Early Improvement of Acute Respiratory Distress Syndrome in Patients With COVID-19 in the Intensive Care Unit: Retrospective Analysis

Background Since the start of the COVID-19 pandemic, there have been over 2 million deaths globally. Acute respiratory distress syndrome (ARDS) may be the main cause of death. Objective This study aimed to describe the clinical features, outcomes, and ARDS characteristics of patients with COVID-19 admitted to the intensive care unit (ICU) in Chongqing, China. Methods The epidemiology of COVID-19 from January 21, 2020, to March 15, 2020, in Chongqing, China, was analyzed retrospectively, and 75 ICU patients from two hospitals were included in this study. On day 1, 56 patients with ARDS were selected for subgroup analysis, and a modified Poisson regression was performed to identify predictors for the early improvement of ARDS (eiARDS). Results Chongqing reported a 5.3% case fatality rate for the 75 ICU patients. The median age of these patients was 57 (IQR 25-75) years, and no bias was present in the sex ratio. A total of 93% (n=70) of patients developed ARDS during ICU stay, and more than half had moderate ARDS. However, most patients (n=41, 55%) underwent high-flow nasal cannula oxygen therapy, but not mechanical ventilation. Nearly one-third of patients with ARDS improved (arterial blood oxygen partial pressure/oxygen concentration >300 mm Hg) in 1 week, which was defined as eiARDS. Patients with eiARDS had a higher survival rate and a shorter length of ICU stay than those without eiARDS. Age (<55 years) was the only variable independently associated with eiARDS, with a risk ratio of 2.67 (95% CI 1.17-6.08). Conclusions A new subphenotype of ARDS—eiARDS—in patients with COVID-19 was identified. As clinical outcomes differ, the stratified management of patients based on eiARDS or age is highly recommended.

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Early Improvement of Acute Respiratory Distress Syndrome in Patients with COVID-19: Insights from the Data of ICU Patients in Chongqing, China (Preprint)

10.2196/preprints.24843 ◽

2020 ◽

Author(s):

Zhu Zhan ◽

Xin Yang ◽

Hu Du ◽

Chuanlai Zhang ◽

Yuyan Song ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Case Fatality ◽

Bivariate Analysis ◽

Icu Patients ◽

Early Improvement ◽

Icu Stay ◽

Arterial Blood

UNSTRUCTURED Background: This study aimed to describe the clinical features, outcomes, and acute respiratory distress syndrome (ARDS) characteristics of patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) in Chongqing, China. Methods: The epidemiology of COVID-19 in Chongqing, China, was analyzed retrospectively, and 75 ICU patients from 2 hospitals were included in this study. On day 1, 56 patients with ARDS were selected for subgroup analysis, and bivariate analysis was performed to identify predictors for early improvement of ARDS (eiARDS). Results: Chongqing reported a 5.3% case fatality rate of the 75 ICU patients. The median age of the ICU patients was 57 years (interquartile range, 25–75), and no bias was obtained in the sex ratio. A total of 93% of patients developed ARDS during ICU stay, and more than half had moderate ARDS. However, most of the patients (55%) were supported with high-flow nasal cannula oxygen therapy, but not mechanical ventilation. Nearly one third of patients with ARDS improved (arterial blood oxygen partial pressure/oxygen concentration >300 mm Hg) in 1 week, which was defined as eiARDS. Patients with eiARDS had a higher survival rate and lower length of ICU stay than those with “non-eiARDS”. Age (<55 years) was the only variable independently associated with eiARDS, with an odds ratio of 7.4. Conclusions: eiARDS was common in patients with COVID-19, and predicted a favorable clinical outcome. Age (<55 years) was an independent predictor of eiARDS, and stratification of patients with COVID-19 by age was recommended.

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Renal dysfunction decreases specificity and overturns cutoff value of serum CC16 while prohibiting 7-day mortality prediction in diagnosing acute respiratory distress syndrome in intensive care unit.

