scholarly journals Microbiology and Outcomes of Institutionalized Patients with Stroke-associated Pneumonia: A Prospective Observational Study

2021 ◽  
Author(s):  
Jie Zhao ◽  
Lei-qing Li ◽  
Ning-xin Zhen ◽  
Lin-lin Du ◽  
Hui Shan ◽  
...  
Keyword(s):  
Observational Study ◽  
Burkholderia Cepacia ◽  
Prospective Observational Study ◽  
Invasive Mechanical Ventilation ◽  
Attributable Mortality ◽  
Baseline Characteristic ◽  
Prolonged Length ◽  
Institutionalized Patients ◽  
Gcs Score ◽  
Serum Crp

Abstract Background: The attributable mortality and microbial etiology of stroke-associated pneumonia (SAP) vary among different studies. We intednd to determine the microbiology and outcomes of SAP in lower respiratory tract (LRT) for patients with invasive mechanical ventilation (MV).Methods: In this prospective observational study, included patients were divided into SAP and non-SAP based on comprehensive analysis of symptom, imaging and laboratory results. Baseline characteristic, clinical characteristic, microbiology and outcomes were recorded and evaluated.Results: Of 185 patients, 41.6% developed SAP after onset of stroke, and they had lower proportion of non-smoker (p=0.016), lower GCS score (p<0.001), higher serum CRP score (p<0.001) at ICU admission, and higher proportion of males (p<0.001) and hypertension (p=0.018) than patients with non-SAP. Gram-negative aerobic bacilli were the predominant organisms isolated (78%), followed by Gram-positive aerobic cocci (29.9%). Out of 19 isolated pathogens, main pathogens included K. pneumoniae, S. aureus, H. influenzae, A. baumannii, P. aeruginosa, E. aerogens, Serratia marcescens, and Burkholderia cepacia. SAP significantly prolonged length of MV (p<0.001) and duration of ICU stays (p<0.001), shorten MV-free days by 28 (p<0.001), caused elevated vasopressor application (p=0.002) and 60-day mortality (p=0.001).Conclusion: Microbiology of SAP is similar to early-phase HAP and VAP. SAP significantly prolongs duration of MV and lengths of ICU stays, but also markedly increase 60-day mortality.Trial registration: ChiCTR2000028849; http://www.chictr.org.cn/index.aspx, Registered 05 January 2020.

scholarly journals Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Jie Zhao ◽  
Lei-qing Li ◽  
Ning-xin Zhen ◽  
Lin-lin Du ◽  
Hui Shan ◽  
...  
Keyword(s):  
Burkholderia Cepacia ◽  
Invasive Mechanical Ventilation ◽  
Attributable Mortality ◽  
Prolonged Length ◽  
Observational Cohort ◽  
Microbial Etiology ◽  
Hospital Stays ◽  
Institutionalized Patients ◽  
Gcs Score ◽  
Serum Crp

Background: The attributable mortality and microbial etiology of stroke-associated pneumonia (SAP) vary among different studies and were inconsistent.Purpose: To determine the microbiology and outcomes of SAP in the lower respiratory tract (LRT) for patients with invasive mechanical ventilation (MV).Methods: In this observational study, included patients were divided into SAP and non-SAP based on a comprehensive analysis of symptom, imaging, and laboratory results. Baseline characteristics, clinical characteristics, microbiology, and outcomes were recorded and evaluated.Results: Of 200 patients, 42.5% developed SAP after the onset of stroke, and they had a lower proportion of non-smokers (p = 0.002), lower GCS score (p &lt; 0.001), higher serum CRP (p &lt; 0.001) at ICU admission, and a higher proportion of males (p &lt; 0.001) and hypertension (p = 0.039) than patients with non-SAP. Gram-negative aerobic bacilli were the predominant organisms isolated (78.8%), followed by Gram-positive aerobic cocci (29.4%). The main pathogens included K. pneumoniae, S. aureus, H. influenzae, A. baumannii, P. aeruginosa, E. aerogenes, Serratia marcescens, and Burkholderia cepacia. SAP prolonged length of MV (p &lt; 0.001), duration of ICU stay (p &lt; 0.001) and hospital stay (p = 0.027), shortened MV-free days by 28 (p &lt; 0.001), and caused elevated vasopressor application (p = 0.001) and 60-day mortality (p = 0.001). Logistic regression analysis suggested that patients with coma (p &lt; 0.001) have a higher risk of developing SAP.Conclusion: The microbiology of SAP is similar to early phase of HAP and VAP. SAP prolongs the duration of MV and length of ICU and hospital stays, but also markedly increases 60-day mortality.

