scholarly journals Mortality rate among critically ill patients with COVID-19 in a medical system with adequate hospital resources: a prospective observational study

2020 ◽  
Author(s):  
Christina Routsi ◽  
Eleni Magira ◽  
Stelios Kokkoris ◽  
Ilias Siembos ◽  
Charikleia Vrettou ◽  
...  
Keyword(s):  
Observational Study ◽  
Hospital Mortality ◽  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Mortality Rates ◽  
Entire Cohort ◽  
Icu Admission ◽  
Hospital Resources

Abstract Background: For critically ill patients with coronavirus disease 2019 (COVID-19) who require intensive care unit (ICU) admission, mortality rates vary widely depending on many factors, among which hospital resources and clinical setting seem important. We sought to determine the outcome of critically ill patients admitted in the usual multidisciplinary ICUs of a big referral for COVID-19 tertiary-care hospital with adequate resources.Methods: We performed a prospective observational study of all adult patients with COVID-19 consecutively admitted to four COVID-designated ICUs at Evangelismos Hospital, Athens, Greece, from March 11 to April 27, 2020.Results: Among 50 critically ill patients, ICU and hospital mortality for the entire cohort was 32% (16/50), whereas 66% (33/50) of patients were discharged alive from the ICU and 2% (1/50) were still treated in the ICU until June 16, 2020. ICU and hospital mortality for those who received invasive mechanical ventilation was 39% (16/41). Patients who eventually died had already increased risk of death on ICU admission, as suggested by the high values of the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, the presence of current malignancy and occurrence of cardiac arrest in 44% (7/16) of patients, and the general need for circulatory support by noradrenaline. Median PaO2/FiO2 on ICU admission for the entire cohort was 121 mmHg [interquartile range (IQR), 86-171 mmHg] and most patients had moderate and severe acute respiratory distress syndrome (ARDS) according to the Berlin Definition. The primary cause of death of all patients was multi-organ failure, most commonly due to sepsis, whereas none died from refractory hypoxemia, neurologic dysfunction or withdrawal of life support. Hospital stay was long in patients who survived [median 24 days (IQR, 15-35 days)] and was frequently complicated by bacteremias [36% (12/33)].Conclusion: Severely ill COVID-19 patients with moderate and severe ARDS may have equal or even lower mortality rates compared to ARDS due to other causes, when they are admitted in general ICUs with experienced and adequate staff without limitations in hospital resources, where established ARDS therapies are used.

scholarly journals Relation between fluid balance and incidence of morbidity and mortality rates in critically ill patients prospective observational study

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M G A Gerges ◽  
H M M Elazzazi ◽  
M H S A Elsersi ◽  
S A R Mustafa ◽  
M A Saeed
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
University Hospitals ◽  
Cumulative Fluid Balance

Abstract Background While administration of fluid can be lifesaving, it has been suggested that the fluid accumulation after initial resuscitation and hemodynamic stabilization can contribute to potentially avoidable adverse effects and less favorable outcomes. Objective The aim of this study is to assess whether positive fluid balance in comparison with negative or even fluid balance is associated with increased morbidity and mortality rates in critically ill patients. Patients and Methods This prospective observational study was performed on 145 Patients older than 18 years admitted to intensive care units at Helwan university hospitals and Ain shams university hospitals during the period from November 2017 till May 2018. Results A total of 145 patients with an ICU mortality rate of 14.5% were enrolled. The median cumulative fluid balance of the 124 patients who survive was -110 ml (IQR -2.1-2.2 L) after the fourth day following randomization while the median cumulative fluid balance of the 21 patients who not survive was 3800 ml (IQR 1.7-5.2 L) after the fourth day in ICU. In our study critically ill patients with fluid balance more than 1.2 litres per day had higher ICU complications: increased risk of AKI, longer ICU and hospital stays, and mechanical ventilation, and fluid balance was independently associated with mortality. Conclusion In the view of this study, we concluded that:Zero fluid balance and negative fluid balance independently associated with decrease mortality and morbidity rates in critically ill patients after 4 days from admission in ICU.There was higher cumulative fluid balance in non survivors compared to survivors. Cumulative fluid balance after 4 days from admission was independently predictive of mortality in a heterogeneous group of critically ill patients.96 hour negative fluid balance in critically ill patients was associated with less length of stay at ICU and less mechanical ventilation duration.Positive fluid balance, mechanical ventilation, vasopressors, and high admission SAPS II, SOFA, APACHE II and KIDGO were significantly associated with high mortality.

