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Abstract
Acute respiratory distress syndrome (ARDS) is an acute respiratory illness characterised by bilateral chest radiographical opacities with severe hypoxaemia due to non-cardiogenic pulmonary oedema. The COVID-19 pandemic has caused an increase in ARDS and highlighted challenges associated with this syndrome, including its unacceptably high mortality and the lack of effective pharmacotherapy. In this Seminar, we summarise current knowledge regarding ARDS epidemiology and risk factors, differential diagnosis, and evidence-based clinical management of both mechanical ventilation and supportive care, and discuss areas of controversy and ongoing research. Although the Seminar focuses on ARDS due to any cause, we also consider commonalities and distinctions of COVID-19-associated ARDS compared with ARDS from other causes.
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Affiliation(s)
- Nuala J Meyer
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | - Luciano Gattinoni
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Carolyn S Calfee
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Departments of Medicine and Anesthesia, University of California San Francisco, San Francisco, CA, USA
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52
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Quilliot D, Gérard M, Bonsack O, Malgras A, Vaillant MF, Di Patrizio P, Jaussaud R, Ziegler O, Nguyen-Thi PL. Impact of severe SARS-CoV-2 infection on nutritional status and subjective functional loss in a prospective cohort of COVID-19 survivors. BMJ Open 2021; 11:e048948. [PMID: 34261689 PMCID: PMC8282420 DOI: 10.1136/bmjopen-2021-048948] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
UNLABELLED The nutritional sequelae of COVID-19 have not been explored in a large cohort study. OBJECTIVES To identify factors associated with the change in nutritional status between discharge and 30 days post-discharge (D30). Secondary objectives were to determine the prevalence of subjective functional loss and severe disability at D30 and their associated factors. METHODS Collected data included symptoms, nutritional status, self-evaluation of food intake, Performance Status (PS) Scale, Asthenia Scale, self-evaluation of strength (SES) for arms and legs at discharge and at D30. An SES <7 was used to determine subjective functional loss. A composite criteria for severe disability was elaborated combining malnutrition, subjective functional loss and PS >2. Patients were classified into three groups according to change in nutritional status between discharge and D30 (persistent malnutrition, correction of malnutrition and the absence of malnutrition). RESULTS Of 549 consecutive patients hospitalised for COVID-19 between 1 March and 29 April 2020, 130 died including 17 after discharge (23.7%). At D30, 312 patients were at home, 288 (92.3%) of whom were interviewed. Of the latter, 33.3% were malnourished at discharge and still malnourished at D30, while 23.2% were malnourished at discharge but no longer malnourished at D30. The highest predictive factors of persistent malnutrition were intensive care unit (ICU) stay (OR=3.42, 95% CI: 2.04 to 5.75), subjective functional loss at discharge (OR=3.26, 95% CI: 1.75 to 6.08) and male sex (OR=2.39, 95% CI: 1.44 to 3.97). Subjective functional loss at discharge (76.8%) was the main predictive factor of subjective functional loss at D30 (26.3%) (OR=32.6, 95% CI: 4.36 to 244.0). Lastly, 8.3% had a severe disability, with a higher risk in patients requiring an ICU stay (OR=3.39, 95% CI: 1.43 to 8.06). CONCLUSION Patients who survived a severe form of COVID-19 had a high risk of persistent malnutrition, functional loss and severe disability at D30. We believe that nutritional support and rehabilitation should be strengthened, particularly for male patients who were admitted in ICU and had subjective functional loss at discharge. TRIAL REGISTRATION NUMBER NCT04451694.
