scholarly journals Vitamin D levels and intensive care unit outcomes of a cohort of critically ill COVID-19 patients

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Laurence Orchard ◽  
Matthew Baldry ◽  
Myra Nasim-Mohi ◽  
Chantelle Monck ◽  
Kordo Saeed ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Vitamin D ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Large Scale ◽  
Invasive Mechanical Ventilation ◽  
Plasma Vitamin ◽  
Vitamin D Levels

Abstract Objectives The pattern of global COVID-19 has caused many to propose a possible link between susceptibility, severity and vitamin-D levels. Vitamin-D has known immune modulatory effects and deficiency has been linked to increased severity of viral infections. Methods We evaluated patients admitted with confirmed SARS-COV-2 to our hospital between March-June 2020. Demographics and outcomes were assessed for those admitted to the intensive care unit (ICU) with normal (>50 nmol/L) and low (<50 nmol/L) vitamin-D. Results There were 646 SARS-COV-2 PCR positive hospitalisations and 165 (25.5%) had plasma vitamin-D levels. Fifty patients were admitted to ICU. There was no difference in vitamin-D levels of those hospitalised (34, IQR 18.5–66 nmol/L) and those admitted to the ICU (31.5, IQR 21–42 nmol/L). Higher proportion of vitamin-D deficiency (<50 nmol/L) noted in the ICU group (82.0 vs. 65.2%). Among the ICU patients, low vitamin D level (<50 nmol/L) was associated with younger age (57 vs. 67 years, p=0.04) and lower Cycle Threshold (CT) real time polymerase chain reaction values (RT-PCR) (26.96 vs. 33.6, p=0.02) analogous to higher viral loads. However, there were no significant differences in ICU clinical outcomes (invasive and non-invasive mechanical ventilation, acute kidney injury and mechanical ventilation and hospital days) between patients with low and normal vitamin-D levels. Conclusions Despite the association of low vitamin-D levels with low CT values, there is no difference in clinical outcomes in this small cohort of critically ill COVID-19 patients. The complex relationship between vitamin-D levels and COVID-19 infection needs further exploration with large scale randomized controlled trials.

scholarly journals Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

2013 ◽  
pp. 184-188 ◽  
Author(s):  
Alvaro Sanabria ◽  
Ximena Gomez ◽  
Valentin Vega ◽  
Luis Carlos Dominguez ◽  
Camilo Osorio
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Medical Condition ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

scholarly journals Obesity May Not Be Associated with 28-Day Mortality, Duration of Invasive Mechanical Ventilation and Length of Intensive Care Unit and Hospital Stay in Critically Ill Patients with Severe Acute Respiratory Syndrome Coronavirus-2: A Retrospective Cohort Study

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 674
Author(s):  
Sjaak Pouwels ◽  
Dharmanand Ramnarain ◽  
Emily Aupers ◽  
Laura Rutjes-Weurding ◽  
Jos van Oers
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Significant Difference

Background and Objectives: The aim of this study was to investigate the association between obesity and 28-day mortality, duration of invasive mechanical ventilation and length of stay at the Intensive Care Unit (ICU) and hospital in patients admitted to the ICU for SARS-CoV-2 pneumonia. Materials and Methods: This was a retrospective observational cohort study in patients admitted to the ICU for SARS-CoV-2 pneumonia, in a single Dutch center. The association between obesity (body mass index > 30 kg/m2) and 28-day mortality, duration of invasive mechanical ventilation and length of ICU and hospital stay was investigated. Results: In 121 critically ill patients, pneumonia due to SARS-CoV-2 was confirmed by RT-PCR. Forty-eight patients had obesity (33.5%). The 28-day all-cause mortality was 28.1%. Patients with obesity had no significant difference in 28-day survival in Kaplan–Meier curves (log rank p 0.545) compared with patients without obesity. Obesity made no significant contribution in a multivariate Cox regression model for prediction of 28-day mortality (p = 0.124), but age and the Sequential Organ Failure Assessment (SOFA) score were significant independent factors (p < 0.001 and 0.002, respectively). No statistically significant correlation was observed between obesity and duration of invasive mechanical ventilation and length of ICU and hospital stay. Conclusion: One-third of the patients admitted to the ICU for SARS-CoV-2 pneumonia had obesity. The present study showed no relationship between obesity and 28-day mortality, duration of invasive mechanical ventilation, ICU and hospital length of stay. Further studies are needed to substantiate these findings.

scholarly journals Perfusion Abnormalities Shown On Subtraction CT Angiography In Apparently Normal Lungs And Their Impact On Patient Outcome. A Prospective Cohort Study: What Could We Be Missing?

