scholarly journals ICU-Acquired Pneumonia Is Associated with Poor Health Post-COVID-19 Syndrome

2021 ◽  
Vol 11 (1) ◽  
pp. 224
Author(s):  
Ignacio Martin-Loeches ◽  
Anna Motos ◽  
Rosario Menéndez ◽  
Albert Gabarrús ◽  
Jessica González ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Poor Health ◽  
Health Post ◽  
Factors Associated ◽  
Beneficial Effects ◽  
Female Sex ◽  
Icu Stay ◽  
Discharged Patients ◽  
Final Cohort

Background. Some patients previously presenting with COVID-19 have been reported to develop persistent COVID-19 symptoms. While this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the incidence and factors associated with the characteristics of persistent COVID-19. On the other hand, these patients very often have intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence on poor health post-COVID 19 syndrome in ICU-discharged patients. Methods: This prospective, multicentre, and observational study was carrid out across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. Results: A total of 1255 ICU patients were scheduled to be followed up at 3 months; however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP). Patients requiring invasive mechanical ventilation had more persistent post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, development of ICUAP, and ARDS were independent factors for persistent poor health post-COVID-19. Conclusions: Persistent post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay, development of ICUAP, and ARDS all comprised independent factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-COVID-19.

scholarly journals ICU-Acquired Pneumonia is a Risk Factor of a Poor Health Post-Covid-19 Syndrome

2021 ◽  
Author(s):  
Ignacio Martin-Loeches ◽  
Anna Motos ◽  
Rosario Menéndez ◽  
Albert Gabarrus ◽  
Jessica González ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Poor Health ◽  
Health Post ◽  
Beneficial Effects ◽  
Female Sex ◽  
Icu Stay ◽  
Discharged Patients ◽  
Independent Risk Factors

Abstract Background. Some patients who had previously presented with COVID-19 have been reported to develop persistent COVID-19 symptoms. Whilst this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the prevalence and risk factors and characteristics of persistent COVID_19 . On other hand these patients have very often intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence in the poor health post-Covid 19 syndrome in ICU discharged patientsMethods: This prospective, multicentre and observational study was done across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. Results: A total of 1,255 ICU patients were scheduled to be followed up at 3 months; however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP) Patients requiring invasive mechanical ventilation had persistent, post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, and development of ICUAP were independent risk factors for persistent poor health post-COVID-19.Conclusions: Persistent, post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay and the onset of ICUAP comprised all independent risk factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-Covid 19

scholarly journals Factors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Lídia Miranda Barreto ◽  
◽  
Cecilia Gómez Ravetti ◽  
Thiago Bragança Athaíde ◽  
Renan Detoffol Bragança ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Judgment ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Orotracheal Intubation ◽  
Icu Mortality ◽  
Factors Associated ◽  
Non Invasive ◽  
Ventilation Failure

Abstract Background The usefulness of non-invasive mechanical ventilation (NIMV) in oncohematological patients is still a matter of debate. Aim To analyze the rate of noninvasive ventilation failure and the main characteristics associated with this endpoint in oncohematological patients with acute respiratory failure (ARF). Methods A ventilatory support protocol was developed and implemented before the onset of the study. According to the PaO2/FiO2 (P/F) ratio and clinical judgment, patients received supplementary oxygen therapy, NIMV, or invasive mechanical ventilation (IMV). Results Eighty-two patients were included, average age between 52.1 ± 16 years old; 44 (53.6%) were male. The tested protocol was followed in 95.1% of cases. Six patients (7.3%) received IMV, 59 (89.7%) received NIMV, and 17 (20.7%) received oxygen therapy. ICU mortality rates were significantly higher in the IMV (83.3%) than in the NIMV (49.2%) and oxygen therapy (5.9%) groups (P < 0.001). Among the 59 patients who initially received NIMV, 30 (50.8%) had to eventually be intubated. Higher SOFA score at baseline (1.35 [95% CI = 1.12–2.10], P = 0.007), higher respiratory rate (RR) (1.10 [95% CI = 1.00–1.22], P = 0.048), and sepsis on admission (16.9 [95% CI = 1.93–149.26], P = 0.011) were independently associated with the need of orotracheal intubation among patients initially treated with NIMV. Moreover, NIMV failure was independently associated with ICU (P < 0.001) and hospital mortality (P = 0.049), and mortality between 6 months and 1 year (P < 0.001). Conclusion The implementation of a NIMV protocol is feasible in patients with hematological neoplasia admitted to the ICU, even though its benefits still remain to be demonstrated. NIMV failure was associated with higher SOFA and RR and more frequent sepsis, and it was also related to poor prognosis.

