scholarly journals Dysphagia and Mechanical Ventilation in Sars-Cov-2 Pneumonia: It’s Real

Author(s):  
Mª Luisa Bordeje Laguna ◽  
Pilar Marcos-Neira ◽  
Itziar Martínez de Lagrán Zurbano ◽  
Esther Mor Marco ◽  
Carlos Pollan Guisasola ◽  
...  

Abstract BACKGROUND. Severe SARS-CoV-2 pneumonia has brought intensive care units (ICUs) and the consequences of prolonged hospitalisation, such as dysphagia, into focus.METHODS. Study population: Patients with severe pneumonia due to SARS-CoV-2 who required admission to critical units from March to June 2020. Dysphagia diagnostic method: Modified Viscosity Volume Swallowing Test (mV-VST). Objectives. To identify risk factors for dysphagia in patients with severe SARS-CoV-2 pneumonia requiring invasive mechanical ventilation and determine their incidence. Statistical analysis: Descriptive analysis of means or medians according to the normality of quantitative variables and proportions for the descriptive variables (95% CI). Univariate analysis of dysphagia using simple logistic regression. Multivariate analysis and construction of a predictive model for dysphagia using logistic regression.RESULTS. Descriptive analysis. Sample size: 232 patients; 72% (167) required intubation. Of these, 65.9% (110) survived and 84.5% (93) underwent the mV-VST, which diagnosed 26.9% (25) with dysphagia. Age: 60.5 years (95% CI: 58.5 to 61.9). Men: 74.1% (95% CI: 68.1 to 79.4). APACHE II score: 17.7 (95% CI: 13.3 to 23.2). Mechanical ventilation: 14 days (95% CI: 11 to 16); prone position: 79% (95% CI: 72.1 to 84.6); respiratory infection: 34.5% (95% CI: 28.6 to 40.9). Renal failure: 38.5% (95% CI: 30 to 50). Overall mortality: 25.9% (95% CI: 20.6 to 31.9). Mortality in intubated patients: 34.1% (95% CI: 27.3 to 41.7). No patient diagnosed with dysphagia died. Univariate analysis. APACHE II, prone position, days of mechanical ventilation and need for tracheostomy, respiratory infection, kidney failure developed during admission and length of ICU and hospital stay were significantly associated (p<0.05) with dysphagia. Multivariate analysis. Dysphagia is independently explained by APACHE II score (OR: 1.1; 95% CI: 1.01 to 1.3; p=0.04) and tracheostomy (OR: 10.2; 95% CI: 3.2 to 32.1; p<0.001). The resulting predictive model predicts dysphagia with a good ROC curve (AUC: 0.8; 95% CI: 0.7 to 0.9)CONCLUSIONS. Dysphagia affects almost one-third of patients, and the risk of developing dysphagia increases with prolonged mechanical ventilation, tracheostomy and greater severity on admission (APACHE II score).

2020 ◽  
pp. 175114371990010 ◽  
Author(s):  
Raymond Dominic Savio ◽  
Rajalakshmi Parasuraman ◽  
Daphnee Lovesly ◽  
Bhuvaneshwari Shankar ◽  
Lakshmi Ranganathan ◽  
...  

Aim To assess the feasibility, tolerance and effectiveness of enteral nutrition in critically ill patients receiving invasive mechanical ventilation in the prone position for severe Acute Respiratory Distress Syndrome (ARDS). Methods Prospective observational study conducted in a multidisciplinary critical care unit of a tertiary care hospital from January 2013 until July 2015. All patients with ARDS who received invasive mechanical ventilation in prone position during the study period were included. Patients’ demographics, severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE II) score), baseline markers of nutritional status (subjective global assessment (SGA) and body mass index), details of nutrition delivery during prone and supine hours and outcomes (Length of stay and discharge status) were recorded. Results Fifty-one patients met inclusion criteria out of whom four patients were excluded from analysis since they did not receive any enteral nutrition due to severe hemodynamic instability. The mean age of patients was 46.4 ± 12.9 years, with male:female ratio of 7:3. On admission, SGA revealed moderate malnutrition in 51% of patients and the mean APACHE II score was 26.8 ± 9.2. The average duration of prone ventilation per patient was 60.2 ± 30.7 h. All patients received continuous nasogastric/orogastric feeds. The mean calories (kcal/kg/day) and protein (g/kg/day) prescribed in the supine position were 24.5 ± 3.8 and 1.1 ± 0.2 while the mean calories and protein prescribed in prone position were 23.5 ± 3.6 and 1.1 ± 0.2, respectively. Percentage of prescribed calories received by patients in supine position was similar to that in prone position (83.2% vs. 79.6%; P = 0.12). Patients received a higher percentage of prescribed protein in supine compared to prone position (80.8% vs. 75%, P = 0.02). The proportion of patients who received at least 75% of the caloric and protein goals was 37 (78.7%) and 37 (78.7%) in supine and 32 (68.1%) and 21 (44.6%) in prone position. Conclusion In critically ill patients receiving invasive mechanical ventilation in the prone position, enteral nutrition with nasogastric/orogastric feeding is feasible and well tolerated. Nutritional delivery of calories and proteins in prone position is comparable to that in supine position.


