scholarly journals Timing and Causes of Death in Severe COVID-19 Patients

2021 ◽  
Author(s):  
Charles de ROQUETAILLADE ◽  
Swann Bredin ◽  
Jean-Baptiste Lascarrou ◽  
Thibaud Soumagne ◽  
Mariana Cojocaru ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Multiple Organ ◽  
Specific Pattern ◽  
Icu Mortality ◽  
Refractory Hypoxemia ◽  
Timing Of Death

Abstract Introduction: Although early identified as a deadly infectious disease, the precise mortality rate of the most severe forms of COVID-19 is a matter of debate. To the best of our knowledge, no study investigated so far, the causes that ultimately led to death as well as the relation between timing and causes of death.Material & Methods: We performed a retrospective study in eight ICU within eight French hospitals. All consecutive adult patients (aged≥ 18 years old) admitted in the ICU with a PCR-confirmed SARS-CoV-2 infection and acute respiratory failure were included in the analysis. Causes and timing of death were reported based on medical records. A binomial logistic regression statistical analysis was performed to identify the determinants associated with ICU-mortality.Results: From March 1st, 2020 to April 28th, 287 patients were admitted to ICU for SARS-CoV-2 related acute respiratory failure. COVID-19 related multiple organ dysfunction syndromes (MODS) was the leading cause of death (29%, n=27/93). End-of-life decisions occurred in 25% of patients (n=23/93). Secondary infections-related MODS accounted for 21% of ICU death, with a majority of ventilator-associated pneumonia. Fatal ischemic events (venous or arterial) occurred in 12% of patients. Refractory hypoxemia was a relatively uncommon cause of death and occurred only in 8 cases (9%). Regarding the timing of death, only one death occurred during the first three days of ICU admission. Determinants associated with ICU-mortality in logistic regression were age >65, requirement for vasopressors, renal replacement therapy and extracorporeal membrane oxygenation.Conclusion: Our data suggest the existence of a specific pattern of outcome in severe COVID-19 patients compared to severe bacterial and viral pneumonia, consisting in a high proportion of delayed COVID-19 related MODS.

scholarly journals Timing and causes of death in severe COVID-19 patients

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Charles de Roquetaillade ◽  
Swann Bredin ◽  
Jean-Baptiste Lascarrou ◽  
Thibaud Soumagne ◽  
Mariana Cojocaru ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Median Time ◽  
Causes Of Death ◽  
Secondary Infection ◽  
Multiple Organ ◽  
Multicenter Observational Study ◽  
Icu Admission ◽  
Secondary Infections ◽  
Refractory Hypoxemia

Abstract Background Previous studies reporting the causes of death in patients with severe COVID-19 have provided conflicting results. The objective of this study was to describe the causes and timing of death in patients with severe COVID-19 admitted to the intensive care unit (ICU). Methods We performed a retrospective study in eight ICUs across seven French hospitals. All consecutive adult patients (aged ≥ 18 years) admitted to the ICU with PCR-confirmed SARS-CoV-2 infection and acute respiratory failure were included in the analysis. The causes and timing of ICU deaths were reported based on medical records. Results From March 1, 2020, to April 28, 287 patients were admitted to the ICU for SARS-CoV-2 related acute respiratory failure. Among them, 93 patients died in the ICU (32%). COVID-19-related multiple organ dysfunction syndrome (MODS) was the leading cause of death (37%). Secondary infection-related MODS accounted for 26% of ICU deaths, with a majority of ventilator-associated pneumonia. Refractory hypoxemia/pulmonary fibrosis was responsible for death in 19% of the cases. Fatal ischemic events (venous or arterial) occurred in 13% of the cases. The median time from ICU admission to death was 15 days (25th–75th IQR, 7–27 days). COVID-19-related MODS had a median time from ICU admission to death of 14 days (25th–75th IQR: 7–19 days), while only one death had occurred during the first 3 days since ICU admission. Conclusions In our multicenter observational study, COVID-19-related MODS and secondary infections were the two leading causes of death, among severe COVID-19 patients admitted to the ICU.

scholarly journals Relationship between 24-h venous blood glucose variation and mortality among patients with acute respiratory failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaoling Zhang ◽  
Jingjing Zhang ◽  
Jiamei Li ◽  
Ya Gao ◽  
Ruohan Li ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Venous Blood ◽  
Sensitivity Analyses ◽  
Icu Mortality ◽  
Logistic Regression Models ◽  
The Mean ◽  
The Relationship

AbstractEvidence indicates that glucose variation (GV) plays an important role in mortality of critically ill patients. We aimed to investigate the relationship between the coefficient of variation of 24-h venous blood glucose (24-hVBGCV) and mortality among patients with acute respiratory failure. The records of 1625 patients in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database were extracted. The 24-hVBGCV was calculated as the ratio of the standard deviation (SD) to the mean venous blood glucose level, expressed as a percentage. The outcomes included ICU mortality and in-hospital mortality. Participants were divided into three subgroups based on tertiles of 24-hVBGCV. Multivariable logistic regression models were used to evaluate the relationship between 24-hVBGCV and mortality. Sensitivity analyses were also performed in groups of patients with and without diabetes mellitus. Taking the lowest tertile as a reference, after adjustment for all the covariates, the highest tertile was significantly associated with ICU mortality [odds ratio (OR), 1.353; 95% confidence interval (CI), 1.018–1.797] and in-hospital mortality (OR, 1.319; 95% CI, 1.003–1.735), especially in the population without diabetes. The 24-hVBGCV may be associated with ICU and in-hospital mortality in patients with acute respiratory failure in the ICU, especially in those without diabetes.

scholarly journals Multiple Organ Dysfunction in Children Mechanically Ventilated for Acute Respiratory Failure*

