scholarly journals Impact of Corticosteroid Administration within 7 Days of the Hospitalization for Influenza Pneumonia with Respiratory Failure: A Propensity Score Analysis Using a Nationwide Administrative Database

2021 ◽  
Vol 10 (3) ◽  
pp. 494
Author(s):  
Daisuke Okuno ◽  
Takashi Kido ◽  
Keiji Muramatsu ◽  
Kei Tokutsu ◽  
Sakiko Moriyama ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Mortality Rate ◽  
Corticosteroid Therapy ◽  
Invasive Mechanical Ventilation ◽  
Administrative Database ◽  
Unit Management ◽  
Influenza Pneumonia ◽  
Intensive Care Unit Management

Influenza pneumonia, which causes acute respiratory distress syndrome and multiple organ failure, has no established management protocol. Recently, corticosteroid therapy was used to treat coronavirus disease 2019 with respiratory failure; however, its effectiveness as a treatment for influenza pneumonia remains controversial. To investigate the impact of corticosteroid therapy for the early phase of severe influenza pneumonia, we compared influenza pneumonia patients with respiratory failure treated with or without corticosteroids within 7 days after hospital admission using a Japanese nationwide administrative database. The primary endpoint was the mortality rate. The secondary endpoints were duration of intensive-care unit management, invasive mechanical ventilation, and hospital stay. The inverse probability weighting method with estimated propensity scores was used to minimize the data collection bias. We included 3519 patients with influenza pneumonia with respiratory failure. Of these, 875 were treated with corticosteroids. There was no significant difference between the groups regarding 30-day and 90-day mortality, duration of intensive-care unit management, invasive mechanical ventilation, and hospital stay. However, the in-hospital mortality rate was higher in the corticosteroid group. The use of systematic corticosteroid therapy in patients with influenza pneumonia was associated with a higher in-hospital mortality rate.

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

scholarly journals Pseudomonas aeruginosa bacteremia: resistance to antibiotics, risk factors, and patient mortality

Medicina ◽  
2010 ◽  
Vol 46 (7) ◽  
pp. 490 ◽  
Author(s):  
Astra Vitkauskienė ◽  
Erika Skrodenienė ◽  
Asta Dambrauskienė ◽  
Andrius Macas ◽  
Raimundas Sakalauskas
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Mortality Rate ◽  
Central Vein ◽  
Vein Catheter ◽  
Central Vein Catheter

The aim of our study was to determine the prevalence of Pseudomonas aeruginosa bacteremia, risk factors, and outcome of patients treated at the Hospital of Kaunas University of Medicine. Material and methods. All hospitalized patients with blood culture positive for Pseudomonas aeruginosa during the 5-year period were included. A retrospective data analysis was performed to evaluate patients’ risk factors and mortality caused by P. aeruginosa bacteremia. Results. A total of 47 (58.8%) bacteremia episodes occurred in an intensive care unit (ICU). A primary source of bacteremia was identified in 50 (62.5%) episodes. Overall mortality rate was 58.8%. Univariate risk factors analysis showed the factors, which significantly increased the risk of death: mechanical ventilation (13.67 times, P<0.001), patient hospitalization in the ICU (8.51 times, P<0.001), acute respiratory failure (8.44 times, P<0.001), infection site in the respiratory tract (4.93 times, P=0.003), and central vein catheter (4.44 times, P=0.002). Timely and appropriate treatment and surgery were significant protective factors for 30-day mortality (11.1 and 5.26 times, respectively; P=0.001). Meropenem-resistant Pseudomonas aeruginosa strains caused bacteremia more frequently in patients older than 65 years than meropenem-sensitive strains (57.9%, n=11). All 19 patients with meropenem-resistant Pseudomonas aeruginosa bacteremia received inappropriate empirical antibiotic therapy. Conclusions. Treatment at the intensive care unit, mechanical ventilation, acute respiratory failure, source of infection in respiratory tract, and central vein catheter are the major risk factors associated with an increased mortality rate in patients with Pseudomonas aeruginosa bacteremia. The patients older than 65 years are at increased risk for bacteremia caused by carbapenemresistant Pseudomonas aeruginosa strains. Carbapenems are not antibiotics of the choice of treatment for Pseudomonas aeruginosa bacteremia at the Hospital of Kaunas University of Medicine.

scholarly journals High flow nasal cannula oxygen and non-invasive mechanical ventilation in management of COVID-19 patients with acute respiratory failure: a retrospective observational study

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Amr Mounir Shoukri
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Mortality Rate ◽  
Endotracheal Intubation ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