2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Daichi Ishikawa ◽  
Yukako Takehara ◽  
Atsushi Takata ◽  
Kazuhito Takamura ◽  
Hirohiko Sato

Abstract Background “Dirty mass” is a specific computed tomography (CT) finding that is seen frequently in colorectal perforation. The prognostic significance of this finding for mortality is unclear. Methods Fifty-eight consecutive patients with colorectal perforation who underwent emergency surgery were retrospectively reviewed in the study. Dirty mass identified on multi-detector row CT (MDCT) was 3D-reconstructed and its volume was calculated using Ziostation software. Dirty mass volume and other clinical characteristics were compared between survivor (n = 45) and mortality groups (n = 13) to identify predictive factors for mortality. Mann–Whitney U test and Χ2 test were used in univariate analysis and logistic regression analysis was used in multivariate analysis. Results Dirty mass was identified in 36/58 patients (62.1%) and located next to perforated colorectum in all cases. Receiver-operating characteristic (ROC) curve analysis identified the highest peak at 96.3 cm3, with sensitivity of 0.643 and specificity of 0.864. Univariate analysis revealed dirty mass volume, acute disseminated intravascular coagulation (DIC) score, acute physiology and chronic health evaluation II (APACHE II) score, and sequential organ failure assessment (SOFA) score as prognostic markers for mortality (p<0.01). Multivariate analysis revealed dirty mass volume and APACHE II score as independent prognostic indicators for mortality. Mortality was stratified by dividing patients into four groups according to dirty mass volume and APACHE II score. Conclusions The combination of dirty mass volume and APACHE II score could stratify the postoperative mortality risk in patients with colorectal perforation. According to the risk stratification, surgeons might be able to decide the surgical procedures and intensity of postoperative management.


2021 ◽  
Author(s):  
Daichi Ishikawa ◽  
Yukako Takehara ◽  
Atsushi Takata ◽  
Kazuhito Takamura ◽  
Hirohiko Sato

Abstract Background: “Dirty mass” is a specific computed tomography (CT) finding that is seen frequently in colorectal perforation. The prognostic significance of this finding for mortality is unclear.Methods: Fifty-eight consecutive patients with colorectal perforation who underwent emergency surgery were retrospectively reviewed in the study. Dirty mass identified on multi-detector row CT (MDCT) was 3D-reconstructed and its volume was calculated using Ziostation software. Dirty mass volume and other clinical characteristics were compared between survivor (n = 45) and mortality groups (n = 13) to identify predictive factors for mortality. Mann–Whitney U test and Χ2 test were used in univariate analysis and logistic regression analysis was used in multivariate analysis.Results: Dirty mass was identified in 36/58 patients (62.1%) and located next to perforated colorectum in all cases. Receiver-operating characteristic (ROC) curve analysis identified the highest peak at 96.3 cm3, with sensitivity of 0.643 and specificity of 0.864. Univariate analysis revealed dirty mass volume, acute disseminated intravascular coagulation (DIC) score, acute physiology and chronic health evaluation II (APACHE II) score, and sequential organ failure assessment (SOFA) score as prognostic markers for mortality (p<0.01). Multivariate analysis revealed dirty mass volume and APACHE II score as independent prognostic indicators for mortality. Mortality was stratified by dividing patients into four groups according to dirty mass volume and APACHE II score. Conclusions: The combination of dirty mass volume and APACHE II score could stratify the postoperative mortality risk in patients with colorectal perforation. According to the risk stratification, surgeons might be able to decide the surgical procedures and intensity of postoperative management.


Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2778-2778
Author(s):  
Snehal G. Thakkar ◽  
Zachariah A. McIver ◽  
Sanjay R. Mohan ◽  
Giridharan Ramsingh ◽  
Anjali S. Advani ◽  
...  

Abstract Background: Patients with acute leukemia fare poorly when admitted to intensive care units (ICUs). Predictors of outcome and rates of successful discharge have not been defined in the United States. Methods: This is a retrospective analysis of 78 acute leukemia patients admitted to the medical ICU from 2001–2004. Patients were identified by ICD-9 codes and a sudden increase in daily hospital charges (indicating a direct ICU admission or transfer to the ICU from a medical floor). The primary endpoints were improvement and subsequent ICU discharge with continued aggressive leukemia management and survival to 2 months following hospital discharge. Secondary endpoints included 6 and 12 month survival. Univariate and multivariate logistic regression analyses were performed to identify factors predicting outcome. Results: Sixty-five patients were diagnosed with AML and 13 with ALL. Seven patients had good-risk cytogenetics, 32 intermediate, 30 poor and 9 unknown, as defined by CALGB 8461. Fever or infection (37.2%) was the leading cause of hospital admission. The mean age was 53 years, 85% were Caucasian and 51% were female. The median white blood cell (WBC) count was 6.9K. On average, patients were transferred to the ICU on hospital day 13. Of the 69 patients who received chemotherapy, 29 (42%) were in the induction phase and 40 (58%) in the consolidation or relapsed/refractory phase, with a mean chemotherapy day of 15. The most common reason for transfer to the ICU was respiratory compromise (68%) with sepsis (56%) second. Most patients transferred to the ICU had either 1 (47%) or 2 (45%) reasons for transfer. While in the ICU 57 patients required mechanical ventilation with 21 eventually extubated (19 improved; 2 withdrew care). Hemodynamic support (pressors) was used in 41 patients. The mean length of stay in the ICU was 7 days. The mean APACHE II score was 23 ± 7, predicting a mortality of 40%. Overall, 22 patients (28%) improved and 49 (63%) died in the ICU. Seven patients (9%) died after transfer out of the ICU. Two month survival following hospital discharge was 21%. At 6 and 12 months, 13% and 12% were alive, respectively. In univariate analysis, patients with lower APACHE II scores were more likely to improve in the ICU (p=0.002) and to live 2 months post-discharge (p=0.004) than those with higher scores; these findings remained significant in multivariate analysis. In univariate analysis, patients requiring hemodynamic support had lower 6 and 12 month survival than patients not requiring support (p=0.017 and 0.025); these findings remained significant in multivariate analysis (p=0.007 and 0.013). Multivariate analysis also showed that patients with poor risk cytogenetics had lower 6 and 12 month survival than patients with good or intermediate risk cytogenetics (p=0.026 and 0.05). Neither age, WBC, or treatment phase predicted outcome. Conclusion: Higher APACHE II score, use of pressors and adverse cytogenetics predicted for worse outcome. Increased age and presenting WBC did not. One out of five patients survived an ICU admission to be discharged from the hospital. Aggressive medical management is appropriate for patients with acute leukemia and should not be withheld even in patients with advanced age.


2020 ◽  
Author(s):  
Ismail Necati Hakyemez ◽  
Turan Aslan ◽  
Bulent Durdu

Abstract Background: This study was performed to investigate the combination of serum C-reactive protein (CRP) and procalcitonin (PCT) kinetics as a best marker in predicting mortality in patients with nosocomial blood stream infection (BSI).Methods: We retrospectively reviewed the medical records of patients ≥ 18 years of age with nosocomial BSIs hospitalized in intensive care units during the period from January 2016 to June 2018. Eighty-four patients who met the inclusion criteria were included in the study. Clinical, microbiological and biochemical data were compared in patients who survivors and deaths. Binary logistic regression analyses (backward LR) were used to identify independent risk factors. A receiver operating characteristic (ROC) curve analysis was performed to compare the predictive accuracy. The kinetic changes were expressed as Δ (delta) and defined the as difference between level on day 5 and level at day 1 of BSI.Results: Of the 84 included patients, 46 (58.4%) had survivors and 35 (41.6%) had deaths. In univariate analysis, renal disease (p = 0.007), cardiac disease (p = 0.042), septic shock (p = <0.001), maximum SOFA (p = <0.001) and APACHE-II (p <0.001), ΔCRP (p = 0.004), ΔPCT (p = <0.001), and ΔPCR (p = 0.025) were significantly higher in non-survivors than in survivors. In the logistic regression analysis, APACHE-II score (odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.20-1.78, p <0.001), ΔCRP (OR = 1.18, %95 CI =1.04-1.34, p = 0.009), ΔPCT (OR = 0.87, 95% CI = 0.79-0.95, p = 0.001), and ∆PCR (OR = 36.78, 95% CI = 4.52-299.01, p = 0.001) were independent predictors of 28-day mortality. After a ROC analysis, the AUC of ∆PCR was higher than that of ∆PCT for mortality in ICU patients (0.745 vs. 0.712, p <0.001).Conclusions: The PCR kinetic was a strong independent predictor of mortality in patients with nosocomial BSIs in intensive care units. Especially in patients with CRP and PCT tested together, it is expected to be a fast and rational tool for clinical practice.


