A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions.

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A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral Diseases (INRVD)

10.21203/rs.3.rs-326352/v1 ◽

2021 ◽

Author(s):

Alireza Fahimzad ◽

Iraj Sedighi ◽

Neda Pak ◽

Mitra Khalili ◽

Mohammad Farahmand ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Patients ◽

Heart Diseases ◽

Cardiac Injury ◽

High Risk Group ◽

Contributing Factors ◽

Positive Real ◽

Laboratory Findings ◽

Icu Patients

Abstract Background: To date, less is known about the clinical features of COVID-19 pediatric patients admitting to ICUs. Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes between COVID-19 pediatric patients admitting to ICU and non-ICU settings.Methods: This multicenter study involved 15 general and pediatrics hospitals on confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive real-time reverse transcription polymerase chain reaction (RT-PCR) between March 19 and May 31, 2020, during the initial peak of the COVID-19 pandemic in Iran.Results: Overall, 166 patients were included, of which 61 (36.7%) required ICU admission, especially in <5 years old age group. Malignancy and heart diseases were the most frequent underlying condition. There was significant decrease in platelet counts, PH, HCO3 and base excess as well as increases in creatinine, creatine phosphokinase and potassium levels between ICU-admitted and non-ICU patients. Dyspnea was the major symptom for ICU group patients. Acute respiratory distress syndrome (ARDS), shock and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate was substantially higher in the ICU than in non-ICU patients (45.9% vs. 1.9%, respectively; P<0.001).Conclusions: Underlying diseases were the major contributing factors in COVID-19 pediatric patients for the increased ICU admissions and mortality rates. There are few paraclinical parameters for differentiating pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with younger age and underlying medical conditions and define strategies to control and prevent COVID-19 transmission in this population.

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Clinical Characteristics, Comorbidities, Initial Management and Outcome of COVID-19 Infected Patients Admitted to Intensive Care Unit in Somalia: A National Retrospective Study.

10.21203/rs.3.rs-66767/v1 ◽

2020 ◽

Author(s):

Mohamed Farah Yusuf Mohamud ◽

Abdullahi Said Hashi ◽

Abdikarim Hussein Mohamed ◽

Ali Mohamed Yusuf ◽

Ibrahim Hussein Ali ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Characteristics ◽

Clinical Manifestations ◽

Laboratory Findings ◽

Altered Level ◽

Clinical Presentations ◽

High Flow Oxygen ◽

Independent Risk Factors ◽

Poor Outcomes

Abstract Purpose: To investigate the clinical characteristics, morbidities, management, and outcomes of COVID-19 Infected patients admitted to the intensive care unit (ICU) in Somalia.Material and methods: We conducted a retrospective observational study of laboratory 60 confirmed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) admitted to an ICU from March 28, to May 28, 2020.The sociodemographic characteristics, comorbidities, exposure history, clinical manifestations (symptoms and signs), laboratory findings, treatment, and outcomes were collected from medical records.Results: Most of the patients admitted to ICU were men over 59 years of age, and nearly half had diabetes followed by hypertension chronic kidney disease and asthma. The most clinical presentations were dyspnea (91.2%), Fever (81.1%), (68.75%), Fatigue and myalgia (25%), and Altered level of conscious (16.6%). Among 48 patients admitted to the ICU, about 24 (50%) patients had required endotracheal intubation and mechanical ventilation, and 11(29.9%) patients needed noninvasive ventilation, while 13(27.08%) patients treated with high-flow oxygen therapy >15 L/min (Table 3). Corticosteroids were administered to most patients (85.4%), while 77.1% of the patients received inhaled bronchodilators and morethan half of the patients administered antibiotics. 58.3% of the patients had received Oseltamivir, while 22.9% received Vasopressors.Conclusion This study represents the first description of critically ill patients infected with SARS-CoV-2 admitted to ICU in Somalia. The study identified that elder age, male gender, and diabetic and hypertensive comorbidities as independent risk factors of poor outcomes for patients admitted to the ICU (p<0.005).