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Affiliation(s)
- Didier Quilliot
- Unité Transversale de Nutrition, CHRU de Nancy, Nancy, France
| | - Marine Gérard
- Unité Transversale de Nutrition, CHRU de Nancy, Nancy, France
| | - Olivier Bonsack
- Unité Transversale de Nutrition, CHRU de Nancy, Nancy, France
| | - Aurélie Malgras
- Unité Transversale de Nutrition, CHRU de Nancy, Nancy, France
| | | | | | - Roland Jaussaud
- Internal Medicine and Clinical Immunology Department, CHRU de Nancy, Nancy, France
| | - Olivier Ziegler
- Endocrinology Diabetology and Nutrition Department, CHRU de Nancy, Nancy, France
| | - Phi-Linh Nguyen-Thi
- Medical Evaluation Department, Department of Clinical Research Support PARC, University of Lorraine, CHRU de Nancy, Nancy, France
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53
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Carenzo L, Protti A, Dalla Corte F, Aceto R, Iapichino G, Milani A, Santini A, Chiurazzi C, Ferrari M, Heffler E, Angelini C, Aghemo A, Ciccarelli M, Chiti A, Iwashyna TJ, Herridge MS, Cecconi M. Short-term health-related quality of life, physical function and psychological consequences of severe COVID-19. Ann Intensive Care 2021; 11:91. [PMID: 34089104 PMCID: PMC8177269 DOI: 10.1186/s13613-021-00881-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/21/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Survivors of severe COVID-19 are at risk of impaired health-related quality of life (HRQoL) and persistent physical and psychological disability after ICU and hospital discharge. The subsequent social burden is a major concern. We aimed to assess the short-term HRQoL, physical function and prevalence of post-traumatic stress symptoms of invasively mechanically ventilated COVID-19 patients treated in our ICU. METHODS Prospective, observational cohort study in a follow-up clinic. Patients completed a 6-min walking test (6MWT) to assess their cardio-pulmonary function around 2 months (early follow-up) from hospital discharge, the EQ-5D-5L questionnaire for quality of life assessment around 2 months and at 6 months from hospital discharge and an anonymous web-based Impact of Event Scale-Revised (IES-R) questionnaire for Post-Traumatic Stress symptoms at 2 months. RESULTS 47 patients attended our follow-up program, mean age 59 ± 10 years, median pre-morbid Clinical Frailty Scale (CFS) 2 [2-3]. The median distance walked in 6 min was 470 [406-516] m, 83 [67-99]% of the predicted value. Overall 1 out 3 patients and 4/18 (22%) among those with a good functional baseline prior to COVID-19 (CFS of 1 or 2) had lower (84%) than predicted 6MWT. EQ-5D-5L quality of life VAS was 80 [70-90] out of 100 at early follow-up with a slight improvement to 85 [77.5-90] at 6 months. Mobility, self-care and usual activities improved between the two timepoints, while pain/discomfort and depression/anxiety did not improve or got worse. The IES-R total score was greater than the threshold for concern of 1.6 in 27/41(66%) respondents. CONCLUSIONS Patients recovering from severe COVID-19 requiring invasive mechanical ventilation surviving hospital discharge present with early mild to moderate functional impairment, mildly reduced quality of life from hospital discharge with an overall improvement of mobility, self-care and the ability of performing usual activities, while a worsening of pain and depression/anxiety symptoms at 6 months and a large proportion of symptoms of post-traumatic distress soon after hospital discharge.
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Affiliation(s)
- Luca Carenzo
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy.
| | - Alessandro Protti
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Italy
| | - Francesca Dalla Corte
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Romina Aceto
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Giacomo Iapichino
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Angelo Milani
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Italy
| | - Alessandro Santini
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Chiara Chiurazzi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Michele Ferrari
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Claudio Angelini
- Department of Renal Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Italy.,Department of Internal Medicine and Hepatology, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Michele Ciccarelli
- Department of Respiratory Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Italy.,Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Theodore J Iwashyna
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, USA
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, Institute of Medical Science, Toronto General Research Institute, University of Toronto, Toronto, Canada
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Italy
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Jain E, Harmon EY, Sonagere MB. Functional outcomes and post-discharge care sought by patients with COVID-19 compared to matched controls after completing inpatient acute rehabilitation. PM R 2021; 13:618-625. [PMID: 33870659 PMCID: PMC8250521 DOI: 10.1002/pmrj.12607] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/08/2021] [Accepted: 04/09/2021] [Indexed: 02/03/2023]
Abstract
Introduction A subset of patients with coronavirus disease 19 (COVID‐19) can develop severe illness, resulting in significant functional and cognitive deficits that require acute inpatient rehabilitation. Guidelines following discharge from acute inpatient rehabilitation have not yet been established. This study seeks to establish outcomes of rehabilitation patients with COVID‐19 and characterize their need for long‐term care. Objective To determine the functional outcomes and utilization of follow‐up medical care for patients with COVID‐19 90 days following discharge from acute inpatient rehabilitation, as compared to rehabilitation impairment and age‐matched controls. Design Prospective, single‐center cohort study. Setting Inpatient rehabilitation facility (IRF). Patients Sixty‐four patients recovering from COVID‐19 and 64 age and impairment group category controls were identified to answer survey questions following discharge from inpatient rehabilitation. A total of 36 patients participated in the study (18 patients with COVID‐19 and 18 controls). Interventions Not applicable. Main Outcome Measure(s) Functional outcomes at discharge (GG Self‐Care and Mobility Activities items of the IRF‐PAI Version 3.0), hospital readmissions, and follow‐up care sought by patients. Results The COVID‐19 patient group had similar improvements in functional outcomes as compared to controls. Patients with COVID‐19 required fewer 0–90 day readmissions than their matched controls (22.2% vs 61.1%, P < .05), but there were no differences in 0–90 day urgent care/emergency department visits, clinic visits and use of outpatient therapies. Conclusions Patients with functional deficits as a result of COVID‐19 who require multiple therapy disciplines should be considered for acute inpatient rehabilitation as this study demonstrates their ability to participate in and benefit from IRF level care.
