scholarly journals Death in hospital following ICU discharge: insights from the LUNG SAFE study

2020 ◽  
Author(s):  
Fabiana Madotto ◽  
Bairbre McNicholas ◽  
Emanuele Rezoagli ◽  
Tài Pham ◽  
John Laffey ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Word Count ◽  
Factors Associated ◽  
Icu Discharge ◽  
Severity Scores ◽  
Hospital Patients ◽  
Multicenter Prospective Cohort Study ◽  
To Receive ◽  
International Multicenter ◽  
Multicenter Prospective Cohort

Abstract Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward.Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments (‘treatment limitations’), and the subpopulations with treatment limitations.Results: 2,186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge.Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. (Word count 251)Trial Registration: ClinicalTrials.gov NCT02010073

scholarly journals Death in hospital following ICU discharge: insights from the LUNG SAFE study

2021 ◽  
Author(s):  
Fabiana Madotto ◽  
Bairbre McNicholas ◽  
Emanuele Rezoagli ◽  
Tài Pham ◽  
John Laffey ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Severe Respiratory Failure ◽  
Factors Associated ◽  
Icu Discharge ◽  
Severity Scores ◽  
Hospital Patients ◽  
Multicenter Prospective Cohort Study ◽  
To Receive ◽  
International Multicenter ◽  
Multicenter Prospective Cohort

Abstract Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward.Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments (‘treatment limitations’), and the subpopulations with treatment limitations.Results: 2,186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge.Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors.Trial Registration: ClinicalTrials.gov NCT02010073

scholarly journals Death in Hospital Following ICU Discharge: Insights from the LUNG SAFE Study

2020 ◽  
Author(s):  
Fabiana Madotto ◽  
Bairbre McNicholas ◽  
Emanuele Rezoagli ◽  
Tài Pham ◽  
John Laffey ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Severe Respiratory Failure ◽  
Factors Associated ◽  
Icu Discharge ◽  
Severity Scores ◽  
Hospital Patients ◽  
Multicenter Prospective Cohort Study ◽  
To Receive ◽  
International Multicenter ◽  
Multicenter Prospective Cohort

Abstract Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge.Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This current study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU sta. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments (‘treatment limitations’), and the subpopulations with treatment limitations.Results: 2,186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge.Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. Trial Registration: ClinicalTrials.gov NCT02010073

scholarly journals Death in hospital following ICU discharge: insights from the LUNG SAFE study

2020 ◽  
Author(s):  
Fabiana Madotto ◽  
Bairbre McNicholas ◽  
Emanuele Rezoagli ◽  
Tài Pham ◽  
John Laffey ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Severe Respiratory Failure ◽  
Factors Associated ◽  
Icu Discharge ◽  
Severity Scores ◽  
Hospital Patients ◽  
Multicenter Prospective Cohort Study ◽  
To Receive ◽  
International Multicenter ◽  
Multicenter Prospective Cohort

Abstract Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward.Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments (‘treatment limitations’), and the subpopulations with treatment limitations.Results: 2,186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge.Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. Trial Registration: ClinicalTrials.gov NCT02010073

scholarly journals Death in hospital following ICU discharge: insights from the LUNG SAFE study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Fabiana Madotto ◽  
◽  
Bairbre McNicholas ◽  
Emanuele Rezoagli ◽  
Tài Pham ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Significant Proportion ◽  
Factors Associated ◽  
Icu Discharge ◽  
Severity Scores ◽  
Hospital Patients ◽  
Large Observational Study ◽  
Multicenter Prospective Cohort Study ◽  
To Receive ◽  
Multicenter Prospective Cohort

Abstract Background To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments (‘treatment limitations’), and the subpopulations with treatment limitations. Results 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. Conclusions A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. Trial Registration: ClinicalTrials.gov NCT02010073.

Factors related to spiritual well-being in the last days of life in three East Asian countries: An international multicenter prospective cohort study

2021 ◽  
pp. 026921632110221
Author(s):  
Yusuke Hiratsuka ◽  
Sang-Yeon Suh ◽  
Sun-Hyun Kim ◽  
Shao-Yi Cheng ◽  
Seok-Joon Yoon ◽  
...  
Keyword(s):  
Palliative Care ◽  
East Asian ◽  
Well Being ◽  
Asian Countries ◽  
Factors Associated ◽  
Spiritual Well Being ◽  
Palliative Care Units ◽  
Multicenter Prospective Cohort Study ◽  
International Multicenter ◽  
Multicenter Prospective Cohort