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Healing experience for family caregivers after an intensive care unit death

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-001561 ◽

2019 ◽

pp. bmjspcare-2018-001561 ◽

Cited By ~ 2

Author(s):

Susan DeSanto-Madeya ◽

Dan Willis ◽

Julie McLaughlin ◽

Aristotle Boslet

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Family Caregivers ◽

Phenomenological Study ◽

Healthcare Providers ◽

Loved One ◽

Hermeneutic Phenomenological ◽

Telephone Interviews ◽

Hermeneutic Phenomenological Study ◽

Purposive Sample

ObjectivesFamily caregivers suffer a high burden of emotional and psychological distress following the death of a loved one in the intensive care unit and often struggle to heal in the weeks following their loss. The purpose of this hermeneutic phenomenological study was to describe and interpret the experience of healing for family caregivers six weeks following the death of a loved one in the ICU.MethodsSemi-structured telephone interviews were conducted with a purposive sample of twenty-four family caregivers six weeks following the death of their loved ones in the ICU. Qualitative analysis techniques were used to identify common themes central to the experience of healing across all interviews.ResultsSeven themes were interpreted from the data: searching for clarity from a time of uncertainty; riding an emotional rollercoaster; seeking peace in one’s decisions; moving forward with each new day; taking comfort in the memories; valuing layers of support; and discovering life on one’s own.ConclusionBy identifying and gaining an understanding of healing following the death of a loved one in the ICU, nursing and other healthcare providers have an opportunity to promote healing and positively impact family caregiver’s bereavement.

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Completeness of the operating room to intensive care unit handover: a matter of time?

BMC Anesthesiology ◽

10.1186/s12871-021-01247-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fabian Dusse ◽

Johanna Pütz ◽

Andreas Böhmer ◽

Mark Schieren ◽

Robin Joppich ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Information Transfer ◽

Time Pressure ◽

Intraoperative Complications ◽

Patient Characteristics ◽

Information Loss ◽

Ensure Patient Safety ◽

Underlying Diseases

Abstract Background Handovers of post-anesthesia patients to the intensive care unit (ICU) are often unstructured and performed under time pressure. Hence, they bear a high risk of poor communication, loss of information and potential patient harm. The aim of this study was to investigate the completeness of information transfer and the quantity of information loss during post anesthesia handovers of critical care patients. Methods Using a self-developed checklist, including 55 peri-operative items, patient handovers from the operation room or post anesthesia care unit to the ICU staff were observed and documented in real time. Observations were analyzed for the amount of correct and completely transferred patient data in relation to the written documentation within the anesthesia record and the patient’s chart. Results During a ten-week study period, 97 handovers were included. The mean duration of a handover was 146 seconds, interruptions occurred in 34% of all cases. While some items were transferred frequently (basic patient characteristics [72%], surgical procedure [83%], intraoperative complications [93.8%]) others were commonly missed (underlying diseases [23%], long-term medication [6%]). The completeness of information transfer is associated with the handover’s duration [B coefficient (95% CI): 0.118 (0.084-0.152), p<0.001] and increases significantly in handovers exceeding a duration of 2 minutes (24% ± 11.7 vs. 40% ± 18.04, p<0.001). Conclusions Handover completeness is affected by time pressure, interruptions, and inappropriate surroundings, which increase the risk of information loss. To improve completeness and ensure patient safety, an adequate time span for handover, and the implementation of communication tools are required.

