scholarly journals Mortality Data in Mechanically Ventilated COVID-19 patients admitted to ICU: A Retrospective Study in Brooklyn

2020 ◽  
Author(s):  
Ravi Karan Patti ◽  
Claudia De Araujo Duarte ◽  
Nishil Dalsania ◽  
Rajat Thawani ◽  
Ankur Sinha ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Ventilatory Support ◽  
Supportive Therapy ◽  
Secondary Outcome ◽  
Mortality Data ◽  
Mechanical Ventilatory Support ◽  
Mechanically Ventilated ◽  
Care Community ◽  
Early Intubation ◽  
Vasopressor Use

Abstract Background: High mortality rates are predominant even in COVID-19 patients requiring minimal supportive therapy, with a short-coming of data on COVID-19 patients requiring mechanical ventilation.Objectives/Design: We performed a single-center, retrospective, cohort study at a tertiary care, community-based teaching hospital with patient who required invasive mechanical ventilatory support and were COVID-19 positive. All patients were treated according to the ARDSnet protocol. The primary outcome was overall mortality, and secondary outcome was successful extubation.Results: A total of 72 COVID-19 positive intubated patients were included. Twenty-six (66.6%) patients died within the first 15 days of hospital admission; thirty-eight (52.7%) died within 28 days, and thirty-nine (54.2%) died within 29 days. A total of 22 patients (30.5%) were successfully extubated. 15 patients (20.8%) who required reintubation or could not be extubated further underwent tracheostomy.Conclusions: Mortality of critically ill COVID-19 patients requiring mechanical ventilatory support is high, our observed mortality rate (54.2%) was significantly lower than currently published reports. We believe our rate to be a consequence of early intubation in conjunction with adherence to ARDSnet protocol. We also observed patients with hyperlipidemia, higher CRP, renal failure, or those requiring vasopressor use had worse outcomes.

scholarly journals Outcome of NIV in Critical Care Setting: Experience from a Tertiary Care Center

2013 ◽  
Vol 1 (1) ◽  
pp. 3-7
Author(s):  
Md Motiul Islam ◽  
Mirza Nazim Uddin ◽  
ARM Nooruzzaman ◽  
Rahan Rabbani ◽  
Ahmad Mursel Anam ◽  
...  
Keyword(s):  
Care Setting ◽  
Tertiary Care Hospital ◽  
Care Center ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Positive Outcome ◽  
Care Hospital ◽  
Positive Outcomes ◽  
Mechanical Ventilatory Support ◽  
Report Data

NIV is a method of ventilatory support which is delivered to the patient without using an invasive airway. For the last two decades it is increasingly used as an accepted method of mechanical ventilatory support as it is proved to have many positive outcomes as it can prevent invasive ventilation & its complication. In a tertiary care hospital of Bangladesh we are using this method in all patients meeting the NIV criteria & not having absolute contraindication irrespective of diagnosis. Our study aimed to access the out come of the NIV trial using our local resource & to compare it with others. This is an ongoing prospective study and till this report data from 82 patients were analyzed here of which 50% patient ended with positive outcome & 50% ended as negative outcome. As the result of this method varies significantly by diagnosis & severity of disease we are generating specific recommendations according to the likely outcome according to the diagnosis. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14358 Bangladesh Crit Care J March 2013; 1: 3-7

Development of a Shortened State Anxiety Scale From the Spielberger State-Trait Anxiety Inventory (STAI) for Patients Receiving Mechanical Ventilatory Support

2003 ◽  
Vol 11 (3) ◽  
pp. 283-293 ◽  
Author(s):  
Linda Chlan ◽  
Kay Savik ◽  
Craig Weinert
Keyword(s):  
Instrument Development ◽  
State Anxiety ◽  
Ventilatory Support ◽  
State Trait Anxiety Inventory ◽  
Mechanical Ventilatory Support ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Analysis Techniques ◽  
Item Scale ◽  
Ventilated Patients

Anxiety is a common experience for mechanically ventilated patients. There are a number of established instruments available to measure anxiety. However, there are significant limitations with these instruments, particularly the length of many scales when using them with ill persons. An instrument development study was conducted to develop a shortened scale from the 20-item Spielberger State Anxiety Inventory. Two-hundred ventilated patients were recruited from nine ICUs in the urban Midwest. Exploratory factor analysis techniques were used to create a shortened, 6-item scale, which accounted for 66.6 percent of the variance. A Cronbach’s alpha of 0.78 with a correlation of 0.92 to the 20-item version resulted based on a 6-item scale, and the shortened scale retained many of the desirable properties of the full-length version. The shortened version of the Spielberger State Anxiety Inventory generally had good psychometric properties. However, additional research is needed to further validate this shortened scale.