2021 ◽  
Author(s):  
Mario G. Santamarina ◽  
Felipe Martinez Lomakin ◽  
Ignacio Beddings ◽  
Dominique Boisier Riscal ◽  
Jose Chang Villacís ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Risk Factor ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Ct Angiography ◽  
Independent Risk Factor ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Increased Risk

Abstract Background: COVID-19 pneumonia seems to affect the regulation of pulmonary perfusion. In this study, through iodine distribution maps obtained with subtraction CT angiography, we quantified and analyzed perfusion abnormalities in patients with COVID-19 pneumonia and correlated them with clinical outcomes.Methods: 205 patients were included in this cohort, from two different tertiary-care hospitals in Chile. All patients had RT-PCR confirmed SARS-CoV-2 infection. CT scans were performed within 24 h of admission, in supine position. Airspace compromise was assessed with CT severity score, and the extension of hypoperfusion in apparently healthy lung parenchyma with perfusion score. CT severity and perfusion scores were then correlated with clinical outcomes. Multivariable analyses using Cox Proportional Hazards regression were used to control for clinical confounders.Results: Fourteen patients were excluded due to uninterpretable images. This left 191 patients, 112 males and 79 females. The mean age was 60.8±16.0 years. The median SOFA score on admission was 2 and average PaFi ratio was 250±118. Patients with severe perfusion abnormalities showed significantly higher SOFA scores and lower Pa/Fi ratios when compared to individuals with mild or moderate anomalies. Severe perfusion abnormalities were associated with an increased risk of intensive care unit (ICU) admission and the requirement of invasive mechanical ventilation (IMV).Conclusion: Patients with severe perfusion anomalies have a higher risk of admission to the ICU and IMV. Perfusion alterations could be considered as an independent risk factor in patients with COVID-19 pneumonia.Summary Statement: Lung perfusion abnormalities in patients with COVID-19 pneumonia were associated with admission to Intensive Care Unit and requirement of invasive mechanical ventilation. Perfusion abnormalities could be considered as an independent risk factor in patients with COVID-19 pneumonia.

scholarly journals Clinical Characteristics and Outcome of Critically Ill SARS-CoV-2 Patients Admitted to Intensive Care Unit of a Tertiary Care Hospital in North India: A Retrospective Study

2021 ◽  
Author(s):  
Reetu Verma ◽  
Rajeev Kumar Nishad ◽  
Rohit Patawa ◽  
Alok Kumar
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Retrospective Study ◽  
Critically Ill ◽  
Clinical Characteristics ◽  
Invasive Mechanical Ventilation ◽  
Age Groups ◽  
World Health ◽  
Comorbid Conditions

Introduction: World Health Organisation (WHO) declared the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outbreak a pandemic on 11 March 2020, due to the constantly increasing number of cases outside China. Previously, India had global record of highest single day spike of Corona Virus Disease-19 (COVID-19) cases, with 97,894 cases on 17thSeptember 2020. Aim: To find out the demographic and clinical characteristics of critically ill patients of SARS-CoV-2 and comparing the outcomes of patients admitted in COVID dedicated Intensive Care Unit (ICU) with and without co-morbidities and also in different age groups and sex. Material and Methods: This retrospective study from July 2020 to December 2020 was a single centre observational experience of management of COVID-19 patients at COVID dedicated ICU in Firozabad, India. The following data were recorded: age, sex, comorbidities and mode of oxygen delivery (invasive mechanical ventilation, non-invasive mechanical ventilation, high flow nasal canula). Chi-square test was used to compare the outcomes of patients admitted in COVID dedicated ICU with and without co-morbidities and also in different age groups and sex. Results: In this study, the data of 120 severely ill COVID-19 patients were reviewed. The mean age of patients were (58±15.29) years and male to female ratio was 3:1. At least one comorbid condition was reported in 53.3% of patients-most common being Hypertension (36.6%) followed by Diabetes mellitus 2 (20%), COPD (15%). Then Cardiovascular Diseases, Renal, Liver diseases and ailments followed. All patients admitted to COVID ICU had moderate to severe Acute Respiratory Distress Syndrome (ARDS). Older age (61 years and above, mortality 17%), male sex (16.7% deaths among 90 critically ill male COVID patients) and presence of comorbid conditions appear to have higher mortality in this study. However apart from comorbid conditions (p=0.001) none was statistically significant. The overall mortality in this study of 120 critically ill COVID patients was 14.16%. Conclusion: From this study, it can be suggested that survival of critically ill COVID patients can further be improved by better management of their comorbid conditions and avoiding complications of invasive ventilation. However, further multicentric studies with large sample size are needed to confirm these findings.

scholarly journals Timing of elective tracheotomy and duration of mechanical ventilation amongst patients admitted to intensive care with severe COVID-19: a multicentre prospective cohort study

2021 ◽  
Author(s):  
Albert Prats-Uribe ◽  
Marc Tobed ◽  
José Miguel Villacampa ◽  
Adriana Agüero ◽  
Clara García-Bastida ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Postoperative Complications ◽  
Critically Ill ◽  
Prospective Cohort ◽  
Invasive Mechanical Ventilation ◽  
Optimal Timing ◽  
Early Tracheotomy