scholarly journals Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

Infection ◽  
2021 ◽  
Author(s):  
Charlotte Thibeault ◽  
◽  
Barbara Mühlemann ◽  
Elisa T. Helbig ◽  
Mirja Mittermaier ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Median Duration ◽  
Prospective Observational Study ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Detailed Knowledge ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Duration Of Symptoms

Abstract Purpose Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10–1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00–16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26–46.75, vs 18 days, IQR 16–46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6–15.5) for non-IMV and 49.5 days (IQR 36.8–82.5) for IMV patients. Conclusions Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19.

scholarly journals High flow nasal cannula versus non-invasive ventilation in severe asthma: two years prospective observational study.

2021 ◽  
Author(s):  
Carolina Solé-Delgado ◽  
Alberto García-Salido ◽  
Ainhoa Gochi-Valdovinos ◽  
Anthony González-Brabin ◽  
Maria García ◽  
...  
Keyword(s):  
Observational Study ◽  
Severe Asthma ◽  
Prospective Observational Study ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Respiratory Management

Background: in recent years, High Flow Nasal Cannula (HFNC) has been considered an alternative to non-invasive mechanical ventilation (NIMV) in severe asthma respiratory management in children. Objective: to describe the use of HFNC in children with severe asthma admitted to pediatric critical care unit (PICU). To compare its clinical characteristic and evolution with those receiving NIMV or other respiratory support. Methods: prospective observational study done in children admitted to PICU with severe asthma (October 2017 to October 2019). Data collected: epidemiological, clinical, respiratory support, thorax x-ray, pharmacological treatments and days of admission. Patients were divided into groups: 1) Only HFNC 2) HFNC and NIMV, and 3) Only NIMV. Results: Seventy-six patients included, 39 girls. The median age was two years and one month (range 160). The median pulmonary score was 5 (range 7). PICU admission lengths a median of 3 days (range 9), hospital 6 days (range 23). There were no epidemiological or clinical differences between groups. Children with only HNFC showed a shorter time of PICU days (p 0,025) and none of them required NIMV. In the group receiving both modalities, NIMV was used first and then HFNC in all cases. Children with HFNC showed higher SaO2/FiO2 ratio (p=0,025) and lower PCO2 level (p=0,032). There were no deaths. Conclusions: in our study the HFNC did not require escalation to NIMV and did not increase the length of PICU or hospital days. Normal initial blood gases and absence of high oxygen requirements were useful to select responders to HNFC.

scholarly journals Evaluating the predictive factors affecting outcome in patients with severe traumatic brain injury: a prospective observational study

2021 ◽  
Vol 8 (6) ◽  
pp. 1762
Author(s):  
Vikram Singh ◽  
Amar Nath ◽  
Meenu Beniwal ◽  
Paritev Singh ◽  
Rockey Dahiya
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Observational Study ◽  
Severe Traumatic Brain Injury ◽  
Prospective Observational Study ◽  
Midline Shift ◽  
Late Outcome ◽  
Severe Tbi ◽  
Ct Head ◽  
Gcs Score

Background: Severe traumatic brain injury (TBI) is a neurosurgical emergency and timely intervention is critical for favorable outcome. We aimed to evaluate certain demographic, clinical and radiological factors for outcome prediction in TBI patients in terms of morbidity and mortality.Methods: A prospective observational study was conducted in 100 patients of severe TBI admitted to our hospital from September 2016 to June 2018. Those with penetrating head injury, associated severe chest, abdominal or orthopedic trauma and pregnant or lactating women were excluded. Clinical outcome was assessed at the time of discharge and after three months according to Glasgow outcome score (GOS).Results: Majority of patients were adults in the age group 20 to 39 years. Road-side accident (75%) was the commonest mode of injury followed by fall (23%) and assault (2%). Out of 100 patients, 51 had in-hospital mortality. Of 49 patients who survived for GOS assessment at 3 months, three (6.1%) patients had unfavourable GOS I to III. Presence of hypoxemia, pupil non-reactivity, computerised tomography (CT) head findings of hemorrhagic contusion, subarachnoid hemorrhage (SAH), midline shift and effacement of basal cisterne were associated with significantly increased risk of unfavorable early and late outcome after severe TBI (p<0.05). Poor GCS score and fracture skull were associated with adverse early and late outcome respectively (p<0.001).Conclusions: Low GCS score at admission, pupil non reactivity, presence of hypoxemia, abnormal CT head findings (hemorrhagic contusion, SAH, midline shift and effacement of basal cisterne) were strong predictors of adverse outcome after severe TBI.

scholarly journals Thrombomodulin is Associated with Increased Mortality and Organ Failure in Mechanically Ventilated Children with Acute Respiratory Failure: A Prospective Observational Study.