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Healthcare-associated Infections in Pediatric Cardiovascular Surgery Intensive Care Unit between 2016-2020

Kosuyolu Heart Journal ◽

10.51645/khj.2021.m125 ◽

2021 ◽

Author(s):

Mehmet Emirhan Işık ◽

Ergin Arslanoğlu ◽

Ömer Faruk Şavluk ◽

Hakan Ceyran

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cardiovascular Surgery ◽

Heart Diseases ◽

Bloodstream Infections ◽

Healthcare Associated Infections ◽

Developmental Problems ◽

Pediatric Cardiovascular Surgery ◽

Tract Infections ◽

Healthcare Associated

Objectives: Healthcare-associated infections are the most common problem in intensive care unit worldwide. Children with congenital heart diseases have many complications such as developmental problems, respiratory tract infections, endocarditis,pneumonia and after long-term hospital and intensive care stays and surgeries patients become vulnerable to healthcare-associated infections. Patients and Methods: The study presents the frequency of infection, microorganisms in patients hospitalized at SBÜ Koşuyolu High Spesialization Research and Training Hospital pediatric cardiovascular surgery intensive care unit between 2016-2020. Results: One hundred-eight HAI episodes were seen in 83 of 1920 patients hospitalized in pediatric cardiovascular surgery intensive care unit between 2016-2020.HAI rates varied between 4.8% and 7.77%. In the 5-year period,a total of 118 different microorganisms were detected.Among all microorganisms, Candida species (n: 43, 36.4%) ranked first. central line-associated bloodstream infections (CLABSI) 53 (49%), ventilator-associated pneumonia (VAP)40 (37%), surgical site infection (SSI) 8 (6.5%), catheter -associated urinary tract infection (CAUTI) 7 (6%) Conclusion: Healthcare-associated infections are require special attention in pediatric cardiovascular intensive care units. In order to prevent, innovations such as bundle applications should be implemented as well as personnel training.

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Meningoencephalitis in intensive care unit: Do Japanese Encephalitis cases go unsuspected?

Journal of Chitwan Medical College ◽

10.3126/jcmc.v7i1.17362 ◽

2017 ◽

Vol 7 (1) ◽

pp. 7-10

Author(s):

Ashish Ghimire ◽

Balkrishna Bhattarai ◽

Basudha Khanal ◽

Suchana Marhatta ◽

Gopendra Prasad Deo

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Adult Patients ◽

Medical Emergency ◽

Real Problem ◽

Cerebrospinal Fluid Analysis ◽

Laboratory Findings ◽

Fluid Analysis ◽

Intensive Approach ◽

Serology Testing

Background: Meningoencephalitis (ME) is a medical emergency. Acute infective encephalitis is usually viral. Nepal has the second highest prevalence of JE in South East Asia. About one third of the JE cases results in death. The records of the JE in the laboratory of B.P. Koirala Institute of Health Sciences (BPKIHS) showed 760 samples to have the evidence of JE infection out of 3352 tested during the period of 2001-2011 AD. The present study aimed to conduct an audit on meningoencephalitis cases admitted in the ICU of our hospital in an attempt to find its burden.Methods: Medical records of all the adult patients with the provisional diagnosis of Meningoencephalitis at BPKIHS over the period of 2009-2011 AD were examined. Laboratory findings of all the patients diagnosed with ME who were admitted to the eight bedded general intensive care unit (ICU) were also reviewed. The diagnosis was made based on the findings of medical history, clinical examination and cerebrospinal fluid analysis for biochemistry and cytology, results of anti JE IgM test performed on CSF and/or serum.Results: Altogether 127 samples of CSF were obtained from adult patients admitted in different inpatient department of BPKIHS with the clinical diagnosis of meningo encephalitis between 2009-2011 AD. Out of them, 25 (19.68%) were tested positive of JE. A total of 684 patients were admitted over the same period with different diagnoses in 8 bedded ICU of hospital. Fifteen (2.19%) were transferred to the ICU with the ME. In the ICU, 9(60%) were treated as viral encephalitis. Among them CSF of only 4 patients’ were sent for testing for JE and found positive in 2 cases. Seven (46.6%) patients expired while 4(26.6%) were taken home by the relatives against medical advice in critically ill conditions and remaining 4 (26.6%) improved and transferred to ward. Among the expired patients 5 (71.4%) had viral encephalitis.Conclusion: JE is a real problem but many cases are likely to have been gone undetected. Adoption of a more intensive approach with much liberal serology testing policy seems to be appropriate for better detecting JE cases in the setting.

