ASSESSMENT OF RISK FACTORS FOR DEATH OF PATIENTS WITH COVID-19 REQUIRING MECHANICAL LUNG VENTILATION

Relevance: with the increasing incidence of COVID-19, it is clear that early detection of the risk of death in patients on mechanical lung ventilation can help ensure proper treatment planning and optimize health resources.Objectives of our study was to identify predictors of the risk of death in patients with COVID-19 who required mechanical ventilation.Material and methods: research design – retrospective, observational, multicenter. Inclusion criteria: clinical, laboratory, and radiological criteria for severe viral pneumonia. Exclusion criteria: death in the first 12 hours of hospitalization. End points: need for mechanical ventilation and death. One hundred and sixty-eight patients met the inclusion criteria. The number of patients who were given a ventilator was 69 (41,1%), 47 (68,1%) of them died. Risk factors were determined by calculating the odds ratio with a 95% confidence interval. The discriminative ability of factors was evaluated using ROC analysis with the calculation of the area under the curve (AUC ROC).Results: the most significant risk factors for require of mechanical ventilation in patients with COVID-19 were a large extent of changes in the lung parenchyma, more than 5 points of the SOFA scale and blood D-dimers >3000 ng/ml. Deceased patients were more likely to be men and initially had statistically significantly higher points of the SOFA scale, neutrophil-to-lymphocyte ratio, and blood interleukin 6 (IL-6) count >186 ng/ml. However, the discriminative ability of these risk factors was moderate (AUC ROC from 0.69 to 0.76). In deceased patients, there were no changes in the PaO2/FiO2 ratio, blood D-dimer count, and SOFA severity assessment in the first three days of intensive care.Conclusion: Predictors of the development of an unfavorable outcome of the disease with moderate discriminative ability in patients with severe COVID-19 on mechanical ventilation are an increased score on the SOFA scale, an increase of the neutrophil-lymphocyte ratio, high levels of D-dimers and IL-6 in the blood.

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Ventilator-Induced Diaphragm Dysfunction (Review)

General Reanimatology ◽

10.15360/1813-9779-2018-3-82-103 ◽

2018 ◽

Vol 14 (3) ◽

pp. 82-103

Author(s):

M. A. Babaev ◽

D. B. Bykov ◽

Т. M. Birg ◽

M. А. Vyzhigina ◽

A. A. Eremenko

Keyword(s):

Mechanical Ventilation ◽

Spontaneous Breathing ◽

Contractile Function ◽

Clinical Manifestations ◽

Lung Ventilation ◽

Respiratory Support ◽

Diaphragm Dysfunction ◽

Mechanical Lung ◽

Mechanical Lung Ventilation ◽

Ventilation Modes

Mechanical ventilation is associated with a number of complications that increase the cost of treatment and the hospital mortality rate. In 2004, the term «ventilator-induced diaphragm dysfunction» (VIDD) was proposed to explain one of the reasons for the failure of respiratory support. At present, this term is understood as a combination of atrophy and weakness of the contractile function of the diaphragm caused directly by a long-term mechanical lung ventilation. Oxidative stress, proteolysis, mitochondrial dysfunction, as well as passive overdistension of the diaphragm fibers contribute greatly to the pathogenesis of VIDD. Since 30—80% of patients in the ICU require mechanical respiratory support and even 6—8 hours of mechanical lung ventilation can contribute to the development of a significant weakness of the diaphragm, it can be concluded that the VIDD is an extremely urgent problem in most patients. Its typical clinical presentation is characterized by impaired breathing mechanics and unsuccessful attempts to switch the patient to the spontaneous breathing in the absence of other valid reasons for respiratory disorders. The sonography is the most informative and accessible diagnostic method, and preservation of spontaneous breathing activity and the use of the latest mechanical ventilation modes are considered a promising approach to prevention and correction of the disorders. The search for an optimal strategy for lung ventilation, development of diagnostic and physiotherapeutic methods, as well as the consolidation of the work of a multidisciplinary team of specialists (anesthesiologists and intensive care specialists, neurologists, pulmonologists, surgeons, etc.) can help in solving this serious problem. A review of 122 sources about the VIDD presented data on the background of the issue, the definition of the problem, etiology and pathogenesis, clinical manifestations, methods of diagnosis, the effect of drugs, prevention and therapy.

