Air leak syndromes (Pneumomediastinum, pneumothorax, and subcutaneous emphysema) in Critically ill COVID – 19 patients – Prevalence, risk factors, and outcome.

Abstract BACKGROUND: A high incidence of air leak syndromes (ALS) has been reported in critically ill COVID-19 patients. This not only prolongs the hospital stay of patients but also affects the disease outcome.OBJECTIVE: Our objective is to evaluate the incidence, clinical outcome, and risk factors associated with ALS in critically ill COVID-19 patients receiving invasive or non-invasive positive pressure ventilationRESULT: Out of 79 patients, 16(20.2%) patients had ALS. The mean age of the ALS group was 48.6±13.1 years as compared to 52.8±13.1 (p = 0.260) years in the non-ALS group. The ALS group had a lower median BMI (25.9 kg/m2 vs 27.6 kg/m2 , p = 0.096), a higher D-dimer value at presentation (1179.5 vs 762.0, p = 0.024) , lower saturation (74% vs 88%, p = 0.006) and lower PF (134 vs 189, p = 0.028) ratio at presentation as compared to the ALS group. Patients who developed ALS were found to have received a higher median PEEP (10 cm vs 8 cm of water, p = 0.005). Pressure support, highest driving pressure, and peak airway pressure were not significantly different in the two groups. ALS group was seen to have a significantly longer duration of hospital stay (17.5 days vs 9 days, p = 0.003). Multiple Logistic Regressions analysis indicated patients who received Inj. Dexamethasone was less likely to develop ALS (OR: 12.6 (95% CI 1.6-95.4), p=0.015). CONCLUSION: A high incidence of ALS is present in critically ill COVID 19 patients. High inflammatory parameters, severe hypoxia at presentation, and use of high PEEP are significant risk factors associated with the development of ALS. The risk of developing ALS was observed to be lower in patients who received Inj. Dexamethasone. ALS is associated with a longer duration of hospital stay.

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Risk factors and clinical outcome of hypomagnesemic patients in pediatric intensive care

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20201132 ◽

2020 ◽

Vol 7 (4) ◽

pp. 790

Author(s):

Poornima Shankar N. ◽

Kavya C. ◽

Varsha Monica Reddy

Keyword(s):

Risk Factors ◽

Clinical Outcome ◽

Critically Ill ◽

Critically Ill Patients ◽

Serum Magnesium ◽

Age Groups ◽

Significant Risk ◽

Common Finding ◽

Therapeutic Implications ◽

Factors Associated

Background: Hypomagnesemia is a common finding in current medical practice, especially in critically ill patients. Magnesium ion plays a vital role in various metabolic processes in body and its deficiency leading to serious clinical consequences. Since hypomagnesemia is most often asymptomatic, it goes unsuspected and therefore undiagnosed. Hence, early detection of hypomagnesemia has prognostic and therapeutic implications. It is imperative to understand the various risk factors and their clinical outcome that is associated with hypomagnesemia.Methods: This is an observational study done in a tertiary centre in Bangalore, India where-in 100 children who met the inclusion criteria, admitted to the PICU were recruited and prospectively studied. Serum Magnesium along with various clinical and biochemical parameters were correlated to enumerate the various risk factors associated with hypomagnesemia.Results: In this study authors found the incidence of hypomagnesemia to be around 53%. Authors found higher incidence in age group of 1-5 yrs (40%) and least were in the age groups of <1 year and more than 10 years (19%) and there was no gender preponderance. Authors also evaluated the various risk factors associated with hypomagnesemia. There was significant association of hypocalcemia (60%) and hypokalemia (45.2%) with hypomagnesemia. Infections (33.9%) and neurological disorders (26.41%) seemed to collectively comprise around 60% of the hypomagnesemic group. All patients admitted secondary to sepsis and Traumatic Brain Injury (TBI) had hypomagnesemia proving to be a significant risk factor. Authors also found increased mortality among hypomagnesemic group. However, found no association between low serum magnesium and PICU stay.Conclusions: There is high prevalence of hypomagnesemia in critically ill patients and is associated with a higher mortality. It is also commonly associated with infections, CNS disorders, respiratory diseases and metabolic derangements like hypokalaemia and hypocalcaemia. There is no association of Hypomagnesemia with duration of PICU stay.

