Age and the Length of Hospital Stay in Patients With Sepsis at the ICU Admission can Prolong the Duration of Endotracheal Intubation

Background: Endotracheal intubation (EI) associated with mechanical ventilation (MV) is frequently performed in critically ill patients admitted to intensive care unit (ICU) with sepsis. Objectives: This study aimed to assess the impact of important factors on the duration of tracheal intubation in patients with sepsis at the ICU admission. Methods: Adult patients admitted to the mixed medical–surgical ICUs with sepsis at the ICU admission who needs prolonged mechanical ventilation (PMV) (≥ 21 days) were included in this retrospective secondary analysis study. The primary outcome was ICU mortality. Baseline demographic and clinical characteristics of all patients were assessed as risk factors associated with the duration of MV by univariate and multivariate Binary logistic regression. Results: Eighty-five patients required more than 21 days of MV. Out of the 85 patients, 52 (61.2%) patients were intubated within 30 to 34.50 days and 33 (38.8%) patients had intubation within 34.51 to 65 days, and categorized as PMV and very prolonged MV groups, respectively. Two parameters were significantly associated with very prolonged MV which are as follows: older age 1.229 (95% CI: 1.002-1.507, P=0.048) and long hospital stay (LOS) 2.996 (95% CI: 1.676-5.356, P<0.001). No significant survival difference was observed between the two groups of study. (33.3% vs. 25%, P=0.406). Conclusion: Our observations showed that the older age and LOS as pre-ICU stay in patients with positive sepsis at the ICU admission can prolong the duration of intubation. In addition, no significant survival difference was observed between patients with PMV and very prolonged MV.

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Severity of hyperoxia as a risk factor in patients undergoing on-pump cardiac surgery

Acta medica Lituanica ◽

10.6001/actamedica.v24i3.3549 ◽

2017 ◽

Vol 24 (3) ◽

pp. 153-158

Author(s):

Gabrielius Jakutis ◽

Ieva Norkienė ◽

Donata Ringaitienė ◽

Tomas Jovaiša

Keyword(s):

Mechanical Ventilation ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Hospital Stay ◽

Prolonged Mechanical Ventilation ◽

Length Of Hospital Stay ◽

Infectious Complications ◽

Research Database ◽

Elective Cardiac Surgery ◽

The Impact

Background. Hyperoxia has long been perceived as a desirable or at least an inevitable part of cardiopulmonary bypass. Recent evidence suggest that it might have multiple detrimental effects on patient homeostasis. The aim of the study was to identify the determinants of supra-physiological values of partial oxygen pressure during on-pump cardiac surgery and to assess the impact of hyperoxia on clinical outcomes. Materials and methods. Retrospective data analysis of the institutional research database was performed to evaluate the effects of hyperoxia in patients undergoing elective cardiac surgery with cardiopulmonary bypass, 246 patients were included in the final analysis. Patients were divided in three groups: mild hyperoxia (MHO, PaO2 100–199 mmHg), moderate hyperoxia (MdHO, PaO2 200–299 mmHg), and severe hyperoxia (SHO, PaO2 >300 mmHg). Postoperative complications and outcomes were defined according to standardised criteria of the Society of Thoracic Surgeons. Results. The extent of hyperoxia was more immense in patients with a lower body mass index (p = 0.001) and of female sex (p = 0.005). A significant link between severe hyperoxia and a higher incidence of infectious complications (p – 0.044), an increased length of hospital stay (p – 0.044) and extended duration of mechanical ventilation (p < 0.001) was confirmed. Conclusions. Severe hyperoxia is associated with an increased incidence of postoperative infectious complications, prolonged mechanical ventilation, and increased hospital stay.

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Pneumonia Is Associated with Increased Mortality in Hospitalized COPD Patients: A Systematic Review and Meta-Analysis

Respiration ◽

10.1159/000510615 ◽

2021 ◽

Vol 100 (1) ◽

pp. 64-76

Author(s):

Yan Yu ◽

Wei Liu ◽

Hong-Li Jiang ◽

Bing Mao

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Hospital Stay ◽

Readmission Rate ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Mortality And Morbidity ◽