scholarly journals Hospital Resources May Be an Important Aspect of Mortality Rate among Critically Ill Patients with COVID-19: The Paradigm of Greece

2020 ◽  
Vol 9 (11) ◽  
pp. 3730
Author(s):  
Christina Routsi ◽  
Eleni Magira ◽  
Stelios Kokkoris ◽  
Ilias Siembos ◽  
Charikleia Vrettou ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Distress Syndrome ◽  
Mortality Rates ◽  
General Icus ◽  
Hospital Resources ◽  
Per Se ◽  
Of Greece

For critically ill patients with coronavirus disease 2019 (COVID-19) who require intensive care unit (ICU) admission, extremely high mortality rates (even 97%) have been reported. We hypothesized that overburdened hospital resources by the extent of the pandemic rather than the disease per se might play an important role on unfavorable prognosis. We sought to determine the outcome of such patients admitted to the general ICUs of a hospital with sufficient resources. We performed a prospective observational study of adult patients with COVID-19 consecutively admitted to COVID—designated ICUs at Evangelismos Hospital, Athens, Greece. Among 50 patients, ICU and hospital mortality was 32% (16/50). Median PaO2/FiO2 was 121 mmHg (interquartile range (IQR), 86–171 mmHg) and most patients had moderate or severe acute respiratory distress syndrome (ARDS). Hospital resources may be an important aspect of mortality rates, since severely ill COVID-19 patients with moderate and severe ARDS may have understandable mortality, provided that they are admitted to general ICUs without limitations on hospital resources.

scholarly journals Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study

Critical Care ◽  
2010 ◽  
Vol 14 (2) ◽  
pp. R64 ◽  
Author(s):  
Michael Fischer ◽  
Stephan Rüegg ◽  
Adam Czaplinski ◽  
Monika Strohmeier ◽  
Angelika Lehmann ◽  
...  
Keyword(s):  
Observational Study ◽  
Glasgow Coma Scale ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Rater Reliability ◽  
Coma Scale

scholarly journals Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Aiko Tanaka ◽  
Akinori Uchiyama ◽  
Yu Horiguchi ◽  
Ryota Higeno ◽  
Ryota Sakaguchi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Spontaneous Breathing Trial ◽  
Leak Test ◽  
Endotracheal Suctioning ◽  
Cuff Leak ◽  
The Impact

AbstractThe cuff leak test (CLT) has been widely accepted as a simple and noninvasive method for predicting post-extubation stridor (PES). However, its accuracy and clinical impact remain uncertain. We aimed to evaluate the reliability of CLT and to assess the impact of pre-extubation variables on the incidence of PES. A prospective observational study was performed on adult critically ill patients who required mechanical ventilation for more than 24 h. Patients were extubated after the successful spontaneous breathing trial, and CLT was conducted before extubation. Of the 191 patients studied, 26 (13.6%) were deemed positive through CLT. PES developed in 19 patients (9.9%) and resulted in a higher reintubation rate (8.1% vs. 52.6%, p < 0.001) and longer intensive care unit stay (8 [4.5–14] vs. 12 [8–30.5] days, p = 0.01) than patients without PES. The incidence of PES and post-extubation outcomes were similar in patients with both positive and negative CLT results. Compared with patients without PES, patients with PES had longer durations of endotracheal intubation and required endotracheal suctioning more frequently during the 24-h period prior to extubation. After adjusting for confounding factors, frequent endotracheal suctioning more than 15 times per day was associated with an adjusted odds ratio of 2.97 (95% confidence interval, 1.01–8.77) for PES. In conclusion, frequent endotracheal suctioning before extubation was a significant PES predictor in critically ill patients. Further investigations of its impact on the incidence of PES and patient outcomes are warranted.

scholarly journals Nutrient pattern analysis in critically ill patients using Omics technology (NAChO) – Study protocol for a prospective observational study

Medicine ◽  
2019 ◽  
Vol 98 (1) ◽  
pp. e13937 ◽  
Author(s):  
Joerg C. Schefold ◽  
Anna S. Messmer ◽  
Stefanie Wenger ◽  
Lionel Müller ◽  
Stephan von Haehling ◽  
...  
Keyword(s):  
Observational Study ◽  
Critically Ill ◽  
Study Protocol ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Pattern Analysis ◽  
Omics Technology
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