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INCREASED HOSPITAL STAY;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.02.3109 ◽

2019 ◽

Vol 26 (02) ◽

Author(s):

Amir Memon

Keyword(s):

Risk Factors ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

University Hospital ◽

Medical Attention ◽

Prolonged Length ◽

Factors Associated ◽

Duration Of Hospital Stay ◽

Group A ◽

Group B

Objectives: This study aims to scientifically fill the gap and provide the scientific data regarding risk factors associated with prolonged length of hospital stay (PLOS) in children admitted at Isra University Hospital. Study Design: Descriptive case series study. Setting: Pediatric ward of Isra University Hospital Hyderabad. Period: 22 months from February 2016 till November 2017. Material and Methods: All the children having age ≥ one year and less than 10 years hospitalized due to any cause of either gender were enrolled under this study. A proforma was designed comprising of basic demographic variables like age and gender and relevant questions like cause of hospitalization, risk factors associated with PLOS, and duration of hospital stay. All the information was noted in proforma and analyzed using SPSS version 17.0. Results: In present study we collected data of 188 children. In group A (age >1 to 5 years) there were 109 children consisted of 57.97% and remaining group B (age >6 years to 10 years) there were 79 children consisted of 42.02%. The overall mean duration of hospital stay with SD was 12.21 ± 3.14. The mean age and SD of group A was 2.33 ± 1.09 years and group B was 7.01 ± 2.39 years. Children with Group A (age ≥1 year to 5 years), Females, late seeking of medical attention, children not responding on medical treatment, and those who get infected during hospitalization were significantly associated with prolonged length of hospital stay (p <0.05). Conclusion: Younger children with age less than 5 years having female predominance and delayed seeking of medical attention were the most significant risk factors associated with PLOS in our population.

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Renal Failure after Coronary Bypass Surgery and the Associated Risk Factors

The Heart Surgery Forum ◽

10.1532/hsf.1216 ◽

2015 ◽

Vol 18 (1) ◽

pp. 006

Author(s):

Hasan Reyhanoglu ◽

Kaan Ozcan ◽

Murat Erturk ◽

Fatih İslamoglu ◽

İsa Durmaz

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Failure ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Bypass Surgery ◽

Artery Bypass ◽

Significant Risk ◽

High Morbidity ◽

Factors Associated

Objective: We aimed to evaluate the risk factors associated with acute renal failure in patients who underwent coronary artery bypass surgery. Methods: One hundred and six patients who developed renal failure after coronary artery bypass grafting (CABG) constituted the study group (RF group), while 110 patients who did not develop renal failure served as a control group (C group). In addition, the RF group was divided into two subgroups: patients that were treated with conservative methods without the need for hemodialysis (NH group) and patients that required hemodialysis (HR group). Risk factors associated with renal failure were investigated. Results: Among the 106 patients that developed renal failure (RF), 80 patients were treated with conservative methods without any need for hemodialysis (NH group); while 26 patients required hemodialysis in the postoperative period (HR group). The multivariate analysis showed that diabetes mellitus and the postoperative use of positive inotropes and adrenaline were significant risk factors associated with development of renal failure. In addition, carotid stenosis and postoperative use of adrenaline were found to be significant risk factors associated with hemodialysis-dependent renal failure (P < .05). The mortality in the RF group was determined as 13.2%, while the mortality rate in patients who did not require hemodialysis and those who required hemodialysis was 6.2% and 34%, respectively. Conclusion: Renal failure requiring hemodialysis after CABG often results in high morbidity and mortality. Factors affecting microcirculation and atherosclerosis, like diabetes mellitus, carotid artery stenosis, and postoperative vasopressor use remain the major risk factors for the development of renal failure.