Intensive care management of Guillain-Barre syndrome: A retrospective outcome study and review of literature

2014 ◽  
Vol 01 (03) ◽  
pp. 188-197 ◽  
Author(s):  
Hemant Bhagat ◽  
Hari Dash ◽  
Rajendra Chauhan ◽  
Puneet Khanna ◽  
Parmod Bithal
Keyword(s):  
Intensive Care ◽  
Care Management ◽  
Prolonged Mechanical Ventilation ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Guillain Barre Syndrome ◽  
Mortality Data ◽  
Intensive Care Management ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Abstract Introduction: Guillain-Barre syndrome (GBS) is an immune mediated disorder which is associated with demyelination of peripheral nervous system and progressive muscle weakness. Severely affected patients have respiratory dysfunction and may need ventilatory support which can cause significant morbidity and mortality. There is limited Indian data with regards to the outcome of severely affected GBS patients. The present study reflects the intensive care management of severely affected GBS patients at neurological centre of a tertiary care institute of India. Materials and Methods: The study was designed to retrospectively review the patient records who were admitted to neurological intensive care unit (ICU) of AIIMS, New Delhi. The epidemiology, clinical features, course of management and outcome of GBS patients admitted between April 2000 to December 2005 were recorded and analysed. Results: The data of 59 patients were available for inclusion in the study. The mean age of patients admitted to neurological ICU was 35 years with male preponderance. Ventilatory failure was the most common indication for ICU admission. 95% patients required ventilatory support for a mean duration of 30 days. The mortality data included 60 patients and 13 patients died during the course of management. Conclusions: The present study indicates that severely affected GBS patients may need prolonged mechanical ventilation. Despite management in a specialized neurological ICU the mortality can be as high as 21%.

scholarly journals The Effect of Bicarbonate Administration via Continuous Venovenous Hemofiltration on Acid-Base Parameters in Ventilated Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Andrew S. Allegretti ◽  
Jennifer E. Flythe ◽  
Vinod Benda ◽  
Emily S. Robinson ◽  
David M. Charytan
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Kidney Injury ◽  
Continuous Venovenous Hemofiltration ◽  
Acid Base ◽  
Mechanical Ventilatory Support ◽  
Base Parameters ◽  
Ventilatory Parameters ◽  
Linear Regression Modeling

Background. Acute kidney injury (AKI) and metabolic acidosis are common in the intensive care unit. The effect of bicarbonate administration on acid-base parameters is unclear in those receiving continuous venovenous hemofiltration (CVVH) and mechanical ventilatory support.Methods. Metabolic and ventilatory parameters were prospectively examined in 19 ventilated subjects for up to 96 hours following CVVH initiation for AKI at an academic tertiary care center. Mixed linear regression modeling was performed to measure changes in pH, partial pressure of carbon dioxide (pCO2), serum bicarbonate, and base excess over time.Results. During the 96-hour study period,pCO2levels remained stable overall (initialpCO242.0 ± 14.6 versus end-studypCO243.8 ± 16.1 mmHg;P=0.13for interaction with time), for those with initialpCO2≤40 mmHg (31.3 ± 5.7 versus 35.0 ± 4.8;P=0.06) and for those with initialpCO2>40 mmHg (52.7 ± 12.8 versus 53.4 ± 19.2;P=0.57).pCO2decreased during the immediate hours following CVVH initiation (42.0 ± 14.6 versus 37.3 ± 12.6 mmHg), though this change was nonsignificant (P=0.052).Conclusions. We did not detect a significant increase inpCO2in response to the administration of bicarbonate via CVVH in a ventilated population. Additional studies of larger populations are needed to confirm this finding.

scholarly journals Profile and outcome of pediatric intussusception: a 5-year experience in a tertiary care center

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Aqeela J. Madan ◽  
Fayza Haider ◽  
Saeed Alhindi
Keyword(s):  
Seasonal Variation ◽  
Success Rate ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Operative Intervention ◽  
Secondary Outcome ◽  
Lead Point ◽  
Pneumatic Reduction ◽  
Tertiary Center

Abstract Background Intussusception is the most frequent cause of bowel obstruction in infants and toddlers; idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years; the highest incidence occurs in infants between 4 and 9 months; the gold standard for treatment of intussusception is non-operative reduction. This research will tackle the problem of pediatric intussusception in our center which is the largest tertiary center in our region. The primary outcome is to study the profile of intussusception; the secondary outcome is to assess the success rate of pneumatic reduction in the center’s pediatric population as well as to study the seasonal variation if present. Results During the study period, eighty-six (N=86) cases were identified, from which 10 cases were recurrent intussusception. Seventy-six (N=76) cases were included from the study period. N=68 (89%) were less than 3 years of age, and only N=2 (3%) were above 6 years. Seasonal variation was not significant; N=69 (91%) patients had successful pneumatic reduction under fluoroscopy while thirteen patients N=13 (17%) needed operative intervention. Conclusion Ileocolic intussusception is one of the most common pediatric surgical emergencies that can be successfully managed non-operatively in our institute; 89% of the cases were below 3 years of age, and no seasonal variation was demonstrated. Operative intervention was required in 13 cases with the main reason being lead point. The fact that the pediatric surgeon performs the reduction might have contributed to a high success rate reaching 91% in our center. This study provides a valuable opportunity for future regional data comparisons and pooled data analyses.

