scholarly journals The Impact of Frailty on Survival in Elderly Intensive Care Patients with COVID-19 – the COVIP Study

2021 ◽  
Author(s):  
Christian Jung ◽  
Hans Flaatten ◽  
Jesper Fjølner ◽  
Raphael Romano Bruno ◽  
Bernhard Wernly ◽  
...  
Keyword(s):  
Intensive Care ◽  
Management Strategies ◽  
Prognostic Indicators ◽  
Prognostic Information ◽  
Clinical Frailty Scale ◽  
Multi Centre Study ◽  
Intensive Care Patients ◽  
Frail Patients ◽  
Large Numbers ◽  
The Impact

Abstract BackgroundThe COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients.MethodsA prospective multi-centre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the Clinical Frailty Scale (CFS). Additionally, comorbidities, management strategies and treatment limitations were recorded.ResultsThe study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years and 21% of the patients were frail. The overall survival at 30 days was 59% (95%CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p<0.001). In frail patients, there was no difference in 30 day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival.ConclusionFrailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities.

scholarly journals The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Christian Jung ◽  
◽  
Hans Flaatten ◽  
Jesper Fjølner ◽  
Raphael Romano Bruno ◽  
...  
Keyword(s):  
Intensive Care ◽  
Management Strategies ◽  
Prognostic Indicators ◽  
Prognostic Information ◽  
Clinical Frailty Scale ◽  
Intensive Care Patients ◽  
Prospective Multicentre Study ◽  
Frail Patients ◽  
Large Numbers ◽  
The Impact

Abstract Background The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. Methods A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. Results The study included 1346 patients (28% female) with a median age of 75 years (IQR 72–78, range 70–96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56–62), with 66% (63–69) in fit, 53% (47–61) in vulnerable and 41% (35–47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival. Conclusion Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: NCT04321265, registered 19 March 2020.

Behavioral Impacts Associated With Students With Disabilities in Australian Schools

2022 ◽  
pp. 1268-1294
Author(s):  
Anthony Charles Tencati
Keyword(s):  
Students With Disabilities ◽  
Management Strategies ◽  
Effective Management ◽  
Australian School ◽  
School Students ◽  
Australian Curriculum ◽  
Curriculum Assessment ◽  
Large Numbers ◽  
A Priority ◽  
The Impact

This chapter explores the link between students with disabilities, the behaviours they exhibit, the impact this has on their schooling, and the impact upon others. The author's school has a population of about 1,000 students, of whom over 10 percent have verified disabilities. According to Education Council (2016), data regarding the number of students with disabilities is inconsistent between schools in Australia's states and territories, however, there are schools throughout Australia that have large numbers of students with verified disabilities. This is reinforced by the Australian Curriculum Assessment and Reporting Authority (2018) where in 2017 there were about 18.8 percent of Australian school students with a verified disability. It is not surprising, therefore, that these statistics are concerning and research continues to be a priority. Identifying appropriate pedagogies and more effective management strategies for these students will benefit them, their families, and the community, and contribute to solving pressing issues in these students' lives.

scholarly journals Characterization of epidemiological distribution and outcome of COVID-19 in patients with hereditary hemorrhagic telangiectasia: a nationwide retrospective multi-centre study during first wave in Italy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Patrizia Suppressa ◽  
Fabio Pagella ◽  
Gennaro Mariano Lenato ◽  
Eleonora Gaetani ◽  
Ilaria Serio ◽  
...  
Keyword(s):  
Intensive Care ◽  
General Population ◽  
Hospital Admission ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Fatal Outcome ◽  
Structured Interview ◽  
Infection Risk ◽  
Multi Centre Study ◽  
The Impact ◽  
Pandemic Wave

Abstract Background Coronavirus Disease 2019 (COVID-19) continues to have a devastating impact across the world. A number of pre-existing common clinical conditions were reported to represent risk factors for more severe COVID-19 outcomes. Hereditary Hemorrhagic Telangiectasia (HHT) is a rare vascular heritable disorders, characterized by complications secondary to visceral Arterio-Venous Malformations. The impact of HHT, as well as for many Rare Diseases (RDs) on infection susceptibility profile and clinical adverse outcome risk is an unresolved issue. Objectives The main objectives were: to assess the clinical features and outcomes of HHT patients infected with COVID-19; to compare the relative infection risk in these patients with the Italian general population throughout the first pandemic wave; to investigate the factors potentially associated with severe COVID-19 outcome in HHT patients, and the possible impact of COVID-19 infection on HHT-related symptoms/complications. Finally, we aimed to estimate how the lockdown-associated wearing of personal protective equipment/individual protection devices could affect HHT-related telangiectasia bleeding frequency. Methods The study is a nation-wide questionnaire-based survey, with a multi-Center retrospective cross-sectional design, addressed to the whole Italian HHT population. COVID-19 cases, occurring throughout the first pandemic wave, were collected by a questionnaire-based semi-structured interview. Only the cases ascertained by laboratory confirmation (molecular/serological) were included for epidemiological estimates. Information concerning eventual SarS-Cov-2 infection, as well as regarding HHT-related manifestations and HHT-unrelated co-morbidities were collected by the questionnaire. Prevalence data were compared to Italian general population in the same period. Results The survey disclosed 9/296 (3.04%) COVID-19 cases, 8/9 of them being resident in Lombardy, the main epidemic epicenter. Pneumonia was reported by 4/9 patients, which prompted hospital admission and intensive care management in 2 cases. No fatal outcome was recorded. After careful refinement of epidemiological analysis, the survey evidenced overlapping infection risk in HHT compared to general population. Conclusions COVID-19 infection profile parallels geographical distribution of epidemic foci. COVID-19 in HHT patients can lead to highly variable clinical profile, likely overlapping with that of general population. The HHT disease does not seem to involve a different approach in terms of hospital admission and access to intensive care with respect to general population.

