scholarly journals A Tale of a Two Waves Epidemic: Characteristics and Mortality Risk Factors for COVID-19 ICU Patients in the French West Indies

2021 ◽  
Author(s):  
jean-david Pommier ◽  
frederic Martino ◽  
Kevin Bleakley ◽  
Laure Flurin ◽  
Fabien Van Roy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
West Indies ◽  
Invasive Mechanical Ventilation ◽  
Severe Pneumonia ◽  
University Hospital ◽  
French West Indies ◽  
Old Patients ◽  
Factors Associated ◽  
Second Wave

Abstract Introduction Guadeloupe, a French West Indies island, has been fiercely affected by two large waves of COVID.Therapeutic approach was different between the two waves in the intensive care unit (ICU). We aimed to compare the two different periods in terms of characteristics and outcomes and to evaluate risk factors associated with 60-day mortality in our overall cohort. Methods All consecutive patients with laboratory confirmed COVID-19 pneumonia and requiring oxygen support admitted in our ICU unit of University Hospital of Guadeloupe were prospectively included. Patients were treated during the first wave with a combination of Hydroxychloroquine and Azithromycin and during the second wave with dexamethasone and reinforced anticoagulation. Results In our cohort, 187 patients were included, 31 during the first one and 156 during the second. Patients were mostly male (69%) with a median age of 64years old. Patients tend to be younger during the second wave and body mass index was higher (respectively 31 vs 27kg/m2, p=0.01). Overall mortality at Day 60 was high (45%) and not different between the two waves. Among patients under mechanical ventilation risk factors associated with death in a multivariate analysis were a high number of comorbidities, a high level of SOFA score and the delay of invasive mechanical ventilation (IMV) onset after admission in ICU (OR=1.6 (95% CI 1.2 – 2.4). Conclusion Although therapeutics approach evolve, COVID-19 severe pneumonia is still associated with a high mortality rate in ICU.

scholarly journals EPISYNC study: predictors of patient-ventilator asynchrony in a prospective cohort of patients under invasive mechanical ventilation - study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e028601 ◽  
Author(s):  
Mayson Laercio de Araujo Sousa ◽  
Rudys Magrans ◽  
Fátima K Hayashi ◽  
Lluis Blanch ◽  
R M Kacmarek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Prospective Cohort ◽  
Respiratory Mechanics ◽  
Cox Regression ◽  
Bronchopleural Fistula ◽  
Invasive Mechanical Ventilation ◽  
University Hospital ◽  
Factors Associated ◽  
Link Type

IntroductionPatient-ventilator asynchrony is common during the entire period of invasive mechanical ventilation (MV) and is associated with worse clinical outcomes. However, risk factors associated with asynchrony are not completely understood. The main objectives of this study are to estimate the incidence of asynchrony during invasive MV and its association with respiratory mechanics and other baseline patient characteristics.Methods and analysisWe designed a prospective cohort study of patients admitted to the intensive care unit (ICU) of a university hospital. Inclusion criteria are adult patients under invasive MV initiated for less than 72 hours, and with expectation of remaining under MV for more than 24 hours. Exclusion criteria are high flow bronchopleural fistula, inability to measure respiratory mechanics and previous tracheostomy. Baseline assessment includes clinical characteristics of patients at ICU admission, including severity of illness, reason for initiation of MV, and measurement of static mechanics of the respiratory system. We will capture ventilator waveforms during the entire MV period that will be analysed with dedicated software (Better Care, Barcelona, Spain), which automatically identifies several types of asynchrony and calculates the asynchrony index (AI). We will use a linear regression model to identify risk factors associated with AI. To assess the relationship between survival and AI we will use Kaplan-Meier curves, log rank tests and Cox regression. The calculated sample size is 103 patients. The statistical analysis will be performed by the software R Programming (www.R-project.org) and will be considered statistically significant if the p value is less than 0.05.Ethics and disseminationThe study was approved by the Ethics Committee of Instituto do Coração, School of Medicine, University of São Paulo, Brazil, and informed consent was waived due to the observational nature of the study. We aim to disseminate the study findings through peer-reviewed publications and national and international conference presentations.Trial registration numberNCT02687802; Pre-results.

Ventilator-Associated Pneumonia: Incidence and risk factors six intensive care units in Tunisia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Ben Cheikh ◽  
S Bhiri ◽  
N ketaka ◽  
A Gara ◽  
S Khefacha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
University Hospital ◽  
Ventilator Associated Pneumonia ◽  
Factors Associated ◽  
History Of ◽  
Independent Risk Factors ◽  
The University ◽  
Very High

