Retrospective evaluation of critical geriatric and adult COVID-19 patients

2021 ◽  
pp. 79-82
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Geriatric Patients ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Retrospective Evaluation ◽  
Intensive Care Patients ◽  
Significant Difference ◽  
Ventilation Support ◽  
Mechanical Ventilation Support

Background: 5% of cases in COVID 19 disease require hospitalization in an intensive care unit. COVID -19 has a high mortality rate in the intensive care unit (ICU). There are many factors that affect this. There is no study on whether aging is one of these factors for intensive care patients. Objective: With this study, the data of critical geriatric and adult COVID-19 patients we followed up in the covid intensive care unit were evaluated and it was aimed to recognize the characteristics of critically ill patients. Material and Method: The files of 70 geriatric and 67 adult patients followed in the COVID-19 ICU were scanned and evaluated. Results: When evaluated in terms of developing organ dysfunction, cardiac arrhythmia was found to be statistically significant in adult patients (P=.01). 53 (75%) of 70 geriatric patients and 45 (67.1%) of 67 adult patients required invasive mechanical ventilation support. Intensive care mortality was 74.2% (52) in geriatric patients and 67.1% (45) in adult patients. There was no significant difference between the two groups in terms of mortality. Conclusion: It turned out that old age and being an adult are not important in terms of mortality in COVID-19 patients who need to be followed up in the intensive care unit.

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

scholarly journals Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

2013 ◽  
pp. 184-188 ◽  
Author(s):  
Alvaro Sanabria ◽  
Ximena Gomez ◽  
Valentin Vega ◽  
Luis Carlos Dominguez ◽  
Camilo Osorio
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Medical Condition ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

scholarly journals Obesity May Not Be Associated with 28-Day Mortality, Duration of Invasive Mechanical Ventilation and Length of Intensive Care Unit and Hospital Stay in Critically Ill Patients with Severe Acute Respiratory Syndrome Coronavirus-2: A Retrospective Cohort Study

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 674
Author(s):  
Sjaak Pouwels ◽  
Dharmanand Ramnarain ◽  
Emily Aupers ◽  
Laura Rutjes-Weurding ◽  
Jos van Oers
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Significant Difference

Background and Objectives: The aim of this study was to investigate the association between obesity and 28-day mortality, duration of invasive mechanical ventilation and length of stay at the Intensive Care Unit (ICU) and hospital in patients admitted to the ICU for SARS-CoV-2 pneumonia. Materials and Methods: This was a retrospective observational cohort study in patients admitted to the ICU for SARS-CoV-2 pneumonia, in a single Dutch center. The association between obesity (body mass index > 30 kg/m2) and 28-day mortality, duration of invasive mechanical ventilation and length of ICU and hospital stay was investigated. Results: In 121 critically ill patients, pneumonia due to SARS-CoV-2 was confirmed by RT-PCR. Forty-eight patients had obesity (33.5%). The 28-day all-cause mortality was 28.1%. Patients with obesity had no significant difference in 28-day survival in Kaplan–Meier curves (log rank p 0.545) compared with patients without obesity. Obesity made no significant contribution in a multivariate Cox regression model for prediction of 28-day mortality (p = 0.124), but age and the Sequential Organ Failure Assessment (SOFA) score were significant independent factors (p < 0.001 and 0.002, respectively). No statistically significant correlation was observed between obesity and duration of invasive mechanical ventilation and length of ICU and hospital stay. Conclusion: One-third of the patients admitted to the ICU for SARS-CoV-2 pneumonia had obesity. The present study showed no relationship between obesity and 28-day mortality, duration of invasive mechanical ventilation, ICU and hospital length of stay. Further studies are needed to substantiate these findings.

scholarly journals High flow nasal oxygen in patients with COVID-19 associated acute respiratory failure

2020 ◽  
Author(s):  
Ricard Mellado Artigas ◽  
Bruno L. Ferreyro ◽  
Federico Angriman ◽  
María Hernández-Sanz ◽  
Egoitz Arruti ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Acute Respiratory Failure ◽  
Unit Length ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Intensive Care Unit Length ◽  
Adult Patients

Abstract Purpose Whether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high flow nasal oxygen on ventilator free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19. Methods We conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units. Main exposure was the use of high flow nasal oxygen (conservative group), while early invasive mechanical (within the first day of critical care admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. Intensive care unit length of stay and all-cause in hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding. Results A total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days), and a reduction in intensive care unit length of stay (mean difference: -8.2 days; 95% CI -12.7 to -3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64). Conclusions The use of high flow nasal oxygen upon intensive care admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in intensive care unit length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.

