Survival Rate of Critically Ill Coronavirus Disease 2019 Patients on Tracheostomy in Indonesia

Abstract Background Major therapeutic advances including immunotherapy and targeted therapies have been changing the face of oncology and resulted in improved prognosis as well as in new toxic complications. The aim of this study is to appraise the trends in intensive care unit (ICU) admissions and outcomes of critically ill patients with solid malignancies. We performed a retrospective single-centre study over a 12-year period (2007–2018) including adult patients with solid malignancies requiring unplanned ICU admission. Admission patterns were classified as: (i) specific if directly related to the underlying cancer; (ii) non-specific; (iii) drug-related or procedural adverse events. Results 1525 patients were analysed. Lung and gastro-intestinal tract accounted for the two main tumour sites. The proportion of patients with metastatic diseases increased from 48.6% in 2007–2008 to 60.2% in 2017–2018 (p = 0.004). Critical conditions were increasingly related to drug- or procedure-related adverse events, from 8.8% of ICU admissions in 2007–2008 to 16% in 2017–2018 (p = 0.01). The crude severity of critical illness at ICU admission did not change over time. The ICU survival rate was 77.4%, without any significant changes over the study period. Among the 1279 patients with complete follow-up, the 1-year survival rate was 33.2%. Independent determinants of ICU mortality were metastatic disease, cancer in progression under treatment, admission for specific complications and the extent of organ failures (invasive and non-invasive ventilation, inotropes/vasopressors, renal replacement therapy and SOFA score). One-year mortality in ICU-survivors was independently associated with lung cancer, metastatic disease, cancer in progression under treatment, admission for specific complications and decision to forgo life-sustaining therapies. Conclusion Advances in the management and the prognosis of solid malignancies substantially modified the ICU admission patterns of cancer patients. Despite underlying advanced and often metastatic malignancies, encouraging short-term and long-term outcomes should help changing the dismal perception of critically ill cancer patients.

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Survival and Biomarkers of COVID-19 Patients Treated with Remdesivir and Favipiravir in ICU: A Single Center Experience in Bangladesh

10.21203/rs.3.rs-123710/v1 ◽

2020 ◽

Author(s):

Nasir M ◽

Perveen RA ◽

Murshed M ◽

Nazneen R ◽

Talha KA

Keyword(s):

Survival Rate ◽

Disease Progression ◽

Critically Ill ◽

Treated Patient ◽

Day Treatment ◽

Therapeutic Option ◽

Tertiary Care ◽

Prognostic Biomarkers ◽

Care Hospital ◽

Single Center Experience

Abstract Background: Since the first detection of a bunch of COVID-19 in late 2019, it become a global concern due to its transmissibility and ability to progress patients in severe respiratory failure and acute respiratory distress syndrome, which need intensive care unit support for a long time. We observed the repurposing use of remdesivir and favipiravir whether considered as a therapeutic option or not through survival rate and changes in biomarker during 10-day treatment stay in ICU.Materials and method: The retrospective observational study in a tertiary care hospital dedicated to COVID-19 at Dhaka, Bangladesh was done at the peak of COVID-19 pandemic in Bangladesh. The mortality rate, length of ICU stays and eight prognostic biomarkers of patients treated with remdesivir and favipiravir was observed as one of the first ever reported experience in Bangladesh.Results: Among the critically ill patients in ICU, 26 (44.8%) died and 32 (55.2%) were cured during the study period and highest mean duration of stay in ICU was observed (14.33 days and 18.13 days) in FPV-treated patients. Mean of means for all biomarkers CRP (26.0) and d-Dimer (2.64) was recorded higher in favipiravir treated patients in death cases, but NLR, d-NLR, platelet, PLR was much higher in remdesivir treated patient of both death and improved cases. Though overall outcome variables between death and improved cases were not statistically significant (p<0.39)Conclusion: The severity of disease progression in critically ill COVID-19 patients in ICU depends on comorbidities and hyper responsive inflammatory or immunological biomarkers to predict. Though the emergency use authorization and repurposing use of different antivirals are still on trial, but remdesivir and favipiravir revealed not much hope in improving prognostic biomarkers, survival rate and disease progression at the initial peak of pandemic in Bangladesh.

