Association Between Timing of Speech and Language Therapy Initiation and Outcomes Among Post-Extubation Dysphagia Patients: A Multicenter Retrospective Cohort Study

Abstract Background: Post-extubation dysphagia (PED) is recognized as a common complication in the intensive care unit (ICU). Speech and language therapy (SLT) can potentially help improve PED; however, the impact of the timing of SLT initiation on persistent PED has not been well investigated. This study aimed to examine the timing of SLT initiation and its effect on patient outcomes after extubation in the ICU.Methods: We conducted this multicenter, retrospective, cohort study, collecting data from eight ICUs in Japan from patients treated between 2017 and 2020. Patients aged ≥ 20 years with orotracheal intubation and mechanical ventilation for longer than 48 hours, and those who received SLT due to PED, defined as patients with modified water swallowing test scores of 3 or lower, were included. The primary outcome was dysphagia at hospital discharge, defined as functional oral intake scale score <5 or death after extubation. Secondary outcomes included dysphagia or death at the seventh, 14th, or 28th day after extubation, aspiration pneumonia, and in-hospital mortality. Associations between the timing of SLT initiation and outcomes were determined using multivariable logistic regression. Results: Two hundred and seventy-two patients met the study inclusion criteria. Of them, 82 (30.1%) patients exhibited dysphagia or death at hospital discharge, and their time spans from extubation to SLT initiation was 1.0 days. The primary outcome revealed that every day of delay in SLT initiation post-extubation was associated with dysphagia or death at hospital discharge (adjusted odds ratio (AOR), 1.09; 95% CI, 1.02 to 1.18). Similarly, secondary outcomes showed associations between this per day delay in SLT initiation and dysphagia or death at the seventh day (AOR, 1.28; 95% CI, 1.05 to 1.55), 14th day (AOR, 1.34; 95% CI, 1.13 to 1.58), or 28th day (AOR, 1.21; 95% CI, 1.07 to 1.36) after extubation and occurrence of aspiration pneumonia (AOR, 1.09; 95% CI, 1.02 to 1.17), while per day delay in post-extubation SLT initiation did not affect in-hospital mortality (AOR, 1.04; 95% CI, 0.97 to 1.12). Conclusions: Delayed initiation of SLT in PED patients was associated with persistent dysphagia or death. Early initiation of SLT may prevent this complication post-extubation.

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Association between diarrhea quantity and in-hospital mortality in intensive care unit patients: A retrospective cohort study

10.21203/rs.3.rs-859799/v1 ◽

2021 ◽

Author(s):

Ryohei Yamamoto ◽

Hajime Yamazaki ◽

Shungo Yamamoto ◽

Yuna Ueta ◽

Ryo Ueno ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Hospital Mortality ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Primary Outcome ◽

Medical Center ◽

Icu Patients ◽

Failure Assessment ◽

Comorbidity Index

Abstract Background Previous studies have shown that diarrhea is associated with increased mortality of patients in intensive care units (ICUs). However, these studies used dichotomized cutoff values, even if diarrhea was a continuous condition. This study aimed to assess the association between diarrhea quantity and mortality in ICU patients with newly developed diarrhea. Methods We conducted this single-center retrospective cohort study at the Kameda Medical Center ICU. We consecutively included all adult ICU patients with newly developed diarrhea in the ICU between January 2017 and December 2018. Newly developed diarrhea was defined based on a Bristol stool chart scale ≥ 6 and frequency of diarrhea ≥ 3 times per day. We excluded patients who already had diarrhea on the day of ICU admission among other criteria. We collected data on the quantity of diarrhea on the day when patients newly developed diarrhea. The primary outcome was in-hospital mortality. The risk ratio (RR) and 95% confidence interval (CI) for the association between the quantity of diarrhea and mortality were estimated using multivariable-modified Poisson regression models adjusted for the Charlson Comorbidity Index, sequential organ failure assessment score, and serum albumin levels. Results Among 231 participants, 68.4% (158/231) were men; the median age of the patients was 72 years. The median quantity of diarrhea was 401 g (interquartile range [IQR] 230‒645 g), and in-hospital mortality was 22.9% (53/231). More diarrhea at baseline was associated with higher in-hospital mortality; the unadjusted RR (95% CI) per 200-g increase was 1.10 (1.01‒1.19). This association remained in the multivariable-adjusted analysis; the adjusted RR (95% CI) per 200-g increase was 1.10 (1.01‒1.20). Conclusions A greater quantity of diarrhea was an independent risk factor for in-hospital mortality. The quantity of diarrhea may be an indicator of disease severity in ICU patients.