2021 ◽  
Author(s):  
Ana C Monteiro ◽  
Heidi Flori ◽  
Mary K Dahmer ◽  
Myung Shin Sim ◽  
Michael W. Quasney ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Observational Study ◽  
Vascular Injury ◽  
Prospective Observational Study ◽  
Cox Regression ◽  
Multiorgan Failure ◽  
Invasive Mechanical Ventilation ◽  
Oxygenation Index ◽  
Mixed Effect ◽  
Soluble Thrombomodulin

Abstract BACKGROUNDAcute respiratory failure (ARF) can progress to acute respiratory distress syndrome (ARDS) and death. Biomarkers such as soluble thrombomodulin (sTM), implicated in pulmonary vascular injury, may allow for risk stratification and prognostic enrichment in ARF.METHODSThis was a prospective observational study of 432 patients aged 2 weeks - 17 years requiring invasive mechanical ventilation. It was ancillary to the multicenter clinical trial, Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE). After consent, patients had up to 3 plasma samples collected at 24-hour intervals within 5 days after intubation. sTM was assayed by ELISA. Hazard ratio (HR) for 90-day mortality was determined by cox regression. Mixed effect models (MEM) were used to test for association with extrapulmonary multiorgan failure (MOF) and oxygenation index (OI). Age, race, sex and PRISM-III scores were used as confounding variables for multivariable analyses.RESULTSsTM values ranged from 16.6 to 670.9 ng/ml within 5 days after intubation. Higher sTM was associated with increased 90-day mortality (n=432, adjusted HR= 1.003, p=0.02) and worse OI in the first 5 days after intubation (n=252, Estimate = 0.02, p<0.01). Both initial and slope of sTM were associated with increased extrapulmonary MOF in unadjusted and adjusted analyses (Intercept, Estimate=0.003, p<0.0001; and slope, Estimate=0.01, p=0.0009, n= 386). CONCLUSIONSPlasma sTM are associated with mortality, severity of ARDS extrapulmonary MOF in children with ARF. This suggests a role of vascular injury in pathogenesis of ARF and provide potential application for targeted therapies. TRIAL REGISTRATIONNCT00814099

scholarly journals Effect of ethanol in carbon monoxide poisoning and delayed neurologic sequelae: A prospective observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245265
Author(s):  
Sungwoo Choi ◽  
Sangsoo Han ◽  
Sangun Nah ◽  
Young Hwan Lee ◽  
Young Soon Cho ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Neuroprotective Effect ◽  
Carbon Monoxide Poisoning ◽  
Co Poisoning ◽  
Ethanol Level ◽  
Neurologic Sequelae ◽  
Gcs Score ◽  
Delayed Neurologic Sequelae

Objectives Carbon monoxide (CO) is one of the most common poisoning substances, which causes mortality and morbidity worldwide. Delayed neurologic sequelae (DNS) have been reported to occur from several days to months after exposure to CO. Thus, there is a need for prevention, recognition, and treatment of DNS. Patients with CO poisoning as a component of intentional suicide often also consume ethanol, but there is debate regarding its role in DNS. We explored whether ethanol has a neuroprotective effect in CO poisoning. Methods This prospective observational study included patients who visited the emergency department from August 2016 to August 2019 due to CO poisoning. After treatment of acute CO poisoning, patients were interviewed by telephone to ascertain whether DNS had occurred within 2 weeks, 1 month, and 3 months from the time of CO exposure. Results During the study period, 171 patients were enrolled. 28 patients (16.37%) developed DNS. The initial Glasgow Coma Scale (GCS) scores were 15 (10.5–15) for the non-DNS group and 10 (7–15) for the DNS group (p = 0.002). The ethanol levels were 11.01 ± 17.58 mg/dL and 1.49 ± 2.63 mg/dL for each group (p < 0.001). In multivariate logistic regression analysis, the GCS score had an odds ratio of 0.770 (p < 0.001) and the ethanol level had 0.882 (p < 0.030) for onset of DNS. Conclusions Higher ethanol level and higher initial GCS score were associated with lower incidence of DNS. Ethanol could have a neuroprotective effect on the occurrence of DNS in CO poisoning patients.