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Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections

Antibiotics ◽

10.3390/antibiotics10020105 ◽

2021 ◽

Vol 10 (2) ◽

pp. 105

Author(s):

Jatapat Hemapanpairoa ◽

Dhitiwat Changpradub ◽

Sudaluck Thunyaharn ◽

Wichai Santimaleeworagun

Keyword(s):

Risk Factors ◽

Clinical Outcomes ◽

Proportional Hazards Model ◽

Significant Risk ◽

Vancomycin Resistance ◽

Cox Proportional Hazards Model ◽

Factors Associated ◽

Joint Infections ◽

Bone And Joint Infections ◽

The Impact

The prevalence of enterococcal infection, especially E. faecium, is increasing, and the issue of the impact of vancomycin resistance on clinical outcomes is controversial. This study aimed to investigate the clinical outcomes of infection caused by E. faecium and determine the risk factors associated with mortality. This retrospective study was performed at the Phramongkutklao Hospital during the period from 2014 to 2018. One hundred and forty-five patients with E. faecium infections were enrolled. The 30-day and 90-day mortality rates of patients infected with vancomycin resistant (VR)-E. faecium vs. vancomycin susceptible (VS)-E. faecium were 57.7% vs. 38.7% and 69.2% vs. 47.1%, respectively. The median length of hospitalization was significantly longer in patients with VR-E. faecium infection. In logistic regression analysis, VR-E. faecium, Sequential Organ Failure Assessment (SOFA) scores, and bone and joint infections were significant risk factors associated with both 30-day and 90-day mortality. Moreover, Cox proportional hazards model showed that VR-E. faecium infection (HR 1.91; 95%CI 1.09–3.37), SOFA scores of 6–9 points (HR 2.69; 95%CI 1.15–6.29), SOFA scores ≥ 10 points (HR 3.71; 95%CI 1.70–8.13), and bone and joint infections (HR 0.08; 95%CI 0.01–0.62) were significant risk factors for mortality. In conclusion, the present study confirmed the impact of VR-E. faecium infection on mortality and hospitalization duration. Thus, the appropriate antibiotic regimen for VR-E. faecium infection, especially for severely ill patients, is an effective strategy for improving treatment outcomes.

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Risk Factors Associated With Dengue Fever Outbreak in Taiz Governorate, Yemen, 2018: Case-control Study

10.21203/rs.3.rs-624873/v1 ◽

2021 ◽

Author(s):

Abdulkareem Ali Hussein Nassar ◽

Amr Abdulaziz Torbosh ◽

Yassin Abdulmalik Mahyoub ◽

Mohammed Abdullah Al Amad

Keyword(s):