scholarly journals LETTER TO THE EDITOR: COVID-19 AND THE CHALLENGES OF FRAILTY SCREENING IN OLDER ADULTS

2020 ◽  
pp. 1-2 ◽  
Author(s):  
R. O’Caoimh ◽  
S. Kennelly ◽  
E. Ahern ◽  
S. O’Keeffe ◽  
R.R. Ortuño
Keyword(s):  
Older Adults ◽  
Severe Acute Respiratory Syndrome ◽  
Healthcare Professionals ◽  
Management Strategies ◽  
Careful Examination ◽  
Geriatric Syndromes ◽  
Clinical Frailty Scale ◽  
The Impact ◽  
Recent Editorial ◽  
The Relationship

We read with interest the recent editorial examining the relationship between geriatric syndromes and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of Covid-19 (1), particularly the authors recognition of the need to identify frailty among older adults presenting with suspected symptoms and the importance of mobilising a range of healthcare professionals to tackle this disease (1). However, the identification of frailty and the utilisation of screening instruments by those without geriatric training and especially in acute care is challenging. Frailty is a complex condition. While age-associated, it is multi-dimensional and remains difficult to define (2). Although the Covid-19 pandemic has disproportionately affected older adults (1), data are lacking and pathophysiological mechanisms and the impact of differential management strategies on the course of the disease among older adults is uncertain (1). Further, the prevalence of frailty among those diagnosed, admitted or dying is not clearly reported at present. Nevertheless, the rationale for using frailty to identify those at risk and to allocate care has been correctly highlighted (1). We suggest however, that the use of instruments such as the Clinical Frailty Scale (CFS) (3) and particularly by non-specialised staff in this setting warrants more careful examination.

scholarly journals Impact of non-invasive respiratory support in severe patients with COVID-19

ANALES RANM ◽  
2020 ◽  
Vol 137 (137(02)) ◽  
pp. 154-160
Author(s):  
Ester Zamarrón ◽  
Carlos Carpio ◽  
Ana Santiago ◽  
Sergio Alcolea ◽  
Juan Carlos Figueira ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Respiratory Therapy ◽  
Respiratory Support ◽  
Intensive Care Patients ◽  
Non Invasive ◽  
Discharged Patients ◽  
Respiratory Treatment ◽  
The Impact

Objectives: to assess the impact of non-invasive respiratory therapies in critically ill patients diagnosed with COVID-19. Methods: retrospective cohort study of COVID-19 hospitalized patients who required non-invasive respiratory support. The impact of these treatments was evaluated in three groups of patients: pre-intensive care patients, discharged patients from critical care unit (CCU) and non-CCU admitted patients. The impact was assessed 30 days after completing respiratory therapy and was categorized as hospital discharge, transfer to a rehabilitation center, admission to the UCC and deceased. Results: a total of 80 patients were included (average age: 65.9 ± 11.9; men = 45 [56.3%]). 29 (36.3%) patients received BIPAP, 35 (43.8%) CPAP and 27 (33.4%) high-oxygen nasal cannula. Regarding the groups for the indication of respiratory treatment, 37 (46.3%) patients corresponded to the pre-intensive care patients, 24 (30%) were discharged patients from the CCU and 19 (23.8%) to the non-CCU admitted group. In the pre-intensive care, admission to a CCU was avoided in 19 (52.8%) patients and, on the other hand, 14 (38.9%) patients finally were admitted in a CCU. In the group of discharged patients from the UCC 19 (82.6%) patients showed a favorable course of disease. Only 3 (13%) patients were admitted in a UCC or died. Finally, in the group of non-CCU admitted, 6 (31.3%) improved after the use of respiratory therapy and 13 (68.4%) were deceased. Conclusions: respiratory therapies have a favorable impact on critically ill patients affected by COVID-19, both in patients with an indication for admission in the CCU, in those who are discharged from the CCUs and in those who do not have criteria for admission in these units.

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