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Affiliation(s)
- Esha Jain
- Department of MedicineAlbany Medical CenterAlbanyNew YorkUSA
| | - Erin Y. Harmon
- Department of Physical Medicine and RehabilitationSunnyview Rehabilitation HospitalSchenectadyNew YorkUSA
| | - Matthew B. Sonagere
- Department of Physical Medicine and RehabilitationSunnyview Rehabilitation HospitalSchenectadyNew YorkUSA
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55
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Development and Content Validation of a Multidisciplinary Standardized Management Pathway for Hypoxemic Respiratory Failure and Acute Respiratory Distress Syndrome. Crit Care Explor 2021; 3:e0428. [PMID: 34036279 PMCID: PMC8133138 DOI: 10.1097/cce.0000000000000428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: Treatment of hypoxemic respiratory failure and acute respiratory distress syndrome is complex. Evidence-based therapies that can improve survival and guidelines advocating their use exist; however, implementation is inconsistent. Our objective was to develop and validate an evidence-based, stakeholder-informed standardized management pathway for hypoxemic respiratory failure and acute respiratory distress syndrome to improve adherence to best practice. Design: A standardized management pathway was developed using a modified Delphi consensus process with a multidisciplinary group of ICU clinicians. The proposed pathway was externally validated with a survey involving multidisciplinary stakeholders and clinicians. Setting: In-person meeting and web-based surveys of ICU clinicians from 17 adult ICUs in the province of Alberta, Canada. Intervention: Not applicable. Measurements and Main Results: The consensus panel was comprised of 30 ICU clinicians (4 nurses, 10 respiratory therapists, 15 intensivists, 1 nurse practitioner; median years of practice 17 [interquartile range, 13–21]). Ninety-one components were serially rated and revised over two rounds of online and one in-person review. The final pathway included 46 elements. For the validation survey, 692 responses (including 59% nurses, 33% respiratory therapists, 7% intensivists and 1% nurse practitioners) were received. Agreement of greater than 75% was achieved on 43 of 46 pathway elements. Conclusions: A 46-element evidence-informed hypoxemic respiratory failure and acute respiratory distress syndrome standardized management pathway was developed and demonstrated to have content validity.
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56
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Stanculescu D, Larsson L, Bergquist J. Theory: Treatments for Prolonged ICU Patients May Provide New Therapeutic Avenues for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Front Med (Lausanne) 2021; 8:672370. [PMID: 34026797 PMCID: PMC8137963 DOI: 10.3389/fmed.2021.672370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/01/2021] [Indexed: 12/20/2022] Open
Abstract
We here provide an overview of treatment trials for prolonged intensive care unit (ICU) patients and theorize about their relevance for potential treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Specifically, these treatment trials generally target: (a) the correction of suppressed endocrine axes, notably through a "reactivation" of the pituitary gland's pulsatile secretion of tropic hormones, or (b) the interruption of the "vicious circle" between inflammation, oxidative and nitrosative stress (O&NS), and low thyroid hormone function. There are significant parallels in the treatment trials for prolonged critical illness and ME/CFS; this is consistent with the hypothesis of an overlap in the mechanisms that prevent recovery in both conditions. Early successes in the simultaneous reactivation of pulsatile pituitary secretions in ICU patients-and the resulting positive metabolic effects-could indicate an avenue for treating ME/CFS. The therapeutic effects of thyroid hormones-including in mitigating O&NS and inflammation and in stimulating the adreno-cortical axis-also merit further studies. Collaborative research projects should further investigate the lessons from treatment trials for prolonged critical illness for solving ME/CFS.
