Clinical Significance of Timing of Intubation in Critically Ill Patients with COVID-19: A Multi-Center Retrospective Study

The effect of intubation timing on the prognosis of critically ill patients with coronavirus 2019 (COVID-19) is not yet well understood. We investigated whether early intubation is associated with the survival of COVID-19 patients with acute respiratory distress syndrome (ARDS). This multicenter, retrospective, observational study was done on 47 adult COVID-19 patients with ARDS who were admitted to the intensive care unit (ICU) in Daegu, Korea between February 17 and April 23, 2020. Clinical characteristics and in-hospital mortality were compared between the early intubation and initially non-intubated groups, and between the early and late intubation groups, respectively. Of the 47 patients studied, 23 (48.9%) were intubated on the day of meeting ARDS criteria (early intubation), while 24 (51.1%) were not initially intubated. Eight patients were never intubated during the in-hospital course. Median follow-up duration was 46 days, and 21 patients (44.7%) died in the hospital. No significant difference in in-hospital mortality rate was noted between the early group and initially non-intubated groups (56.5% vs. 33.3%, p = 0.110). Furthermore, the risk of in-hospital death in the early intubation group was not significantly different compared to the initially non-intubated group on multivariate adjusted analysis (p = 0.385). Results were similar between early and late intubation in the subgroup analysis of 39 patients treated with mechanical ventilation. In conclusion, in this study of critically ill COVID-19 patients with ARDS, early intubation was not associated with improved survival. This result may help in the efficient allocation of limited medical resources, such as ventilators.

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Impact of time to intubation on mortality and pulmonary sequelae in critically ill patients with COVID-19: a prospective cohort study

Critical Care ◽

10.1186/s13054-021-03882-1 ◽

2022 ◽

Vol 26 (1) ◽

Author(s):

Jessica González ◽

Iván D. Benítez ◽

David de Gonzalo-Calvo ◽

Gerard Torres ◽

Jordi de Batlle ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Prospective Cohort ◽

Invasive Mechanical Ventilation ◽

Respiratory Support ◽

Risk Of Mortality ◽

Early Intubation ◽

Delayed Group

Abstract Question We evaluated whether the time between first respiratory support and intubation of patients receiving invasive mechanical ventilation (IMV) due to COVID-19 was associated with mortality or pulmonary sequelae. Materials and methods Prospective cohort of critical COVID-19 patients on IMV. Patients were classified as early intubation if they were intubated within the first 48 h from the first respiratory support or delayed intubation if they were intubated later. Surviving patients were evaluated after hospital discharge. Results We included 205 patients (140 with early IMV and 65 with delayed IMV). The median [p25;p75] age was 63 [56.0; 70.0] years, and 74.1% were male. The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45 (95% CI 1.29–4.65). The continuous predictor time to IMV showed a nonlinear association with the risk of in-hospital mortality. A multivariate mortality model showed that delay of IMV was a factor associated with mortality (HR of 2.40; 95% CI 1.42–4.1). During follow-up, patients in the delayed group showed a worse DLCO (mean difference of − 10.77 (95% CI − 18.40 to − 3.15), with a greater number of affected lobes (+ 1.51 [95% CI 0.89–2.13]) and a greater TSS (+ 4.35 [95% CI 2.41–6.27]) in the chest CT scan. Conclusions Among critically ill patients with COVID-19 who required IMV, the delay in intubation from the first respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up.

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Clinical Significance of Bioimpedance Spectroscopy in Critically Ill Patients

Journal of Intensive Care Medicine ◽

10.1177/0885066617702591 ◽

2017 ◽

Vol 34 (6) ◽

pp. 495-502 ◽

Cited By ~ 3

Author(s):

Shang-Feng Yang ◽

Ching-Min Tseng ◽

I-Fan Liu ◽

Shin-Hung Tsai ◽

Wein-Shung Kuo ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Fluid Management ◽