Abstract Background High flow nasal cannula oxygen (HFNCO) is a relatively new technique used to deliver oxygen in respiratory failure patients. This retrospective study is aiming to assess the role and benefits of using HFNCO compared to non-invasive ventilation (NIV) in management of patients with acute hypoxemic respiratory failure associated with coronavirus disease 2019 (COVID-19). Results A retrospective analysis of the files of 63 patients with COVID-19 and acute hypoxemic respiratory failure admitted to the intensive care unit (ICU), 37 patients received HFNCO as initial therapy, and 26 patients were primarily treated with NIV. There was no significant difference between the 2 groups in terms of baseline characteristics, laboratory tests, arterial blood gases, PaO2/FiO2 values, and vital signs. Re-assessment after 24 h of starting treatment with either HFNCO or NIV showed significant improvement (P<0.01) in the respiratory rate, heart rate, and oxygenation parameters. The magnitude of improvement of the vital signs and oxygenation was not significantly different between patients using HFNCO or NIV. Success rate of HFNCO was 86.4%, endotracheal intubation with invasive mechanical ventilation was required in 10.81% of patients, and mortality rate was 2.7%. Success rate of NIV was 84.6%, endotracheal intubation rate was 11.53%, and mortality rate was 3.8%. No significant difference (P>0.05) between the 2 groups as regards the duration of treatment, rate of endotracheal intubation with invasive mechanical ventilation, and mortality rate. Conclusion High flow nasal cannula oxygen (HFNCO) is effective in the management of acute hypoxemic respiratory failure associated with COVID-19. Its efficacy is similar to NIV, with no difference in the duration of treatment, endotracheal intubation rate, or mortality rate.

scholarly journals Characteristics and outcomes of 974 COVID-19 patients in intensive care units in Turkey

2021 ◽  
Vol 41 (6) ◽  
pp. 318-326
Author(s):  
Hülya Sungurtekin ◽  
Cansu Ozgen ◽  
Ulku Arslan ◽  
Kemal Tolga Saracoglu ◽  
Volkan Yarar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Conflict Of Interest ◽  
Patient Management ◽  
Invasive Mechanical Ventilation ◽  
Imaging Findings ◽  
Common Cause ◽  
Age Range

BACKGROUND: In our previous report on Turkish COVID-19 patients requiring intensive care, the 24 patients in a single ICU were elderly and mortality was high. We extended our analysis to include patients admitted to ten ICUs. OBJECTIVES: Report the demographics, clinical features, imaging findings, comorbidities, and outcomes in COVID-19 patients. DESIGN: Retrospective. SETTING: Intensive care unit. PATIENTS AND METHODS: The study includes patients with clinical and radiological confirmed or laboratory-confirmed COVID-19 infection who were admitted to ten ICUs between 15 March and 30 June 2020. MAIN OUTCOME MEASURES: Clinical outcomes, therapies, and death during hospitalization SAMPLE SIZE: 974, including 571 males (58%). RESULTS: The median age (range) was 72 (21–101) years for patients who died (n=632, 64.9%) and 70 (16–99) years for patients who lived (n=432, 35.2%) ( P <.001). APACHE scores, and SOFA scores were higher in patients who died than in those who survived ( P <.001, both comparisons). Respiratory failure was the most common cause of hospitalization (82.5%), and respiratory failure on admission was associated with death ( P =.013). Most (n=719, 73.8%) underwent invasive mechanical ventilation therapy. CONCLUSIONS: The majority of patients admitted to the ICU with a diagnosis of COVID-19 require respiratory support. LIMITATIONS: Although the Turkish Ministry of Health made recommendations for the treatment of COVID-19 patients, patient management may not have been identical in all ten units. CONFLICT OF INTEREST: None.

scholarly journals Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit

2018 ◽  
Vol 27 (150) ◽  
pp. 180061 ◽  
Author(s):  
Julio A. Huapaya ◽  
Erin M. Wilfong ◽  
Christopher T. Harden ◽  
Roy G. Brower ◽  
Sonye K. Danoff
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Interstitial Lung Disease ◽  
Mortality Rate ◽  
Lung Disease ◽  
Mortality Rates ◽  
Population Heterogeneity

Data on interstitial lung disease (ILD) outcomes in the intensive care unit (ICU) is of limited value due to population heterogeneity. The aim of this study was to examine risk factors for mortality and ILD mortality rates in the ICU.We performed a systematic review using five databases. 50 studies were identified and 34 were included: 17 studies on various aetiologies of ILD (mixed-ILD) and 17 on idiopathic pulmonary fibrosis (IPF). In mixed-ILD, elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality. No increased mortality was found with steroid use. Evidence is inconclusive on advanced age. In IPF, evidence is inconclusive for all factors except mechanical ventilation and hypoxaemia. The overall in-hospital mortality was available in 15 studies on mixed-ILD (62% in 2001–2009 and 48% in 2010–2017) and 15 studies on IPF (79% in 1993–2004 and 65% in 2005–2017). Follow-up mortality rate at 1 year ranged between 53% and 100%.Irrespective of ILD aetiology, mechanical ventilation is associated with increased mortality. For mixed-ILD, hypoxaemia and APACHE scores are also associated with increased mortality. IPF has the highest mortality rate among ILDs, but since 1993 the rate appears to be declining. Despite improving in-hospital survival, overall mortality remains high.

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