2017 ◽  
Vol 18 (4) ◽  
pp. 319-329 ◽  
Author(s):  
Scott L. Weiss ◽  
Lisa A. Asaro ◽  
Heidi R. Flori ◽  
Geoffrey L. Allen ◽  
David Wypij ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Organ Dysfunction ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Mechanically Ventilated

scholarly journals Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers

2021 ◽  
Author(s):  
Willemke Stilma ◽  
Eva Åkerman ◽  
Antonio Artigas ◽  
Andrew Bentley ◽  
Lieuwe D. Bos ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Work Of Breathing ◽  
Supplemental Oxygen ◽  
Expert Advice ◽  
Adjunctive Treatment ◽  
Middle Income ◽  
Resource Limited ◽  
Refractory Hypoxemia ◽  
Potential Benefits

Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6–12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.

scholarly journals In-hospital mortality in the emergency department: clinical and etiological differences between early and late deaths among patients awaiting admission

2021 ◽  
Vol 8 (4) ◽  
pp. 325-332
Author(s):  
Gabriele Valli ◽  
Elisabetta Galati ◽  
Francesca De Marco ◽  
Chiara Bucci ◽  
Paolo Fratini ◽  
...  
Keyword(s):  
Emergency Department ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Causes Of Death ◽  
Vital Signs ◽  
Medical Visit ◽  
The Past ◽  
Number Of Patients ◽  
Critical Patients ◽  
Positive Correlations

Objective Given that there are no studies on diseases that occur by waiting for hospitalization, we aimed to evaluate the main causes of death in the emergency room (ER) and their relationship with overcrowding.Methods Patients who died in the ER in the past 2 years (pediatrics and trauma victims excluded) were divided into two groups: patients who died within 6 hours of arrival (emergency department [ED] group) and patients who died later (LD group). We compared the causes of death, total vital signs, diagnostic tests performed, and therapy between the groups. We assessed for possible correlation between the number of monthly deaths per group and four variables of overcrowding: number of patients treated per month, waiting time before medical visit (W-Time), mean intervention time (I-Time), and number of patients admitted to the ward per month (NPA).Results During the two years, 175 patients had died in our ER (52% in ED group and 48% in LD group). The total time spent in the ER was, respectively, 2.9±0.2 hours for ED group and 17.9± 1.5 hours for LD group. The more frequent cause of death was cardiovascular syndrome (30%) in ED group and sepsis (27%) and acute respiratory failure (27%) in LD group. Positive correlations between number of monthly deaths and W-Time (R2 0.51, P<0.001), I-Time (R2 0.73, P< 0.0001), and NPA (R2 0.37, P<0.01) were found only in LD group.Conclusion Patients with sepsis and acute respiratory failure die after a long stay in the ER, and the risk increases with overcrowding. A fast-track pathway should be considered for hospital admission of critical patients.

scholarly journals Respiratory failure: Classification, Epidemiology and Etiology Review

2020 ◽  
Vol 1 (2) ◽  
pp. 15-20
Author(s):  
Vergel Ernest
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Mortality Rates ◽  
Multiple Organ ◽  
Oxygen Intake ◽  
Multiple Organ Dysfunction ◽  
Central Nervous System Depression ◽  
Organ Systems ◽  
Failure Classification ◽  
Carbon Dioxide Release

Respiratory failure is a detailed syndrome of the respiratory system failing to perform the function of gas exchange, oxygen intake, and carbon dioxide release. Acute respiratory failure is the most common cause of organ failure in intensive care units (ICUs) with high mortality rates. The classification can be reviewed from two categories of acute respiratory failure and chronic respiratory failure. Acute respiratory failure is often found with the failure of other vital organs. Death is caused by multiple organ dysfunction syndrome (MODS). Etiology can be seen in two categories, namely Central nervous system Depression, Impaired ventilation, Impaired equilibrium perfusion ventilation (V/Q Mismatch), Trauma, Pleural effusion, hemothorax, and pneumothorax, Acute pulmonary disease. Respiratory failure, like failure in other organ systems, can be identified based on clinical features or laboratory tests.

Factors Predictive of Postoperative Acute Respiratory Failure Following Inpatient Sinus Surgery

2018 ◽  
Vol 127 (7) ◽  
pp. 429-438 ◽  
Author(s):  
Brittany N. Burton ◽  
Sapideh Gilani ◽  
Matthew W. Swisher ◽  
Richard D. Urman ◽  
Ulrich H. Schmidt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Fungal Infections ◽  
Sinus Surgery ◽  
Multivariable Logistic Regression Analysis ◽  
Multivariable Logistic Regression ◽  
Nationwide Inpatient Sample Database ◽  
The Impact

Objective: The impact of perioperative risk factors on outcomes following outpatient sinus surgery is well defined; however, risk factors and outcomes following inpatient surgery remain poorly understood. We aimed to define risk factors of postoperative acute respiratory failure following inpatient sinus surgery. Methods: Utilizing data from the Nationwide Inpatient Sample Database from the years 2010 to 2014, we identified patients (≥18 years of age) with an Internal Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code of sinus surgery. We used multivariable logistic regression to identify risk factors of postoperative acute respiratory failure. Results: We identified 4919 patients with a median age of 53 years. The rate of inpatient postoperative acute respiratory failure was 3.35%. Chronic sinusitis (57.7%) was the most common discharge diagnosis. The final multivariable logistic regression analysis suggested that pneumonia, bleeding disorder, alcohol dependence, nutritional deficiency, heart failure, paranasal fungal infections, and chronic kidney disease were associated with increased odds of acute respiratory failure (all P < .05). Conclusion: To our knowledge, this represents the first study to evaluate potential risk factors of acute respiratory failure following inpatient sinus surgery. Knowledge of these risk factors may be used for risk stratification.

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