Abstract Background Ventilator-Associated Pneumonia (VAP) continues to cause significant morbidity, mortality, and hospital costs, especially in the intensive care unit (ICU). This study aimed to determine incidence and factors associated with VAP in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018. Methods We conducted a prospective observational cohort study over a three months period in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018. All patients hospitalized with mechanical ventilation (MV) for more than 48 hours in the ICUs were included. Logistic regression with the stepwise method of Hosmer and Lemeshow was used to identify factors associated with VAP. Results Overall, 110 patients were enrolled. The mean age of patients was 44 ± 25 years. Of them, 66.4% were male. The median duration of MV was 5 days [2-16]. The incidence of VAP was 32% and the density incidence was 33/1000 ventilator days. The most common organism were Pseudomonas aeruginosa (n = 14). Of them, 12 were ceftazidime-resistant and thee were resistant to imipenem. Independent risk factors associated with VAP in ICU were history of antibiotic therapy during last 6 months (p = 0.007), tracheotomy (p < 0.001) and reintubation (p < 0.001). Conclusions VAP rates in our ICUs were very high. Antimicrobial stewardship programs involving pharmacists and physicians must be elaborated to optimize the antibiotic prescribing. Mechanical ventilation require more-effective interventions control in our hospital. Key messages Ventilator-Associated Pneumonia rates were very high. Independent risk factors associated with Ventilator-Associated Pneumonia were history of antibiotic therapy during last 6 months, tracheotomy and reintubation.

scholarly journals Factors Associated With Prolonged Viral RNA Shedding in Patients with Coronavirus Disease 2019 (COVID-19)

2020 ◽  
Vol 71 (15) ◽  
pp. 799-806 ◽  
Author(s):  
Kaijin Xu ◽  
Yanfei Chen ◽  
Jing Yuan ◽  
Ping Yi ◽  
Cheng Ding ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Hospital Admission ◽  
Invasive Mechanical Ventilation ◽  
Corticosteroid Treatment ◽  
Viral Rna ◽  
Severe Illness ◽  
Illness Onset ◽  
Factors Associated ◽  
Male Sex

Abstract Background An outbreak of coronavirus disease 2019 (COVID-19) is becoming a public health emergency. Data are limited on the duration and host factors related to viral shedding. Methods In this retrospective study, risk factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding were evaluated in a cohort of 113 symptomatic patients from 2 hospitals outside Wuhan. Results The median (interquartile range) duration of SARS-CoV-2 RNA detection was 17 (13–22) days as measured from illness onset. When comparing patients with early (<15 days) and late (≥15 days after illness onset) viral RNA clearance, prolonged SARS-CoV-2 RNA shedding was associated with male sex (P = .009), old age (P = .033), concomitant hypertension (P = .009), delayed admission to hospital after illness onset (P = .001), severe illness at admission (P = .049), invasive mechanical ventilation (P = .006), and corticosteroid treatment (P = .025). Patients with longer SARS-CoV-2 RNA shedding duration had slower recovery of body temperature (P < .001) and focal absorption on radiograph images (P < .001) than patients with early SARS-CoV-2 RNA clearance. Male sex (OR, 3.24; 95% CI, 1.31–8.02), delayed hospital admission (OR, 1.30; 95% CI, 1.10–1.54), and invasive mechanical ventilation (OR, 9.88; 95% CI, 1.11–88.02) were independent risk factors for prolonged SARS-CoV-2 RNA shedding. Conclusions Male sex, delayed admission to hospital after illness onset, and invasive mechanical ventilation were associated with prolonged SARS-CoV-2 RNA shedding. Hospital admission and general treatments should be started as soon as possible in symptomatic COVID-19 patients, especially male patients.

scholarly journals Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yongfang Zhou ◽  
Steven R. Holets ◽  
Man Li ◽  
Gustavo A. Cortes-Puentes ◽  
Todd J. Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
History Of ◽  
Training Background ◽  
The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

scholarly journals Burnout Syndrome during Residency Training in Jordan: Prevalence, Risk Factors, and Implications

2021 ◽  
Vol 18 (4) ◽  
pp. 1557
Author(s):  
Abdullah Nimer ◽  
Suzan Naser ◽  
Nesrin Sultan ◽  
Rawand Said Alasad ◽  
Alexander Rabadi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Working Hours ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Burnout Syndrome ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Factors Associated ◽  
Resident Physicians ◽  
Healthcare Professions

Burnout syndrome is common among healthcare professions, including resident physicians. We aimed to assess the prevalence of burnout among resident physicians in Jordan, and a secondary aim was to evaluate the risk factors associated with the development of burnout syndrome in those residents, including gender, working hours, psychological distress, training sector, and specialty. In this cross-sectional study, 481 residents were recruited utilizing multistage stratified sampling to represent the four major health sectors in Jordan. Data were collected using an online questionnaire, where the Copenhagen Burnout Inventory (CBI) was used to assess the prevalence of burnout. The prevalence, group differences, and predictors of burnout were statistically analyzed using STATA 15. Overall, 373 (77.5%) residents were found to have burnout. Factors associated with higher levels of burnout were psychological stress (β = 2.34, CI = [1.88–2.81]), longer working hours (β = 4.07, CI = [0.52–7.62], for 51–75 h a week, β = 7.27, CI = [2.86–11.69], for 76–100 h a week and β = 7.27, CI = [0.06–14.49], for >100 h a week), and obstetrics/gynecology residents (β = 9.66, CI = [3.59–15.73]). Conversely, medical sub-specialty residents, as well as private and university hospital residents, had lower burnout levels. We concluded that decreasing the workload on residents, offering psychological counseling, and promoting a safety culture for residents might help in mitigating burnout consequences.

