scholarly journals Impact of using non-rebreathing mask in patients with respiratory failure

2020 ◽  
Author(s):  
Chao-Jui Li ◽  
Yan-Ren Lin ◽  
Chien-Chih Chen ◽  
Xin-Hong Lin ◽  
Po-Chun Chuang
Keyword(s):  
Respiratory Failure ◽  
Mortality Rate ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Pulmonary Disease ◽  
Research Database ◽  
Treatment Groups ◽  
Non Invasive ◽  
Medical Institutions ◽  
The Impact

Abstract Background Liberal oxygen therapy might increase the mortality rate of patients. Non-rebreathing mask (NRM) is a high-flow, non-invasive oxygen device that can provide oxygen concentration up to 95%. This study aimed to determine the impact of using NRM in patients with respiratory failure. Methods This retrospective cohort study was conducted in four medical institutions in Taiwan. Data were extracted from the Chang Gung Research Database between January 2010 and December 2016. The association between mortality and NRM use in patients with respiratory failure in the emergency department was analysed. Before receiving ventilator support, patients were divided into the NRM treatment and no NRM treatment groups. A 1:4 propensity score matching was conducted. Regarding the duration of NRM use, treatments were grouped as 0 hour, 0–1 hour, 1–2 hours, and > 2 hours. Results A total of 18749 patients were included, with 1074 using NRM. After the 1:4 propensity score matching, 1028 patients using NRM and 4112 patients not using NRM were analysed. The 72-hour and 30-day mortality rates were 14.8%, 14.1%, 10.4%, and 11.3% and 29.1%, 28.5%, 27.5%, and 35.5% in the 0 hour, 0–1 hour, 1–2 hour, and > 2 hour treatment groups, respectively. Patients with respiratory failure due to pulmonary disease using NRM (> 2 hours) for a prolonged period had a higher mortality rate than patients not using NRM (OR: 1.4, 95% CI: 1.06–1.74). Conclusions Prolonged use of NRM (> 2 hours) in patients with respiratory failure due to pulmonary disease possibly results in an increased mortality rate.

scholarly journals Intubation is Safe in Respiratory Failure Associated with Septic Shock: An Observational Study

2020 ◽  
Author(s):  
Ting Yang ◽  
Yongchun Shen ◽  
John G. Park ◽  
Phillip J Schulte ◽  
Andrew C Hanson ◽  
...  
Keyword(s):  
Septic Shock ◽  
Respiratory Failure ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Medical Center ◽  
Invasive Mechanical Ventilation ◽  
Hospital Length Of Stay ◽  
Hemodynamic Deterioration ◽  
The Impact

Abstract BackgroundAcute respiratory failure associated with sepsis contributes to higher in-hospital mortality. Intubation and invasive mechanical ventilation is a common rescue procedure. However, the 2016 International Guidelines for Management of Sepsis and Septic Shock does not provide any recommendation on indication nor timing of intubation. Timely intubation may improve outcome. The decision to intubate those patients is often hampered by the fear of further hemodynamic deterioration following intubation. MethodsThis study aimed at evaluating the impact of timely intubation on outcome in sepsis associated respiratory failure. We conducted an ancillary analysis of a prospective registry od adult ICU patients with septic shock admitted to the medical ICU in a tertiary medical center, between April 30th, 2014 and December 31st, 2017. All cases of sepsis with lactate >4 mmol/L, mean arterial pressure <65 mmHg, or vasopressor use after 30 mL/kg fluid boluses and suspected or confirmed infection. Patients who remained hospitalized at 24 hours following sepsis onset were separated into intubated and non-intubated groups. The primary outcome was hospital mortality. Univariate and multivariable analyses were used, adjusted for admission characteristics and stabilization of shock within 6 hours. In a secondary analysis, time-dependent propensity score matching was used to match intubated and non-intubated patients.ResultsWe identified 345 (33%) patients intubated within 24 hours and 707 (67%) not intubated. Intubated patients were younger, transferred more often from an outside facility, had higher severity of illness scores, more lung infection, achieved blood pressure goals more often but less often lactate normalization within 6 hours. The crude in-hospital mortality was higher, 89 (26%) vs. 82 (12%), p<0.001, as were ICU mortality, and ICU and hospital length of stay. After adjustment, intubation showed no effect on hospital mortality but fewer hospital-free days through day 28. After 1:1 propensity score matching, there was no difference in hospital mortality, but fewer hospital-free days in the intubated group. ConclusionsIntubation within 24 hours of sepsis onset was safe and not associated with hospital mortality, but was associated with less 28-day hospital-free days. Intubation should not be discouraged in appropriate patients with septic shock.