Risk Factors ◽

Dengue Fever ◽

Case Control Study ◽

Significant Risk ◽

Case Fatality ◽

Case Control ◽

Case Definition ◽

P Value ◽

Factors Associated ◽

Control Study

Abstract Background: Dengue Fever (DF) is a significant health problem in Yemen especially in the coastal areas. On November 6, 2018, Taiz governorates surveillance officer notified the Ministry of Public Health and Population on an increase in the number of suspected DF in Al Qahirah and Al Mudhaffar districts, Taiz governorate. On November 7, 2018, Field Epidemiology Training Program sent a team to perform an investigation. The aims were to confirm and describe the outbreak by person, place and time in Taiz governorate, and identify its risk factors.Methodology: Descriptive and case-control study (1:2 ratio) were conducted. WHO case definition was used to identify cases in Al Qahirah or Al Mudhaffar districts during August-November 2018. Control was selected from the same districts who did not suffer from DF. Predesigned questionnaire was used to collect data related to sociodemographic, behavioral and environmental characteristics. Bivariate and multivariate backward stepwise analyses were used. The adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated. A P value < 0.05 was considered as the cut point for statistically significant. Epi info version 7.2 was used.Results: A total of 50 DF cases were found. Almost 52% were males and 76% were <30 years of age. The overall attack rate was 1/10,000 of the population. Case fatality rate was 4%. In multivariate analysis, not working (aOR = 26.6, 95% CI: 6.8–104.7), not using mosquito repellent (aOR = 13.9, 95% CI:1.4–136.8), wearing short sleeves/pants (aOR = 27.3, 95% CI: 4.8–156.8), poor sanitation (aOR = 5.4, 95% CI: 1.4–20.3), presence of outdoor trees (aOR = 13.2, 95% CI: 2.8–63.0) and houses without window nets (aOR = 15.7, 95% CI: 3.9–63.4) were statistically significant risk factors associated with DF outbreak. Eleven 11 (58%) of blood samples were positive for DF IgM.Conclusions: DF outbreak in Al Qahirah and Al Mudhaffar districts, Taiz governorate was confirmed. This study provides evidence-based information regarding the identified risk factors that contributed to the occurrence of this outbreak. Raising community awareness on the importance of personal protection measures and improving the sanitation services are strongly recommended.

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A Model to Predict Central-Line–Associated Bloodstream Infection Among Patients With Peripherally Inserted Central Catheters: The MPC Score

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.167 ◽

2017 ◽

Vol 38 (10) ◽

pp. 1155-1166 ◽

Cited By ~ 27

Author(s):

Erica Herc ◽

Payal Patel ◽

Laraine L. Washer ◽

Anna Conlon ◽

Scott A. Flanders ◽

...

Keyword(s):

Risk Factors ◽

Risk Model ◽

Significant Risk ◽

Hospital Medicine ◽

Central Line ◽

Cox Proportional Hazards Model ◽

Operating Characteristics ◽

Peripherally Inserted Central Catheters ◽

Factors Associated ◽

Central Catheters

BACKGROUNDPeripherally inserted central catheters (PICCs) are associated with central-line–associated bloodstream infections (CLABSIs). However, no tools to predict risk of PICC-CLABSI have been developed.OBJECTIVETo operationalize or prioritize CLABSI risk factors when making decisions regarding the use of PICCs using a risk model to estimate an individual’s risk of PICC-CLABSI prior to device placement.METHODSUsing data from the Michigan Hospital Medicine Safety consortium, patients that experienced PICC-CLABSI between January 2013 and October 2016 were identified. A Cox proportional hazards model with robust sandwich standard error estimates was then used to identify factors associated with PICC-CLABSI. Based on regression coefficients, points were assigned to each predictor and summed for each patient to create the Michigan PICC-CLABSI (MPC) score. The predictive performance of the score was assessed using time-dependent area-under-the-curve (AUC) values.RESULTSOf 23,088 patients that received PICCs during the study period, 249 patients (1.1%) developed a CLABSI. Significant risk factors associated with PICC-CLABSI included hematological cancer (3 points), CLABSI within 3 months of PICC insertion (2 points), multilumen PICC (2 points), solid cancers with ongoing chemotherapy (2 points), receipt of total parenteral nutrition (TPN) through the PICC (1 point), and presence of another central venous catheter (CVC) at the time of PICC placement (1 point). The MPC score was significantly associated with risk of CLABSI (P<.0001). For every point increase, the hazard ratio of CLABSI increased by 1.63 (95% confidence interval, 1.56–1.71). The area under the receiver-operating-characteristics curve was 0.67 to 0.77 for PICC dwell times of 6 to 40 days, which indicates good model calibration.CONCLUSIONThe MPC score offers a novel way to inform decisions regarding PICC use, surveillance of high-risk cohorts, and utility of blood cultures when PICC-CLABSI is suspected. Future studies validating the score are necessary.Infect Control Hosp Epidemiol2017;38:1155–1166

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Ethnicity and other COVID-19 death risk factors in Mexico

Archives of Medical Science ◽

10.5114/aoms.2020.101443 ◽

2020 ◽

Author(s):

Erwin Chiquete ◽

Jesus Alegre-Díaz ◽

Ana Ochoa-Guzmán ◽

Liz Nicole Toapanta-Yanchapaxi ◽

Carlos González-Carballo ◽

...