scholarly journals Markers of endothelial and epithelial pulmonary injury in mechanically ventilated COVID-19 ICU patients

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Savino Spadaro ◽  
Alberto Fogagnolo ◽  
Gianluca Campo ◽  
Ottavio Zucchetti ◽  
Marco Verri ◽  
...  
Keyword(s):  
Plasma Levels ◽  
Endothelial Injury ◽  
University Hospital ◽  
Intercellular Adhesion Molecule ◽  
Secondary Outcome ◽  
Intercellular Adhesion Molecule 1 ◽  
Mechanically Ventilated ◽  
Adhesion Protein ◽  
Alveolar Epithelial ◽  
Angiopoietin 2

Abstract Background Biomarkers can be used to detect the presence of endothelial and/or alveolar epithelial injuries in case of ARDS. Angiopoietin-2 (Ang-2), soluble intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion protein-1 (VCAM-1), P-selectin and E-selectin are biomarkers of endothelial injury, whereas the receptor for advanced glycation end-products (RAGE) reflects alveolar epithelial injury. The aims of this study were to evaluate whether the plasma concentration of the above-mentioned biomarkers was different 1) in survivors and non-survivors of COVID-19-related ARDS and 2) in COVID-19-related and classical ARDS. Methods This prospective study was performed in two COVID-19-dedicated Intensive Care Units (ICU) and one non-COVID-19 ICU at Ferrara University Hospital. A cohort of 31 mechanically ventilated patients with COVID-19 ARDS and a cohort of 11 patients with classical ARDS were enrolled. Ang-2, ICAM-1, VCAM-1, P-selectin, E-selectin and RAGE were determined with a bead-based multiplex immunoassay at three time points: inclusion in the study (T1), after 7 ± 2 days (T2) and 14 ± 2 days (T3). The primary outcome was to evaluate the plasma trend of the biomarker levels in survivors and non-survivors. The secondary outcome was to evaluate the differences in respiratory mechanics variables and gas exchanges between survivors and non-survivors. Furthermore, we compared the plasma levels of the biomarkers at T1 in patients with COVID-19-related ARDS and classical ARDS. Results In COVID-19-related ARDS, the plasma levels of Ang-2 and ICAM-1 at T1 were statistically higher in non-survivors than survivors, (p = 0.04 and p = 0.03, respectively), whereas those of P-selectin, E-selectin and RAGE did not differ. Ang-2 and ICAM-1 at T1 were predictors of mortality (AUROC 0.650 and 0.717, respectively). At T1, RAGE and P-selectin levels were higher in classical ARDS than in COVID-19-related ARDS. Ang-2, ICAM-1 and E-selectin were lower in classical ARDS than in COVID-19-related ARDS (all p < 0.001). Conclusions COVID-19 ARDS is characterized by an early pulmonary endothelial injury, as detected by Ang-2 and ICAM-1. COVID-19 ARDS and classical ARDS exhibited a different expression of biomarkers, suggesting different pathological pathways. Trial registration NCT04343053, Date of registration: April 13, 2020

scholarly journals Experience of establishing and coordinating a nationwide network for bidirectional intussusception surveillance in India: lessons for multisite research studies

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e046827
Author(s):  
Manoja Kumar Das
Keyword(s):  
Quality Assurance ◽  
Site Selection ◽  
Information Seeking ◽  
Selection Process ◽  
Tertiary Care ◽  
Vaccine Safety ◽  
Secondary Outcome ◽  
Prospective Surveillance ◽  
Surveillance Network ◽  
Nationally Representative

ObjectivesTo document and share the process of establishing the nationally representative multisite surveillance network for intussusception in India, coordination, data management and lessons learnt from the implementation.DesignThis study combined both retrospective and prospective surveillance approaches.Setting19 tertiary care institutions were selected in India considering the geographic representation and public and private mixParticipantsAll children under-2 years of age with intussusceptionPrimary and secondary outcome measuresThe experience of site selection, regulatory approvals, data collection, quality assurance and network coordination were documented.ResultsThe site selection process involved systematic and objective four steps including shortlisting of potential institutions, information seeking and telephonic interaction, site visits and site selection using objective criteria. Out of over 400 hospitals screened across India, 40 potential institutions were shortlisted and information was sought by questionnaire and interaction with investigators. Out of these, 25 institutes were visited and 19 sites were finally selected to participate in the study. The multistep selection process allowed filtering and identification of sites with adequate capacity and motivated investigators. The retrospective surveillance documented 1588 cases (range: 14–652 cases/site) and prospective surveillance recruited 621 cases (range: 5–191 cases/site). The multilayer quality assurance measures monitored and ensured protocol adherence, complete record retrieval and data completeness. The key challenges experienced included time taken for obtaining regulatory and ethical approvals, which delayed completion of the study. Ten sites continued with another multisite vaccine safety surveillance study.ConclusionThe experience and results of this systematic and objective site selection method in India are promising. The systematic multistep site selection and data quality assurance methods presented here are feasible and practical. The lessons from the establishment and coordination of this surveillance network can be useful in planning, selecting the sites and conducting multisite and surveillance studies in India and developing countries.