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Challenges of paediatric palliative care in the intensive care unit during the COVID-19 pandemic

International Journal of Palliative Nursing ◽

10.12968/ijpn.2021.27.6.303 ◽

2021 ◽

Vol 27 (6) ◽

pp. 303-315

Author(s):

Marzieh Hasanpour ◽

Mamak Tahmasebi ◽

Masoud Mohammadpour ◽

Batool Pouraboli ◽

Fahimeh Sabeti

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Healthcare Providers ◽

Clinical Team ◽

Management Support ◽

Breaking Bad ◽

Paediatric Palliative Care ◽

Home Based ◽

Purposeful Sampling

Background: The integration of paediatric palliative care into the Iranian health system is essential. Aims: The aim of this study was to identify the challenges of palliative care in the paediatric intensive care unit during COVID-19 through the experiences of healthcare providers. Methods: A qualitative study with content analysis approach was conducted. Fifteen physicians and nurses were selected by purposeful sampling. The semi-structured, in-depth interviews were applied in the data collection. Findings: Ten main categories were extracted from data analysis, including ‘caring in COVID-19’, ‘communication and family centre care’, ‘breaking bad news’, palliative care training’, ‘pain and symptom management’, ‘support of the child, family and clinical team’, ‘physical environment’, ‘guidelines’, ‘specialised staff’ and ‘home based palliative care’. Conclusion: Palliative care in the PICU faces several challenges, especially during COVID-19, but the clinical team are making every attempt to improve the comprehensive care of children and their families. Telehealth is important in COVID-19, and education is also a key component to improve palliative care in the PICU in Iran.

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Cardiovascular Diseases and COVID-19 Mortality and Intensive Care Unit Admission: A Systematic Review and Meta-analysis

10.1101/2020.04.12.20062869 ◽

2020 ◽

Cited By ~ 3

Author(s):

Amir Shamshirian ◽

Keyvan Heydari ◽

Reza Alizadeh-Navaei ◽

Mahmood Moosazadeh ◽

Saeed Abrotan ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Cardiovascular Disease ◽