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Affiliation(s)
| | - Lars Larsson
- Basic and Clinical Muscle Biology, Department of Physiology and Pharmacology, Karolinska Institute, Solna, Sweden
| | - Jonas Bergquist
- Analytical Chemistry and Neurochemistry, Department of Chemistry–Biomedical Center, Uppsala University, Uppsala, Sweden
- The Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Collaborative Research Centre at Uppsala University, Uppsala, Sweden
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57
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Sonnweber T, Sahanic S, Pizzini A, Luger A, Schwabl C, Sonnweber B, Kurz K, Koppelstätter S, Haschka D, Petzer V, Boehm A, Aichner M, Tymoszuk P, Lener D, Theurl M, Lorsbach-Köhler A, Tancevski A, Schapfl A, Schaber M, Hilbe R, Nairz M, Puchner B, Hüttenberger D, Tschurtschenthaler C, Aßhoff M, Peer A, Hartig F, Bellmann R, Joannidis M, Gollmann-Tepeköylü C, Holfeld J, Feuchtner G, Egger A, Hoermann G, Schroll A, Fritsche G, Wildner S, Bellmann-Weiler R, Kirchmair R, Helbok R, Prosch H, Rieder D, Trajanoski Z, Kronenberg F, Wöll E, Weiss G, Widmann G, Löffler-Ragg J, Tancevski I. Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial. Eur Respir J 2021; 57:13993003.03481-2020. [PMID: 33303539 PMCID: PMC7736754 DOI: 10.1183/13993003.03481-2020] [Citation(s) in RCA: 263] [Impact Index Per Article: 87.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND After the 2002/2003 severe acute respiratory syndrome outbreak, 30% of survivors exhibited persisting structural pulmonary abnormalities. The long-term pulmonary sequelae of coronavirus disease 2019 (COVID-19) are yet unknown, and comprehensive clinical follow-up data are lacking. METHODS In this prospective, multicentre, observational study, we systematically evaluated the cardiopulmonary damage in subjects recovering from COVID-19 at 60 and 100 days after confirmed diagnosis. We conducted a detailed questionnaire, clinical examination, laboratory testing, lung function analysis, echocardiography and thoracic low-dose computed tomography (CT). RESULTS Data from 145 COVID-19 patients were evaluated, and 41% of all subjects exhibited persistent symptoms 100 days after COVID-19 onset, with dyspnoea being most frequent (36%). Accordingly, patients still displayed an impaired lung function, with a reduced diffusing capacity in 21% of the cohort being the most prominent finding. Cardiac impairment, including a reduced left ventricular function or signs of pulmonary hypertension, was only present in a minority of subjects. CT scans unveiled persisting lung pathologies in 63% of patients, mainly consisting of bilateral ground-glass opacities and/or reticulation in the lower lung lobes, without radiological signs of pulmonary fibrosis. Sequential follow-up evaluations at 60 and 100 days after COVID-19 onset demonstrated a vast improvement of symptoms and CT abnormalities over time. CONCLUSION A relevant percentage of post-COVID-19 patients presented with persisting symptoms and lung function impairment along with radiological pulmonary abnormalities >100 days after the diagnosis of COVID-19. However, our results indicate a significant improvement in symptoms and cardiopulmonary status over time.
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Affiliation(s)
- Thomas Sonnweber
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria.,Contributed equally as first authors
| | - Sabina Sahanic
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria.,Contributed equally as first authors
| | - Alex Pizzini
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Luger
- Dept of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Schwabl
- Dept of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Katharina Kurz
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Sabine Koppelstätter
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - David Haschka
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Verena Petzer
- Dept of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Boehm
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Magdalena Aichner
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Piotr Tymoszuk
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Lener
- Dept of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Theurl
- Dept of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Amra Tancevski
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Schapfl
- Dept of Internal Medicine, St Vinzenz Hospital, Zams, Austria
| | - Marc Schaber
- Dept of Internal Medicine, St Vinzenz Hospital, Zams, Austria
| | - Richard Hilbe
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Manfred Nairz
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Puchner
- The Karl Landsteiner Institute, Reha Zentrum Münster, Münster, Austria
| | - Doris Hüttenberger
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Malte Aßhoff
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Peer
- Division of Intensive Care and Emergency Medicine, Dept of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Frank Hartig
- Division of Intensive Care and Emergency Medicine, Dept of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Romuald Bellmann
- Division of Intensive Care and Emergency Medicine, Dept of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Dept of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Johannes Holfeld
- Dept of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gudrun Feuchtner
- Dept of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander Egger
- Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Innsbruck, Innsbruck, Austria
| | - Gregor Hoermann
- Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Innsbruck, Innsbruck, Austria.,Dept of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.,MLL Munich Leukemia Laboratory, Munich, Germany
| | - Andrea Schroll
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Gernot Fritsche
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Sophie Wildner
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Rudolf Kirchmair
- Dept of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria.,The Karl Landsteiner Institute, Reha Zentrum Münster, Münster, Austria
| | - Raimund Helbok
- Dept of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmut Prosch
