Aspirin Use, Mechanical Ventilation, and Inhospital Mortality in Coronavirus Disease 2019: Are We Missing Something?

The population of the United States is predicted to age dramatically over the next few decades; as such older patients will comprise an increasing proportion of the injured populations. Due to multiple comorbidities and frailty, the old and very old are at greater risk for mortality than younger patients. To identify predictors of inhospital mortality in these patients, we performed a retrospective cohort study at our Level 1 trauma center. Between April 2009 and October 2014, we identified 193 trauma patients aged 80 years and older admitted to the intensive care unit. The mean age was 86 years old (4.9) and a majority of patients were white (57%) and male (54%). Univariate analysis found Injury Severity Score ( P < 0.01), initial Glasgow Coma Scale ( P < 0.01), admission pH ( P = <0.01), admission lactate ( P < 0.01), the need for mechanical ventilation ( P < 0.01), and Geriatric Trauma Outcome Score ( P < 0.01) to be predictors of mortality. Multivariate analysis identified length of mechanical ventilation [odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.60–0.90, P < 0.01], admission lactate (OR = 1.74, 95% CI = 1.21–2.51, P < 0.01), and the need for mechanical ventilation (OR = 18.2, 95% CI = 3.33–99.8, P < 0.01) as independent predictors of mortality. These predictors can help guide clinical decisions and should prompt early discussion of goals of care. The association between mechanical ventilation and mortality is confounded by withdrawal of care.

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Abstract 90: Inhospital Outcome of 458 Patients with Acute Myocardial Infarction Requiring Mechanical Ventilation. Results of the BEAT Registry of the ALKK.

Circulation ◽

10.1161/circ.116.suppl_16.ii_942-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Uwe Zeymer ◽

Kleopatra Kouraki ◽

Steffen Schneider ◽

Herzzentrum Ludwigshafen ◽

Rainer Uebis ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Mechanical Ventilation ◽

Cardiogenic Shock ◽

Artery Bypass ◽

Severe Infection ◽

Inhospital Mortality ◽

Limited Information ◽

St Segment Elevation ◽

St Segment

Background: There is only limited information about characteristics and clinical outcome of patients with acute myocardial infarction (AMI) requiring endotracheal intubation and mechanical ventilation. Therefore we sought to evaluate the clinical course of a large cohort of patients with AMI and mechanical ventilation. Methods: The BEAT Registry of the ALKK prospectively enrolled all consecutive patients requiring mechanical ventilation, who were admitted to an internal intensiv care unit (ICU) of 45 participating German centers. Patient characteristics, treatment and complications until discharge were collected. For this analysis we created a subgroup of patients admitted with ST-segment elevation or non-ST Segment elevation myocardial infarction. Results : During the 9-month study period 458 consecutive patients with AMI were included. The mean age was 68±8 years and 71% were men. While 40% of the patients were intubated in the prehospital phase, 60% were intubated in the hospital. The initial cause for intubation was in 48% of the cases ventricular fibrillation/ tachycardia or sudden cardiac death, in 39% congestive heart failure and in 13% of the cases non-cardiac. Of the 458 patients 256 (56%) developed cardiogenic shock, 86 (19%) acute renal failure, 76 (17%) coma or brain damage, 64 (14%) severe infection, 46 (10%) sepsis, 28 (6%) MODS and 17 (4%) gastrointestinal bleeding. 204 (45%) patients underwent coronary angiography, 38% were treated with PCI and 5% with coronary artery bypass grafting. The inhospital mortality in the total group was 48% and in the subgroup of patients with cardiogenic shock 69%. Conclusion: Patients requiring mechanical ventilation as complication during the early phase of an AMI constitute a high risk subgroup with a mortality of 50%. Further research is necessary to improve the outcome of these patients.

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Mobilising intensive care patients early

Proceedings of Singapore Healthcare ◽

10.1177/2010105820963292 ◽

2020 ◽

pp. 201010582096329

Author(s):

Xi Wern Ling ◽

Yee Hua Lim ◽

Hwee Kuan Ong ◽

Vimal Palanichamy ◽

Kenneth Bao Ren Leong ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Adverse Event ◽

Intensive Care ◽

Event Rate ◽

Adverse Event Rate ◽

Secondary Outcome ◽

Inhospital Mortality ◽

Care Hospital ◽

Early Mobilisation

Background: Early mobilisation in the intensive care unit has been suggested to improve outcomes. However, safety and practical concerns have led to the slow uptake of early mobilisation. Objectives: We designed a study to evaluate the practicability and efficacy of an early mobilisation protocol in intensive care unit patients. Methods: We performed a prospective non-blinded observational cohort study based on a quality improvement project. We implemented a protocol for early mobilisation of suitable patients admitted to medical and surgical intensive care units of a tertiary care hospital. All other aspects of patient care were managed as usual. Patients were followed up to discharge. Data were collected from July to August 2016 pre-implementation and from November 2016 to February 2017 following protocol implementation. The primary outcome measure was the mobilisation rate, defined as the number of days mobilised divided by the number of days each patient met mobilisation criteria. Secondary outcome measures included adverse event rate, length of mechanical ventilation, intensive care unit and hospital stay, intensive care unit and inhospital mortality and discharge destination. Results: A total of 312 patients were analysed, of which 60% were men with a mean age of 63.4 years. Following early mobilisation implementation, the mobilisation rate increased from 39% to 65% ( P=0.006). The percentage of patients discharged home increased from 49.0% to 75.9% ( P<0.001). Mortality, length of mechanical ventilation, length of stay and adverse event rate did not differ significantly. Conclusion: The implementation of an early mobilisation protocol in our intensive care unit was both safe and effective without requiring additional staffing. Efforts are ongoing to increase compliance with the protocol.