Icu Stay ◽

Copd Patients ◽

The Impact

Background: Patients with chronic obstructive pulmonary disease (COPD) are at a heightened risk of pneumonia. Whether coexisting community-acquired pneumonia (CAP) can predict increased mortality in hospitalized COPD patients is still controversial. Objective: This systematic review and meta-analysis aims to assess the association between CAP and mortality and morbidity in COPD patients hospitalized for acute worsening of respiratory symptoms. Methods: In this review, cohort studies and case-control studies investigating the impact of CAP in hospitalized COPD patients were retrieved from 4 electronic databases from inception until December 2019. Methodological quality of included studies was assessed using Newcastle-Ottawa Quality Assessment Scale. The primary outcome was mortality. The secondary outcomes included length of hospital stay, need for mechanical ventilation, intensive care unit (ICU) admission, length of ICU stay, and readmission rate. The Mantel-Haenszel method and inverse variance method were used to calculate pooled relative risk (RR) and mean difference (MD), respectively. Results: A total of 18 studies were included. The presence of CAP was associated with higher mortality (RR = 1.85; 95% CI: 1.50–2.30; p < 0.00001), longer length of hospital stay (MD = 1.89; 95% CI: 1.19–2.59; p < 0.00001), more need for mechanical ventilation (RR = 1.48; 95% CI: 1.32–1.67; p < 0.00001), and more ICU admissions (RR = 1.58; 95% CI: 1.24–2.03; p = 0.0002) in hospitalized COPD patients. CAP was not associated with longer ICU stay (MD = 5.2; 95% CI: −2.35 to 12.74; p = 0.18) or higher readmission rate (RR = 1.02; 95% CI: 0.96–1.09; p = 0.47). Conclusion: Coexisting CAP may be associated with increased mortality and morbidity in hospitalized COPD patients, so radiological confirmation of CAP should be required and more attention should be paid to these patients.

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The Impact of COVID-19 Vaccine on Rate of Hospitalization and Outcome of COVID- 19 Infection in a Single Center in the Eastern Province of Saudi Arabia

10.21203/rs.3.rs-903562/v2 ◽

2021 ◽

Author(s):

Dania M. Alkhafaji ◽

Reem J. Al Argan ◽

Abrar J. Alwaheed ◽

Safi Ghazi Alqatari ◽

Abdulmohsen Alelq ◽

...

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

University Hospital ◽

Hospital Data ◽

Icu Admission ◽

Population Immunity ◽

The Status ◽

Serious Disease ◽

Study Participants ◽

The Impact

Abstract Background: Coronavirus 2019 (COVID-19) is an emerging and quickly disseminating disease that causes deleterious complications. Vaccines have the potential to improve population immunity and avoid serious disease and deaths.Methodology: A retrospective cohort study was conducted on 331 hospitalized patients with Covid 19 infections between April 2021 and July 2021 at King Fahad University Hospital. Data was collected from the medical records stored in the electronic health system of the hospital.Results: 27.7% of the participants required ICU admission, and 10.5% required mechanical ventilation. The mortality rate was around 7.23% of the infected cases. Two thirds of the study participants (64.05%) did not receive any vaccine, and it can be noted that only 16.8% had received 2 doses. The results suggest that the status of receiving a vaccine has significantly influenced the length of hospital stay, decreasing it by 19.7%. In addition, the date of receiving the vaccine was statistically significant in decreasing the incidence of ICU admission, as those who have received a vaccine for longer than 14 days needed ICU admission 82% less compared with their counterparts. The type of vaccine did not impact on any of the reported outcomes in the form of hospitalization rate, ICU admission and death.Conclusion: The majority of the study participants didn’t receive any vaccines before their admission with COVID 19, which in turn prolonged their hospital stay. This necessitates that the public require more awareness regarding the importance of receiving the vaccine.

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Early mortality following COVID-19 infection among cancer patients who received radiotherapy: A meta-analysis

Journal of Radiotherapy in Practice ◽

10.1017/s1460396921000637 ◽

2021 ◽

pp. 1-31

Author(s):

Mona Kamal ◽

Massimo Baudo ◽

Shon Shmushkevich ◽

Yimin Geng ◽

Mohamed Rahouma

Keyword(s):