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Survival and Biomarkers of COVID-19 Patients Treated with Remdesivir and Favipiravir in ICU during the Peak of Pandemic: A Single Center Study in Bangladesh

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2020/v32i4531088 ◽

2021 ◽

pp. 14-22

Author(s):

M. Nasir ◽

R. A. Perveen ◽

M. Murshed ◽

R. Nazneen ◽

K. A. Talha

Keyword(s):

Survival Rate ◽

Disease Progression ◽

Critically Ill ◽

Treated Patient ◽

Day Treatment ◽

Therapeutic Option ◽

Tertiary Care ◽

Prognostic Biomarkers ◽

Care Hospital ◽

Long Time

Since the first detection of a cluster of COVID-19 patients in China in late 2019, it becomes a global concern due to its transmissibility and ability to progress patients in severe respiratory failure and acute respiratory distress syndrome, which need intensive care unit support for a long time. We observed the repurposing use of remdesivir and favipiravir whether considered as a therapeutic option or not through survival rate and changes in biomarker during 10-day treatment stay in ICU. The retrospective observational study in a tertiary care hospital dedicated to COVID-19 at Dhaka, Bangladesh was done at the peak of COVID-19 pandemic in Bangladesh. The mortality rate, length of ICU stays and eight prognostic biomarkers of patients treated with remdesivir and favipiravir was observed as one of the first ever reported experience in Bangladesh. Among the critically ill patients in ICU, 26 (44.8%) died and 32 (55.2%) were cured during the study period and highest mean duration of stay in ICU was observed (14.33 days and 18.13 days) in FPV-treated patients. Mean of means for all biomarkers CRP (26.0) and d-Dimer (2.64) was recorded higher in favipiravir treated patients in death cases, but NLR, d-NLR, platelet, PLR was much higher in remdesivir treated patient of both death and improved cases. Though overall outcome variables between death and improved cases were not statistically significant (p<0.39) The severity of disease progression in critically ill COVID-19 patients in ICU depends on comorbidities and hyper-responsive inflammatory or immunological biomarkers to predict. Though the emergency use authorization and repurposing use of different antivirals are still on trial, but remdesivir and favipiravir revealed not much hope in improving prognostic biomarkers, survival rate and disease progression at the peak of pandemic in Bangladesh.

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Colonization with Extensively Drug-Resistant Acinetobacter baumannii and Prognosis in Critically Ill Patients: An Observational Cohort Study

10.21203/rs.3.rs-225795/v2 ◽

2021 ◽

Author(s):

Yue Zheng ◽

Nana Xu ◽

Jiaojiao Pang ◽

Hui Han ◽

Hongna Yang ◽

...

Keyword(s):

Overall Survival ◽

Survival Rate ◽

Critically Ill ◽

Critically Ill Patients ◽

Drug Resistant ◽

Overall Survival Rate ◽

Short Term ◽

Extensively Drug Resistant ◽

Kaplan Meier

Abstract BackgroundAcinetobacter baumannii is one of the most frequently isolated opportunistic pathogens in intensive care units (ICUs). Extensively drug-resistant A. baumannii (XDR-AB) strains lack susceptibility to almost all antibiotics and pose a heavy burden on healthcare institutions. In this study, we evaluated the impact of XDR-AB colonization on both the short-term and long-term survival of critically ill patients.MethodsWe prospectively enrolled patients from two adult ICUs in Qilu Hospital of Shandong University from March 2018 through December 2018. Using nasopharyngeal and perirectal swabs, we evaluated the presence of XDR-AB colonization. Participants were followed up for 6 months. The primary endpoints were 28-day and 6-month mortality after ICU admission. The overall survival rate was estimated by the Kaplan-Meier method. We identified risk factors associated with 28-day and 6-month mortality using the logistic regression model and a time-dependent Cox regression model, respectively. ResultsOut of 431 patients, 77 were colonized with XDR-AB. Based on the Kaplan-Meier curve results, the overall survival before 28 days did not differ by colonization status; however, a significantly lower overall survival rate was obtained at 6 months in colonized patients. Univariate and multivariate analysis results confirmed that XDR-AB colonization was not associated with 28-day mortality, but was an independent risk factor of lower overall survival at 6 months (HR = 1.749, 95% CI = 1.174–2.608).ConclusionsXDR-AB colonization has no effect on short-term overall survival, but is associated with lower long-term overall survival in critically ill patients.