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Invasive mechanical ventilation at 36 weeks post-menstrual age, adverse outcomes with a comparison of recent definitions of bronchopulmonary dysplasia

Journal of Perinatology ◽

10.1038/s41372-021-01102-w ◽

2021 ◽

Author(s):

Milenka Cuevas Guaman ◽

Nikou Pishevar ◽

Steven H. Abman ◽

Martin Keszler ◽

William E. Truog ◽

...

Keyword(s):

Mechanical Ventilation ◽

Bronchopulmonary Dysplasia ◽

Invasive Mechanical Ventilation ◽

Adverse Outcomes ◽

Inhospital Mortality ◽

Increased Risk ◽

Grade 3 ◽

Using Data

Abstract Objectives To determine whether the need for invasive mechanical ventilation (iMV) at 36 weeks PMA in patients with severe bronchopulmonary dysplasia (sBPD) identifies those patients at highest risk for tracheostomy or gastrostomy, and to compare sBPD with recent definitions of BPD. Study design Observational study from Jan 2015 to Sept 2019 using data from the BPD Collaborative Registry. Results Five hundred and sixty-four patients with sBPD of whom 24% were on iMV at 36 weeks PMA. Those on iMV had significantly (p < 0.0001) increased risk for tracheostomy or gastrostomy. The overall mortality rate was 3% and the risk for mortality was substantially greater in those on iMV than in those on noninvasive support at 36 weeks PMA (RR 13.8, 95% CI 4.3–44.5, p < 0.0001). When applying the NICHD definition (2016) 44% had Grade III BPD. When applying the NRN definition, 6% had Grade 1 BPD, 70% had Grade 2 BPD, and 24% had Grade 3 BPD. Conclusions Patients with sBPD who were on iMV at 36 weeks had a significantly greater risk of inhospital mortality and survivors had a significantly greater risk of undergoing tracheostomy and/or gastrostomy. The use of type 2 sBPD or Grade 3 BPD would enhance the ability to target future studies to those infants with sBPD at the highest risk of adverse long-term outcomes.

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Costs and Outcomes of Patients Admitted to the Intensive Care Unit With Cancer

Journal of Intensive Care Medicine ◽

10.1177/0885066619899653 ◽

2020 ◽

Vol 36 (2) ◽

pp. 203-210

Author(s):

Bo Zheng ◽

Peter M. Reardon ◽

Shannon M. Fernando ◽

Colleen Webber ◽

Kednapa Thavorn ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Liver Disease ◽

Health Care Expenditure ◽

Tertiary Care ◽

Unknown Primary ◽

Inhospital Mortality ◽

Patients With Cancer ◽

The Cost

Introduction: Cancer is associated with significant health-care expenditure, but few studies have examined the cost of patients with cancer in the intensive care unit (ICU). We aimed to describe the costs and outcomes of patients admitted to the ICU with cancer. Methods: We conducted a retrospective cohort study of patients admitted between 2011 and 2016 to 2 tertiary-care ICUs. We included patients with a cancer-related most responsible diagnosis using International Classification of Disease, 10th Revision, Canada codes. We compared costs and outcomes of patients having cancer with noncancer controls matched for age, sex, and Elixhauser comorbidity score. We used logistic regression to determine predictors of mortality among patients with cancer. Results: There were 1022 patients with cancer during the study period. Mean age was 63.2 years and 577 (56.5%) were male. Inhospital mortality for all patients with cancer was 24.0%. Total cost per patient was higher for patients with cancer compared to noncancer patients (CAD$57 084 vs CAD$40 730; P < .001) but there were no differences in the cost per day (CAD$2868 vs CAD$2887; P = .76) or ICU cost (CAD$30 495 vs CAD$29 382; P = .42). Among patients with cancer, the cost per day was higher for nonsurvivors (CAD$3477 vs CAD$2677; P < .001). Liver disease (odds ratio [OR]: 2.96; 95% confidence interval [CI]: 1.22-7.81), mechanical ventilation (OR: 1.73; 95% CI: 1.25-2.39), hematologic malignancy (OR: 3.88; 95% CI: 2.31-6.54), and unknown primary site (OR: 2.13; 95% CI: 1.36-3.35) were independently associated with mortality in patients with cancer. Conclusion: Patients admitted to the ICU with cancer did not differ in cost per day, ICU cost, or mortality compared to matched noncancer controls. Among patients with cancer, nonsurvivors had significantly higher cost per day compared to survivors. Hematologic and unknown primaries, liver disease, and mechanical ventilation were independently associated with mortality in patients with cancer.

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