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Proton pump inhibitors versus histamine-2 receptor blockers for stress ulcer prophylaxis in patients with sepsis: a retrospective cohort study

Journal of International Medical Research ◽

10.1177/03000605211025130 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110251

Author(s):

Minqiang Huang ◽

Ming Han ◽

Wei Han ◽

Lei Kuang

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Hospital Mortality ◽

Critically Ill ◽

Proton Pump ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Stress Ulcer ◽

Increased Risk ◽

Ulcer Prophylaxis

Objective We aimed to compare the efficacy and risks of proton pump inhibitor (PPI) versus histamine-2 receptor blocker (H2B) use for stress ulcer prophylaxis (SUP) in critically ill patients with sepsis and risk factors for gastrointestinal bleeding (GIB). Methods In this retrospective cohort study, we used the Medical Information Mart for Intensive Care III Clinical Database to identify critically ill adult patients with sepsis who had at least one risk factor for GIB and received either an H2B or PPI for ≥48 hours. Propensity score matching (PSM) was conducted to balance baseline characteristics. The primary outcome was in-hospital mortality. Results After 1:1 PSM, 1056 patients were included in the H2B and PPI groups. The PPI group had higher in-hospital mortality (23.8% vs. 17.5%), GIB (8.9% vs. 1.6%), and pneumonia (49.6% vs. 41.6%) rates than the H2B group. After adjusting for risk factors of GIB and pneumonia, PPI use was associated with a 1.28-times increased risk of in-hospital mortality, 5.89-times increased risk of GIB, and 1.32-times increased risk of pneumonia. Conclusions Among critically ill adult patients with sepsis at risk for GIB, SUP with PPIs was associated with higher in-hospital mortality and higher risk of GIB and pneumonia than H2Bs.

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Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211027759 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110277

Author(s):

Tyler Pitre ◽

Angela (Hong Tian) Dong ◽

Aaron Jones ◽

Jessica Kapralik ◽

Sonya Cui ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Cohort Study ◽

Hospital Mortality ◽

Disease Severity ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Kidney Injury ◽

Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

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Admission Braden Scale Score as an Early Independent Predictor of In‐Hospital Mortality Among Inpatients With COVID‐19: A Retrospective Cohort Study

Worldviews on Evidence-Based Nursing ◽

10.1111/wvn.12526 ◽

2021 ◽

Author(s):

Elena Lovicu ◽

Antonio Faraone ◽

Alberto Fortini

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Scale Score ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Independent Predictor ◽

Braden Scale

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The effects of propofol on extracorporeal membrane oxygenation oxygenator exchange

The International Journal of Artificial Organs ◽

10.1177/03913988211016007 ◽

2021 ◽

pp. 039139882110160

Author(s):

Kelsey L Browder ◽

Ayesha Ather ◽

Komal A Pandya

Keyword(s):

Cohort Study ◽

Extracorporeal Membrane Oxygenation ◽

Cumulative Dose ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Primary Outcome ◽

Ecmo Support ◽

Single Center ◽

Membrane Oxygenation ◽

Vv Ecmo

The objective of this study was to determine if propofol administration to veno-venous (VV) extracorporeal membrane oxygenation (ECMO) patients was associated with more incidents of oxygenator failure when compared to patients who did not receive propofol. This was a single center, retrospective cohort study. The primary outcome of the study is oxygenator exchanges per ECMO day in patients who received propofol versus those who did not receive propofol. Patients were 18 years or older on VV-ECMO support between January 1, 2015 and January 31, 2018. Patients were excluded if they required ECMO support for less than 48 h or greater than 21 days. There were five patients in the propofol arm that required oxygenator exchanges and seven patients in the control arm. The total number of oxygenator exchanges per ECMO day was not significantly different between groups ( p = 0.50). When comparing those who required an oxygenator exchange and those who did not, there was no difference in the cumulative dose of propofol received per ECMO hour (0.64 mg/kg/h vs 0.96 mg/kg/h; p = 0.16). Propofol use in patients on VV-ECMO does not appear to increase the number of oxygenator exchanges.

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In-hospital mortality after surgery: a retrospective cohort study in a Japanese university hospital

SpringerPlus ◽

10.1186/s40064-016-2279-1 ◽

2016 ◽

Vol 5 (1) ◽

Cited By ~ 5

Author(s):

Yo Shidara ◽

Yoshihisa Fujita ◽

Saiko Fukunaga ◽

Kae Ikeda ◽

Mayumi Uemura

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

University Hospital ◽

Japanese University

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Risk factors for mortality in hospitalized patients with COVID-19 from three hospitals in Peru: a retrospective cohort study

F1000Research ◽

10.12688/f1000research.51474.1 ◽

2021 ◽

Vol 10 ◽

pp. 224

Author(s):

Cristian Díaz-Vélez ◽

Diego Urrunaga-Pastor ◽

Anthony Romero-Cerdán ◽

Eric Ricardo Peña-Sánchez ◽

Jorge Luis Fernández Mogollon ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Hospital Mortality ◽

Oxygen Saturation ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cox Regression ◽