10.21203/rs.2.20735/v1 ◽

2020 ◽

Author(s):

Jinle Lin ◽

Wuyuan Tao ◽

Jian Wei ◽

Wu Jian ◽

Wenwu Zhang ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Renal Dysfunction ◽

Predictive Value ◽

Distress Syndrome ◽

Icu Patients ◽

Cutoff Value

Abstract Background: A contradictory tendency between occurrence of acute respiratory distress syndrome (ARDS) and serum club cell protein 16 (CC16) level, However, renal dysfunction (RD) separately raised serum CC16 in our current observation. The purpose of this study was to find the limitation caused by renal dysfunction in the diagnostic performance of CC16 on ARDS in intensive care unit (ICU) patients. Method: We measured serum CC16 in 479 ICU patients. Patients were divided into six subgroups: control, acute kidney injury (AKI), chronic kidney dysfunction (CKD), ARDS, ARDS+AKI, and ARDS+CKD. The cutoff value, sensitivity and specificity of serum CC16 were assessed by receiver operating characteristic curves. Result: Serum CC16 increased among the ARDS group when compared to the control group, which helps identify ARDS and predicts the outcome in patients with normal renal function. However, level of serum CC16 was similar among ARDS+AKI, ARDS+CKD, AIK and CKD groups. Consequently, when compare to AKI and CKD, specificity for diagnosing whether ARDS or ARDS with renal failure decreased from 86.62% to 2.82% or 81.70% to 2.12%. Consistently, a cutoff value of 11.57 ng/mL was overturned from previously at 32.77 ng/mL or 33.72 ng/mL. Moreover, its predictive value for mortality is prohibited before 7 day but works after 28 day. Conclusion: Renal dysfunction limits the specificity, cutoff point, and predictive value at 7-day mortality of CC16 in diagnosing ARDS among ICU patients.

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Early Improvement of Acute Respiratory Distress Syndrome in Patients with COVID-19: Insights from the Data of ICU Patients in Chongqing, China

10.1101/2020.07.15.20154047 ◽

2020 ◽

Author(s):

Zhu Zhan ◽

Xin Yang ◽

Hu Du ◽

Chuanlai Zhang ◽

Yuyan Song ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Independent Predictor ◽

Case Fatality ◽

High Flow Nasal Cannula ◽

Icu Patients ◽

Early Improvement

Acute respiratory distress syndrome (ARDS) may be the main cause of death in patients with coronavirus disease 2019 (COVID-19). Herein, we retrospect clinical features, outcomes and ARDS characteristics of 75 intensive care unit (ICU) patients with COVID-19 in Chongqing, China. We found a 5.3% case fatality rate of the ICU patients in Chongqing. 93% patients developed ARDS during the intensive care, and more than half were moderate. However, most of the patients (55%) supported with high flow nasal cannula (HFNC) oxygen therapy, but not mechanical ventilation. Nearly one third of patients with ARDS got an early improvement (eiARDS), and the rate is much higher than the other causes of ARDS in a previous study. Patients with eiARDS had a higher survival rate and lower length of ICU stay. The age (< 55 years) is an independent predictor for the eiARDS, and stratification of COVID-19 patients by age is recommended.

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Acute respiratory distress syndrome: A pediatric intensive care unit experience from an eastern Indian state

JOURNAL OF PEDIATRIC CRITICAL CARE ◽

10.21304/2017.0403.00188 ◽

2017 ◽

Vol 4 (3) ◽

pp. 16

Author(s):

BijayKumar Meher ◽

Leena Das ◽

BalajiBhusan Patnaik ◽

DeeptiDamayanty Pradhan ◽

Jatadhari Mahar

Keyword(s):

Intensive Care Unit ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Pediatric Intensive Care Unit ◽

Distress Syndrome ◽

Pediatric Intensive Care ◽

Indian State

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Clinical Year in Review IV: Acute Respiratory Distress Syndrome, Radiology in the Intensive Care Unit, Nonpulmonary Critical Care, and Pulmonary Infections in the Immunocompromised Host

Proceedings of the American Thoracic Society ◽

10.1513/pats.200806-049tt ◽

2008 ◽

Vol 5 (7) ◽

pp. 755-760 ◽

Cited By ~ 2

Author(s):

L. B. Ware

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Immunocompromised Host ◽

Pulmonary Infections

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Acute respiratory distress syndrome on the intensive care unit

British Journal of Hospital Medicine ◽

10.12968/hmed.2014.75.12.672 ◽

2014 ◽

Vol 75 (12) ◽

pp. 672-677 ◽

Cited By ~ 2

Author(s):

Felicity Liew ◽

Daniel Martin

Keyword(s):

Intensive Care Unit ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome

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Acute Respiratory Distress Syndrome in an African Intensive Care Unit Setting: A Prospective Study of Prevalence and Outcomes

Annals of the American Thoracic Society ◽

10.1513/annalsats.202103-270rl ◽

2021 ◽

Author(s):

Arthur Kwizera ◽

David P Kateete ◽

Ronald Ssenyonga ◽

Lydia Nakiyingi ◽

Jane Nakibuuka ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Prospective Study ◽

Distress Syndrome ◽

Intensive Care Unit Setting ◽

A Prospective Study

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Nursing Management of Prone Positioning in Patients With COVID-19