Keyword(s):

Risk Factors ◽

Proportional Hazards Model ◽

Invasive Mechanical Ventilation ◽

Significant Risk ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Chronic Obstructive ◽

Death Risk ◽

Factors Associated ◽

Risk Of Death

IntroductionPatients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop coronavirus disease 2019 (COVID-19). Risk factors associated with death vary among countries with different ethnic backgrounds. We aimed to describe the factors associated with death in Mexicans with confirmed COVID-19.Material and methodsWe analysed the Mexican Ministry of Health’s official database on people tested for SARS-CoV-2 infection by real-time reverse transcriptase–polymerase chain reaction (rtRT-PCR) of nasopharyngeal fluids. Bivariate analyses were performed to select characteristics potentially associated with death, to integrate a Cox-proportional hazards model.ResultsAs of May 18, 2020, a total of 177,133 persons (90,586 men and 86,551 women) in Mexico received rtRT-PCR testing for SARS-CoV-2. There were 5332 deaths among the 51,633 rtRT-PCR-confirmed cases (10.33%, 95% CI: 10.07–10.59%). The median time (interquartile range, IQR) from symptoms onset to death was nine days (5–13 days), and from hospital admission to death 4 days (2–8 days). The analysis by age groups revealed that the significant risk of death started gradually at the age of 40 years. Independent death risk factors were obesity, hypertension, male sex, indigenous ethnicity, diabetes, chronic kidney disease, immunosuppression, chronic obstructive pulmonary disease, age > 40 years, and the need for invasive mechanical ventilation (IMV). Only 1959 (3.8%) cases received IVM, of whom 1893 were admitted to the intensive care unit (96.6% of those who received IMV).ConclusionsIn Mexico, highly prevalent chronic diseases are risk factors for death among persons with COVID-19. Indigenous ethnicity is a poorly studied factor that needs more investigation.

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Analysis of risk factors associated with caesarean section surgical site infections: a case control study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205250 ◽

2020 ◽

Vol 9 (12) ◽

pp. 5075

Author(s):

Riya Rano ◽

Purvi K. Patel

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Subcutaneous Tissue ◽

White Blood Cells ◽

Significant Risk ◽

Surgical Site Infections ◽

Patient Characteristics ◽

Factors Associated ◽

Operative Care ◽

Duration Of Surgery

Background: Surgical site infection (SSI) is defined as infection occurring within 30 days after a surgical procedure and affecting either the incision or deep tissues at the operation site. SSIs are the most common nosocomial infections, accounting for 38% of hospital-acquired infections. Despite the advances in SSI control practices, SSIs remain common causes of morbidity and mortality among hospitalized patients. This study was undertaken with an objective to determine and analyze the risk factors associated with cesarean section SSIs.Methods: The study was carried out at Medical College and SSG Hospital, Baroda. After obtaining informed consent to be a part of the study, 140 subjects having cesarean section SSI as per the definition, were included as cases in the study. The controls (140) were also selected from the hospital subjects. The primary post-operative care was similar for the cases as well as controls. For patients who had SSI, samples of discharge from the cesarean section wound were collected and transported for culture. Antibiotics were given accordingly. Details about patient characteristics and outcomes were collected in the proforma for cases and controls and data analyzed.Results: The cesarean section SSI rate was 4.78%. Of the parameters studied, maternal age, parity, gestational age, HIV status, meconium stained amniotic fluid, amount of blood loss, previous surgery, duration of surgery were not associated with cesarean section SSI.Conclusions: Number of antenatal care (ANC) visits, haemoglobin, total white blood cells (WBC) count, pre eclampsia, premature rupture of membranes (PROM), non-progression in 2nd stage and subcutaneous tissue thickness were the independent significant risk factors associated with post-cesarean SSI.