2020 ◽  
Author(s):  
Daichi Ishikawa ◽  
Yukako Takehara ◽  
Atsushi Takata ◽  
Kazuhito Takamura ◽  
Hirohiko Sato

Abstract Background: “Dirty mass” is a specific computed tomography (CT) finding that is seen frequently in colorectal perforation. The prognostic significance of this finding for mortality is unclear. Methods: Fifty-eight consecutive patients with colorectal perforation who underwent emergency surgery were included in the study. Dirty mass identified on multi-detector row CT (MDCT) was 3D-reconstructed and its volume was calculated using Ziostation software. Dirty mass volume and other clinical characteristics were compared between survivor (n = 45) and mortality groups (n = 13) to identify predictive factors for mortality. Mann–Whitney U test and Χ2 test were used in univariate analysis and logistic regression analysis was used in multivariate analysis. Results: Dirty mass was identified in 36/58 patients (62.1%) and located next to perforated colorectum in all cases. Receiver-operating characteristic (ROC) curve analysis identified the highest peak at 96.3 cm3, with sensitivity of 0.643 and specificity of 0.864. Univariate analysis revealed dirty mass volume, acute disseminated intravascular coagulation (DIC) score, acute physiology and chronic health evaluation II (APACHE II) score, and sequential organ failure assessment (SOFA) score as prognostic markers for mortality (p<0.01). Multivariate analysis revealed dirty mass volume and APACHE II score as independent prognostic indicators for mortality. Mortality was stratified by dividing patients into four groups according to dirty mass volume and APACHE II score. Conclusions: The combination of dirty mass volume and APACHE II score could stratify the postoperative mortality risk in patients with colorectal perforation. According to the risk stratification, surgeons might be able to decide the surgical procedures and intensity of postoperative management.


2020 ◽  
Author(s):  
Ismail Necati Hakyemez ◽  
Turan Aslan ◽  
Bulent Durdu

Abstract Purpose: To investigate the combination of serum C-reactive protein (CRP) and procalcitonin (PCT) kinetics in predicting mortality in nosocomial blood stream infections (BSIs).Materials and Methods: We retrospectively reviewed the medical records of patients ≥ 18 years of age with nosocomial BSIs hospitalized in intensive care units (ICU). Clinical, microbiological and biochemical data were compared in patients who survivors and deaths. Binary logistic regression analyses were used to identify independent risk factors. The kinetic changes were defined the as difference between level on 5th day and level at 1st day of BSI.Results: Of the 84 included patients, 49 (58.4%) had survivors and 35 (41.6%) had deaths. In univariate analysis, renal disease (p=0.007), cardiac disease (p=0.042), septic shock (p=<0.001), SOFA (p=<0.001) and APACHE-II (p <0.001), ΔCRP (p=0.004), ΔPCT (p=<0.001), and ΔPCR (p=0.025) were significantly higher in non-survivors. In the logistic regression analysis, APACHE-II score (OR=1.46, 95% CI=1.20-1.78, p <0.001), ΔCRP (OR=1.18, %95 CI =1.04-1.34, p=0.009), ΔPCT (OR=0.87, 95% CI=0.79-0.95, p=0.001), and ∆PCR (OR=36.78, 95%C = 4.52-299.01, p=0.001) were independent predictors of 28-day mortality.Conclusions: The ∆PCR kinetic was a strong independent predictor of mortality in nosocomial BSIs in ICUs.


