Mortality Rate and Predictors among Patients with COVID-19 Related Acute Respiratory Failure Requiring Mechanical Ventilation: A Retrospective Single Centre Study

Abstract Aim The objective of the study was to assess mortality rates in COVID-19 patients suffering from acute respiratory distress syndrome (ARDS) who also requiring mechanical ventilation. The predictors of mortality in this cohort were analysed, and the clinical characteristics recorded. Material and method A single centre retrospective study was conducted on all COVID-19 patients admitted to the intensive care unit of the Epicura Hospital Center, Province of Hainaut, Belgium, between March 1st and April 30th 2020. Results Forty-nine patients were included in the study of which thirty-four were male, and fifteen were female. The mean (SD) age was 68.8 (10.6) and 69.5 (12.6) for males and females, respectively. The median time to death after the onset of symptoms was eighteen days. The median time to death, after hospital admission was nine days. By the end of the thirty days follow-up, twenty-seven patients (55%) had died, and twenty–two (45%) had survived. Non-survivors, as compared to those who survived, were similar in gender, prescribed medications, COVID-19 symptoms, with similar laboratory test results. They were significantly older (p = 0.007), with a higher co-morbidity burden (p = 0.026) and underwent significantly less tra-cheostomy (p < 0.001). In multivariable logistic regression analysis, no parameter significantly predicted mortality. Conclusions This study reported a mortality rate of 55% in critically ill COVID-19 patients with ARDS who also required mechanical ventilation. The results corroborate previous findings that older and more comorbid patients represent the population at most risk of a poor outcome in this setting.

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A Comparative Study of CURB-65 and Expanded CURB-65 Scoring Systems in Community Acquired Pneumonia in a Tertiary Care Centre of Patna

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/207 ◽

2021 ◽

Vol 8 (16) ◽

pp. 1074-1078

Author(s):

Debjit Mitra ◽

Uttiya Roy ◽

Abhay Kumar Sinha ◽

Shiv Shankar Bharti

Keyword(s):

Mechanical Ventilation ◽

Mortality Rate ◽

Scoring System ◽

Tertiary Care ◽

Community Acquired Pneumonia ◽

Care Centre ◽

Tertiary Care Centre ◽

Medical College ◽

Co Morbidity ◽

Significant Difference

BACKGROUND A variety of organisms cause community-acquired pneumonia, including bacteria, viruses and fungi. Pathogens vary in age and other factors, but the relative importance of each pneumonia as a cause of community-acquired pneumonia remains uncertain because most patients do not undergo thorough testing and because even when tested, specific agents are found in < 50 percent of cases. This study was conducted to evaluate a severity scoring system for community acquired pneumonia and compare it with the standard confusion, urea, respiratory rate, blood pressure and 65 years of age or older (CURB-65) scoring system in a tertiary care centre in Patna Medical College. METHODS This hospital based prospective study was conducted among 100 consecutive patients of community-acquired pneumonia (CAP) attending OPD or getting admitted in General Medicine ward of Patna Medical College. The CURB-65 and Expanded CURB-65 scores for these patients were calculated and the accuracy of either in predicting outcomes was statistically analysed, during the period September 2018 - May 2019. RESULTS The mean age of CAP patients in our study was 59.09 ± 12.942 years, the most common co-morbidity observed was diabetes mellitus followed by chronic obstructive pulmonary disorders (COPD), cardiovascular disease, chronic liver disease and chronic renal disease. Our study showed that the mortality rate of the study population was 12 % and 30 % patients needed admission in the ICU and 24 % patients needed invasive mechanical ventilation. In the above analysis for 30-day mortality rate, ICU admission rate, and the need for mechanical ventilation among 0 - 2 and 3 - 5 CURB 65 scores, we found no statistically significant difference (P-value = > 0.05). CONCLUSIONS The extended CURB-65 score gives priority to both clinical and laboratory parameters and is a more accurate marker for the evaluation of CAP severity and may boost the effectiveness of predicting mortality in CAP patients compared to the current CURB-65 score system. KEYWORDS CAP, CURB-65, Expanded CURB-65

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Concomitant Myeloproliferative Disorders (MPD) and Amyloidosis

Blood ◽

10.1182/blood.v128.22.5480.5480 ◽

2016 ◽

Vol 128 (22) ◽

pp. 5480-5480 ◽

Cited By ~ 1

Author(s):

Angeline J Pallante ◽

Nelson Leung ◽

Robert A. Kyle ◽

Ayalew Tefferi ◽

Stephen J. Russell ◽

...