scholarly journals Impact of dexamethasone on the incidence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ines Gragueb-Chatti ◽  
Alexandre Lopez ◽  
Dany Hamidi ◽  
Christophe Guervilly ◽  
Anderson Loundou ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Length Of Stay ◽  
Critically Ill ◽  
Invasive Mechanical Ventilation ◽  
Blood Stream ◽  
Hospital Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Blood Stream Infections ◽  
Second Wave

Abstract Background Dexamethasone decreases mortality in patients with severe coronavirus disease 2019 (COVID-19) and has become the standard of care during the second wave of pandemic. Dexamethasone is an immunosuppressive treatment potentially increasing the risk of secondary hospital acquired infections in critically ill patients. We conducted an observational retrospective study in three French intensive care units (ICUs) comparing the first and second waves of pandemic to investigate the role of dexamethasone in the occurrence of ventilator-associated pneumonia (VAP) and blood stream infections (BSI). Patients admitted from March to November 2020 with a documented COVID-19 and requiring mechanical ventilation (MV) for ≥ 48 h were included. The main study outcomes were the incidence of VAP and BSI according to the use of dexamethasone. Secondary outcomes were the ventilator-free days (VFD) at day-28 and day-60, ICU and hospital length of stay and mortality. Results Among the 151 patients included, 84 received dexamethasone, all but one during the second wave. VAP occurred in 63% of patients treated with dexamethasone (DEXA+) and 57% in those not receiving dexamethasone (DEXA−) (p = 0.43). The cumulative incidence of VAP, considering death, duration of MV and late immunosuppression as competing factors was not different between groups (p = 0.59). A multivariate analysis did not identify dexamethasone as an independent risk factor for VAP occurrence. The occurrence of BSI was not different between groups (29 vs. 30%; p = 0.86). DEXA+ patients had more VFD at day-28 (9 (0–21) vs. 0 (0–11) days; p = 0.009) and a reduced ICU length of stay (20 (11–44) vs. 32 (17–46) days; p = 0.01). Mortality did not differ between groups. Conclusions In this cohort of COVID-19 patients requiring invasive MV, dexamethasone was not associated with an increased incidence of VAP or BSI. Dexamethasone might not explain the high rates of VAP and BSI observed in critically ill COVID-19 patients.

scholarly journals 832. Assessment of Risk Factors Associated with Wide-resistance Gram-negative Bacteria Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S457-S457
Author(s):  
Henry Pablo Lopes Campos e Reis ◽  
Ana Beatriz Ferreira Rodrigues ◽  
Julio César Castro Silva ◽  
Lia Pinheiro de Lima ◽  
Talita Lima Quinaher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Univariate Analysis ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Gram Negative Bacteria ◽  
Multiresistant Pathogens ◽  
Gram Negative ◽  
Contact Isolation ◽  
Bladder Catheter

Abstract Background Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil. Methods The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test. Results 51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p &lt; 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p &lt; 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study. Conclusion This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies. Disclosures All Authors: No reported disclosures

scholarly journals Clinical Risk Factors Associated with Mortality Among Burn Patients Admitted to Jinnah Burn and Reconstructive Surgery Center, Lahore

2020 ◽  
Vol 34 (3) ◽  
pp. 46-50
Author(s):  
Fatima Sakhawat
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Reconstructive Surgery ◽  
Low Income ◽  
Burn Injuries ◽  
Clinical Risk Factors ◽  
Burn Patients ◽  
Factors Associated ◽  
Clinical Risk ◽  
Surgery Center

Introduction: Burn injuries being highly devastating in nature, are associated with extensive morbidity and mortality. Although the incidence of burn injuries is less in developed countries but it is increasing in developing and low income countries. Aims & Objectives: The aim of this study was to determine clinical risk factors associated with mortality among burn patients. Place and duration of study: Jinnah Burn and Reconstructive Surgery Center, Lahore from August 2018 till January 2019. Material & Methods: Data was collected by researchers themselves by studying files of patients. Data analysis was done by using SPSS and Pearson Chi Square test was used to determine association of clinical risk factors with mortality among burn patients. Results: Out of 200 patients, 137 were males. The Mortality rate was 12.50 %. Cardiopulmonary arrest was the most common cause of death. Sepsis was the most common complication among burn patients. Higher mortality rates were observed among patients with arterial/venous and urinary catheterization done. Higher survival rates were seen in those patients who were treated with debridement, grafting surgeries, Colistin Use and aided by mechanical ventilation. Conclusion: Aid through mechanical ventilation, grafting surgeries, wound debridement, use of colistin are associated with improved survival outcomes among burn patients. Whereas inhalational injury, arterial/venous catheterization, urinary catheter and sepsis are seen as major predictors of mortality among burn patients

scholarly journals Ethnicity and other COVID-19 death risk factors in Mexico

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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