scholarly journals The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Christian Jung ◽  
◽  
Hans Flaatten ◽  
Jesper Fjølner ◽  
Raphael Romano Bruno ◽  
...  
Keyword(s):  
Intensive Care ◽  
Management Strategies ◽  
Prognostic Indicators ◽  
Prognostic Information ◽  
Clinical Frailty Scale ◽  
Intensive Care Patients ◽  
Prospective Multicentre Study ◽  
Frail Patients ◽  
Large Numbers ◽  
The Impact

Abstract Background The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. Methods A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. Results The study included 1346 patients (28% female) with a median age of 75 years (IQR 72–78, range 70–96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56–62), with 66% (63–69) in fit, 53% (47–61) in vulnerable and 41% (35–47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival. Conclusion Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: NCT04321265, registered 19 March 2020.

scholarly journals The Impact of Frailty on Survival in Elderly Intensive Care Patients with COVID-19 – the COVIP Study

2021 ◽  
Author(s):  
Christian Jung ◽  
Hans Flaatten ◽  
Jesper Fjølner ◽  
Raphael Romano Bruno ◽  
Bernhard Wernly ◽  
...  
Keyword(s):  
Intensive Care ◽  
Management Strategies ◽  
Prognostic Indicators ◽  
Prognostic Information ◽  
Clinical Frailty Scale ◽  
Multi Centre Study ◽  
Intensive Care Patients ◽  
Frail Patients ◽  
Large Numbers ◽  
The Impact

Abstract BackgroundThe COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients.MethodsA prospective multi-centre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the Clinical Frailty Scale (CFS). Additionally, comorbidities, management strategies and treatment limitations were recorded.ResultsThe study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years and 21% of the patients were frail. The overall survival at 30 days was 59% (95%CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p<0.001). In frail patients, there was no difference in 30 day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival.ConclusionFrailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities.

Behavioral Impacts Associated With Students With Disabilities in Australian Schools

2022 ◽  
pp. 1268-1294
Author(s):  
Anthony Charles Tencati
Keyword(s):  
Students With Disabilities ◽  
Management Strategies ◽  
Effective Management ◽  
Australian School ◽  
School Students ◽  
Australian Curriculum ◽  
Curriculum Assessment ◽  
Large Numbers ◽  
A Priority ◽  
The Impact

This chapter explores the link between students with disabilities, the behaviours they exhibit, the impact this has on their schooling, and the impact upon others. The author's school has a population of about 1,000 students, of whom over 10 percent have verified disabilities. According to Education Council (2016), data regarding the number of students with disabilities is inconsistent between schools in Australia's states and territories, however, there are schools throughout Australia that have large numbers of students with verified disabilities. This is reinforced by the Australian Curriculum Assessment and Reporting Authority (2018) where in 2017 there were about 18.8 percent of Australian school students with a verified disability. It is not surprising, therefore, that these statistics are concerning and research continues to be a priority. Identifying appropriate pedagogies and more effective management strategies for these students will benefit them, their families, and the community, and contribute to solving pressing issues in these students' lives.

scholarly journals LETTER TO THE EDITOR: COVID-19 AND THE CHALLENGES OF FRAILTY SCREENING IN OLDER ADULTS

2020 ◽  
pp. 1-2 ◽  
Author(s):  
R. O’Caoimh ◽  
S. Kennelly ◽  
E. Ahern ◽  
S. O’Keeffe ◽  
R.R. Ortuño
Keyword(s):  
Older Adults ◽  
Severe Acute Respiratory Syndrome ◽  
Healthcare Professionals ◽  
Management Strategies ◽  
Careful Examination ◽  
Geriatric Syndromes ◽  
Clinical Frailty Scale ◽  
The Impact ◽  
Recent Editorial ◽  
The Relationship

We read with interest the recent editorial examining the relationship between geriatric syndromes and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of Covid-19 (1), particularly the authors recognition of the need to identify frailty among older adults presenting with suspected symptoms and the importance of mobilising a range of healthcare professionals to tackle this disease (1). However, the identification of frailty and the utilisation of screening instruments by those without geriatric training and especially in acute care is challenging. Frailty is a complex condition. While age-associated, it is multi-dimensional and remains difficult to define (2). Although the Covid-19 pandemic has disproportionately affected older adults (1), data are lacking and pathophysiological mechanisms and the impact of differential management strategies on the course of the disease among older adults is uncertain (1). Further, the prevalence of frailty among those diagnosed, admitted or dying is not clearly reported at present. Nevertheless, the rationale for using frailty to identify those at risk and to allocate care has been correctly highlighted (1). We suggest however, that the use of instruments such as the Clinical Frailty Scale (CFS) (3) and particularly by non-specialised staff in this setting warrants more careful examination.

scholarly journals Impact of non-invasive respiratory support in severe patients with COVID-19