Intensive Care Unit ◽

Intensive Care ◽

Cardiovascular Diseases ◽

Meta Analysis ◽

Cardiac Injury ◽

Icu Admission ◽

The World

AbstractImportanceOn 11th March, the World Health Organization declared a pandemic of COVID-19. There are over 1 million cases around the world with this disease and it continues to raise. Studies on COVID-19 patients have reported high rate of cardiovascular disease (CVD) among them and patients with CVD had higher mortality rate.ObjectivesSince there were controversies between different studies about CVD burden in COVID-19 patients, we aimed to study cardiovascular disease burden among COVID-19 patients using a systematic review and meta-analysis.Data SourcesWe have systematically searched databases including PubMed, Embase, Cochrane Library, Scopus, Web of Science as well as medRxiv pre-print database. Hand searched was also conducted in journal websites and Google Scholar.Study SelectionStudies reported cardiovascular disease among hospitalized adult COVID-19 patients with mortality or ICU admission (primary outcomes) were included into meta-analysis. In addition, all of studies which reported any cardiovascular implication were included for descriptive meta-analysis. Cohort studies, case-control, cross-sectional, case-cohort and case series studies included into the study. Finally, 16 studies met the inclusion criteria for primary outcome and 59 studies for descriptive outcome.Data Extraction and SynthesisTwo investigators have independently evaluated quality of publications and extracted data from included papers. In case of disagreement a supervisor solved the issue and made the final decision. Quality assessment of studies was done using Newcastle-Ottawa Scale tool. Heterogeneity was assessed using I-squared test and in case of high heterogeneity (>%50) random effect model was used.Main Outcomes and MeasuresMeta-analyses were carried out for Odds Ratio (OR) of mortality and Intensive Care Unit (ICU) admission for different CVDs and Standardized Mean Difference (SMD) was calculated for Cardiac Troponin I. We have also performed a descriptive meta-analysis on different CVDs.ResultsSixteen papers including 3473 patients entered into meta-analysis for ICU admission and mortality outcome and fifty-nine papers including 9509 patients for descriptive outcomes. Results of meta-analysis indicated that acute cardiac injury, (OR: 15.94, 95% CI 2.31-110.14), hypertension (OR: 1.92, 95% CI 1.92-2.74), heart Failure (OR: 11.73, 95% CI 5.17-26.60), other cardiovascular disease (OR: 1.95, 95% CI 1.17-3.24) and overall CVDs (OR: 3.37, 95% CI 2.06-5.52) were significantly associated with mortality in COVID-19 patients. Arrhythmia (OR: 22.17, 95%CI 4.47-110.04), acute cardiac injury (OR: 19.83, 95%CI 7.85-50.13), coronary heart disease (OR: 4.19, 95%CI 1.27-13.80), cardiovascular disease (OR: 4.17, 95%CI 2.52-6.88) and hypertension (OR: 2.69, 95%CI 1.55-4.67) were also significantly associated with ICU admission in COVID-19 patients.ConclusionOur findings showed a high burden of CVDs among COVID-19 patients which was significantly associated with mortality and ICU admission. Proper management of CVD patients with COVID-19 and monitoring COVID-19 patients for acute cardiac conditions is highly recommended to prevent mortality and critical situations.Key PointsQuestionAre cardiovascular disease associated with mortality and Intensive Care Unit admission (ICU) of COVID-19 patients?FindingsIn this systematic review and meta-analysis, acute cardiac injury, hypertension, heart failure and overall cardiovascular diseases were significantly associated with mortality in COVID-19 patients. Arrhythmia, coronary heart disease, hypertension, acute cardiac injury and other cardiovascular disease were significantly associated with ICU admission of COVID-19 patients.MeaningCardiovascular diseases have significant role in mortality and disease severity of COVID-19 patients. COVID-19 patients need to be carefully monitored for cardiovascular diseases and managed properly in case of acute cardiac conditions.

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Central Line Access is Predictive of Diagnostic Blood Loss and Transfusion in the Surgical Intensive Care Unit

10.21203/rs.3.rs-1062127/v1 ◽

2021 ◽

Author(s):

Brian D Adkins ◽

Abe Deanda ◽

Judy A Trieu ◽

Srinivas Polineni ◽

Anthony O Okorodudu ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Loss ◽

Retrospective Chart Review ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Diagnostic Laboratory ◽

Laboratory Findings ◽

Female Ratio ◽

Rbc Transfusion

Abstract Background: Diagnostic laboratory testing (DLT) is a source of blood loss in critically ill patients. Approximately half of patients admitted to the intensive care unit (ICU) present with anemia, with the remainder developing a multifactorial anemia with etiologies including central venous catheter (CVC) placement. Consequently, about a third of ICU patients require red blood cell (RBC) transfusion, a practice associated with poorer clinical outcomes. Our objectives were to characterize DLT blood loss in the surgical intensive care unit (SICU), and its relationship with anemia, RBC transfusion, and CVC placement.Methods: An observational study was performed by retrospective chart review of patients admitted to a SICU over 1-year. The number of DLT blood draws, average volume of blood drawn, and estimated discard volume were recorded along with clinical and laboratory findings. Results: A cohort of 292 patients (mean age 62.2 years, male to female ratio 1.5) underwent 299 hospitalizations with an average daily DLT blood loss of 14.3 mL (229.5 mL per admission). Among admissions, 51.2% presented with anemia and 95.3% were anemic at discharge, with 32% of patients receiving an RBC transfusion. Patients with greater DLT-associated blood loss had lower discharge hemoglobin (p=<0.001). Admissions requiring CVC (49.8%), demonstrated a significantly greater number of DLT blood draws, increased DLT-associated blood loss, higher rates of RBC transfusion, and an increased length of stay.Conclusions: Findings from this study suggest that DLT blood loss contributes to anemia in the SICU and the presence and duration of CVC leads to increased testing, blood loss, anemia, and is predictive of RBC transfusion.

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