- Dept of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Dietmar Rieder
- Institute for Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Zlatko Trajanoski
- Institute for Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ewald Wöll
- Dept of Internal Medicine, St Vinzenz Hospital, Zams, Austria
| | - Günter Weiss
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerlig Widmann
- Dept of Radiology, Medical University of Innsbruck, Innsbruck, Austria.,Contributed equally to this article as lead authors and supervised the work
| | - Judith Löffler-Ragg
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria.,Contributed equally to this article as lead authors and supervised the work
| | - Ivan Tancevski
- Dept of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria.,Contributed equally to this article as lead authors and supervised the work
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Ghaffari Darab M, Keshavarz K, Sadeghi E, Shahmohamadi J, Kavosi Z. The economic burden of coronavirus disease 2019 (COVID-19): evidence from Iran. BMC Health Serv Res 2021; 21:132. [PMID: 33573650 PMCID: PMC7877330 DOI: 10.1186/s12913-021-06126-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/27/2021] [Indexed: 12/25/2022] Open
Abstract
This study aimed to estimate both direct medical and indirect costs of treating the Coronavirus disease 2019 (COVID-19) from a societal perspective in the patients at a referral hospital in Fars province as well as the economic burden of COVID-19 in Iran in 2020. METHODS This study is a partial economic evaluation and a cross-sectional cost-description study conducted based on the data of the COVID-19 patients referred to a referral university hospital in Fars province between March and July 2020. The data were collected by examining the patients' records and accounting information systems. The subjects included all the inpatients with COVID-19 (477 individuals) who admitted to the medical centre during the 4 months. Bottom-up costing (also called micro-costing approach), incidence-based and income-based human capital approaches were used as the main methodological features of this study. RESULTS The direct medical costs were estimated to be 28,240,025,968 Rials ($ 1,791,172) in total with mean cost of 59,203,409 Rials ($ 3755) per person (SD = 4684 $/ 73,855,161 Rials) in which significant part (41%) was that of intensive and general care beds (11,596,217,487 Rials equal to $ 735,510 (M = 24,310,728 Rials or $ 1542, SD = 34,184,949 Rials or $ 2168(. The second to which were the costs of medicines and medical consumables (28%). The mean indirect costs, including income loss due to premature death, economic production loss due to hospitalization and job absenteeism during recovery course were estimated to be 129,870,974 Rials ($ 11,634) per person. Furthermore, the economic burden of the disease in the country for inpatient cases with the definitive diagnosis was 22,688,925,933,095 Rials equal to $ 1,439,083,784. CONCLUSION The results of this study showed that the severe status of the disease would bring about the extremely high cost of illness in this case. It is estimated that the high prevalence rate of COVID-19 has been imposing a heavy economic burden on the country and health system directly that may result in rationing or painful cost-control approaches.
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Affiliation(s)
- Mohsen Ghaffari Darab
- School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Centre, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elnaz Sadeghi
- Student Research Committee, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Shahmohamadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kavosi
- Health Human Resources Research Centre, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
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59
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Wu Y, Zhang Z, Jiang B, Wang G, Wei H, Li B, Shen X, Zhang C. Current practice and barriers to ICU-acquired weakness assessment: a cross-sectional survey. Physiotherapy 2021; 112:135-142. [PMID: 34052568 DOI: 10.1016/j.physio.2021.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Intensive-care-unit-acquired weakness (ICU-AW) not only leads to difficulty weaning off mechanical ventilation, prolonged hospital stay and increased medical costs, but also reduces the patient's quality of life after discharge and increases the 1-year mortality rate. Early identification and intervention can improve the prognosis of critically ill patients. However, much remains unknown about current clinical practice for ICU-AW assessment by ICU staff in China. OBJECTIVES To investigate current practices and barriers to ICU-AW assessment among ICU staff, and provide insights to improve ICU-AW assessment in ICUs in China. METHODS Qualitative interviews were used to construct a survey questionnaire (test-retest reliability 0.92, validity 0.96). This survey was subsequently completed by 3206 ICU staff from 31 provinces, municipalities and autonomous regions in China. RESULTS In total, 3206 ICU staff responded to the survey (response rate 90%): 616 doctors (19%), 2371 nurses (74%), 129 respiratory therapists (4%), 51 physiotherapists (2%) and 39 dieticians (1%). Only 27% of the respondents had treated/cared for patients with ICU-AW. Reported methods for ICU-AW assessment were clinical experience (53%), ICU-AW assessment tools (12%), and physiotherapy consultation (35%). Forty-three percent of respondents felt that their ICU-AW-related knowledge did not meet clinical needs, only 10% had received ICU-AW-related training, and 19% proactively assessed whether their patients had ICU-AW. In terms of frequency of assessment, 42%, 16% and 11% of respondents considered that ICU-AW should be assessed daily, every 3 days, and on ICU admission and discharge, respectively. The Medical Research Council scale, electrophysiological assessment and the Manual Muscle Testing scale were considered to be optimal tools for ICU-AW diagnosis by 79%, 70%, and 73% of respondents, respectively. The main reported barriers to ICU-AW assessment were lack of knowledge, cognitive impairment among patients, and lack of ICU-AW assessment guidelines and procedures. CONCLUSION Current practices for ICU-AW assessment are non-specific, and the main barriers include lack of skills and knowledge.