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Development and Implementation of an ICU Quality Improvement Checklist

AACN Advanced Critical Care ◽

10.4037/15597768-2007-2010 ◽

2007 ◽

Vol 18 (2) ◽

pp. 183-189

Author(s):

Steven Q. Simpson ◽

Douglas A. Peterson ◽

Amy R. O’Brien-Ladner

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Improvement ◽

Survival Rate ◽

Length Of Stay ◽

Critically Ill ◽

Evidence Based ◽

Optimal Care ◽

Life Threatening ◽

Medical Intensive Care

Hospitals, especially their intensive care units, are not particularly safe for patients. Life-threatening mistakes and omissions in care can and do occur. To deter omissions and mistakes wherever possible, our medical intensive care team developed a checklist of care issues that must be addressed daily for every patient in our intensive care unit. The checklist augments our daily, multidisciplinary quality rounds and informs all personnel when important items have been missed. It is too soon to tell whether the checklist has had an impact on our survival rate or length of stay, but we have documented clear imrovement in our attention to these core intensive care issues. In addition, our team’s collegiality and team bonding are enhanced by using an evidence-based tool to achieve our care goals. We share our checklist, so that others can use and/or adapt it in their pursuit of optimal care for their critically ill patiens.

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Distribution of the Probability of Survival Is a Strategic Issue for Randomized Trials in Critically Ill Patients

Anesthesiology ◽

10.1097/00000542-200107000-00014 ◽

2001 ◽

Vol 95 (1) ◽

pp. 56-63 ◽

Cited By ~ 62

Author(s):

Bruno Riou ◽

Paul Landais ◽

Benoît Vivien ◽

Philippe Stell ◽

Iheb Labbene ◽

...

Keyword(s):

Survival Rate ◽

Critically Ill ◽

Critically Ill Patients ◽

Randomized Clinical Trials ◽

Bimodal Distribution ◽

Trauma Patients ◽

Probability Of Survival ◽

Individual Probability ◽

Number Of Patients ◽

The Individual

Background Many randomized clinical trials in trauma have failed to demonstrate a significant improvement in survival rate. Using a trauma patient database, we simulated what could happen in a trial designed to improve survival rate in this setting. Methods The predicted probability of survival was assessed using the TRISS methodology in 350 severely injured trauma patients. Using this probability of survival, the authors simulated the effects of a drug that may increase the probability of survival by 10-50% and calculated the number of patients to be included in a triad, assuming alpha = 0.05 and beta = 0.10 by using the percentage of survivors or the individual probability of survival. Other distributions (Gaussian, J shape, uniform) of the probability of survival were also simulated and tested. Results The distribution of the probability of survival was bimodal with two peaks (< 0.10 and > 0.90). There were major discrepancies between the number of patients to be included when considering the percentage of survivors or the individual value of the probability of survival: 63,202 versus 2,848 if the drug increases the probability of survival by 20%. This discrepancy also occurred in other types of distribution (uniform, J shape) but to a lesser degree, whereas it was very limited in a Gaussian distribution. Conclusions The bimodal distribution of the probability of survival in trauma patients has major consequences on hypothesis testing, leading to overestimation of the power. This statistical pitfall may also occur in other critically ill patients.

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Interleukin 1 Receptor Antagonist Anakinra, Intravenous Immunoglobulin, and Corticosteroids in the Management of Critically Ill Adult Patients With Hemophagocytic Lymphohistiocytosis

Journal of Intensive Care Medicine ◽

10.1177/0885066617711386 ◽

2017 ◽

Vol 34 (9) ◽

pp. 723-731 ◽

Cited By ~ 28

Author(s):

Philipp Wohlfarth ◽

Hermine Agis ◽

Guido A. Gualdoni ◽

Johannes Weber ◽

Thomas Staudinger ◽

...