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Abstract TP208: Sleep Disordered Breathing (SDB) - An Overlooked Modifiable Risk Factor in Acute Stroke Care

Stroke ◽

10.1161/str.48.suppl_1.tp208 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Vishal Shah ◽

Ashrai Gudlavalleti ◽

Julius G Latorre

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Sleep Disordered Breathing ◽

Modifiable Risk Factor ◽

Inclusion Criteria ◽

Risk Of Death ◽

Disordered Breathing

Introduction: In patients with acute stroke, part of the acute management entails identifying the risk factors; modifiable or non modifiable. Early recognition of these factors is essential for optimizing therapeutic procedures, especially those with a known effective treatment. In this sense, Sleep Disordered Breathing (SDB) has also been suggested as a modifiable and independent risk factor for stroke as defined by international guidelines and some studies have demonstrated that patients with stroke and particularly Obstructive Sleep Apnea (OSA) have an increased risk of death or new vascular events. Pathogenesis of ischemic stroke in SDB is probably related to worsening of existing cardiovascular risk factors such as hypertension and hypoxia driven cardiac arrhythmia leading to higher prevalence of ischemic stroke in patients with sleep disordered breathing disease. Despite strong evidence linking SDB to ischemic stroke, evaluation for SDB is rarely performed in patients presenting with an acute ischemic stroke. Hypothesis: Evaluation of SDB is rarely performed in patients presenting with acute ischemic stroke. Methods: We performed a retrospective review of all patients above the age of 18 who were admitted to the acute stroke service at University Hospital July 2014 to December 2014. Demographic data, etiology of stroke as identified per TOAST criteria, modifiable risk factors, presenting NIHSS and frequency of testing for SDB and their results were collected. The data was consolidated and tabulated by using STATA version 14. Results: Total of 240 patients satisfied our inclusion criteria. Only 24 patients ie 10% of those who satisfied our inclusion criteria received evaluation for SDB. Out of those evaluated, 62.5% ie 15 patients out of 24 patients had findings concerning for significant desaturation. Only 2 providers out of 8 stroke physicians ie 25% tested for SDB in more than 5 patients. Conclusions: Our observations highlight the paucity in evaluation for SDB in acute ischemic stroke in a tertiary care setting. Being a modifiable risk factor, greater emphasis must be placed on evaluation for SDB in patients in patients with acute stroke. Education must be provided to all patients and providers regarding identification of these factors.

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Possibilities of automated video monitoring of mechanical lung ventilation – a case study

Sleep Medicine ◽

10.1016/j.sleep.2017.11.800 ◽

2017 ◽

Vol 40 ◽

pp. e273

Author(s):

M. Kontorovich ◽

K. Purtov ◽

A. Chistyakov ◽

V. Kublanov

Keyword(s):

Lung Ventilation ◽

Video Monitoring ◽

Mechanical Lung ◽

Mechanical Lung Ventilation

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COVID-19 and hematologic diseases: Risk factors and long-term follow-up of CHRONOS19 Registry.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18715 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18715-e18715

Author(s):

Kristina Zakurdaeva ◽

Olga A. Gavrilina ◽

Anastasia N. Vasileva ◽

Sergei Dubov ◽

Vitaly S. Dubov ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Disease Progression ◽

Primary Endpoint ◽

Acute Leukemias ◽

Risk Of Death ◽

All Cause Mortality ◽

Long Term Follow Up

e18715 Background: Pts with hem diseases are at high risk of COVID-19 severe course and mortality. Emerging data on risk factors and outcomes in this patient population is of great value for developing strategies of medical care. Methods: CHRONOS19 is an ongoing nationwide observational cohort study of adult (≥18 y) pts with hem disease (both malignant and non-malignant) and lab-confirmed or suspected (clinical symptoms and/or CT) COVID-19. Primary objective was to evaluate treatment outcomes. Primary endpoint was 30-day all-cause mortality. Long-term follow-up was performed at 90 and 180 days. Data from 14 centers was collected on a web platform and managed in a deidentified manner. Results: As of data cutoff on January 27, 2021, 575 pts were included in the registry, 486 of them eligible for primary endpoint assessment, n(%): M/F 243(50%)/243(50%), median age 56 [18-90], malignant disease in 452(93%) pts, induction phase/R/R/remission 160(33%)/120(25%)/206(42%). MTA in 93(19%) pts, 158(33%) were transfusion dependent, comorbidities in 278(57%) pts. Complications in 335(69%) pts: pneumonia (67%), CRS (8%), ARDS (7%), sepsis (6%). One-third of pts had severe COVID-19, 25% were admitted to ICU, 20% required mechanical ventilation. All-cause mortality at 30 days – 17%; 80% due to COVID-19 complications. At 90 days, there were 14 new deaths: 6 (43%) due to hem disease progression. Risk factors significantly associated with OS are listed in Tab 1. In multivariate analysis – ICU+mechanical ventilation, HR, 53.3 (29.1-97.8). Acute leukemias were associated with higher risk of death, HR, 2.40 (1.28-4.51), less aggressive diseases (CML, CLL, MM, non-malignant) – with lower risk of death, HR, 0.54 (0.37-0.80). No association between time of COVID-19 diagnosis (Apr-Aug vs. Sep-Jan) and risk of death. COVID-19 affected treatment of hem disease in 65% of pts, 58% experienced treatment delay for a median of 4[1-10] weeks. Relapse rate on Day 30 and 90 – 4%, disease progression on Day 90 detected in 13(7%) pts; 180-day data was not mature at the time of analysis. Several cases of COVID-19 re-infection were described. Conclusions: Thirty-day all-cause mortality in pts with hem disease was higher than in general population with COVID-19. Longer-term follow-up (180 days) for hem disease outcomes and OS will be presented. [Table: see text]