scholarly journals Clinical Characteristics of Severe Covid Pneumonia: Exploring New Trends in ICU

2020 ◽  
Author(s):  
Aftab Akhtar ◽  
Sheher Bano ◽  
Ahtesham Iqbal ◽  
Moazma Ramzan ◽  
Aayesha Qadeer ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Rare Complication ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Severe Pneumonia ◽  
Icu Mortality ◽  
Icu Stay ◽  
Vasopressor Support ◽  
Study Population ◽  
Surgical Emphysema

Abstract Background: In late December 2019, Covid-19 emerged as clusters of pneumonia of unknown cause in a province of china, Wuhan. Etiological agent was identified as novel coronavirus that resembles severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East Respiratory syndrome coronavirus (MERS-CoV) and has zoonotic transmission. Covid pneumonia can remain asymptomatic, present as mild infection, severe pneumonia or respiratory failure. Diagnosis is based on rRT-PCR carried out on respiratory secretions. Covid related mortality exceeds 50% once patient requires ICU admission. Objective: To study the characteristics of ICU population admitted to ICU of Shifa International hospital.Results: we prospectively analysed 74 patients which included 43.3% females and 56.7% males. Commonest symptoms were shortness of breath (94.5%), fever (74.3%) and cough (74.3%). Most of our study population consisted of non-smokers (79.7%) and had hypertension (59.4%) followed by diabetes (47.2%). Hydroxychloroquine (HCQ) and azithromycin combination is superior to hydroxychloroquine and doxycycline in reducing mortality (p=0.023) whereas Doxycycline alone resulted in increased mortality (p=0.009). Those who did not require antibiotics or required only narrow spectrum antibiotics had increased survival and reduced requirement of invasive mechanical ventilation (p=< 0.0001). in our study population, (44.9%) developed acute kidney injury, 2.7% needed re-intubations 10.8% developed surgical emphysema and 2.7 % thromboembolic events despite full anticoagulation. ICU mortality was 41.8% and was higher in females (59.4%, p=0.008), those who had SOFA score > 3.5 at time of admission, raised D-Dimers > 931 ng/ml, NLR > 9.2. It was further high in those who required invasive mechanical ventilation and vasopressor support (58.1% mortality p=< 0.001). ICU stay was more prolonged in those requiring invasive mechanical ventilation as compared to those who did not. (23 days vs 6 days, p=0.001). Mean plateau pressure was 19.6 ± 7.6; mean Driving pressures 14.4 ± 4.6; mean PaO2/FiO2 150.7 ± 73.9; mean SPO2/FiO2 173.9 ± 106.9; mean PEEP was 8.2 ±4.33.Conclusion: We concluded that severe covid pneumonia is common amongst males, non-smokers those who had comorbid. HCQ and azithromycin combination is superior to combination of HCQ and doxycycline or doxycycline alone and QT prolongation is a rare complication. Baseline NLR, APACHI II, SOFA, SAPS II, NUTRIC scores, D-Dimers, invasive ventilation and vasopressor support are important tools to predict ICU mortality. Invasive mechanical ventilation carries higher mortality and associated with more prolonged ICU stay. AKI is most common complication followed by shock and surgical emphysema. CRP, Ferritin levels has no impact on outcome.

scholarly journals Association between lung compliance phenotypes and mortality in COVID-19 patients with acute respiratory distress syndrome