Laboratory Data ◽

Acute Stage ◽

Volume Control ◽

Hospital Death ◽

Icu Admission ◽

The Third

Background: Early fluid resuscitation is a key aspect in the successful management of critically ill patients, but the optimal goal for volume control after the acute stage of critical illness remains unclear. This study aimed to evaluate the prognostic value of bioimpedance spectrometry for fluid management in critically ill patients. Methods: In this prospective observational study, patients who consented to participate were screened within the first 24 hours of admission to a medical intensive care unit (ICU) from February 4, 2015, to January 31, 2016. Information on demographics, comorbidities, primary reasons for admission, baseline laboratory data, and ventilator or inotropic use were documented. Data of fluid intake, fluid output, and body weight were recorded for the first 3 days of ICU admission. Bioimpedance spectrometry was performed on the first and third days after ICU admission. All participants were followed until death or hospital discharge. Results: Of the 140 enrolled patients (median age: 70 years, interquartile range: 60-77 years), 23 (16.4%) patients died during hospitalization. Independent predictors of hospital mortality were Acute Physiology and Chronic Health Evaluation II scores (per 1 point increase, odds ratio [OR]: 1.101) and overhydration (OH) volume on the first day (per 1 L increase, OR: 1.216). Compared to normal OH status (OH volume between −1 and 1 L), hyper OH status (OH volume < −1 L) on the third day after ICU admission was an independent predictor of hospital death (OR: 7.609). Normal OH status on the third day was associated with greater numbers of ICU-free and ventilator-free days. Conclusion: Bioimpedance spectrometry can be used to predict outcomes in critically ill patients. Increased OH volume on day 1 and hyper OH volume on day 3 of ICU admission are associated with a greater risk of hospital mortality. Volume status on day 3 is associated with durations of ventilator use and ICU stay.

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The Prognostic Value of Brain Dysfunction in Critically Ill Patients with and without Sepsis: A Post Hoc Analysis of the ICON Audit

Brain Sciences ◽

10.3390/brainsci11050530 ◽

2021 ◽

Vol 11 (5) ◽

pp. 530

Author(s):

Ilaria Crippa ◽

Fabio Taccone ◽

Xavier Wittebole ◽

Ignacio Martin-Loeches ◽

Mary Schroeder ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Brain Function ◽

Brain Dysfunction ◽

Hospital Death ◽

Post Hoc Analysis ◽

Increased Risk ◽

Brain Failure ◽

Post Hoc

Brain dysfunction is associated with poor outcome in critically ill patients. In a post hoc analysis of the Intensive Care over Nations (ICON) database, we investigated the effect of brain dysfunction on hospital mortality in critically ill patients. Brain failure was defined as a neurological sequential organ failure assessment (nSOFA) score of 3–4, based on the assumed Glasgow Coma Scale (GCS) score. Multivariable analyses were performed to assess the independent roles of nSOFA and change in nSOFA from admission to day 3 (ΔnSOFA) for predicting hospital mortality. Data from 7192 (2096 septic and 5096 non-septic) patients were analyzed. Septic patients were more likely than non-septic patients to have brain failure on admission (434/2095 (21%) vs. 617/4665 (13%), p < 0.001) and during the ICU stay (625/2063 (30%) vs. 736/4665 (16%), p < 0.001). The presence of sepsis (RR 1.66 (1.31–2.09)), brain failure (RR 4.85 (3.33–7.07)), and both together (RR 5.61 (3.93–8.00)) were associated with an increased risk of in-hospital death, but nSOFA was not. In the 3280 (46%) patients in whom ΔnSOFA was available, sepsis (RR 2.42 (1.62–3.60)), brain function deterioration (RR 6.97 (3.71–13.08)), and the two together (RR 10.24 (5.93–17.67)) were associated with an increased risk of in-hospital death, whereas improvement in brain function was not.

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Association between phosphate disturbances and mortality among critically ill patients with sepsis or septic shock

BMC Pharmacology and Toxicology ◽

10.1186/s40360-021-00487-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Shmeylan A. Al Harbi ◽

Hasan M. Al-Dorzi ◽

Albatool M. Al Meshari ◽

Hani Tamim ◽

Sheryl Ann I. Abdukahil ◽

...

Keyword(s):

Septic Shock ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Clinical Characteristics ◽

Serum Phosphate ◽

The Other ◽

Icu Admission ◽

Surgical Icus

Abstract Objective The aim of this study is to examine the association of hypophosphatemia and hyperphosphatemia on the first day of ICU admission with mortality in septic critically ill patients. Methods In this retrospective cohort study, all adult patients who were admitted to the medical-surgical ICUs between 2014 and 2017 with sepsis or septic shock were categorized as having hypophosphatemia, normophosphatemia and hyperphosphatemia based on day 1 serum phosphate values. We compared the clinical characteristics and outcomes between the three groups. We used multivariate analysis to examine the association of hypophosphatemia and hyperphosphatemia with these outcomes. Results Of the 1422 patients enrolled in the study, 188 (13%) had hypophosphatemia, 865 (61%) normophosphatemia and 369 (26%) had hyperphosphatemia. The patients in the hyperphosphatemia group had significantly lower GCS, higher APACHE II scores, higher serum creatinine, increased use of vasopressors, and required more mechanical ventilation with lower PaO2/FiO2 ratio compared with the other two groups. In addition, the hyperphosphatemia group showed significantly higher ICU and hospital mortality in comparison with the other two groups. Conclusion Hyperphosphatemia and not hypophosphatemia on the first ICU admission day was associated with an increase in the ICU and hospital mortality in septic critically ill patients.