Mechanical Ventilation ◽

Hospital Admission ◽

Cancer Patients ◽

Length Of Hospital Stay ◽

Early Mortality ◽

Older Age ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Icu Admission ◽

Meta Regression

Abstract Introduction: Identifying the patients at higher risk for poor outcomes after radiotherapy (RT) during COVID-19 era is an unmet clinical need. Methods: The Ovid MEDLINE, Ovid Embase, Clarivate Analytics Web of Science, PubMed, and Wiley-Blackwell Cochrane Library databases were searched. Eligible studies were required to address the outcomes of cancer patients who underwent RT during the COVID-19 era. The primary outcome was early mortality, while secondary outcomes included length of hospital stay, hospital admission, intensive care unit (ICU) admission, and use of mechanical ventilation. Pooled event rates were calculated and meta-regression and “leave-one-out” sensitivity analyses were performed. Results: Twelve eligible studies were included out of 928. The prevalence of early mortality after COVID-19 infection was 21.0%. The prevalence of hospital admission, ICU admission, and mechanical ventilation was 78.1%, 15.4%, and 20.0%, respectively. Meta-regression showed that older age was significantly and positively associated with early mortality (β=0.0765 ± 0.0349, p = 0.0284), while breast cancer was negatively associated with early mortality (β=-1.2754 ± 0.6373, p = 0.0454). Conclusion: Older age adversely impacts the early mortality rate in cancer patients during COVID-19 era. The risks of interruption/delay of cancer treatment should be weighed against the risk of increased morbidity and mortality from the infection. A global registry is needed to establish international oncologic guidelines during the COVID-19 era.

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Impact of Renin-Angiotensin-Aldosterone System Inhibition on Mortality in Critically Ill COVID-19 Patients with Pre-Existing Hypertension: A Prospective Cohort Study

10.21203/rs.3.rs-898264/v1 ◽

2021 ◽

Author(s):

Kei Sato ◽

Nicole White ◽

Jonathon P. Fanning ◽

Nchafatso Obonyo ◽

Michael H. Yamashita ◽

...

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Hospital Stay ◽

Critically Ill ◽

Length Of Hospital Stay ◽

Hospital Death ◽

Renin Angiotensin Aldosterone System ◽

Renin Angiotensin ◽

Icu Admission ◽

The Impact

Abstract BackgroundThe influence of renin-angiotensin-aldosterone system (RAAS) inhibitors on the critically ill COVID-19 patients with pre-existing hypertension remains uncertain. This study examined the impact of previous use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on the critically ill COVID-19 patients.MethodsData from an international, prospective, observational cohort study involving 354 hospitals spanning 54 countries were included. A cohort of 746 COVID-19 patients with pre-existing hypertension admitted to intensive care units (ICUs) in 2020 were targeted. Multi-state survival analysis was performed to evaluate in-hospital mortality and hospital length of stay up to 90 days following ICU admission.ResultsA total of 746 patients were included - 543 (73%) with pre-existing hypertension had received ACEi/ARBs before ICU admission, while 203 (27%) had not. Cox proportional hazards model showed that previous ACEi/ARB use was associated with a decreased hazard of in-hospital death (HR, 0.73, 95% CI, 0.58 to 0.93). Sensitivity analysis adjusted for propensity scores showed similar results for hazards of death. The average length of hospital stay was longer in ACEi/ARB group with 21.4 days (95% CI: 19.9 to 23.0 days) in ICU and 6.7 days (5.9 to 7.6 days) in general ward compared to non-ACEi/ARB group with 16.2 days (14.1 to 18.5 days) and 6.3 days (5.0 to 7.7 days), respectively. When analysed separately, there was insufficient evidence of differential effects between ACEi and ARB use on the hazards of death and discharge.ConclusionsIn critically ill COVID-19 patients with comorbid hypertension, use of ACEi/ARBs prior to ICU admission was associated with a reduced risk of in-hospital mortality following adjustment for baseline characteristics although patients with ACEi/ARB showed longer length of hospital stay.

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The Impact of COVID-19 Vaccine on Rate of Hospitalization and Outcome of COVID-19 Infection in a Single Center in the Eastern Province of Saudi Arabia

10.21203/rs.3.rs-903562/v1 ◽

2021 ◽

Author(s):

Dania M. Alkhafaji ◽

Reem Al Argan ◽

Abrar Jamal Alwaheed ◽

Safi Ghazi Alqatari ◽

Abdulmohsen Alelq ◽

...

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

University Hospital ◽

Hospital Data ◽

Icu Admission ◽

Population Immunity ◽

The Status ◽

Serious Disease ◽

Study Participants ◽

The Impact

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Cross-sectional observational study of epidemiology of COVID-19 and clinical outcomes of hospitalised patients in North West London during March and April 2020

BMJ Open ◽

10.1136/bmjopen-2020-044384 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044384

Author(s):

Guduru Gopal Rao ◽

Alexander Allen ◽

Padmasayee Papineni ◽

Liyang Wang ◽

Charlotte Anderson ◽

...