2021 ◽  
Vol 50 (9) ◽  
pp. 686-694
Author(s):  
Ser Hon Puah ◽  
Matthew Edward Cove ◽  
Jason Phua ◽  
Amit Kansal ◽  
Jonathen Venkatachalam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Lung Compliance ◽  
High Compliance ◽  
Factors Associated ◽  
Risk Of Death

ABSTRACT Introduction: Acute respiratory distress syndrome (ARDS) in COVID-19 is associated with a high mortality rate, though outcomes of the different lung compliance phenotypes are unclear. We aimed to measure lung compliance and examine other factors associated with mortality in COVID-19 patients with ARDS. Methods: Adult patients with COVID-19 ARDS who required invasive mechanical ventilation at 8 hospitals in Singapore were prospectively enrolled. Factors associated with both mortality and differences between high (<40mL/cm H2O) and low (<40mL/cm H2O) compliance were analysed. Results: A total of 102 patients with COVID-19 who required invasive mechanical ventilation were analysed; 15 (14.7%) did not survive. Non-survivors were older (median 70 years, interquartile range [IQR] 67–75 versus median 61 years, IQR 52–66; P<0.01), and required a longer duration of ventilation (26 days, IQR 12–27 vs 8 days, IQR 5–15; P<0.01) and intensive care unit support (26 days, IQR 11–30 vs 11.5 days, IQR 7–17.3; P=0.01), with a higher incidence of acute kidney injury (15 patients [100%] vs 40 patients [46%]; P<0.01). There were 67 patients who had lung compliance data; 24 (35.8%) were classified as having high compliance and 43 (64.2%) as having low compliance. Mortality was higher in patients with high compliance (33.3% vs 11.6%; P=0.03), and was associated with a drop in compliance at day 7 (-9.3mL/cm H2O (IQR -4.5 to -15.4) vs 0.2mL/cm H2O (4.7 to -5.2) P=0.04). Conclusion: COVID-19 ARDS patients with higher compliance on the day of intubation and a longitudinal decrease over time had a higher risk of death. Keywords: ARDS, COVID-19-associated respiratory failure, high-flow nasal cannula therapy, HFNC, post-intubation, ventilation strategies

scholarly journals A Tale of a Two Waves Epidemic: Characteristics and Mortality Risk Factors for COVID-19 ICU Patients in the French West Indies

2021 ◽  
Author(s):  
jean-david Pommier ◽  
frederic Martino ◽  
Kevin Bleakley ◽  
Laure Flurin ◽  
Fabien Van Roy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
West Indies ◽  
Invasive Mechanical Ventilation ◽  
Severe Pneumonia ◽  
University Hospital ◽  
French West Indies ◽  
Old Patients ◽  
Factors Associated ◽  
Second Wave

Abstract Introduction Guadeloupe, a French West Indies island, has been fiercely affected by two large waves of COVID.Therapeutic approach was different between the two waves in the intensive care unit (ICU). We aimed to compare the two different periods in terms of characteristics and outcomes and to evaluate risk factors associated with 60-day mortality in our overall cohort. Methods All consecutive patients with laboratory confirmed COVID-19 pneumonia and requiring oxygen support admitted in our ICU unit of University Hospital of Guadeloupe were prospectively included. Patients were treated during the first wave with a combination of Hydroxychloroquine and Azithromycin and during the second wave with dexamethasone and reinforced anticoagulation. Results In our cohort, 187 patients were included, 31 during the first one and 156 during the second. Patients were mostly male (69%) with a median age of 64years old. Patients tend to be younger during the second wave and body mass index was higher (respectively 31 vs 27kg/m2, p=0.01). Overall mortality at Day 60 was high (45%) and not different between the two waves. Among patients under mechanical ventilation risk factors associated with death in a multivariate analysis were a high number of comorbidities, a high level of SOFA score and the delay of invasive mechanical ventilation (IMV) onset after admission in ICU (OR=1.6 (95% CI 1.2 – 2.4). Conclusion Although therapeutics approach evolve, COVID-19 severe pneumonia is still associated with a high mortality rate in ICU.