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Implementation of modern trends in ventilation support in the New Avenir-221R mechanical lung ventilation apparatus

Biomedical Engineering ◽

10.1007/s10527-006-0020-z ◽

2005 ◽

Vol 39 (6) ◽

pp. 280-283

Author(s):

Yu. Sh. Gal’perin ◽

L. R. Alkhimova ◽

N. D. Dmitriev ◽

I. A. Kozlova ◽

S. B. Nemirovskii ◽

...

Keyword(s):

Lung Ventilation ◽

Mechanical Lung ◽

Mechanical Lung Ventilation ◽

Ventilation Apparatus ◽

Ventilation Support

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MO850OUTCOMES OF COVID-19 INFECTION IN DIALYSIS PATIENTS IN QATAR: A NATIONWIDE COHORT STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab098.0042 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Tarek Abdellatif ◽

Abdullah Hamad ◽

Mohamad Alkadi ◽

Essa Abuhelaiqa ◽

Muftah Othman ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critical Care ◽

Mortality Rate ◽

General Population ◽

Hospital Stay ◽

Laboratory Tests ◽

Length Of Hospital Stay ◽

Dialysis Patients ◽

Risk Of Death

Abstract Background and Aims Patients on maintenance dialysis are more susceptible to COVID-19 and its severe complications. We studied outcomes of COVID-19 infection in dialysis patients in the state of Qatar. Our primary outcome was to determine the mortality rate of dialysis patients with COVID-19 infection and associated risk factors. Our secondary outcomes were to assess the severity of COVID-19 in dialysis patients and its related complications such as the incidence of hypoxia, critical care unit admission, need for mechanical ventilation or inotropes, incidence of acute respiratory distress syndrome (ARDS), and length of hospital stay. Method This was an observational, analytical, retrospective, nationwide study. We included all adult patients on dialysis who tested positive for COVID-19 (PCR assay of nasopharyngeal swab) during the period from February 1, 2020 to July 19, 2020. Patient demographics and clinical features were collected from a national electronic medical record. Laboratory tests were evaluated upon diagnosis and on day 7. Results There were 76 out of 1068 dialysis patients who were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). Eleven patients (15%) died during study period. Mortality due to COVID-19 among our dialysis cohort was 100 times higher than that in the general population for the same period (15% vs. 0.15%; OR 114.2 [95% CI: 1.53 to 2.44]; p<0.001). Univariate analysis for risk factors associated with COVID-19-related death in dialysis patients showed minor but statistically significant increases in risks with age (OR 1.07), peak WBC peak level (OR 1.189), AST level at day 7 (OR 1.04), fibrinogen level at day 7 (OR 1.4), D-dimer level on day 7 (OR 1.94), and peak CRP level (OR 1.01). A major increase in the risk of death was noted with atrial fibrillation (OR, 8.7; p=0.008) and hypoxia (OR: 28; p=0.001). High severity of COVID-19 illness in dialysis manifested as 25% of patients required admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes for intractable hypotension or shock. The mean length of hospital stay was 19.2±10.4 days. Laboratory tests were remarkable for severely elevated ferritin, fibrinogen, CRP, and peak IL-6 levels and decreased albumin levels on day 7. Conclusion This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high mortality rate of COVID-19 infection compared to the general population. Dialysis patients had severe COVID-19 course complicated by prolonged hospitalization and high need for critical care, mechanical ventilation and inotropes. Special care should be done to prevent COVID-19 in dialysis patients to avoid severe complications and mortality.