Keyword(s):

Mortality Rate ◽

Polycythemia Vera ◽

Median Time ◽

Chronic Myelogenous Leukemia ◽

Mayo Clinic ◽

Research Funding ◽

Myelogenous Leukemia ◽

Time To Death ◽

Mean Time ◽

Common Combination

Abstract Background: The combination of MPD and amyloidosis is rare, and this patient population's clinical outcome is not well studied. Methods: Pts with a MPD and amyloidosis were identified via an clinical note search engine that searches through the electronic medical records of patients seen at Mayo Clinic Rochester, Jacksonville, and Scottsdale between 1990 and 2016. Terms used included amyloid or amyloidosis, chronic myelogenous leukemia or CML, essential thrombocytopenia or ET, and polycythemia vera or PV. Demographic and clinical data were abstracted from the medical record. Pts with both disorders were analyzed and their mortality rates along with median time to death were calculated. Prevalences at the Mayo Clinic were calculated for the years 2014 and 2015. Results: Twenty-three pts diagnosed with both a MPD and amyloidosis were identified. Thirteen (56.5%) were male, 10 (43%) were female. Eleven (47.8%) were initially diagnosed at the Mayo Clinic. Types of amyloidosis were as follows: Eleven (47%) had immunoglobulin light-chain (AL), four had localized (17%), two (8.7%) had wild-type transthyretin (ATTR), one (4.3%) had mutant ATTR, and five (21.8%) were unknown. Types of MPD were as follows: Seven (30%) had polycythemia vera (PV), seven (30%) had chronic myelogenous leukemia (CML), five (22%) had myelofibrosis, and four (17%) had essential thrombocytosis (ET). Fifteen (65%) were initially diagnosed with a MPD. Median time to last follow-up from second diagnosis was 1.7 years, and median time to death following second diagnosis was 1.4 years. The mortality rate was 87% in the total population. The median time to death for AL and PV was 2.7 years, AL and CML 1.0 years, and AL and ET 1.17 years. Myelofibrosis did not occur with AL. The most common combination was AL and PV, which accounted for five (22%) of the cases. Treatment regimens for the patients with AL were varied. Multiple drugs were combined with dexamethasone including melphalan, velcade, pomalidomide, lenalidomide, doxorubicin, and revlimid. Cyclophosphamide, bortezomib, and dexamethasone (CyBorD) were used in two cases. The mean time to diagnosis of amyloidosis from symptom onset was 10.3 months. Prevalences of AL and a MPD in 2014 and 2015 at the Mayo Clinic were 2.8% and 1.5%, respectively. Conclusions: The mortality rate for the combined diagnoses is high. The most common combination of diagnoses was that of AL and PV, which was associated with a mean time to death of 2.7 years. Disclosures Al-Kali: Celgene: Research Funding; Onconova Therapeutics, Inc.: Research Funding.

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Oxygen reserve index for non-invasive early hypoxemia detection during endotracheal intubation in intensive care: the prospective observational NESOI study

Annals of Intensive Care ◽

10.1186/s13613-021-00903-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hugo Hille ◽

Aurelie Le Thuaut ◽

Emmanuel Canet ◽

Jeremie Lemarie ◽

Laura Crosby ◽

...

