Whether Early Steroid  Dose Is Associated with Lower Mortality in COVID-19 Critically Ill Patients- An Exploratory Chart Review

2020 ◽  
Author(s):  
Abhishek Goyal ◽  
Saurabh Saigal ◽  
Ankur Joshi ◽  
Dodda Brahmam ◽  
Yogesh Niwariya ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Chart Review ◽  
Lower Mortality

scholarly journals Prognostic impact of elevated lactate levels on mortality in critically ill patients with and without preadmission metformin treatment: a Danish registry-based cohort study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Rene A. Posma ◽  
Trine Frøslev ◽  
Bente Jespersen ◽  
Iwan C. C. van der Horst ◽  
Daan J. Touw ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mortality Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Lower Mortality ◽  
Prognostic Impact ◽  
Icu Admission ◽  
Lactate Levels ◽  
Restricted Cubic Splines

Abstract Background Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whether the association between lactate levels around ICU admission and mortality is different in metformin users compared to metformin nonusers. Methods This cohort study included patients admitted to ICUs in northern Denmark between January 2010 and August 2017 with any circulating lactate measured around ICU admission, which was defined as 12 h before until 6 h after admission. The association between the mean of the lactate levels measured during this period and 30-day mortality was determined for metformin users and nonusers by modelling restricted cubic splines obtained from a Cox regression model. Results Of 37,293 included patients, 3183 (9%) used metformin. The median (interquartile range) lactate level was 1.8 (1.2–3.2) in metformin users and 1.6 (1.0–2.7) mmol/L in metformin nonusers. Lactate levels were strongly associated with mortality for both metformin users and nonusers. However, the association of lactate with mortality was different for metformin users, with a lower mortality rate in metformin users than in nonusers when admitted with similar lactate levels. This was observed over the whole range of lactate levels, and consequently, the relation of lactate with mortality was shifted rightwards for metformin users. Conclusion In this large observational cohort of critically ill patients, early lactate levels were strongly associated with mortality. Irrespective of the degree of hyperlactataemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with metformin nonusers. Therefore, lactate levels around ICU admission should be interpreted according to metformin use.

scholarly journals Protein provision and lower mortality in critically ill patients with COVID-19

2021 ◽  
Author(s):  
Jose Henrique Silvah ◽  
Cristiane Maria Martires de Lima ◽  
Carolina Ferreira Nicoletti ◽  
Ana Carolina Barbosa ◽  
Gizela Pedroso Junqueira ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Lower Mortality

scholarly journals Kinetic Patterns of Candida albicans Germ Tube Antibody in Critically Ill Patients: Influence on Mortality

2009 ◽  
Vol 16 (10) ◽  
pp. 1527-1528 ◽  
Author(s):  
Rafael Zaragoza ◽  
Javier Pemán ◽  
Guillermo Quindós ◽  
Jose R. Iruretagoyena ◽  
María S. Cuétara ◽  
...  
Keyword(s):  
Candida Albicans ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Germ Tube ◽  
Antifungal Agents ◽  
Mortality Rates ◽  
Antifungal Treatment ◽  
Lower Mortality

ABSTRACT The influence of kinetic patterns of Candida albicans germ tube antibodies (CAGTA) on mortality was analyzed in six intensive care units. Statistically significant lower mortality rates were found in patients with patterns of increasing CAGTA titers who had been treated with antifungal agents. Thus, antifungal treatment should be considered when CAGTA titers are increasing in critically ill patients.

scholarly journals 970: EVALUATION OF THE USE OF MODAFINIL IN CRITICALLY ILL PATIENTS: A RETROSPECTIVE CHART REVIEW

2021 ◽  
Vol 50 (1) ◽  
pp. 482-482
Author(s):  
Lindsey Branstetter ◽  
Jolie Gallagher ◽  
Kayla Nichols ◽  
Subir Goyal ◽  
Ayesha Mukhtar
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Chart Review ◽  
Retrospective Chart Review

scholarly journals Whether Early Pulse Steroid dose is associated with lower mortality in COVID-19 critically ill Patients- An exploratory retrospective Chart Review

2020 ◽  
Author(s):  
Abhishek Goyal ◽  
Saurabh Saigal ◽  
Ankur Joshi ◽  
Dodda Brahmam ◽  
Yogesh Niwariya ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Protective Effect ◽  
Critically Ill ◽  
Steroid Therapy ◽  
Critically Ill Patients ◽  
Chart Review ◽  
Cox Regression ◽  
Exploratory Analysis ◽  
Model Diagnostics ◽  
Cox Regression Analysis