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COVID-19 pneumonia in Galicia (Spain): Impact of prognostic factors and therapies on mortality and need for mechanical ventilation

PLoS ONE ◽

10.1371/journal.pone.0253465 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253465

Author(s):

Luis Pérez-de-Llano ◽

Eva María Romay-Lema ◽

Adolfo Baloira-Villar ◽

Christian Anchorena ◽

María Luisa Torres-Durán ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Logistic Regression ◽

Therapeutic Interventions ◽

Outcome Variable ◽

Multivariable Logistic Regression Analysis ◽

Composite Outcome ◽

Multicenter Observational Study ◽

Risk Of Death ◽

Hospital Beds

Introduction This study was aimed to identify risk factors associated with unfavorable outcomes (composite outcome variable: mortality and need for mechanical ventilation) in patients hospitalized in Galicia with COVID-19 pneumonia. Methods Retrospective, multicenter, observational study carried out in the 8 Galician tertiary hospitals. All Patients admitted with confirmed COVID-19 pneumonia from 1st of March to April 24th, 2020 were included. A multivariable logistic regression analysis was performed in order to identify the relationship between risk factors, therapeutic interventions and the composite outcome variable. Results A total of 1292 patients (56.1% male) were included. Two hundred and twenty-five (17.4%) died and 327 (25.3%) reached the main outcome variable. Age [odds ratio (OR) = 1.03 (95% confidence interval (CI): 1.01–1.04)], CRP quartiles 3 and 4 [OR = 2.24 (95% CI: 1.39–3.63)] and [OR = 3.04 (95% CI: 1.88–4.92)], respectively, Charlson index [OR = 1.16 (95%CI: 1.06–1.26)], SaO2 upon admission [OR = 0.93 (95% CI: 0.91–0.95)], hydroxychloroquine prescription [OR = 0.22 (95%CI: 0.12–0.37)], systemic corticosteroids prescription [OR = 1.99 (95%CI: 1.45–2.75)], and tocilizumab prescription [OR = 3.39 (95%CI: 2.15–5.36)], significantly impacted the outcome. Sensitivity analysis using different alternative logistic regression models identified consistently the ratio admissions/hospital beds as a predictor of the outcome [OR = 1.06 (95% CI: 1.02–1.11)]. Conclusion These findings may help to identify patients at hospital admission with a higher risk of death and may urge healthcare authorities to implement policies aimed at reducing deaths by increasing the availability of hospital beds.

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The Lipid Paradox Among Acute Ischemic Stroke Patients-A Retrospective Study of Outcomes and Complications

Medicina ◽

10.3390/medicina55080475 ◽

2019 ◽

Vol 55 (8) ◽

pp. 475 ◽

Cited By ~ 1

Author(s):

Patel ◽

Malik ◽

Dave ◽

DeMasi ◽

Lunagariya ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Sampling Strategy ◽

Hemorrhagic Transformation ◽

Nursing Facility ◽

Logistic Regression Models ◽

Post Stroke ◽

Risk Of Death ◽

Number Of Patients

Background and objectives: The Studies have suggested hypercholesterolemia is a risk factor for cerebrovascular disease. However, few of the studies with a small number of patients had tested the effect of hypercholesterolemia on the outcomes and complications among acute ischemic stroke (AIS) patients. We hypothesized that lipid disorders (LDs), though risk factors for AIS, were associated with better outcomes and fewer post-stroke complications. Materials and Method: We performed a retrospective analysis of the Nationwide Inpatient Sample (years 2003–2014) in adult hospitalizations for AIS to determine the outcomes and complications associated with LDs, using ICD-9-CM codes. In 2014, we also aimed to estimate adjusted odds of AIS in patients with LDs compared to patients without LDs. The multivariable survey logistic regression models, weighted to account for sampling strategy, were fitted to evaluate relationship of LDs with AIS among 2014 hospitalizations, and outcomes and complications amongst AIS patients from2003–2014. Results and Conclusions: In 2014, there were 28,212,820 (2.02% AIS and 5.50% LDs) hospitalizations. LDs patients had higher prevalence and odds of having AIS compared with non-LDs. Between 2003–2014, of the total 4,224,924 AIS hospitalizations, 451,645 (10.69%) had LDs. Patients with LDs had lower percentages and odds of mortality, risk of death, major/extreme disability, discharge to nursing facility, and complications including epilepsy, stroke-associated pneumonia, GI-bleeding and hemorrhagic-transformation compared to non-LDs. Although LDs are risk factors for AIS, concurrent LDs in AIS is not only associated with lower mortality and disability but also lower post-stroke complications and higher chance of discharge to home.

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