Critical Care Nurse ◽

10.4037/ccn2020222 ◽

2020 ◽

pp. e1-e9

Author(s):

Filippo Binda ◽

Federica Marelli ◽

Alessandro Galazzi ◽

Riccardo Pascuzzo ◽

Ileana Adamini ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Older Patients ◽

Distress Syndrome ◽

Rescue Therapy ◽

Prone Positioning ◽

Improvement Project

Background At the height of the coronavirus disease 2019 (COVID-19) pandemic, Italy had the highest number of deaths in Europe; most occurred in the Lombardy region. Up to 4% of patients with COVID-19 required admission to an intensive care unit because they developed a critical illness (eg, acute respiratory distress syndrome). Numerous patients with acute respiratory distress syndrome who had been admitted to the intensive care unit required rescue therapy like prone positioning. Objectives To describe the respiratory management of and the extensive use of prone positioning in patients with COVID-19 at the intensive care unit hub in Lombardy, Italy. Methods A total of 89 patients (67% male; median age, 59 years [range, 23-80 years]) with confirmed COVID-19 who were admitted between February 23 and March 31, 2020, were enrolled in this quality improvement project. Results Endotracheal intubation was required in 86 patients (97%). Prone positioning was used as rescue therapy in 43 (48%) patients. Significantly more younger patients (age ≤ 59 years) were discharged alive (43 of 48 [90%]) than were older patients (age ≥ 60 years; 26 of 41 [63%]; P < .005). Among the 43 patients treated with prone ventilation, 15 (35% [95% CI, 21%-51%]) died in the intensive care unit, of which 10 (67%; P < .001) were older patients. Conclusions Prone positioning is one strategy available for treating acute respiratory distress syndrome in patients with COVID-19. During this pandemic, prone positioning can be used extensively as rescue therapy, per a specific protocol, in intensive care units.

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Síndrome de Dificuldade Respiratória Aguda: Casuística de Dois Anos numa Unidade de Cuidados Intensivos

Acta Médica Portuguesa ◽

10.20344/amp.4266 ◽

2014 ◽

Vol 27 (2) ◽

pp. 211 ◽

Cited By ~ 1

Author(s):

Lúcia Taborda ◽

Filipa Barros ◽

Vitor Fonseca ◽

Manuel Irimia ◽

Ramiro Carvalho ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Invasive Mechanical Ventilation ◽

Interquartile Range ◽

The Mean

Introduction: Acute Respiratory Distress Syndrome has a significant incidence and mortality at Intensive Care Units. Therefore, more studies are necessary in order to develop new effective therapeutic strategies. The authors have proposed themselves to characterize Acute Respiratory Distress Syndrome patients admitted to an Intensive Care Unit for 2 years. Material and Methods: This was an observational retrospective study of the patients filling the Acute Respiratory Distress Syndrome criteria from the American-European Consensus Conference on ARDS, being excluded those non invasively ventilated. Demographic data, Acute Respiratory Distress Syndrome etiology, comorbidities, Gravity Indices, PaO2/FiO2, ventilator modalities and programmation, pulmonary compliance, days of invasive mechanical ventilation, corticosteroids use, rescue therapies, complications, days at Intensive Care Unit and obits were searched for and were submitted to statistic description and analysis. Results: A 40 patients sample was obtained, with a median age of 72.5 years (interquartile range = 22) and a female:male ratio of ≈1:1.86. Fifty five percent of the Acute Respiratory Distress Syndrome cases had pulmonary etiology. The mean minimal PaO2/FiO2 was 88mmHg (CI 95%: 78.5–97.6). The mean maximal applied PEEP was 12.4 cmH2O (Standard Deviation 4.12) and the mean maximal used tidal volume was 8.2 mL/ Kg ideal body weight (CI 95%: 7.7–8.6). The median invasive mechanical ventilation days was 10. Forty seven and one half percent of the patients had been administered corticosteroids and 52.5% had been submitted to recruitment maneuvers. The most frequent complication was Ventilator Associated Pneumonia (20%). The median Intensive Care Unit stay was 10.7 days (interquartile range 10.85). The fatality rate was 60%. The probability of the favorable outcome ‘non-death in Intensive Care Unit’ was 4.4x superior for patients who were administered corticosteroids and 11x superior for patients < 65 years old. Discussion and Conclusions: Acute Respiratory Distress Syndrome is associated with long hospitalization and significant mortality. New prospective studies will be necessary to endorse the potential benefit of steroid therapy and to identify the subgroups of patients that warrant its use.

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