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Affiliation(s)
- Yuchen Wu
- Lanzhou University, First Affiliated Hospital, Lanzhou, China; School of Nursing, Lanzhou University, Lanzhou, China
| | - Zhigang Zhang
- Lanzhou University, First Affiliated Hospital, Lanzhou, China; School of Nursing, Lanzhou University, Lanzhou, China.
| | | | - Guoqiang Wang
- Lanzhou University, First Affiliated Hospital, Lanzhou, China
| | - Huaping Wei
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Bin Li
- Lanzhou University, First Affiliated Hospital, Lanzhou, China
| | - Xiping Shen
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Caiyun Zhang
- Lanzhou University, First Affiliated Hospital, Lanzhou, China; School of Nursing, Lanzhou University, Lanzhou, China
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Nebulised heparin for patients with or at risk of acute respiratory distress syndrome: a multicentre, randomised, double-blind, placebo-controlled phase 3 trial. THE LANCET RESPIRATORY MEDICINE 2021; 9:360-372. [PMID: 33493448 PMCID: PMC7826120 DOI: 10.1016/s2213-2600(20)30470-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 12/16/2022]
Abstract
Background Mechanical ventilation in intensive care for 48 h or longer is associated with the acute respiratory distress syndrome (ARDS), which might be present at the time ventilatory support is instituted or develop afterwards, predominantly during the first 5 days. Survivors of prolonged mechanical ventilation and ARDS are at risk of considerably impaired physical function that can persist for years. An early pathogenic mechanism of lung injury in mechanically ventilated, critically ill patients is inflammation-induced pulmonary fibrin deposition, leading to thrombosis of the microvasculature and hyaline membrane formation in the air sacs. The main aim of this study was to determine if nebulised heparin, which targets fibrin deposition, would limit lung injury and thereby accelerate recovery of physical function in patients with or at risk of ARDS. Methods The Can Heparin Administration Reduce Lung Injury (CHARLI) study was an investigator-initiated, multicentre, double-blind, randomised phase 3 trial across nine hospitals in Australia. Adult intensive care patients on invasive ventilation, with impaired oxygenation defined by a PaO2/FiO2 ratio of less than 300, and with the expectation of invasive ventilation beyond the next calendar day were recruited. Key exclusion criteria were heparin allergy, pulmonary bleeding, and platelet count less than 50 X 109/L. Patients were randomly assigned 1:1, with stratification by site and using blocks of variable size and random seed, via a web-based system, to either unfractionated heparin sodium 25 000 IU in 5 mL or identical placebo (sodium chloride 0·9% 5 mL), administered using a vibrating mesh membrane nebuliser every 6 h to day 10 while invasively ventilated. Patients, clinicians, and investigators were masked to treatment allocation. The primary outcome was the Short Form 36 Health Survey Physical Function Score (out of 100) of survivors at day 60. Prespecified secondary outcomes, which are exploratory, included development of ARDS to day 5 among at-risk patients, deterioration of the Murray Lung Injury Score (MLIS) to day 5, mortality at day 60, residence of survivors at day 60, and serious adverse events. Analyses followed the intention-to-treat principle. There was no imputation of missing data. The trial is registered with the Australian and New Zealand Clinical Trials Register, number ACTRN12612000418875 . Findings Between Sept 4, 2012, and Aug 23, 2018, 256 patients were randomised. Final follow-up was on Feb 25, 2019. We excluded three patients who revoked consent and one ineligible participant who received no intervention. Of 252 patients included in data analysis, the mean age was 58 years (SD 15), 157 (62%) were men, and 118 (47%) had ARDS. 128 (51%) patients were assigned to the heparin group and 124 (49%) to the placebo group, all of whom received their assigned intervention. Survivors in the heparin group (n=97) had similar SF-36 Physical Function Scores at day 60 compared to the placebo group (n=94; mean 53·6 [SD 31·6] vs 48·7 [35·7]; difference 4·9 [95% CI −4·8 to 14·5]; p=0·32). Compared with the placebo group, the heparin group had fewer cases of ARDS develop to day 5 among the at-risk patients (nine [15%] of 62 patients vs 21 [30%] of 71 patients; hazard ratio 0·46 [95% CI 0·22 to 0·98]; p=0·0431), less deterioration of the MLIS to day 5 (difference −0·14 [–0·26 to −0·02]; p=0·0215), similar day 60 mortality (23 [18%] of 127 patients vs 18 [15%] of 123 patients; odds ratio [OR] 1·29 [95% CI 0·66 to 2·53]; p=0·46), and more day 60 survivors at home (86 [87%] of 99 patients vs 73 [73%] of 100 patients; OR 2·45 [1·18 to 5·08]; p=0·0165). A similar number of serious adverse events occurred in each group (seven [5%] of 128 patients in the heparin group vs three [2%] of 124 patients in the placebo group; OR 2·33 [0·59 to 9·24]; p=0·23), which were a transient increase in airway pressure during nebulisation (n=3 in the heparin group), major non-pulmonary bleeding (n=2 in each group), haemoptysis (n=1 in the heparin group), tracheotomy site bleeding (n=1 in the heparin group), and hypoxaemia during nebulisation (n=1 in the placebo group). Interpretation In patients with or at risk of ARDS, nebulised heparin did not improve self-reported performance of daily physical activities, but was well tolerated and exploratory outcomes suggest less progression of lung injury and earlier return home. Further research is justified to establish if nebulised heparin accelerates recovery in those who have or are at risk of ARDS. Funding Rowe Family Foundation, TR and RB Ditchfield Medical Research Endowment Fund, Patricia Madigan Charitable Trust, and The J and R McGauran Trust Fund.
