognostic Indices

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Facing COVID-19 Pandemic in a Tertiary Hospital in Milan: Prevalence of Burnout in Nursing Staff Working in Sub-Intensive Care Units

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18136684 ◽

2021 ◽

Vol 18 (13) ◽

pp. 6684

Author(s):

Alberto Bisesti ◽

Andrea Mallardo ◽

Simone Gambazza ◽

Filippo Binda ◽

Alessandro Galazzi ◽

...

Keyword(s):

Intensive Care ◽

Respiratory Failure ◽

Intensive Care Units ◽

Healthcare Workers ◽

Maslach Burnout Inventory ◽

Tertiary Hospital ◽

Personal Accomplishment ◽

Preventive Strategies ◽

Common Condition ◽

Hospital Units

In early March 2020, Italy became the epicenter of the Coronavirus Disease 2019 (COVID-19) pandemic in Europe. A different organization of hospital units was required to take care of patients affected by acute respiratory failure caused by COVID-19. This study aimed to evaluate the prevalence of burnout in two sub-intensive care units (SICUs) of the COVID-19 hub center of the Lombardia region in Milan (Italy). All nurses and healthcare assistants working in the SICUs during June 2020 were included in the study. Burnout was assessed via the Maslach Burnout Inventory questionnaire. One hundred and five (84%) SICU staff participated in the study. The prevalence of high burnout for nurses and healthcare assistants was 61.9% for emotional exhaustion, 47.6% for depersonalization and 34.3% for personal accomplishment. Depersonalization was significantly more frequent in younger nurses (p = 0.009). Nurses were 4.5 times more likely to have burnout than healthcare assistants. Burnout was a common condition among healthcare workers operating in SICUs during the pandemic. Urgent actions are needed, especially for nurses, as well as preventive strategies for future pandemic scenarios.

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