ANALES RANM ◽  
2020 ◽  
Vol 137 (137(02)) ◽  
pp. 154-160
Author(s):  
Ester Zamarrón ◽  
Carlos Carpio ◽  
Ana Santiago ◽  
Sergio Alcolea ◽  
Juan Carlos Figueira ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Respiratory Therapy ◽  
Respiratory Support ◽  
Intensive Care Patients ◽  
Non Invasive ◽  
Discharged Patients ◽  
Respiratory Treatment ◽  
The Impact

Objectives: to assess the impact of non-invasive respiratory therapies in critically ill patients diagnosed with COVID-19. Methods: retrospective cohort study of COVID-19 hospitalized patients who required non-invasive respiratory support. The impact of these treatments was evaluated in three groups of patients: pre-intensive care patients, discharged patients from critical care unit (CCU) and non-CCU admitted patients. The impact was assessed 30 days after completing respiratory therapy and was categorized as hospital discharge, transfer to a rehabilitation center, admission to the UCC and deceased. Results: a total of 80 patients were included (average age: 65.9 ± 11.9; men = 45 [56.3%]). 29 (36.3%) patients received BIPAP, 35 (43.8%) CPAP and 27 (33.4%) high-oxygen nasal cannula. Regarding the groups for the indication of respiratory treatment, 37 (46.3%) patients corresponded to the pre-intensive care patients, 24 (30%) were discharged patients from the CCU and 19 (23.8%) to the non-CCU admitted group. In the pre-intensive care, admission to a CCU was avoided in 19 (52.8%) patients and, on the other hand, 14 (38.9%) patients finally were admitted in a CCU. In the group of discharged patients from the UCC 19 (82.6%) patients showed a favorable course of disease. Only 3 (13%) patients were admitted in a UCC or died. Finally, in the group of non-CCU admitted, 6 (31.3%) improved after the use of respiratory therapy and 13 (68.4%) were deceased. Conclusions: respiratory therapies have a favorable impact on critically ill patients affected by COVID-19, both in patients with an indication for admission in the CCU, in those who are discharged from the CCUs and in those who do not have criteria for admission in these units.

scholarly journals Vital signs of severe COVID-19 patients during inter-hospital helicopter transfer

2021 ◽  
Author(s):  
Cornelis Slagt ◽  
Eduard Johannes Spoelder ◽  
Marijn Cornelia Theresia Tacken ◽  
Maartje Frijlink ◽  
Sjoerd Servaas ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Intensive Care ◽  
The Netherlands ◽  
Stroke Volume ◽  
Critically Ill ◽  
Systemic Vascular Resistance ◽  
Vital Signs ◽  
Intensive Care Patients ◽  
Non Invasive ◽  
The Impact

Abstract Background: During the COVID-19 pandemic in The Netherlands, critically ill ventilated COVID-19 patients were not only transferred between hospitals by ambulance, but also by the Helicopter Emergency Medical Service (HEMS). To date, little is known about the impact of helicopter transport on critically ill patients, and COVID-19 patients in particular. This study was conducted to explore the impact of inter-hospital helicopter transfer on vital signs of mechanically ventilated severe COVID-19 intensive care patients, with special focus on take-off, midflight, and landing. Methods: All ventilated critically ill COVID-19 patients who were transported between April 2020 and June 2021 by the Dutch ‘Lifeliner 5’ HEMS team and who were fully monitored including non-invasive cardiac output, were included in this study. Three 10 minute timeframes (take-off, midflight and landing) were defined for analysis. Continuous data of vital parameters heartrate, peripheral oxygen saturation, arterial blood pressure, end-tidal CO2 and non-invasive cardiac output using electrical cardiometry were collected and stored at a 1 minute interval. Data were analysed for differences over time within the timeframes using 1-way analysis of variance. Significant differences were checked for clinical relevance. Results: Ninety-eight patients were included in the analysis. During take-off an increase was noticed in cardiac output (from 6.7 to 8.1 Lmin-1; P<0.0001) which was determined by a decrease in systemic vascular resistance (from 1068 to 750 dyne·s·cm−5, P<0.0001) accompanied by an increase in stroke volume (from 92.0 to 110.2 ml, P<0.0001). Other parameters were unchanged during take-off and mid-flight. During the landing cardiac output and stroke volume slightly decreased (from 7.9 to 7.1 Lmin-1, P<0.0001 and from 108.3 to 100.6 ml, P<0.0001 respectively) and total systemic vascular resistance increased (P<0.0001). Though statistically significant, the found changes were small and not clinically relevant to the medical status of the patients as judged by the attending physicians. Conclusions: Interhospital helicopter transfer of ventilated intensive care patients with COVID-19 can be performed safely and does not result in clinically relevant changes in vital signs. This study this has been assessed by the medical ethical committee Arnhem-Nijmegen, the Netherlands (identifier 2021-7313). The committee waived the need for informed consent. The study was registered at www.trialregister.nl (identifier NL9307).

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