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Plapler PG, de Souza DR, Kaziyama HHS, Battistella LR, de Barros-Filho TEP. Relationship between the coronavirus disease 2019 pandemic and immobilization syndrome. Clinics (Sao Paulo) 2021; 76:e2652. [PMID: 33567050 PMCID: PMC7847256 DOI: 10.6061/clinics/2021/e2652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/17/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
- Pérola Grinberg Plapler
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Daniel Rubio de Souza
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto de Medicina de Reabilitacao (IMRea), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Helena Hideko Seguchi Kaziyama
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Linamara Rizzo Battistella
- Instituto de Medicina de Reabilitacao (IMRea), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail: /
| | - Tarcisio Eloy Pessoa de Barros-Filho
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Cao J, Zheng X, Wei W, Chu X, Chen X, Wang Y, Liu Q, Luo S, Weng J, Hu X. Three-month outcomes of recovered COVID-19 patients: prospective observational study. Ther Adv Respir Dis 2021; 15:17534666211009410. [PMID: 33878961 PMCID: PMC8064514 DOI: 10.1177/17534666211009410] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS A novel coronavirus SARS-CoV-2 has resulted in an ongoing global pandemic of Coronavirus disease 2019 (COVID-19). However, the outcomes of recovered patients have not been well defined. METHODS This is a prospective observational follow-up study of survivors with COVID-19 from a designated tertiary center in Hefei, China. We examined chest computed tomography (CT) scanning, pulmonary function, 6-min walk distance (6MWD), and 36 item Short Form General Health Survey (SF-36). RESULTS Among 81 enrolled patients, 62 (77%) patients and 61 (75%) patients, respectively, completed 1-month and 3-month follow-ups. Abnormal CT findings were still present in 73% of patients at 1 month and 54% at 3 months, whereas chest CT scan scores improved progressively at 1-month (5.0 ± 5.1) and 3-month follow up (3.0 ± 4.5) compared with that during hospitalization (11 ± 6.8). Mild restrictive pulmonary impairment was detected in 11% and 10% of patients at 1-month and 3-month follow up, respectively. The 6MWD was 523 ± 77 m in male patients and 484 ± 58 m in female patients, which was significantly lower than in healthy controls (606 ± 68 m, 568 ± 78 m, p < 0.001). SF-36 scores were significantly impaired in the domains of role physical (RP), role emotional (RE), and social functioning (SF) compared with the normal age-matched population. RP was improved at 3-month compared with 1-month follow up in the 41-64 years group (p < 0.01). Multivariable analysis showed that older age (over 40 years) and steroid administration during hospitalization were independently associated with worse chest CT scores at 3-month follow up. CONCLUSIONS At 3 months, chest CT abnormalities were present in one half of COVID-19 survivors and worse chest CT scores were independently associated with older age and steroid administration during hospitalization. Residual pulmonary function impairments were modest, whereas exercise capacity and SF-36 scores were significantly lower than the general population. Support program and further follow-up evaluations may be needed.The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Jie Cao
- Department of Pulmonary and Critical Care Medicine, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xueying Zheng
- Department of Endocrine, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wei Wei
- Department of Radiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xinmin Chu
- Department of Clinical Laboratory, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xianmeng Chen
- Department of Pulmonary and Critical Care Medicine, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Ying Wang
- Department of Radiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Qiqi Liu
- Department of Rehabilitation (now at Department of Rehabilitation, the Second People’s Hospital of Hefei), The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Sihui Luo
- Department of Endocrine, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Jianping Weng
- Department of Endocrine, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiaowen Hu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Room 302, Building 9, 17 Lujiang Road, Luyang District, Hefei, Anhui, 230001, China
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Poenaru S, Abdallah SJ, Corrales-Medina V, Cowan J. COVID-19 and post-infectious myalgic encephalomyelitis/chronic fatigue syndrome: a narrative review. Ther Adv Infect Dis 2021; 8:20499361211009385. [PMID: 33959278 PMCID: PMC8060761 DOI: 10.1177/20499361211009385] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/13/2021] [Indexed: 12/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a viral infection which can cause a variety of respiratory, gastrointestinal, and vascular symptoms. The acute illness phase generally lasts no more than 2-3 weeks. However, there is increasing evidence that a proportion of COVID-19 patients experience a prolonged convalescence and continue to have symptoms lasting several months after the initial infection. A variety of chronic symptoms have been reported including fatigue, dyspnea, myalgia, exercise intolerance, sleep disturbances, difficulty concentrating, anxiety, fever, headache, malaise, and vertigo. These symptoms are similar to those seen in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a chronic multi-system illness characterized by profound fatigue, sleep disturbances, neurocognitive changes, orthostatic intolerance, and post-exertional malaise. ME/CFS symptoms are exacerbated by exercise or stress and occur in the absence of any significant clinical or laboratory findings. The pathology of ME/CFS is not known: it is thought to be multifactorial, resulting from the dysregulation of multiple systems in response to a particular trigger. Although not exclusively considered a post-infectious entity, ME/CFS has been associated with several infectious agents including Epstein-Barr Virus, Q fever, influenza, and other coronaviruses. There are important similarities between post-acute COVID-19 symptoms and ME/CFS. However, there is currently insufficient evidence to establish COVID-19 as an infectious trigger for ME/CFS. Further research is required to determine the natural history of this condition, as well as to define risk factors, prevalence, and possible interventional strategies.