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Significant risk factors associated with facilities management (FM) outsourcing

Engineering Construction & Architectural Management ◽

10.1108/ecam-03-2014-0046 ◽

2015 ◽

Vol 22 (6) ◽

pp. 771-796 ◽

Cited By ~ 3

Author(s):

Dubem I. Ikediashi ◽

Stephen O. Ogunlana

Keyword(s):

Risk Factors ◽

Significant Risk ◽

The Body ◽

Healthcare Sector ◽

Public Healthcare ◽

Facilities Management ◽

Content Type ◽

Healthcare Facilities ◽

Factors Associated ◽

Body Of Knowledge

Purpose – The purpose of this paper is to extend the body of knowledge on healthcare facilities management (FM) by investigating the risks associated with outsourcing of FM services in hospitals. Design/methodology/approach – The paper relied on two strands of methodology common with pragmatic research. Questionnaire survey (QS) used data from 208 respondents representing ten hospitals while three out of the ten hospitals involved in the QS were selected based on their willingness to enter the case study (CS) interview. Data collected were analysed using descriptive and inferential statistics for QS and using narrative techniques by discussing themes, sub-themes for the CS. Findings – Findings established 24 out of the 35 risk factors as critical, four factors as somehow critical, and five factors as not critical. Besides, nine risk factors were found to be significantly loaded on the five risk categories. The rank analysis also revealed that the top five critical risk factors are: inexperience and lack of requisite skills; possibility of fraud by vendor; financial failure of chosen vendor; vendor opportunism; and fall in morale of employees. Originality/value – The study provides an unambiguous contribution to exiting body of knowledge on outsourcing risks as it relates to healthcare FM. It reinforces the theory that risks exist in any form of relationship but developed a distinct body of factors associated with outsourcing of FM services particularly from the context of Nigeria’s public healthcare sector.

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Incidence and determinants of malpositioning tracheostomy tubes in critically ill adult patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x211039226 ◽

2021 ◽

pp. 0310057X2110392

Author(s):

Prakkash P Ananthan ◽

Kwok M Ho ◽

Matthew H Anstey ◽

Bradley A Wibrow

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Tracheostomy Tube ◽

Clinical Audit ◽

Internal Diameter ◽

Air Leak ◽

Common Cause ◽

Factors Associated ◽

Tracheal Stoma ◽

Tracheostomy Tubes

Tracheostomy tubes are chosen primarily based on their internal diameter; however, the length of the tube may also be important. We performed a prospective clinical audit of 30 critically ill patients following tracheostomy to identify the type of tracheostomy tube inserted, the incidence of malpositioning and the factors associated with the need to change the tracheostomy tube subsequently. Anthropometric neck measurements, distance between the skin and tracheal rings and the position of the tracheostomy cuff relative to the tracheal stoma were recorded and analysed. Malpositioning of the tracheostomy tube was noted in 20%, with a high riding cuff being the most common cause of malpositioning, resulting in an audible leak and a need to change the tracheostomy tube subsequently. A high riding cuff was more common when a small tracheostomy tube (e.g. Portex (Smiths Medical Australasia, Macquarie Park, NSW) ≤8.0 mm internal diameter with length <7.5 cm) was used, with risk further increased when the patient’s skin to trachea depth was greater than 0.8 cm. Identifying a high riding cuff relative to the tracheal stoma confirmed by a translaryngeal bronchoscopy strongly predicted the risk of air leak and the need to change the tracheostomy tube subsequently. Our study suggests that when a small (and short) tracheostomy tube is planned for use, intraoperative translaryngeal bronchoscopy is warranted to exclude malpositioning of the tracheostomy tube with a high riding cuff.

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