Introduction: Steroids have shown its usefulness in critically ill COVID19 patients. However time of starting steroid and dose tailored to severity remains a matter of inquiry due to still emerging evidences and wide-ranging concerns of benefits and harms. We did a retrospective record analysis in an apex teaching hospital ICU setting to explore optimal doses and duration of steroid therapy which minimizes the hazard of death. Methodology: 114 adults with COVID19-ARDS admitted to ICU between 20thMarch-15thAugust2020 were included in chart review. We did preliminary exploratory analysis(rooted in steroid therapy matrix categorized by dose and duration) to understand the effect of several covariates on survival. This was followed by univariate and multivariate Cox proportion hazard regression analysis and model diagnostics. Results: Exploratory analysis and visualization indicated age, optimal steroid, severity (measured in P/F) of disease and infection status as potential covariates for survival. Univariate cox regression analysis showed significant positive association of age>60 years{2.6 (1.5-4.7)} and protective effect of optimum steroid{0.38(0.2-0.72)} on death (hazard) in critically ill patients. Multivariate cox regression analysis after adjusting effect of age showed protective effect of optimum steroid on hazard defined as death {0.46(0.23-0.87),LR=17.04,(p=2e-04)}.The concordance was 0.70 and model diagnostics fulfilled the assumption criteria for proportional hazard model. Conclusion: Optimal dose steroid as per defined optimum(<24 hours and doses tailored to P/F at presentation) criteria can offer protective effect from mortality which persists after adjusting for age. This protective effect was not found to be negatively influenced by the risk of infection.

Survival, Outcomes, and Use of Acuity Scoring Systems Following Tracheotomy in Veteran Patients

2020 ◽  
Vol 37 (11) ◽  
pp. 890-896
Author(s):  
Carol M. Bier-Laning ◽  
Jeffrey Hotaling ◽  
W. Jeffrey Canar ◽  
Aziz A. Ansari
Keyword(s):  
General Population ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Scoring Systems ◽  
Survival Outcomes ◽  
Logistic Organ Dysfunction ◽  
Failure Assessment

Objectives: To determine whether established prognosis tools used in the general population of critically ill patients will accurately predict tracheotomy-related outcomes and survival outcomes in critically ill patients undergoing tracheotomy. Methods: Retrospective chart review of 94 consecutive critically ill patients undergoing isolated tracheotomy. Results: Logistic Organ Dysfunction System (LODS) and sepsis-related organ failure assessment (SOFA) scores, 2 validated measures of acuity in critically ill patients, were calculated for all patients. The only tracheotomy-related outcome of significance was the finding that patients with an LODS score ≤6 were more likely to become ventilator independent ( P < .015). Higher LODS or SOFA scores were associated with in-house death (LODS, P = .001, SOFA, P = .008) and death within 90 days (LODS, P = .009, SOFA, P = .031), while death within 180 days was associated only with a higher LODS score (LODS, P = .018). When controlling for age, there was an association between both LODS ( P = .015) and SOFA ( P = .019) scores and death within 90 days of tracheotomy. Conclusions: The survival outcome for critically ill patients undergoing tracheotomy seems accurately predicted based on scoring systems designed for use in the general population of critically ill patients. Logistic Organ Dysfunction System may also be useful to predict the likelihood of the tracheotomy-related outcome of ventilator independence. This suggests that LODS scores may be helpful to palliative care clinicians as part of a shared decision-making aid in critically ill, ventilated patients for whom tracheotomy is being considered.

Documentation of Crucial Information Relating to Critically Ill Patients

2017 ◽  
Vol 33 (1) ◽  
pp. 5-8 ◽  
Author(s):  
Alexandria Bear ◽  
Elizabeth Thiel
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Medical Decision ◽  
Care Providers ◽  
Significant Difference ◽  
Review Study

Background: Medical decision-making has evolved to the modern model of shared decision-making among patients, surrogate decision-makers, and medical providers. As such, informed consent discussions with critically ill patients often should include larger discussions relating to values and goals of care. Documentation of care options and prognosis serves as an important component of electronic communication relating to patient preferences among care providers. Objective: This retrospective chart review study sought to evaluate the prevalence of documentation of critical data, care options, prognosis, and medical plan, within primary team and palliative care consult team documentation. Results: Three hundred two electronic medical records were reviewed. There was a significant difference in documentation between palliative care and primary teams for prognosis (83% vs 32%, P < .001), care options (82% vs 50%, P < .001), and care plan (82% vs 46%, P < .001). Conclusions: Our retrospective chart review study demonstrated a significant difference in documentation between primary and palliative care teams. We acknowledge that review of documentation cannot be extrapolated to the presence or absence of conversations between providers and patients and/or surrogates. Additional studies to evaluate this connection would be advantageous.