scholarly journals Efficacy of remdesivir-containing therapy in hospitalized COVID-19 patients: a prospective clinical experience

2021 ◽  
Author(s):  
Alessandro Russo ◽  
Erica Binetti ◽  
Cristian Borrazzo ◽  
Elio Gentilini Cacciola ◽  
Luigi Battistini ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Cox Regression ◽  
Large Population ◽  
Real Life ◽  
Cox Regression Analysis ◽  
Non Invasive ◽  
High Flow Oxygen ◽  
The Impact

Objectives: remdesivir is currently approved for the treatment of COVID-19. The recommendation for using remdesivir in COVID-19 was based on the in vitro and in vivo activity of this drug against SARS-CoV-2. Methods: this was a prospective, observational study conducted on a large population of patients hospitalized for COVID-19. The primary endpoint of the study was to evaluate the impact of remdesivir-containing therapy on 30-day mortality; secondary endpoint was the impact of remdesivir-containing therapy on the need of high flow oxygen therapy (HFNC) or non-invasive ventilation (NIV) or mechanical ventilation. Data were analyzed after propensity score matching. Results: 407 patients with SARS-CoV-2 pneumonia were consecutively enrolled. Out of these, 294 (72.2%) and 113 (27.8%) were respectively treated or not with remdesivir. Overall, 61 (14.9%) patients were treated during hospitalization with non-invasive or mechanical ventilation, while a 30-day mortality was observed in 21 (5.2%) patients. Cox regression analysis, after propensity score matching, showed that therapies, including remdesivir-containing therapy, were not statistically associated with 30-day survival or mortality, while need of HFNC/NIV (HR 17.921, CI95% 0.954-336.73, p=0.044) and mechanical ventilation (HR 3.9, CI95% 5.36-16.2, p=0.003) resulted independently associated with 30-day mortality. Finally, therapies including or not remdesivir were not independently associated with lower or higher risk of HFNC/NIV or mechanical ventilation. Conclusions: this real-life experience about the remdesivir use in hospitalized patients with COVID-19 was not associated with significant increase in rates of survival or reduced use of HFNC/NIV or mechanical ventilation, compared to patients treated with other therapies not including remdesivir.

scholarly journals Impact of Multidisciplinary Stroke Post-Acute Care on Cost and Functional Status: A Prospective Study Based on Propensity Score Matching

2021 ◽  
Vol 11 (2) ◽  
pp. 161
Author(s):  
Chong-Chi Chiu ◽  
Jhi-Joung Wang ◽  
Chao-Ming Hung ◽  
Hsiu-Fen Lin ◽  
Hong-Hsi Hsien ◽  
...  
Keyword(s):  
Propensity Score ◽  
Functional Status ◽  
Propensity Score Matching ◽  
Acute Care ◽  
Medical Cost ◽  
Economic Burden ◽  
Stroke Rehabilitation ◽  
Stroke Patients ◽  
The Impact ◽  
Post Acute Care

