Outcomes Associated With Stage 2 Pressure Injuries Among Surgical Critical Care Patients: A Retrospective Cohort Study

Abstract Aims A better understanding of patient monitoring and outcomes is required following emergency laparotomy. We aimed to evaluate recovery following emergency laparotomy during the ‘first wave’ of the COVID-19 pandemic and assess for COVID-19-associated coagulopathy in this group. Methods We performed a single-centre, retrospective cohort study on adult patients undergoing emergency laparotomy from 23rdMarch – 16thMay 2020 comparing patients with or without suspected or confirmed SARS-CoV-2. Main outcome measures included; 30-day mortality, post-operative respiratory failure, ARDS and other complications, critical care admission and length of stay (CCLOS) and total length of stay (LOS). Laboratory results were collected for three days post-operatively including platelet counts and clotting screen. Results 33 patients undergoing 36 emergency laparotomies were included, of which 9 had confirmed or suspected COVID-19. Patients with COVID-19 were more likely to have severe complications (Clavien-Dindo grade ≥3) (9/9 vs 5/24; p < 0.001), post-operative respiratory failure (9/9 vs 2/24; p < 0.001), ARDS (3/9 vs 0/24; p = 0.015) and need for critical care stay (9/9 vs 12/24; p = 0.012) with a longer LOS and CCLOS (17 vs 7 days; p = 0.004 and 6 vs 1 day; p < 0.001 respectively). Platelet counts were consistently lower on all peri-operative days and patients had a higher incidence of coagulopathy (7/11 vs 3/17; p = 0.020). Conclusions Emergency laparotomy is associated with increased post-operative morbidity in patients with confirmed or suspected COVID-19 with increased respiratory complications and critical care stay. Post-operative patients with COVID-19 show mildly reduced platelet counts and deranged clotting that may be part of a COVID-19-associated coagulopathy.

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Sepsis Mortality in Critical Care and Prior Statin Therapy: A Retrospective Cohort Study in Central Argentina

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2017/25810.9992 ◽

2017 ◽

Author(s):

Liberth Incahuanaco Paricahua

Keyword(s):

Critical Care ◽

Cohort Study ◽

Statin Therapy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Sepsis Mortality ◽

Central Argentina

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Is sleep apnoea a risk factor for Covid-19? Findings from a retrospective cohort study

10.1101/2020.05.14.20098319 ◽

2020 ◽

Cited By ~ 4

Author(s):

Thijs Feuth ◽

Tarja Saaresranta ◽

Antti Karlsson ◽

Mika Valtonen ◽

Ville Peltola ◽

...

Keyword(s):

Critical Care ◽

Risk Factor ◽

Cohort Study ◽

Oxygen Saturation ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Sleep Apnoea ◽

Study Data ◽

University Hospital ◽

Obstructive Sleep

Background: In the early phase of the coronavirus disease-19 (Covid-19) pandemic, Southwest Finland remained relatively spared. By the 3rd of May 2020, a total of 28 patients have been admitted to the Turku University Hospital. In this paper, we explore baseline characteristics in order to identify risk for severe Covid-19 disease and critical care admission. Methods For this retrospective cohort study, data were derived from hospital records. Basic descriptive statistics were used to characterise patients, including medians, percentiles and frequencies. Differences were tested with Mann Whitney U-test and Pearson's chi-square test. Results Pre-existent obstructive sleep apnoea (OSA) was present in 29% of patients admitted in the hospital for Covid-19, none of them having severe OSA. Overall, other findings on admission were comparable with those reported elsewhere. C-reactive protein (CRP) and procalcitonin (PCT) were higher in patients who were eventually transferred to critical care in comparison to in those who were not (median CRP 187 mg/L versus 52 mg/L, p<0.005 and median PCT 0.46 versus 0.12, p=0.047). Moreover, there was a trend towards lower oxygen saturation on admission in ICU-patients (87% versus 93%, p=0.09). Discussion OSA was pre-existent in a disproportional large group of patients, which suggests that it is an important risk factor for severe Covid-19. Furthermore, we identified high CRP, PCT and possibly oxygen saturation as useful clinical measures to identify patients at risk for critical care.

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Comparing Risk Profiles in Critical Care Patients With Stage 2 and Deep Tissue Pressure Injuries: Exploratory Retrospective Cohort Study (Preprint)

10.2196/preprints.29757 ◽

2021 ◽

Author(s):

Jenny Alderden ◽

Linda Amoafo ◽

Yue Zhang ◽

Caroline Fife ◽

David Yap ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Critical Care ◽

Cohort Study ◽

Length Of Stay ◽

Retrospective Cohort ◽

Deep Tissue ◽

Risk Profiles ◽

Pressure Injury ◽

Critical Care Patients

BACKGROUND Understanding hospital-acquired pressure injury (HAPrI) etiology is essential for developing effective preventive interventions. Pressure injuries are classified based on the degree of visible tissue damage; the two most commonly identified HAPrI stages in critical care patients are stage 2 and deep tissue injury (DTI). Some experts speculate that stage 2 and DTI have different etiologies, with stage 2 injuries formed from the “outside in” as a result of tissue deformation, decreased perfusion, and subsequent ischemia caused by external pressure and/or shear forces, whereas DTI emerges from the “inside out” due to inadequate perfusion to the deeper tissues causing tissue ischemia. OBJECTIVE The purpose of this study was to compare risk profiles of intensive care unit (ICU) patients who developed stage 2 injuries versus DTIs. METHODS This was a retrospective cohort study to compare the risk profiles of patients in the ICU with stage 2 injuries and DTIs using electronic health record data. Eligible patients were admitted to the surgical or cardiovascular ICU at an academic medical center in the United States between 2014 and 2018. Anatomic locations were examined, and differences in anatomic patterns were compared using the χ2 test. Risk profile variables included demographic characteristics, Braden Scale scores, vasopressor infusions, hypotension, surgical factors, length of stay, BMI, laboratory values, diabetes, Charlson Comorbidity Index, and the levels of sedation or agitation. The distributions of potential risk variables between patients with stage 2 injuries and DTIs were summarized and compared. A logistic regression model with the least absolute shrinkage and selection operator method was developed to identify the critical risk factors for distinguishing stage 2 and DTI patients. RESULTS A total of 244 patients developed a stage 2 injury or DTI during the study period. Of those, 38 patients with medical device–related pressure injury were excluded. The final study sample consisted of 206 patients (n=146 stage 2 and n=60 DTI). Compared with DTIs, stage 2 HAPrIs were more likely to be located on a bony prominence (n=206, χ21=8.43, P=.03). The multivariate model showed that patients who developed stage 2 HAPrIs had a longer length of stay in the ICU than those with DTIs (odds ratio [OR] 1.001, 95% CI 1-1.002, P=.03) but were less likely than patients with DTIs to experience a diastolic blood pressure <50 mmHg (OR 0.179, 95% CI 0.072-0.416, P<.001) or receive an epinephrine infusion (OR 0.316, 95% CI 0.079-0.525, P=.008). CONCLUSIONS Stage 2 injuries and DTIs have different risk factors and different anatomic patterns. Patients who developed DTIs were more likely to experience low diastolic blood pressure and receive epinephrine, a potent vasopressor. Stage 2 injuries were more likely to occur on the bony prominences, whereas DTIs commonly occurred on the fleshy parts of the body such as the buttock.

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