Comparison between different weaning methods in chronic obstructive pulmonary disease patients with respiratory failure (BIPAP, CPAP and T piece)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Omar Mohamed Taha Elsafty ◽  
Osama Ramzy Yousef ◽  
Marwa Mostafa Mohamed Mowafy ◽  
Ahmed Farag Abdelsamie Sadek Salama
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Gas Exchange ◽  
General Hospital ◽  
Pulmonary Disease ◽  
Invasive Mechanical Ventilation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Icu Stay

Abstract Background Invasive mechanical ventilation (IMV) for management of chronic obstructive pulmonary disease (COPD) associated respiratory failure is increasing in Intensive Care Units. The bridging process from IMV to extubation is called weaning in which mechanical ventilation is gradually withdrawn and the patient resumes spontaneous breathing. Many objective parameters have been defined for weaning success. The following review focuses on the different weaning methods in patients chronic obstructive pulmonary disease with respiratory failure. Objective To compare among the different methods of weaning in chronic obstructive pulmonary disease patients with respiratory failure weaned with different method ie BIPAP, CPAP and T-Piece. Patients and Methods Cross sectional descriptive study. 60 patients diagnosed as COPD with respiratory failure on MV, will be recruited from ICU Department Zefta general hospital. This study included 60 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) with age more than18 years old admitted in adult ICU Department in Zefta general hospital that are on mechanical ventilation. These patients fulfilled the inclusion criteria of the study. Patients were classified randomly into 3 groups. Results In this study I try to overcome these challenges by studying the effect of using of NIPPV both CPAP or BIPAP immediately after extubation or using T piece for 1 hour followed by extubation and using oxygen therapy that BIPAP improves patient gas exchange, hemodynamics and associated with shortest ICU stay which reflects on utilization of resources. Conclusion We suggest that BIPAP improves patient gas exchange specially in hypercapnic patients, hemodynamics and associated with shortest duration of ICU stay and decrease rate of reintuabtion.

scholarly journals Tracheostomy Practice in Mechanically Ventilated Patients With SARS-CoV-2 Induced Acute Respiratory Distress Syndrome: a Single-center Retrospective Study With Focus on Tracheomalacia

2021 ◽  
Author(s):  
Marcello Guarnieri ◽  
Patrizia Andreoni ◽  
Hedwige Gay ◽  
Riccardo Giudici ◽  
Maurizio Bottiroli ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Single Center ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Factors Associated ◽  
Ventilated Patients

Abstract Background: The SARS-CoV-2 pandemic increased the number of patients needing invasive mechanical ventilation, either through an endotracheal tube or through a tracheostomy. Tracheomalacia is a rare, but potentially severe complication of mechanical ventilation, which can significantly complicate the weaning process. Aim of this study was to describe the strategies of airway management in mechanically ventilated patients with respiratory failure due to SARS-CoV-2, the incidence of severe tracheomalacia, and investigate the factors associated with its occurrence.Methods. Retrospective, single-center study performed in an Italian teaching hospital. All adult patients admitted to the Intensive Care Unit (ICU) between February 24 and June 30, 2020, treated with invasive mechanical ventilation for respiratory failure caused by SARS-CoV-2 were included. Clinical data were collected on the day of ICU admission, while information regarding airway management was collected daily.Results. A total of 151 patients were included in the study. On admission, ARDS severity was mild in 21%, moderate in 62%, and severe in 17% of the cases, with an overall mortality of 39.7%. A tracheostomy was performed in 73 (48.3%) patients: open surgical technique in 54 patients (74%) and percutaneous Ciaglia technique in 19 patients (26%). Patients in whom a tracheostomy was performed had, compared to the other patients, a longer duration of mechanical ventilation and longer ICU and hospital length of stay. Tracheomalacia was diagnosed in 8 (5%) patients. The factors associated with tracheomalacia were female sex, obesity, and tracheostomy.Conclusions. In our population, approximately 50% of patients with ARDS due to SARS-CoV-2 were tracheostomized. Tracheostomized patients had a longer ICU and hospital length of stay. Five percent of our population was diagnosed with tracheomalacia. This percentage is 10 times higher than what is reported in available literature and the underlying mechanisms are not fully understood.

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