AbstractBackgroundThe COVID-19 pandemic has strained intensive care unit (ICU) resources. Tracheotomy is the most frequent surgery performed on ICU patients and can affect the duration of ICU care. We studied the association between when tracheotomy occurs and weaning from mechanical ventilation, mortality, and intraoperative and postoperative complications.MethodsMulticentre prospective cohort including all COVID-19 patients admitted to ICUs in 36 hospitals in Spain who received invasive mechanical ventilation and tracheotomy between 11 March and 20 July 2020. We used a target emulation trial framework to study the causal effects of early (7 to 10 days post-intubation) versus late (>10 days) tracheotomy on time from tracheotomy to weaning, postoperative mortality, and tracheotomy complications. Cause-specific Cox models were used for the first two outcomes and Poisson regression for the third, all adjusted for potential confounders.FindingsWe included 696 patients, of whom 142 (20·4%) received early tracheotomy. Using late tracheotomy as the reference group, multivariable cause-specific analysis showed that early tracheotomy was associated with faster post-tracheotomy weaning (fully adjusted hazard ratio (HR) [95% confidence interval (CI)]: 1·31 [1·02 to 1·81]) without differences in mortality (fully adjusted HR [95% CI]: 0·91 [0·56 to 1·47]) or intraoperative or postoperative complications (adjusted rate ratio [95% CI]: 0·21 [0·03 to 1·57] and 1·49 [0·99 to 2·24], respectively).InterpretationEarly tracheotomy reduced post-tracheotomy weaning time, resulting in fewer mechanical ventilation days and shorter ICU stays, without changing complication or mortality rates. These results support early tracheotomy for COVID-19 patients when clinically indicated.FundingSupported by the NIHR, FAME, and MRC.Research in contextEvidence before this studyThe optimal timing of tracheotomy for critically ill COVID-19 patients remains controversial. Existing guidelines and recommendations are based on limited experiences with SARS-CoV-1 and expert opinions derived from situations that differ from a pandemic outbreak. Most of the available guidance recommends late tracheotomy (>14 days), mainly due to the potential risk of infection for the surgical team and the high patient mortality rate observed early in the first wave of the COVID-19 pandemic.Recent publications have shown that surgical teams can safely perform tracheotomies for COVID-19 patients if they use adequate personal protective equipment. Early tracheotomy seems to reduce the length of invasive mechanical ventilation without increasing complications, which may release crucial intensive care unit (ICU) beds sooner.The current recommendations do not suggest an optimal time for tracheotomy for COVID-19 patients, and no study has provided conclusions based on objective clinical parameters.Added value of this studyThis is the first study aiming to establish the optimal timing for tracheotomy for critically ill COVID-19 patients requiring invasive mechanical ventilation (IMV). The study prospectively recruited a large multicentre cohort of 696 patients under IMV due to COVID-19 and collected data about the severity of respiratory failure, clinical and ventilatory parameters, and whether patients need to be laid flat during their ICU stay (proned). The analysis focused on the duration of IMV, mortality, and complication rates. We used a prospective cohort study design to compare the ‘exposures’ of early (performed at day 7 to 10 after starting IMV) versus late (performed after day 10) tracheotomy and set the treatment decision time on the 7th day after orotracheal intubation.Implications of all the available evidenceThe evidence suggests that tracheotomy within 10 days of starting COVID-19 patients on mechanical ventilation allows these patients to be removed from ventilation and discharged from ICU quicker than later tracheotomy, without added complications or increased mortality. This evidence may help to release ventilators and ICU beds more quickly during the pandemic.

scholarly journals Predictive Biomarkers of Intensive Care Unit and Mechanical Ventilation Duration in Critically-Ill Coronavirus Disease 2019 Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Sara Taleb ◽  
Hadi M. Yassine ◽  
Fatiha M. Benslimane ◽  
Maria K. Smatti ◽  
Sven Schuchardt ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Pearson Correlation ◽  
Invasive Mechanical Ventilation ◽  
Predictive Biomarkers ◽  
Published Data ◽  
Metabolomics Data ◽  
Model Based

Introduction: Detection of early metabolic changes in critically-ill coronavirus disease 2019 (COVID-19) patients under invasive mechanical ventilation (IMV) at the intensive care unit (ICU) could predict recovery patterns and help in disease management.Methods: Targeted metabolomics of serum samples from 39 COVID-19 patients under IMV in ICU was performed within 48 h of intubation and a week later. A generalized linear model (GLM) was used to identify, at both time points, metabolites and clinical traits that predict the length of stay (LOS) at ICU (short ≤ 14 days/long &gt;14 days) as well as the duration under IMV. All models were initially trained on a set of randomly selected individuals and validated on the remaining individuals in the cohort. Further validation in recently published metabolomics data of COVID-19 severity was performed.Results: A model based on hypoxanthine and betaine measured at first time point was best at predicting whether a patient is likely to experience a short or long stay at ICU [area under curve (AUC) = 0.92]. A further model based on kynurenine, 3-methylhistidine, ornithine, p-cresol sulfate, and C24.0 sphingomyelin, measured 1 week later, accurately predicted the duration of IMV (Pearson correlation = 0.94). Both predictive models outperformed Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and differentiated COVID-19 severity in published data.Conclusion: This study has identified specific metabolites that can predict in advance LOS and IMV, which could help in the management of COVID-19 cases at ICU.

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

Sign in / Sign up

Export Citation Format

Share Document