scholarly journals Diabetes mellitus is associated with lower mortality in intensive care unit: a multicenter historical cohort study

2020 ◽  
Author(s):  
Chang Hu ◽  
Bo Hu ◽  
Jing Wang ◽  
Zhiyong Peng ◽  
Kianoush B. Kashani ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Critically Ill ◽  
Old Age ◽  
Critically Ill Patients ◽  
Lower Mortality ◽  
Research Database ◽  
Icu Mortality ◽  
Historical Cohort ◽  
Basic Characteristics ◽  
Apache Iv

Abstract Background: The association of pre-existing diabetes mellitus and outcomes among critically ill patients remains unknown.Methods: This retrospective study enrolled patients who were covered by the eICU Collaborative Research Database from 2014 to 2015. DM was the exposure of interest, and diabetic individuals were adjudicated by the medical history, and blood glucose level (BGL). We abstracted basic characteristics, laboratory variables, and primary exposures. ICU mortality was the primary outcome.Results: In a cohort of 134,429 critically ill patients (male 54.4%, median age 66 [54-77] years, BMI 28[24-33] kg/m2), the prevalence of DM was 29%. In comparison with nondiabetics, DM patients were older, more obese, had higher Acute Physiology and Chronic Health Evaluation (APACHE)-IV score, and ICU admission BGL. In comparison with nondiabetics, pre-existing DM was associated with lower ICU mortality (OR: 0.846, 95%CI: 0.791-0.905). In multivariable logistic regression and Cox proportional hazard analyses, pre-existing DM was associated with decreased odds of ICU mortality in hyperglycemic patients (>163 mg/dL), higher APACHE IV score (>67), middle to old age (45-75 years), sepsis and morbid obesity (BMI>35 kg/m2). Also, in comparison with nondiabetics, pre-existing DM was associated with lower mortality among those with higher mean BGL (>128 mg/dL), and higher mortality in lower mean BGL (<107 mg/dL). Conclusions: In comparison with nondiabetics, pre-existing DM is associated with a lower adjusted ICU mortality. This association is stronger in DM patients with hyperglycemia, obesity, sepsis, middle to old age, and higher APACHE IV score.

scholarly journals Tocilizumab as a Therapeutic Agent for Critically Ill Patients Infected with SARS-CoV-2

2020 ◽  
Author(s):  
Russell M. Petrak ◽  
Nathan C. Skorodin ◽  
Nicholas W. Van Hise ◽  
Robert M. Fliegelman ◽  
Jonathan Pinsky ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Inflammatory Markers ◽  
Chart Review ◽  
Therapeutic Agent ◽  
P Value ◽  
Cytokine Storm ◽  
Multi Center Study ◽  
Center Study

AbstractBackgroundTocilizumab is an IL-6 receptor antagonist with the ability to suppress the cytokine storm in critically ill patients infected with SARS-CoV-2.MethodsWe evaluated patients treated with tocilizumab for a SARS-CoV-2 infection who were admitted between 3/13/20 and 4/16/20. This was a multi-center study with data collected by chart review both retrospectively and concurrently. Parameters evaluated included age, sex, race, use of mechanical ventilation (MV), usage of steroids and vasopressors, inflammatory markers, and comorbidities. Early dosing was defined as a tocilizumab dose administered prior to or within one (1) day of intubation. Late dosing was defined as a dose administered greater than one (1) day after intubation. In the absence of mechanical ventilation, the timing of the dose was related to the patient’s date of admission only.ResultsWe evaluated 145 patients. The average age was 58.1 years, 64% were male, 68.3% had comorbidities, and 60% received steroid therapy. Disposition of patients was 48.3% discharged and 29.3% expired, of which 43.9% were African American. Mechanical ventilation was required in 55.9%, of which 34.5% expired. Avoidance of MV (p value = 0.002) and increased survival (p value < 0.001) was statistically associated with early dosing.ConclusionsTocilizumab therapy was effective at decreasing mortality and should be instituted early in the management of critically ill COVID-19 patients.SummaryUtilizing tocilizumab early in the treatment course of critically ill patients with COVID-19 resulted in significant decreases in mortality and the avoidance of mechanical ventilation.

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