Keyword(s):

Survival Rate ◽

Intravenous Immunoglobulin ◽

Critically Ill ◽

Organ Dysfunction ◽

Sofa Score ◽

Hemophagocytic Lymphohistiocytosis ◽

Interleukin 1 ◽

Adult Patients ◽

Hospital Survival ◽

Icu Discharge

Background: Hemophagocytic lymphohistiocytosis (HLH) causes multiple organ dysfunction frequently leading to intensive care unit (ICU) referral and/or death. We report on a series of critically ill adult patients treated with a non-etoposide-based regimen including interleukin 1 antagonist anakinra, intravenous immunoglobulin (IVIG), and/or corticosteroids (CS) for HLH. Methods: Eight adult (≥18 years) ICU patients having received treatment with anakinra ± IVIG ± CS for HLH between March 2014 and March 2016 at a large tertiary care university hospital (Medical University of Vienna, Vienna, Austria) were retrospectively analyzed. Results: Eight patients (median age: 38 years; range: 20-58 years; 4 males and 4 females) received anakinra together with IVIG (n = 7) and/or high-dose CS (n = 5) for suspected reactive HLH (median H-score: 214; range: 171-288). Seven (88%) patients required vasopressors and invasive mechanical ventilation and 6 (75%) patients required renal replacement therapy (median Sequential Organ Failure Assessment [SOFA] score at HLH diagnosis: 9.5; range: 6-14). Six patients showed a significant decline in the SOFA score at 1 and 2 weeks following treatment initiation ( P = .03), and the remainder 2 patients experienced early death. Five patients survived to ICU discharge, 4 of them could further be discharged from hospital (hospital survival rate: 50%). No overt treatment-related toxicity was noted. Conclusion: Anakinra in combination with IVIG and/or CS resulted in a hospital survival rate of 50% in 8 critically ill adult patients with HLH despite a vast degree of organ dysfunction and the need for aggressive ICU treatment. Further research on non-etoposide-based treatment strategies for HLH in critically ill adults is warranted.

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The effect of omega-3 fatty acid supplementation on clinical and biochemical parameters of critically ill patients with COVID-19: a randomized clinical trial

Journal of Translational Medicine ◽

10.1186/s12967-021-02795-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Saeid Doaei ◽

Somayeh Gholami ◽

Samira Rastgoo ◽

Maryam Gholamalizadeh ◽

Fatemeh Bourbour ◽

...

Keyword(s):

Clinical Trial ◽

Blood Glucose ◽

Survival Rate ◽

Partial Pressure ◽

Randomized Clinical Trial ◽

Critically Ill ◽

Critically Ill Patients ◽

Trial Registry ◽

Omega 3 ◽

Arterial Ph

Abstract Background Omega-3 polyunsaturated fatty acids (n3-PUFAs) may exert beneficial effects on the immune system of patients with viral infections. This paper aimed to examine the effect of n3-PUFA supplementation on inflammatory and biochemical markers in critically ill patients with COVID-19. Methods A double-blind, randomized clinical trial study was conducted on 128 critically ill patients infected with COVID-19 who were randomly assigned to the intervention (fortified formula with n3-PUFA) (n = 42) and control (n = 86) groups. Data on 1 month survival rate, blood glucose, sodium (Na), potassium (K), blood urea nitrogen (BUN), creatinine (Cr), albumin, hematocrit (HCT), calcium (Ca), phosphorus (P), mean arterial pressure (MAP), O2 saturation (O2sat), arterial pH, partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3), base excess (Be), white blood cells (WBCs), Glasgow Coma Scale (GCS), hemoglobin (Hb), platelet (Plt), and the partial thromboplastin time (PTT) were collected at baseline and after 14 days of the intervention. Results The intervention group had significantly higher 1-month survival rate and higher levels of arterial pH, HCO3, and Be and lower levels of BUN, Cr, and K compared with the control group after intervention (all P < 0.05). There were no significant differences between blood glucose, Na, HCT, Ca, P, MAP, O2sat, PO2, PCO2, WBCs, GCS, Hb, Plt, PTT, and albumin between two groups. Conclusion Omega-3 supplementation improved the levels of several parameters of respiratory and renal function in critically ill patients with COVID-19. Further clinical studies are warranted. Trial registry Name of the registry: This study was registered in the Iranian Registry of Clinical Trials (IRCT); Trial registration number: IRCT20151226025699N3; Date of registration: 2020.5.20; URL of trial registry record: https://en.irct.ir/trial/48213

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Colonization With Extensively Drug-Resistant Acinetobacter baumannii and Prognosis in Critically Ill Patients: An Observational Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.667776 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yue Zheng ◽

Nana Xu ◽

Jiaojiao Pang ◽

Hui Han ◽

Hongna Yang ◽

...