The Pediatric Intensive Care Unit as a Critical Care Setting for Adults during the COVID-19 Pandemic: A Service Evaluation

2021 ◽  
Author(s):  
Elizabeth J. A. Fitchett ◽  
Matthew Rubens ◽  
Katherine Styles ◽  
Thomas Bycroft ◽  
Simon Nadel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Adult Patients ◽  
Pediatric Care ◽  
Organ Support ◽  
Adult Intensive Care Unit ◽  
Significant Difference

AbstractOne strategy to expand critical care capacity during the coronavirus disease 2019 (COVID-19) pandemic within the United Kingdom has been to repurpose other clinical departments, including the pediatric intensive care unit (PICU) and pediatric multidisciplinary team, to accommodate critically unwell adult patients. While multiple PICUs have treated adult patients with COVID-19, there is an absence of data on the characteristics of patients transferred to pediatric care and their resulting outcomes in comparison to standard adult intensive care unit (AICU) provision. Data were collected for all adult COVID-19 intensive care admissions between March and May 2020, in three ICUs within a single center: PICU, AICU, and theater recovery ICU (RICU). Patient characteristics, severity of illness, and outcomes were described according to the ICU where most of their bed-days occurred. Outcomes included duration of organ support and ICU admission, and mortality at 30 days. Mortality was compared between patients in PICU and the other adult ICUs, using a logistic regression model, adjusting for known confounding variables. Eighty-eight patients were included: 15 (17.0%) in PICU, 57 (64.7%) in AICU, and 16 (18.1%) in RICU. Patients' characteristics and illness severity on admission were comparable across locations, with similar organ support provided. Ten (66.7%) patients survived to hospital discharge from PICU, compared with 27 (47.4%) and nine (56.3%) patients from AICU and RICU, respectively, with no significant difference in 30-day mortality (OR 0.46, 95% CI 0.12–1.85; p = 0.276). Our analysis illustrates the feasibility of evaluating outcomes of patients who have been cared for in additional, emergency ICU beds, whilst demonstrating comparable outcomes for adults cared for in pediatric and adult units.

scholarly journals Effects of hand massage and acupressure therapy for mechanically ventilated patients

2015 ◽  
Vol 12 (2) ◽  
pp. 881 ◽  
Author(s):  
Şebnem Çınar Yücel ◽  
İsmet Eser
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Control Groups ◽  
Physiological Indicators ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Ventilation Support ◽  
Mechanical Ventilation Support ◽  
Hand Massage ◽  
And Control

<p class="Default"><strong>Purpose: </strong>This research is an experimental study (randomized controlled) which is carried out to investigate the effect on anxiety of hand massage and acupressure therapy in patients having mechanical ventilation support.</p><p><strong>Method and material: </strong>This randomized controlled research was conducted in Intensive care units of Ege University Faculty of Medicine, Department of Chest Diseases and Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital between the dates 18 June 2007 and 3 May 2008. The research sample was comprised of a total of 70 patients who met the research criteria in the hand massage and acupressure (n=35) and control (n =35) groups. Data were collected by using Patient Information Form, Patient Record Form and Visual Analogue Scale. It was following patients in experimental and control groups during seven days. It was recorded physiological indicators of anxiety, perceived anxiety and dyspnoea of patients in control group. These patients weren’t used hand massage and acupressure therapy. The patients in experimental group weren’t used hand massage and acupressure therapy in the first and seventh days. It was recorded physiological indicators of anxiety, perceived anxiety and dyspnoea. The other days, it was used hand massage and acupressure therapy. It was recorded physiological indicators of anxiety, perceived anxiety and dyspnoea This research is an experimental study (randomized controlled) which is carried out to investigate the effect on anxiety of hand massage and acupressure therapy in patients having mechanical ventilation support. Research was conducted in Intensive care units of Ege University Faculty of Medicine, Department of Chest Diseases and Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital between the dates 18 June 2007 and 3 May 2008. The research sample was comprised of a total of 70 patients who met the research criteria in the hand massage and acupressure (n=35) and control (n =35) groups. Data were collected by using Patient Information Form, Patient Record Form and Visual Analogue Scale. It was following patients in experimental and control groups during seven days. It was recorded physiological indicators of anxiety, perceived anxiety and dyspnoea of patients in control group. These patients weren’t used hand massage and acupressure therapy. The patients in experimental group weren’t used hand massage and acupressure therapy in the first and seventh days. It was recorded physiological indicators of anxiety, perceived anxiety and dyspnoea. The other days, it was used hand massage and acupressure therapy. Hand massage and acupressure therapy was limited to 18 minutes. It was recorded physiological indicators of anxiety, perceived anxiety and dyspnoea before and after hand massage and acupressure therapy. It was calculated intensive care unit costs and determined duration in intensive care unit after discharge of patients in experimental and control groups. In the data analysis were used chi square, repeated measures analysis of variance, independent samples t test, paired samples t test, LSD (Least-Significant difference) tests.</p><p class="Default"><strong>Results: </strong>According to the research findings, it wasn’t found significant as clinical which is the statistically significant difference in the physiological indicators of anxiety, perceived anxiety and dyspnoea except from oxygen saturation.</p><p><strong>Conclusion:</strong> In conclusion, our results suggest that hand massage and acupressure therapy might effectively relieve perceived dyspnoea and anxiety and reduce physiological indicators of anxiety in patients having mechanical ventilation support. The study provides a research-based intervention model for clinicians caring for MVP.</p>

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