scholarly journals Characteristics of infective endocarditis in a cancer population

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001664
Author(s):  
Cullen Grable ◽  
Syed Yusuf ◽  
Juhee Song ◽  
George M Viola ◽  
Owais Ulhaq ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Mortality Data ◽  
Limited Information ◽  
Tertiary Care Centre ◽  
Indwelling Catheters ◽  
Patients With Cancer ◽  
Duke Criteria ◽  
Immunocompromised State

BackgroundInfective endocarditis (IE) is more common in patients with cancer as compared with the general population. Due to an immunocompromised state, the need for invasive procedures, hypercoagulability and the presence of indwelling catheters, patients with cancer are particularly predisposed to the development of IE.ObjectivesLimited information exists about IE in patients with cancer. We aimed to evaluate the characteristics of patients with cancer and IE at our tertiary care centre, including a comparison of the microorganisms implicated and their association with mortality.MethodsA retrospective chart review of patients with cancer who had echocardiography for suspicion of endocarditis was conducted. A total of 56 patients with a confirmed diagnosis of cancer and endocarditis, based on the modified Duke criteria, were included in the study. Baseline demographics, risk factors for developing IE, echocardiography findings, microbiology and mortality data were analysed.ResultsFollowing the findings of vegetations by echocardiography, the median survival time was 8.5 months. Staphylococcus aureus was the most common organism identified as causing endocarditis. The mitral and aortic valves were the most commonly involved sites of endocarditis. Patients with S. aureus endocarditis (SAE) had a significantly poorer survival when compared with patients without SAE (p=0.0217) over the 12-month period from diagnosis of endocarditis.ConclusionsOverall survival of patients with cancer and endocarditis is poor, with a worse outcome in patients with SAE.

scholarly journals 556. Evaluation of Hydroxychloroquine-based Combination Therapies for the Treatment of COVID-19

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S343-S343
Author(s):  
Andrew David Berti ◽  
Pramodini Kale-Pradhan ◽  
Christopher Giuliano ◽  
Bianca Aprilliano ◽  
Christopher R Miller ◽  
...  
Keyword(s):  
Vitamin D ◽  
Sofa Score ◽  
Laboratory Data ◽  
Organ Damage ◽  
Secondary Outcome ◽  
Mortality Data ◽  
Observational Cohort ◽  
Comorbidity Index ◽  
Significant Change ◽  
Investigational Agents

Abstract Background During the early COVID-19 pandemic a large number of investigational agents were utilized due to lack of therapeutic options. We evaluate the utility of commonly-used investigational agents combined with hydroxychloroquine (HCQ). Methods This multicenter observational cohort study included patients admitted with COVID-19 between March - May 2020 in Detroit, Michigan who received at least 2 doses of HCQ. Our primary outcome was the change in Sequential Organ Failure Assessment (SOFA) score from presentation to day 5 of HCQ therapy with a secondary outcome of in-hospital mortality. Data collected included demographics, Charlson Comorbidity index (CCI), daily SOFA score, laboratory data and COVID-directed therapies. Multiple linear regressions were performed to control for potential confounders between different therapies and change in SOFA score. Results Three hundred thirty-five patients receiving HCQ were included. Patients were 62 ± 14.8 years of age, male (54%) and African-American (82%) with a mean CCI of 1.7 ± 1.9. In our cohort, 32% were admitted to the intensive care unit and 35% expired. Therapies received by more than 20% of patients in addition to HCQ included azithromycin (80%), zinc (76%) and vitamin D (29%). In our unadjusted analysis, a significant improvement in SOFA score was observed with zinc (0.76) while no significant change was observed with azithromycin (-0.46) or vitamin D (0.05). However, there was no significant change in SOFA score after adjusting for confounders for azithromycin, zinc and vitamin D. No difference in mortality was observed between the groups. Conclusion Overall, no benefit in end-organ damage or mortality was observed with the addition of azithromycin, zinc or vitamin D to HCQ. Further studies are needed to confirm this observation. Disclosures All Authors: No reported disclosures

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