Keyword(s):

Overall Survival ◽

Survival Rate ◽

Critically Ill ◽

Critically Ill Patients ◽

Drug Resistant ◽

Overall Survival Rate ◽

Short Term ◽

Extensively Drug Resistant ◽

Kaplan Meier

Background:Acinetobacter baumannii is one of the most frequently isolated opportunistic pathogens in intensive care units (ICUs). Extensively drug-resistant A. baumannii (XDR-AB) strains lack susceptibility to almost all antibiotics and pose a heavy burden on healthcare institutions. In this study, we evaluated the impact of XDR-AB colonization on both the short-term and long-term survival of critically ill patients.Methods: We prospectively enrolled patients from two adult ICUs in Qilu Hospital of Shandong University from March 2018 through December 2018. Using nasopharyngeal and perirectal swabs, we evaluated the presence of XDR-AB colonization. Participants were followed up for 6 months. The primary endpoints were 28-day and 6-month mortality after ICU admission. The overall survival rate was estimated by the Kaplan-Meier method. We identified risk factors associated with 28-day and 6-month mortality using the logistic regression model and a time-dependent Cox regression model, respectively.Results: Out of 431 patients, 77 were colonized with XDR-AB. Based on the Kaplan-Meier curve results, the overall survival before 28 days did not differ by colonization status; however, a significantly lower overall survival rate was obtained at 6 months in colonized patients. Univariate and multivariate analysis results confirmed that XDR-AB colonization was not associated with 28-day mortality, but was an independent risk factor of lower overall survival at 6 months (HR = 1.749, 95% CI = 1.174–2.608).Conclusions: XDR-AB colonization has no effect on short-term overall survival, but is associated with lower long-term overall survival in critically ill patients.

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Convalescent plasma in Severe/ Critically Ill COVID-19 patients; impact of time and mechanical ventilation

10.32592/ircmj.2021.23.9.802 ◽

2021 ◽

Keyword(s):

Mechanical Ventilation ◽

Survival Rate ◽

Ct Scan ◽

Critically Ill ◽

Severe Disease ◽

Multiple Organ ◽

Arterial Oxygen ◽

Secondary Outcome ◽

Blood Oxygen Saturation ◽

Fraction Of Inspired Oxygen

Background: Convalescent plasma (CP) transfusion is one of the suggested treatments for Coronavirus disease 2019 (COVID-19) especially in critically ill patients. Methods: We investigated the efficacy and safety of CP transfusion in 50 consecutive COVID-19 patients with severe/ critically ill disease. Severe disease was defined as having at least one of the following: shortness of breath, respiratory frequency ≥ 20/min, blood oxygen saturation ≤ 93%, partial pressure of arterial oxygen to fraction of inspired oxygen ratio < 300, lung infiltrates > 50% within recent 24-48 hours. Critically ill disease was considered as intensive care unit admission, respiratory failure, septic shock, or multiple organ dysfunction or failure. Primary outcomes included the safety of CP transfusion, 14-day and 30-day survival rate, and change in lung computed tomography (CT) scan score. Several other clinical and laboratory features were evaluated as secondary outcome. Results: Of 50 consecutive patients, 21 were on mechanical ventilation at time of CP transfusion. Totally, 32 patients (64%) survived 30 days after CP transfusion. Survival rate was 74% and 44% in patients who received CP <7 and ≥7 days of admission, respectively. While 92% of patients without mechanical ventilation survived, survival was 29% in patients on mechanical ventilation. CT scan score and some other clinical features were improved. No adverse effects were observed. Conclusion: CP transfusion is a safe and effective treatment in COVID-19 patients with severe/ critically ill disease. The best outcome can be achieved in patients who are not on mechanical ventilation especially early in the disease course.

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