Vulnerable Groups ◽

Vital Functions ◽

The Mean

Background: Peru was one of the countries with the highest COVID-19 mortality worldwide during the first stage of the pandemic. It is then relevant to evaluate the risk factors for mortality in patients hospitalized for COVID-19 in three hospitals in Peru in 2020, from March to May, 2020. Methods: We carried out a retrospective cohort study. The population consisted of patients from three Peruvian hospitals hospitalized for a diagnosis of COVID-19 during the March-May 2020 period. Independent sociodemographic variables, medical history, symptoms, vital functions, laboratory parameters and medical treatment were evaluated. In-hospital mortality was assessed as the outcome. We performed Cox regression models (crude and adjusted) to evaluate risk factors for in-hospital mortality. Hazard ratios (HR) with their respective 95% confidence intervals (95% CI) were calculated. Results: We analyzed 493 hospitalized adults; 72.8% (n=359) were male and the mean age was 63.3 ± 14.4 years. COVID-19 symptoms appeared on average 7.9 ± 4.0 days before admission to the hospital, and the mean oxygen saturation on admission was 82.6 ± 13.8. While 67.6% (n=333) required intensive care unit admission, only 3.3% (n=16) were admitted to this unit, and 60.2% (n=297) of the sample died. In the adjusted regression analysis, it was found that being 60 years old or older (HR=1.57; 95% CI: 1.14-2.15), having two or more comorbidities (HR=1.53; 95% CI: 1.10-2.14), oxygen saturation between 85-80% (HR=2.52; 95% CI: 1.58-4.02), less than 80% (HR=4.59; 95% CI: 3.01-7.00), and being in the middle (HR=1.65; 95% CI: 1.15-2.39) and higher tertile (HR=2.18; 95% CI: 1.51-3.15) of the neutrophil-to-lymphocyte ratio, increased the risk of mortality. Conclusions: The risk factors found agree with what has been described in the literature and allow the identification of vulnerable groups in whom monitoring and early identification of symptoms should be prioritized in order to reduce mortality.

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Use of Vasopressors Increases the Risk of Mortality in Severe Traumatic Brain Injury: A Nationwide Retrospective Cohort Study in Japan

10.21203/rs.3.rs-149055/v1 ◽

2021 ◽

Author(s):

Sanae Hosomi ◽

Tomotaka Sobue ◽

Tetsuhisa Kitamura ◽

Atsushi Hirayama ◽

Hiroshi Ogura ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Cohort Study ◽

Brain Injury ◽

Propensity Score ◽

Hospital Discharge ◽

Severe Traumatic Brain Injury ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Clinical Practices

Abstract BackgroundPharmacological elevation of blood pressure is frequently incorporated in severe traumatic brain injury management algorithms. However, there is limited evidence on prevalent clinical practices regarding resuscitation for severe traumatic brain injury using vasopressors. We conducted a nationwide retrospective cohort study to determine the association between the use of vasopressors and mortality following hospital discharge in patients with severe traumatic brain injury, and to determine whether the use of vasopressors affects emergency department mortality or the occurrence of cognitive dysfunction.MethodsData were collected between January 2004 and December 2018 from the Japanese Trauma Data Bank, which includes data from 272 emergency hospitals in Japan. Adults aged ≥16 years with severe traumatic brain injury, without other major injuries, were examined. A severe traumatic brain injury was defined based on the Abbreviated Injury Scale code and a Glasgow Coma Scale score of 3–8 on admission. Multivariable analysis and propensity score matching were performed. Statistical significance was assessed using 95% confidence intervals (CIs).ResultsIn total, 10 284 patients were eligible for analysis, with 650 patients (6.32%) included in the vasopressor group and 9634 patients (93.68%) included in the non-vasopressor group. The proportion of deaths on hospital discharge was higher in the vasopressor group than in the non-vasopressor group (81.69% [531/650] vs. 40.21% [3,874/9,634]). This finding was confirmed by multivariable logistic regression analysis (adjusted odds ratio [OR], 5.71; 95% CI: 4.56–7.16). Regarding propensity score-matched patients, the proportion of deaths on hospital discharge remained higher in the vasopressor group than in the non-vasopressor group (81.66% [530/649] vs. 50.69% [329/649]) (OR, 4.33; 95% CI: 3.37–5.57). The vasopressor group had a higher emergency department mortality rate than the non-vasopressor group (8.01% [52/649] vs. 2.77% [18/649]) (OR, 3.05; 95% CI: 1.77–5.28). There was no reduction in complications of cognitive disorders in the vasopressor group (5.39% [35/649] vs. 5.55% [36/649]) (OR, 0.97; 95% CI: 0.60–1.57).ConclusionsIn this population, the use of vasopressors for severe traumatic brain injury was associated with higher mortality on hospital discharge. Our results suggest that vasopressors should be avoided in most cases of severe traumatic brain injury.

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