Keyword(s):

Intensive Care ◽

Endotracheal Intubation ◽

Median Time ◽

Multivariable Analysis ◽

Systolic Arterial Pressure ◽

Preventive Action ◽

Single Centre ◽

Non Invasive ◽

Single Centre Study ◽

Oesophageal Intubation

Abstract Background To evaluate the ability of the oxygen reserve index (ORI) to predict the occurrence of mild hypoxemia (defined as SpO2 < 97%) during endotracheal intubation (ETI) of patients in the intensive care unit (ICU). Methods This observational single-centre study included patients without hypoxemia (defined as SpO2/FiO2 > 214) who required ETI in the ICU. Patients were followed during preoxygenation and ETI then until hospital discharge and/or day 28. We recorded cases of mild hypoxemia, moderate (SpO2 < 90%) and severe (SpO2 < 80%) hypoxemia, moderate arterial hypotension (systolic arterial pressure < 90 mmHg), oesophageal intubation, aspiration, cardiac arrest, and death. Results Between January 2019 and July 2020, 56 patients were included prospectively and 51 patients were analysed. Twenty patients had mild hypoxemia between the end of preoxygenation and the end of intubation; in 10 of these patients, the decrease in SpO2 below 97% was preceded by an ORI < 0.4, the median time difference being 81 s [interquartile range, 34–146]. By multivariable analysis, a higher ORI (by 0.1 increase) value during preoxygenation was associated with absence of hypoxemia (odds ratio, 0.76; 95% confidence interval, 0.61;0.95; P = 0.0141). Conclusion In non-hypoxemic patients, the 81-s [34–146] median time between the ORI decrease below 0.4 and the SpO2 decrease below 97% during apnoea may allow preventive action. A higher ORI value during preoxygenation was independently protective against hypoxemia. Whether these findings also apply to hypoxemic patients, and the clinical impact of a preoxygenation strategy based on ORI monitoring, remain to be evaluated prospectively. Trial Registration ClinicalTrial.gov, #NCT03600181.

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Characterization and Outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: A single center experience

10.21203/rs.3.rs-49674/v1 ◽

2020 ◽

Author(s):

Rahul Y. Mahida ◽

Minesh Chotalia ◽

Joseph Alderman ◽

Chhaya Patel ◽

Amber Hayden ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Ethnic Group ◽

Single Center ◽

Single Centre ◽

Centre Study ◽

Icu Admission ◽

Single Center Experience ◽

Clinical Syndromes ◽

Single Centre Study

Abstract ARDS is the major cause of mortality in patients with SARS-CoV-2 pneumonia. We report a single-centre study comparing the characteristics of ARDS patients with and without SARS-CoV-2. A greater proportion of SARS-CoV-2 patients were from an Asian ethnic group (p=0.002). SARS-CoV-2 patients had lower circulating leukocytes, neutrophils and monocytes (p<0.0001), but higher CRP (p=0.016) on ICU admission. SARS-CoV-2 patients required a longer duration of mechanical ventilation (p=0.01), but had lower vasopressor requirements (p=0.016). While the clinical syndromes of SARS-CoV-2 and CAP-ARDS are similar, the dysregulated inflammation observed in SARS-CoV-2 may contribute to the increased duration of respiratory failure.

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Outcomes of secondary trapeziectomy after revision of trapeziometacarpal implants: a retrospective comparative matched study

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211039184 ◽

2021 ◽

pp. 175319342110391

Author(s):

Alexandre Cerlier ◽

Didier Guinard ◽

André M Gay ◽

Régis Legré

Keyword(s):

Median Time ◽

Prosthesis Failure ◽

Single Centre ◽

Level Of Evidence ◽

Centre Study ◽

Significant Difference ◽

Single Centre Study ◽

Matched Study

We evaluated secondary trapeziectomy for revision of trapeziometacarpal implants and compared this to primary trapeziectomy with a matched retrospective single centre study performed between October 2003 and February 2015. Thirty-one patients with trapeziometacarpal prosthesis failure who had a secondary trapeziectomy were matched with a primary trapeziectomy regarding sex, date of the operation and age. We evaluated function, mobility, autonomy, pain, strength, complications and shortening of the thumb on radiographs. The median time until removal of the implant was 37 months. The median age in both groups was similar. Median follow-up was more than 7 years in both groups. There was no statistically significant difference in terms of function, mobility, autonomy, pain, strength, complications and shortening of the thumb. Secondary trapeziectomy after revision of trapeziometacarpal implants provides results comparable with primary trapeziectomy. Level of evidence: III

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