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540. Does Remdesivir Impact the Clinical Outcome of Patients with COVID 19 Infection?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.739 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S371-S372

Author(s):

Karthik Gunasekaran ◽

Jisha S John ◽

Hanna Alexander ◽

Naveena Gracelin ◽

Prasanna Samuel ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Primary Outcome ◽

P Value ◽

Invasive Ventilation ◽

Quick Recovery ◽

Significant Difference ◽

Male Preponderance ◽

The Impact

Abstract Background Remdesivir (RDV), was included for the treatment of mild to moderate COVID-19 since July 2020 in our institution, following the initial results from ACTT-1 interim analysis report. With the adoption of RDV, there seems to be anecdotal evidence of efficacy as evidenced by early fever defervescence, quick recovery when on oxygen with decreased need for ventilation and ICU care. We aimed to study the impact of RDV on clinical outcomes among patients with moderate to severe COVID –19. Methods Nested case control study in the cohort of consecutive patients with moderate to severe COVID – 19. Cases were patients initiated on RDV and age and sex- matched controls who did not receive RDV were included. The primary outcome was in-hospital mortality. Secondary outcomes were, duration of hospital stay, need for ICU, duration of oxygen therapy and need for ventilation. Results A total of 926 consecutive patients with COVID – 19 were included, among which 411 patients were cases and 515 controls. The mean age of the cohort was 57.05±13.5 years, with male preponderance (75.92%). The overall in-hospital mortality was 22.46%(n=208). On comparison between cases and controls there was no statistically significant difference with respect to primary outcome [22.54% vs. 20.78%, (p value: 0.17)]. Progression to non-invasive ventilation (NIV) was higher among the controls [24.09% vs. 40.78% (p value: < 0.001*)]. Progression to invasive ventilation was also higher among the controls [5.35% vs. 9.71% (p value: 0.014*)]. In subgroup analysis among critically ill patients, the use of RDV showed decrease in mortality (OR 0.32 95% CI; 0.13 – 0.75 p value – 0.009*). Conclusion RDV did not decrease the in-hospital mortality among moderate to severe COVID – 19. However, there seems to be a significant reduction in mortality in critically ill patients. Disclosures All Authors: No reported disclosures

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Single Versus Multiple Doses of Tocilizumab in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19): A Two-center, Retrospective Cohort Study

10.21203/rs.3.rs-526150/v3 ◽

2021 ◽

Author(s):

Khalid Al Sulaiman ◽

Ohoud Al Juhani ◽

Khalid Bin Salah ◽

Ghazwa Koryem ◽

Khalid Eljaaly ◽

...

Keyword(s):

Single Dose ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Secondary Infection ◽

Demographic Data ◽

Vital Signs ◽

Multiple Doses ◽

Significant Difference

Abstract Background: In COVID-19 patients, increased IL-6 levels have been associated with poor disease prognosis. The use of tocilizumab shown to be effective in treating COVID-19 with varying success. This study aims to evaluate the effectiveness and safety of using a single dose of tocilizumab compared with multiple doses in critically ill COVID-19 patients.Methods:This study is a two-center, retrospective cohort, in which patients who received tocilizumab and were admitted to the ICU at two tertiary hospitals from March 1st, 2020, until January 31st, 2021were included. Patients were divided into two groups based on the number of doses of tocilizumab they received. Furthermore, we gathered additional data from the patients, such as but not limited to demographic data, vital signs, and laboratory markers. Multivariable logistic and generalized linear regression were used. We considered a P value of < 0.05 statistically significant. Results: Two hundred sixty-one patients were included in this study; 72.4% received a single dose of tocilizumab, while the rest (27.6%) had received multiple doses. Most of the patients were male, with an average age of 59.2. After adjusting for possible confounders, the 30-day mortality (HR 0.92; 95% CI, 0.48-1.75 p = 0.79) and in-hospital mortality (HR 0.69; 95% CI, 0.36-1.31 p = 0.25) were not significantly different between the two groups. On the flip side, patients who received multiple doses of tocilizumab have higher odds of secondary infection compared with a single dose (OR 3.06; 95% CI, 1.18-7.89 p = 0.02).Conclusion: Multiple doses of tocilizumab were not associated with a statistically significant difference in ICU and hospital mortality in critically ill patients infected with COVID-19. In contrast, it was associated with higher odds of secondary infections compared to a single dose.