scholarly journals Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study

2020 ◽  
Author(s):  
Marco Falcone ◽  
Giusy Tiseo ◽  
Cesira Giordano ◽  
Alessandro Leonildi ◽  
Melissa Menichini ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Invasive Mechanical Ventilation ◽  
Length Of Hospital Stay ◽  
Previous Treatment ◽  
University Hospital ◽  
Reactive Protein ◽  
Control Rules ◽  
The University ◽  
Hospital Acquired

Abstract Background Bacterial and fungal superinfections may complicate the course of hospitalized patients with COVID-19. Objectives To identify predictors of superinfections in COVID-19. Methods Prospective, observational study including patients with COVID-19 consecutively admitted to the University Hospital of Pisa, Italy, between 4 March and 30 April 2020. Clinical data and outcomes were registered. Superinfection was defined as a bacterial or fungal infection that occurred ≥48 h after hospital admission. A multivariate analysis was performed to identify factors independently associated with superinfections. Results Overall, 315 patients with COVID-19 were hospitalized and 109 episodes of superinfections were documented in 69 (21.9%) patients. The median time from admission to superinfection was 19 days (range 11–29.75). Superinfections were caused by Enterobacterales (44.9%), non-fermenting Gram-negative bacilli (15.6%), Gram-positive bacteria (15.6%) and fungi (5.5%). Polymicrobial infections accounted for 18.3%. Predictors of superinfections were: intestinal colonization by carbapenem-resistant Enterobacterales (OR 16.03, 95% CI 6.5–39.5, P &lt; 0.001); invasive mechanical ventilation (OR 5.6, 95% CI 2.4–13.1, P &lt; 0.001); immunomodulatory agents (tocilizumab/baricitinib) (OR 5.09, 95% CI 2.2–11.8, P &lt; 0.001); C-reactive protein on admission &gt;7 mg/dl (OR 3.59, 95% CI 1.7–7.7, P = 0.001); and previous treatment with piperacillin/tazobactam (OR 2.85, 95% CI 1.1–7.2, P = 0.028). Length of hospital stay was longer in patients who developed superinfections ompared with those who did not (30 versus 11 days, P &lt; 0.001), while mortality rates were similar (18.8% versus 23.2%, P = 0.445). Conclusions The risk of bacterial and fungal superinfections in COVID-19 is consistent. Patients who need empiric broad-spectrum antibiotics and immunomodulant drugs should be carefully selected. Infection control rules must be reinforced.

scholarly journals A study on drug therapy issues in the department of medicine of a tertiary care teaching hospital-prospective observational study

2021 ◽  
Vol 10 (12) ◽  
pp. 1405
Author(s):  
Revathi J. ◽  
Venkatesh A. P. ◽  
Aswin C. ◽  
Guru Prasad Mohanta ◽  
Senthilvelan M.
Keyword(s):  
Drug Therapy ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Prolonged Length ◽  
Medical Indication ◽  
Medical College ◽  
Undesirable Event ◽  
Increased Risk ◽  
Improper Use

Background: A drug therapy problem (DTP) is any undesirable event experienced by a patient that involves or is suspected to involve, drug therapy, and that interferes with achieving the desired goals of therapy. The improper use of drugs can lead to patient morbidity and even mortality. DTP s are the clinical territory of the pharmaceutical care practitioner and the resolution of identifying the DTPs help patients to achieve their goals of therapy. Identifying DTPs enables risk quantification and determination of the potential impact of prevention strategies.  DTPs are associated with prolonged length of stay and increased economic burden and results in increased risk of death.Methods: A hospital based, prospective observational study was conducted at department of medicine in Rajah Muthiah medical college and hospital, 80 patients were enrolled in this study based on the inclusion-exclusion criteria. The DTPs were identified using the Cipolle’s method of classification of DTP.Results: The study has shown that 80 of the patients involved in the study had a total of 136 DTPs. An average of 1.7 DTPs were recorded per patient during the study. The most common DTP identified was unnecessary drug therapy accounting to 47%. The absence of valid medical indication was (30%) and (16%) were due to the duplication of therapy. The second most common DTP was unsafe drug for patients, accounting to 45% were due to patient non-compliance and drug interaction which was minor. Need for additional drug therapy was the third most identified accounting 13% were due to medical indication indicate the need of drug therapy.Conclusions: The foremost commonly observed DTP is unnecessary therapy and patient non-compliance to the drugs. The study suggests that DTPs are significantly occurring in hospital can cause the patient for comorbidity, prolonged hospitalization. The study suggests that clinical pharmacist and general practitioners can work together to spot and resolve the DTPs.

Sign in / Sign up

Export Citation Format

Share Document