Background: Some factors associated with spiritual well-being in dying patients have previously been reported. However, there has been no cross-cultural study comparing factors related to spiritual well-being. The current investigation may shed light on this under-investigated area through a comparison of diverse factors. Aim: We aimed to (1) examine factors associated with spiritual well-being in the last days and (2) compare those factors across three East Asian countries. Design: This is an international multicenter prospective cohort study. Setting/participants: Newly admitted inpatients with far advanced cancer in palliative care units in Japan, Korea and Taiwan were enrolled. Each patient was classified into one of two groups based on spiritual well-being score in the last days of life. Univariate and multivariate analyses were performed to identify the factors related to better spiritual well-being score in each country. Results: A total of 1761 patients treated at 37 palliative care units from January 2017 to September 2018 were analyzed. Seven variables were significant in Japan, three in Korea, and five in Taiwan. “Good death scale [acceptance],” “fatigue” and “expressed wish for hastened death” were unique in Japan. “Visit from a pastoral care worker within 48 h of death” was unique in Korea. “Patient’s preferences for place of death,” “dyspnea” and “continuous deep sedation” were unique in Taiwan. Conclusions: This study found novel factors related to spiritual well-being in the last days of life, several of which differed according to country. Recognition of factors associated with spiritual well-being can improve the quality of palliative care.

scholarly journals Understanding the sociodemographic factors associated with intention to receive SMS messages for health information in a rural area of Bangladesh

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fakir M Amirul Islam ◽  
Elisabeth A Lambert ◽  
Sheikh Mohammed Shariful Islam ◽  
M Arzan Hosen ◽  
Bruce R Thompson ◽  
...  
Keyword(s):  
Willingness To Pay ◽  
Mobile Phone ◽  
Health Information ◽  
Rural Area ◽  
Significant Proportion ◽  
Sociodemographic Factors ◽  
Factors Associated ◽  
Rich People ◽  
Education And Awareness ◽  
To Receive

Abstract Background The use of digital interventions for managing chronic diseases is significantly increasing. The aim of this study was to estimate the proportion of ownership of a mobile phone, and factors associated with the ability to read and access SMS delivered health information, and willingness to pay for it among people with hypertension in a rural area in Bangladesh. Methods Data were collected from 307 participants aged 30 to 75 years with hypertension from a rural area in Bangladesh from December 2020 to January 2021. Outcome measures included ownership of a mobile phone, ability to read SMS, willingness to receive and pay for health information by SMS. Associated factors included age, gender, level of education, occupation, and socioeconomic status. We used regression analysis to identify variables associated with the outcome variables. Results Overall, 189 (61.6%) people owned a mobile phone which was higher in men (73.3% vs. 50%, p < 0.001), younger people (82.6% aged 30–39 years vs. 53.5% aged 60–75 years, p < 0.001). Of the total participants, 207 (67.4%) were willing to receive SMS, and 155 (50.5%) were willing to pay for receiving SMS for health information. The prevalence was significantly higher among professionals (odds ratio (OR), 95% confidence interval (CI): 4.58, 1.73–12.1) and businesspersons (OR 3.68, 95% CI 1.49–9.10) compared to farmers, respectively. The median (interquartile range [IQR]) of willingness to pay for health information SMS was 10 (28) Bangladesh Taka (BDT) (1 BDT ~ 0.013 US$), and there were no specific factors that were associated with the willingness of any higher amounts of payment. In terms of reading SMS of people who own a mobile, less than half could read SMS. The proportion of people who could read SMS was significantly higher among men, younger people, educated people, middle class or rich people, professionals or businesspersons. Of people who could read SMS, the majority read SMS occasionally. Conclusion A significant proportion of people are unable to read SMS. However, people are willing to receive and pay to receive SMS for health information. Education and awareness programs should be conducted among targeted groups, including people with low education and women.

scholarly journals LO89: Describing the evolution of post-concussion symptoms after sports-related mTBI

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S40-S40
Author(s):  
F. Beauchamp ◽  
V. Boucher ◽  
X. Neveu ◽  
V. Ouellet ◽  
P. Archambault ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Recovery Process ◽  
Public Health Issue ◽  
Post Injury ◽  
Adjusted Risk ◽  
Multicenter Prospective Cohort Study ◽  
Mechanism Of Trauma ◽  
The Impact ◽  
Multicenter Prospective Cohort