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Dysbiosis of intestinal microbiota to predict in-hospital mortality in critically ill patients: results of a prospective observational cohort study

10.21203/rs.2.20261/v1 ◽

2020 ◽

Author(s):

Ru Wei ◽

Xu Chen ◽

Linhui Hu ◽

Zhimei He ◽

Xin Ouyang ◽

...

Keyword(s):

Intensive Care ◽

Hospital Mortality ◽

Critically Ill ◽

Intestinal Microbiota ◽

Sofa Score ◽

Critically Ill Patients ◽

Prognostic Value ◽

Apache Ii ◽

Hospital Death ◽

Death Group

Abstract Background: Despite the essential functions of the intestinal microbiota in human physiology, little research has been reported on the gut microbiota alteration in intensive care patients. This investigation aimed to explore the dysbacteriosis of intestinal flora in critically ill patients, and evaluate the prognostic performance of this dysbiosis to predict in-hospital mortality. Methods: A prospective cohort of patients were consecutively recruited at Intensive Care Units (ICUs) in Guangdong Provincial People's Hospital from March 2017 through October 2017. Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score were assessed, and fecal samples were taken for examination within 24 hours of ICU admission. The taxonomic composition of intestinal microbiome was determined using 16S rDNA gene sequencing. Patients were divided into survival and death group based on the outcomes in hospital. The two groups were statistically compared using the independent samples t test and Metastats analysis. Genera of bacteria showing significantly different abundance between groups were assessed for predictors of in-hospital death. The prognostic value of bacterial abundance alone and in combination with APACHE II or SOFA score were evaluated using the area under the receiver operating characteristic curve (AUROC). Results: Among the 61 patients that were examined, a total of 12 patients (19.7%) died during hospital stay. Bifidobacterium differed significantly in abundance between survival and death group ( P =0.031). The AUROC of Bifidobacterium abundance identifying in-hospital death at a cut-off probability of 0.0041 was 0.718 (95% confidence interval [CI], 0.588-0.826). The panel of Bifidobacterium abundance plus SOFA (AUROC, 0.882; 95% CI, 0.774-0.950) outperformed SOFA (AUROC, 0.649; 95% CI, 0.516-0.767; P =0.012) and Bifidobacterium abundance alone ( P =0.007). The panel of Bifidobacterium abundance plus APACHE II (AUROC, 0.876; 95% CI, 0.766-0.946) outperformed APACHE II (AUROC, 0.724; 95% CI, 0.595-0.831; P =0.035) and Bifidobacterium abundance alone ( P =0.012). Conclusions: Dysbiosis of intestinal microbiota with variable degree of reduction in Bifidobacterium abundance exhibits promising performance in predicting in-hospital mortality, and provides incremental prognostic value to existing scoring systems in the adult intensive care unit (ICU) setting.

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Single Versus Multiple Doses of Tocilizumab in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19): A Two-center, Retrospective Cohort Study

10.21203/rs.3.rs-526150/v2 ◽

2021 ◽

Author(s):

Khalid Al Sulaiman ◽

Ohoud Al Juhani ◽

Khalid Bin Salah ◽

Ghazwa Koryem ◽

Khalid Eljaaly ◽

...

Keyword(s):

Single Dose ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Secondary Infection ◽

Demographic Data ◽

Vital Signs ◽

Multiple Doses ◽

Significant Difference

Abstract Background: In COVID-19 patients, increased IL-6 levels have been associated with poor disease prognosis. The use of tocilizumab shown to be effective in treating COVID-19 with varying success. This study aims to evaluate the effectiveness and safety of using a single dose of tocilizumab compared with multiple doses in critically ill COVID-19 patients.Methods:This study is a two-center, retrospective cohort, in which patients who received tocilizumab and were admitted to the ICU at two tertiary hospitals from March 1st, 2020, until January 31st, 2021were included. Patients were divided into two groups based on the number of doses of tocilizumab they received. Furthermore, we gathered additional data from the patients, such as but not limited to demographic data, vital signs, and laboratory markers. Multivariable logistic and generalized linear regression were used. We considered a P value of < 0.05 statistically significant. Results: Two hundred sixty-one patients were included in this study; 72.4% received a single dose of tocilizumab, while the rest (27.6%) had received multiple doses. Most of the patients were male, with an average age of 59.2. After adjusting for possible confounders, the ICU mortality within 30 days (OR 0.83; 95% CI, 0.33-2.08 p = 0.69) and in-hospital mortality (OR 0.64; 95% CI, 0.26-1.60 p = 0.35) were not significantly different between the two groups. On the flip side, patients who received multiple doses of tocilizumab have higher odds of secondary infection compared with a single dose (OR 3.06; 95% CI, 1.18-7.89 p = 0.02).Conclusion: Multiple doses of tocilizumab were not associated with a statistically significant difference in ICU and hospital mortality in critically ill patients infected with COVID-19. In contrast, it was associated with higher odds of secondary infections compared to a single dose.