Author(s):  
Sneha Sharma ◽  
Raman Tandon

Abstract Background Prediction of outcome for burn patients allows appropriate allocation of resources and prognostication. There is a paucity of simple to use burn-specific mortality prediction models which consider both endogenous and exogenous factors. Our objective was to create such a model. Methods A prospective observational study was performed on consecutive eligible consenting burns patients. Demographic data, total burn surface area (TBSA), results of complete blood count, kidney function test, and arterial blood gas analysis were collected. The quantitative variables were compared using the unpaired student t-test/nonparametric Mann Whitney U-test. Qualitative variables were compared using the ⊠2-test/Fischer exact test. Binary logistic regression analysis was done and a logit score was derived and simplified. The discrimination of these models was tested using the receiver operating characteristic curve; calibration was checked using the Hosmer—Lemeshow goodness of fit statistic, and the probability of death calculated. Validation was done using the bootstrapping technique in 5,000 samples. A p-value of <0.05 was considered significant. Results On univariate analysis TBSA (p <0.001) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p = 0.004) were found to be independent predictors of mortality. TBSA (odds ratio [OR] 1.094, 95% confidence interval [CI] 1.037–1.155, p = 0.001) and APACHE II (OR 1.166, 95% CI 1.034–1.313, p = 0.012) retained significance on binary logistic regression analysis. The prediction model devised performed well (area under the receiver operating characteristic 0.778, 95% CI 0.681–0.875). Conclusion The prediction of mortality can be done accurately at the bedside using TBSA and APACHE II score.


2013 ◽  
Vol 1 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Md Sayedul Islam

Objective: To determine the significance of acute physiology and chronic health evaluation (APACHE) score as an important parameter of weaning outcome for mechanical ventilation. Design: prospective, observational. Setting: The medical ICU of a modernized private hospital, Dhaka. Method: The study was carried out during the period of 2008 to 2009 in a specialized private hospital Dhaka. Critical care physicians were asked to filled up the data sheets having detail problem of the patients including the APACHE II score. The APACHE II score is divided into three steps High score>25, Medium score 20-24 and Low score < 20. The clinicians were suggested to predict whether it would take < 3 days or 4to 7days or >8days to wean each patients from mechanical ventilation. The cause of respiratory failure and total duration of weaning were recorded. The significance was set at p<.05. Result: Total number of patients included in this study were 40. Male were 22 (55%) and female were 18 (45%), the mean age of the patients were 51.1±13.9. The most common cause of respiratory failure were COPD 11(24.5%) and next common were pneumonia and ARDS due to sepsis 8 (20%) each. Among the studied population 20 (50%) having low APACHE score (<20), 12 (30%) were medium score (20-24) and 8 (20%) patients were high score (>25). Total 25 (62.5%) of the patients were successfully weaned from mechanical ventilation, 10 (25%) of the patient died and 5 (12.5%) of the patent were shifted to other low cost hospital. The successfully weaned groups 17 (68%) had lower APACHE II score than the unsuccessfully (failure) group which were statistically significant ÷2 =.8546, df =2, p-value >.005. Conclusions: The overall severity of illness as assessed by APACHE II score correlates better with weaning outcome. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14360 Bangladesh Crit Care J March 2013; 1: 18-22


2017 ◽  
Vol 13 (1) ◽  
pp. 190
Author(s):  
Mansour S. M. A. M. Lotayif

The current Research aims at figuring out relationships between performance (as measured by ROE and PM) and demographics, interest in scanning, kinds of scanning, scanning frequency, sources of scanning (impersonal and personal), and obstacles of scanning. Experiences of 292 UAE executives have been used to fulfill these objectives. Via SPSS package release ten and seventeen, multivariate analysis (e.g. Multiple Regression), bivariate analysis (e.g. WSRT), and univariate analysis (e.g. descriptive analysis like mean, percentage, and sum) were conducted to explore the network of relationships amongst variables. Significant relationships between performance (as measured ROE) and interest in scanning, scanning frequency, sources of scanning (impersonal), and obstacles of scanning are existed. Significant relationships between performance (as measured by PM) and interest in scanning, scanning frequency, sources of scanning (personal), and sources of scanning (impersonal) are also existed. Finally, the current study revealed that UAE businesses are conducting regular, proactive, and hoc scanning more often than irregular, reactive, and primitive scanning.


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