Few papers discuss how the economic burden of patients with stroke receiving rehabilitation courses is related to post-acute care (PAC) programs. This is the first study to explore the economic burden of stroke patients receiving PAC rehabilitation and to evaluate the impact of multidisciplinary PAC programs on cost and functional status simultaneously. A total of 910 patients with stroke between March 2014 and October 2018 were separated into a PAC group (at two medical centers) and a non-PAC group (at three regional hospitals and one district hospital) by using propensity score matching (1:1). A cost–illness approach was employed to identify the cost categories for analysis in this study according to various perspectives. Total direct medical cost in the per-diem-based PAC cohort was statistically lower than that in the fee-for-service-based non-PAC cohort (p < 0.001) and annual per-patient economic burden of stroke patients receiving PAC rehabilitation is approximately US $354.3 million (in 2019, NT $30.5 = US $1). Additionally, the PAC cohort had statistical improvement in functional status vis-à-vis the non-PAC cohort and total score of each functional status before rehabilitation and was also statistically significant with its total score after one-year rehabilitation training (p < 0.001). Early stroke rehabilitation is important for restoring health, confidence, and safe-care abilities in these patients. Compared to the current stroke rehabilitation system, PAC rehabilitation shortened the waiting time for transfer to the rehabilitation ward and it was indicated as an efficient policy for treatment of stroke in saving medical cost and improving functional status.

scholarly journals Adoption of improved agricultural technology and its impact on household income: a propensity score matching estimation in eastern Ethiopia

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Muluken G. Wordofa ◽  
Jemal Y. Hassen ◽  
Getachew S. Endris ◽  
Chanyalew S. Aweke ◽  
Dereje K. Moges ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Technology Use ◽  
Household Income ◽  
Agricultural Technology ◽  
Primary Data ◽  
Farm Income ◽  
Agricultural Technologies ◽  
Eastern Ethiopia ◽  
The Impact

Abstract Background Adoption of improved agricultural technologies remains to be a promising strategy to achieve food security and poverty reduction in many developing countries. However, there are limited rigorous impact evaluations on the contributions of such technologies on household welfare. This paper investigates the impact of improved agricultural technology use on farm household income in eastern Ethiopia. Methods Primary data for the study was obtained from a random sample of 248 rural households, 119 of which are improved technology users and the rest are non-users. The research employed the Propensity Score Matching (PSM) procedure to establish the causal relationship between adoption of improved crop and livestock technologies and changes in farm income. Results Results from the econometric analysis show that households using improved agricultural technologies had, on average, 23,031.28 Birr (Birr is the official currency of Ethiopia. The exchange rate according to the National Bank of Ethiopia (NBE) was 1 USD = 27.6017 Birr on 04 October 2018.) higher annual farm income compared to those households not using such technologies. Our findings highlight the importance of promoting multiple and complementary agricultural technologies among rural smallholders. Conclusions We suggest that rural technology generation, dissemination and adoption interventions be strengthened. Moreover, the linkage among research, extension, universities and farmers needs to be enhanced through facilitating a multistakeholders innovation platforms.

scholarly journals Decreased risk of liver and intrahepatic cancer in non-H. pylori-infected perforated peptic ulcer patients with truncal vagotomy: a nationwide study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shih-Chi Wu ◽  
Han-Tsung Cheng ◽  
Yu-Chun Wang ◽  
Chia-Wei Tzeng ◽  
Chia-Hao Hsu ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Asian Population ◽  
Perforated Peptic Ulcer ◽  
Truncal Vagotomy ◽  
Research Database ◽  
Cancer History ◽  
Simple Closure ◽  
H Pylori