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Single Versus Multiple Doses of Tocilizumab in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19): A Two-center, Retrospective Cohort Study

10.21203/rs.3.rs-526150/v1 ◽

2021 ◽

Author(s):

Khalid Al Sulaiman ◽

Ohoud Al Juhani ◽

Khalid Bin Salah ◽

Ghazwa Koryem ◽

Khalid Eljaaly ◽

...

Keyword(s):

Single Dose ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Secondary Infection ◽

Demographic Data ◽

Vital Signs ◽

Multiple Doses ◽

Significant Difference

Abstract Background: In COVID-19 patients, increased IL-6 levels have been associated with poor disease prognosis. The use of tocilizumab shown to be effective in treating COVID-19 with varying success. This study aims to evaluate the effectiveness and safety of using a single dose of tocilizumab compared with multiple doses in critically ill COVID-19 patients.Methods:This study is a two-center, retrospective cohort, in which patients who received tocilizumab and were admitted to the ICU at two tertiary hospitals from March 1st, 2020, until January 31st, 2021were included. Patients were divided into two groups based on the number of doses of tocilizumab they received. Furthermore, we gathered additional data from the patients, such as but not limited to demographic data, vital signs, and laboratory markers. Multivariable logistic and generalized linear regression were used. We considered a P value of < 0.05 statistically significant. Results: Two hundred sixty-one patients were included in this study; 72.4% received a single dose of tocilizumab, while the rest (27.6%) had received multiple doses. Most of the patients were male, with an average age of 59.2. After adjusting for possible confounders, the ICU mortality within 30 days (OR 0.83; 95% CI, 0.33-2.08 p = 0.69) and in-hospital mortality (OR 0.64; 95% CI, 0.26-1.60 p = 0.35) were not significantly different between the two groups. On the flip side, patients who received multiple doses of tocilizumab have higher odds of secondary infection compared with a single dose (OR 3.06; 95% CI, 1.18-7.89 p = 0.02).Conclusion: Multiple doses of tocilizumab were not associated with a statistically significant difference in ICU and hospital mortality in critically ill patients infected with COVID-19. In contrast, it was associated with higher odds of secondary infections compared to a single dose.

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Convalescent plasma is of limited clinical benefit in critically ill patients with coronavirus disease-2019: a cohort study

Journal of Translational Medicine ◽

10.1186/s12967-021-03028-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Li Huang ◽

Che Zhang ◽

Xihui Zhou ◽

Zhou Zhao ◽

Weiping Wang ◽

...

Keyword(s):

Cohort Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Benefit ◽

Clinical Characteristics ◽

Clinical Evidence ◽

Control Group ◽

Cumulative Mortality ◽

Kaplan Meier ◽

Significant Difference

Abstract Background Recently, convalescent plasma (CP) transfusion was employed for severe or critically ill patients with coronavirus disease-2019. However, the benefits of CP for patients with different conditions are still in debate. To contribute clinical evidence of CP on critically ill patients, we analyze the characteristics and outcomes of patients with or without CP transfusion. Methods In this cohort study, 14 patients received CP transfusion based on the standard treatments, whereas the other 10 patients received standard treatments as control. Clinical characteristics and outcomes were analyzed. The cumulative survival rate was calculated by Kaplan–Meier survival analysis. Results Data analysis was performed on 24 patients (male/female: 15/9) with a median age of 64.0 (44.5–74.5) years. Transient fever was reported in one patient. The cumulative mortality was 21% (3/14) in patients receiving CP transfusion during a 28-day observation, whereas one dead case (1/10) was reported in the control group. No significant difference was detected between groups in 28-day mortality (P = 0.615) and radiological alleviation of lung lesions (P = 0.085). Conclusion In our current study, CP transfusion was clinically safe based on the safety profile; however, the clinical benefit was not significant in critically ill patients with more comorbidities at the late stage of disease during a 28-day observation. Graphic abstract

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