Introduction: Mild traumatic brain injury (mTBI) is a serious public health issue and as much as one third of mTBI patients could be affected by persistent post-concussion symptoms (PPCS) three months after their injury. Even though a significant proportion of all mTBIs are sports-related (SR), little is known on the recovery process of SR mTBI patients and the potential differences between SR mTBI and patients who suffered non-sports-related mTBI. The objective of this study was to describe the evolution of PPCS among patients who sustained a SR mTBI compared to those who sustained non sport-related mTBI. Methods: This Canadian multicenter prospective cohort study included patients aged ≥ 14 who had a documented mTBI that occurred within 24 hours of Emergency Department (ED) visit, with a Glasgow Coma Scale score of 13-15. Patients who were hospitalized following their ED visit or unable to consent were excluded. Clinical and sociodemographic information was collected during the initial ED visit. Three follow-up phone interviews were conducted by a research nurse at 7, 30 and 90 days post-injury to assess symptom evolution using the validated Rivermead Post-concussion Symptoms Questionnaire (RPQ). Adjusted risk ratios (RR) were calculated to demonstrate the impact of the mechanism of injury (sports vs non-sports) on the presence and severity of PPCS. Results: A total of 1676 mTBI patients were included, 358 (21.4%) of which sustained a SR mTBI. At 90 days post-injury, patients who suffered a SR mTBI seemed to be significantly less affected by fatigue (RR: 0.70 (95% CI: 0.50-0.97)) and irritability (RR: 0.60 (95% CI: 0.38-0.94)). However, no difference was observed between the two groups regarding each other symptom evaluated in the RPQ. Moreover, the proportion of patients with three symptoms or more, a score ≥21 on the RPQ and those who did return to their normal activities were also comparable. Conclusion: Although persistent post-concussion symptoms are slightly different depending on the mechanism of trauma, our results show that patients who sustained SR-mTBI could be at lower risk of experiencing some types of symptoms 90 days post-injury, in particular, fatigue and irritability.

Risk Factors for and Outcomes Associated With Peri-Intubation Hypoxemia: A Multicenter Prospective Cohort Study

2020 ◽  
pp. 088506662096244
Author(s):  
Nathan J. Smischney ◽  
Ashish K. Khanna ◽  
Ernesto Brauer ◽  
Lee E. Morrow ◽  
Uchenna R. Ofoma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Endotracheal Intubation ◽  
Point Estimate ◽  
Mask Ventilation ◽  
Factors Associated ◽  
Icu Length Of Stay ◽  
Multicenter Prospective Cohort Study ◽  
Bag Mask Ventilation ◽  
Multicenter Prospective Cohort

Background: Little is known about hypoxemia surrounding endotracheal intubation in the critically ill. Thus, we sought to identify risk factors associated with peri-intubation hypoxemia and its effects’ on the critically ill. Methods: Data from a multicenter, prospective, cohort study enrolling 1,033 critically ill adults who underwent endotracheal intubation across 16 medical/surgical ICUs in the United States from July 2015-January 2017 were used to identify risk factors associated with peri-intubation hypoxemia and its effects on patient outcomes. We defined hypoxemia as any pulse oximetry ≤ 88% during and up to 30 minutes following endotracheal intubation. Results: In the full analysis (n = 1,033), 123 (11.9%) patients experienced the primary outcome. Five risk factors independently associated with our outcome were identified on multiple logistic regression: cardiac related reason for endotracheal intubation (OR 1.67, [95% CI 1.04, 2.69]); pre-intubation noninvasive ventilation (OR 1.66, [95% CI 1.09, 2.54]); emergency intubation (OR 1.65, [95% CI 1.06, 2.55]); moderate-severe difficult bag-mask ventilation (OR 2.68, [95% CI 1.72, 4.19]); and crystalloid administration within the preceding 24 hours (OR 1.24, [95% CI 1.07, 1.45]; per liter up to 4 liters). Higher baseline SpO2 was found to be protective (OR 0.93, [95% CI 0.91, 0.96]; per percent up to 97%). Consistent results were seen in a separate analysis on only stable patients (n = 921, 93 [10.1%]) (those without baseline hypoxemia ≤ 88%). Peri-intubation hypoxemia was associated with in-hospital mortality (OR 2.40, [95% CI 1.33, 4.31]; stable patients: OR 2.67, [95% CI 1.38, 5.17]) but not ICU length of stay (point estimate 0.9 days, [95% CI −1.0, 2.8 days]; stable patients: point estimate 1.5 days, [95% CI −0.4, 3.4 days]) after adjusting for age, body mass index, illness severity, airway related reason for intubation (i.e., acute respiratory failure), and baseline SPO2. Conclusions: Patients with pre-existing noninvasive ventilation and volume loading who were intubated emergently in the setting of hemodynamic compromise with bag-mask ventilation described as moderate-severe were at increased risk for peri-intubation hypoxemia. Higher baseline oxygenation was found to be protective against peri-intubation hypoxemia. Peri-intubation hypoxemia was associated with in-hospital mortality but not ICU length of stay. Trial registration: Clinicaltrials.gov identifier: NCT02508948 and Registered Report Identifier: RR2-10.2196/11101.

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