AbstractThe vagal nervous system is central to the physiological responses and systemic diseases of the liver. We evaluated the subsequent risk of liver and intrahepatic cancer (HCC/ICC) in non-H. pylori (HP)-infected perforated peptic ulcer (PPU) patients with and without vagotomy. Hospitalized PPU patients who underwent simple closure or truncal vagotomy/pyloroplasty (TVP) in the National Health Insurance Research Database from 2000 to 2008 were enrolled. The exclusion criteria included: (1) Multiple surgeries for PPU were received at the same admission; (2) Any cancer history; (3) Previous peptic ulcer-associated surgery; (4) HP infection history; (5) Viral hepatitis infection history; (6) Follow-up duration < 1 year; and (7) Age < 18 years. The risks of developing HCC/ICC in PPU patients with and without vagotomy were assessed at the end of 2013. To balance the baseline condition between groups, we used the propensity score matched method to select study subjects. Cox proportional hazard regression was used to estimate the hazard ratio and 95% confidence interval (CI) of HCC/ICC. Before propensity score matching, 675 simple suture patients and 54 TVP patients had HCC/ICC, which corresponded to incidences of 2.11 and 0.88 per 1000 person-years, respectively. After propensity score matching, 145 simple suture patients and 54 TVP patients experienced HCC/ICC, which corresponded to incidences of 1.45 and 0.88 per 1000 person-years, respectively. The TVP patients had a 0.71 (95% CI 0.54–0.95)- and 0.69 (95% CI 0.49–0.97)-fold risk of developing HCC/ICC compared to simple suture patients before and after propensity score matching. Our findings reported that, in the Asian population, TVP decreases the risk of HCC/ICC in non-HP-infected PPU patients compared to simple closure patients. However, further studies are warranted.

Patients With Idiopathic Pulmonary Fibrosis Admitted to the ICU With Acute Respiratory Failure—A Reevaluation of the Risk Factors and Outcomes

2021 ◽  
pp. 088506662198924
Author(s):  
Matthew Schrader ◽  
Matheni Sathananthan ◽  
Niranjan Jeganathan
Keyword(s):  
Risk Factors ◽  
Respiratory Failure ◽  
Mortality Rate ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Acute Respiratory Failure ◽  
Small Sample ◽  
Apache Score ◽  
Non Invasive ◽  
Organ Failures

Introduction: Idiopathic pulmonary fibrosis (IPF) patients admitted to the ICU with acute respiratory failure (ARF) are known to have a poor prognosis. However, the majority of the studies published to date are older and had small sample sizes. Given the advances in ICU care since the publication of these studies, we sought to reevaluate the outcomes and risk factors associated with mortality in these patients. Methods: Retrospective study using a large multi-center ICU database. We identified 411 unique patients with IPF admitted with ARF between 2014-2015. Results: Of all IPF patients admitted to the ICU with ARF, 81.3% required mechanical ventilation (MV): 48.9% invasive and 32.4% non-invasive alone. The hospital mortality rate was 34.5% for all patients; 48.8% in patients requiring invasive MV, 21.8% in those requiring non-invasive MV and 19.5% with no MV. In multiple regression analyses, age, APACHE score, invasive MV, and hyponatremia at admission were associated with increased mortality whereas post-op status was associated with lower mortality. In patients requiring invasive MV, baseline PaO2/FiO2 ratio was also predictive of mortality. Non-pulmonary organ failures were present in less than 20% of the patients. Conclusions: Although the overall mortality rate for IPF patients admitted to the ICU with ARF has improved, the mortality rates for patients requiring invasive MV remains high at approximately 50%. Older age, high APACHE score, and low baseline PaO2/FiO2 ratio are factors predictive of increased mortality in this population.

Was it worth it? The impact of the German minimum wage on union membership of employees

2021 ◽  
pp. 0143831X2110358
Author(s):  
Simon Ress ◽  
Florian Spohr
Keyword(s):  
Propensity Score ◽  
Social Security ◽  
Labour Market ◽  
Propensity Score Matching ◽  
Minimum Wage ◽  
Trade Union ◽  
Union Membership ◽  
Difference In Differences ◽  
German Trade ◽  
The Impact

This contribution scrutinises how introducing a statutory minimum wage of EUR 8.50 per hour, in January 2015, impacted German employees’ decision with regard to union membership. Based on representative data from the Labour Market and Social Security panel, the study applies a logistic difference-in-differences propensity score matching approach on entries into and withdrawals from unions in the German Trade Union Confederation (Deutscher Gewerkschaftsbund, DGB). The results show no separate effect on withdrawals from or entries into unions after the minimum wage introduction for those employees who benefited financially from it, but a significant increase of entries overall. Thus, unions’ campaign for a minimum wage strengthened their position in total but did not reverse the segmentation of union membership patterns.

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