Keyword(s):

Mechanical Ventilation ◽

Clinical Outcomes ◽

Severe Infection ◽

Older Age ◽

Cross Sectional ◽

North West ◽

Icu Admission ◽

Risk Of Death ◽

Hospitalised Patients ◽

Increased Risk

ObjectiveThe aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London.DesignObservational cohort study.SettingLondon North West Healthcare NHS Trust (LNWH).ParticipantsPatients tested and/or admitted for COVID-19 at LNWH during March and April 2020Main outcome measuresDescriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19.ResultsThe outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p<0.05). These groups also had more severe infection resulting in ICU admission and need for mechanical ventilation (p<0.05). However, in a multivariate analysis, only increasing age was independently associated with increased risk of death (p<0.05). Mortality rate was 26.9% in hospitalised patients.ConclusionThe findings confirm that men, BAME and older population were most commonly and severely affected groups. Only older age was independently associated with mortality.

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Therapeutic efficacy, mechanical ventilation, length of hospital stay, and mortality rate in severe COVID‐19 patients treated with tocilizumab

International Journal of Clinical Practice ◽

10.1111/ijcp.14079 ◽

2021 ◽

Cited By ~ 1

Author(s):

Rania M Sarhan ◽

Yasmin M. Madney ◽

Ahmed E. Abou Warda ◽

Marian S. Boshra

Keyword(s):

Mechanical Ventilation ◽

Mortality Rate ◽

Hospital Stay ◽

Therapeutic Efficacy ◽

Length Of Hospital Stay

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SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study

Gut ◽

10.1136/gutjnl-2020-323364 ◽

2021 ◽

pp. gutjnl-2020-323364

Author(s):

Sanjay Pandanaboyana ◽

John Moir ◽

John S Leeds ◽

Kofi Oppong ◽

Aditya Kanwar ◽

...

Keyword(s):

Acute Pancreatitis ◽

Hospital Stay ◽

Organ Failure ◽

Collaborative Study ◽

Length Of Hospital Stay ◽

Secondary Outcome ◽

Icu Admission ◽

Local Complications ◽

Persistent Organ Failure ◽

Increased Risk

ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.DesignA prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.Results1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.ConclusionPatients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

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565 POST-OPERATIVE WEIGHT LOSS AND OUTCOMES FOLLOWING ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doaa087.148 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

R Khaw ◽

S Munro ◽

J Sturrock ◽

H Jaretzke ◽

S Kamarajah ◽

...

Keyword(s):

Weight Loss ◽

Length Of Stay ◽

Hospital Stay ◽

Enhanced Recovery ◽

Length Of Hospital Stay ◽

Failure To Thrive ◽

Post Discharge ◽

Postoperative Weight Loss ◽

Poor Outcomes ◽

The Impact

Abstract Oesophageal cancer is the 11th most common cancer worldwide, with oesophagectomy remaining the mainstay curative treatment, despite significant associated morbidity and mortality. Postoperative weight loss remains a significant problem and is directly correlated to poor prognosis. Measures such as the Enhanced Recovery After Surgery (ERAS) programme and intraoperative jejunostomy feed have looked to tackle this. This study investigates the impact of these on mortality, length of hospital stay and postoperative weight loss. Methods Patients undergoing oesophagectomy between January 1st 2012—December 2014 and 28th October 2015–December 31st 2019 in a national tertiary oesophagogastric unit were included retrospectively. Variables measured included comorbidities, operation, histopathology, weights (pre- and post-operatively), length of hospital stay, postoperative complications and mortality. Pre-operative body weight was measured at elective admission, and further weights were identified from a prospectively maintained database, during further clinic appointments. Other data was collected through patient notes. Results 594 patients were included. Mean age at diagnosis was 65.9 years (13–65). Majority of cases were adenocarcinoma (63.3%), with varying stages of disease (TX-4, NX-3). Benign pathology accounted for 8.75% of cases. Mean weight loss post-oesophagectomy exceeded 10% at 6 months (SD 14.49). Majority (60.1%) of patients were discharged with feeding jejunostomy, and 5.22% of these required this feed to be restarted post-discharge. Length of stay was mean 16.5 days (SD 22.3). Complications occurred in 68.9% of patients, of which 13.8% were infection driven. Mortality occurred in 26.6% of patients, with 1.83% during hospital admission. 30-day mortality rate was 1.39%. Conclusion Failure to thrive and prolonged weight-loss following oesophagectomy can contribute to poor recovery, with associated complications and poor outcomes, including increased length of stay and mortality. Further analysis of data to investigate association between weight loss and poor outcomes for oesophagectomy patients will allow for personalised treatment of high-risk patients, in conjunction with members of the multidisciplinary team, including dieticians.

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