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Affiliation(s)
- Sonia Poenaru
- Department of Medicine, The Ottawa Hospital,
General Campus, 501 Smyth Road, Box 206, Ottawa, Ontario, K1H 8L6,
Canada
| | - Sara J. Abdallah
- Clinical Epidemiology Program, The Ottawa
Hospital Research Institute, Ottawa, Ontario, Canada
| | - Vicente Corrales-Medina
- Clinical Epidemiology Program, The Ottawa
Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Infectious Diseases, Department of
Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Juthaporn Cowan
- Clinical Epidemiology Program, The Ottawa
Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Infectious Diseases, Department of
Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Leigh AE, McCall J, Burke RV, Rome R, Raines AM. Predictors of Functional Dependence After COVID-19: A Retrospective Examination Among Veterans. Am J Phys Med Rehabil 2021; 100:34-38. [PMID: 33048890 DOI: 10.1097/phm.0000000000001614] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to examine the impact of demographics, preexisting medical conditions, and in-hospital complications of COVID-19 infection on functional status at discharge. DESIGN AND PARTICIPANTS A retrospective chart review was conducted on 119 patients hospitalized for COVID-19 infection between March 1, 2020, and April 20, 2020. Demographics, preexisting medical conditions, and newly diagnosed COVID-19 complications were collected from electronic medical records and entered in a deidentified database. MAIN OUTCOME The primary outcome was functional status at discharge, as measured by independence in activities of daily living. RESULTS Older age, respiratory failure, cardiac conditions, and thromboembolic complications all made a statistically significant contribution to functional dependence at discharge, with thromboembolic complications evincing the strongest association (odds ratio, 25.58). CONCLUSION AND RELEVANCE New diagnosis of thrombosis during COVID-19 hospitalization, a measure of COVID-19 disease severity, was the factor most associated with dependence in activities of daily living at discharge. Interestingly, preexisting conditions including hypertension, severe obesity, lung disease, and diabetes did not correlate with dependent functional status at discharge.
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Affiliation(s)
- Alexandra E Leigh
- From the Geriatrics Service, Section of Hospice and Palliative Care, Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana (AEL, JM, RVB, RR, AMR); School of Medicine, Tulane University, New Orleans, Louisiana (AEL, RVB); South Central Mental Illness Research, Education, and Clinical Center (MIRECC), New Orleans, Louisiana (AMR); and School of Medicine, Louisiana State University, New Orleans, Louisiana (AMR)
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Livingston DH. A Review of "Pulmonary Disability Following Blunt Chest Trauma" (1990). Am Surg 2020; 87:188-190. [PMID: 33339469 DOI: 10.1177/0003134820981716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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66
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Kassirian S, Taneja R, Mehta S. Diagnosis and Management of Acute Respiratory Distress Syndrome in a Time of COVID-19. Diagnostics (Basel) 2020; 10:E1053. [PMID: 33291238 PMCID: PMC7762111 DOI: 10.3390/diagnostics10121053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) remains a serious illness with significant morbidity and mortality, characterized by hypoxemic respiratory failure most commonly due to pneumonia, sepsis, and aspiration. Early and accurate diagnosis of ARDS depends upon clinical suspicion and chest imaging. Coronavirus disease 2019 (COVID-19) is an important novel cause of ARDS with a distinct time course, imaging and laboratory features from the time of SARS-CoV-2 infection to hypoxemic respiratory failure, which may allow diagnosis and management prior to or at earlier stages of ARDS. Treatment of ARDS remains largely supportive, and consists of incremental respiratory support (high flow nasal oxygen, non-invasive respiratory support, and invasive mechanical ventilation), and avoidance of iatrogenic complications, all of which improve clinical outcomes. COVID-19-associated ARDS is largely similar to other causes of ARDS with respect to pathology and respiratory physiology, and as such, COVID-19 patients with hypoxemic respiratory failure should typically be managed as other patients with ARDS. Non-invasive respiratory support may be beneficial in avoiding intubation in COVID-19 respiratory failure including mild ARDS, especially under conditions of resource constraints or to avoid overwhelming critical care resources. Compared to other causes of ARDS, medical therapies may improve outcomes in COVID-19-associated ARDS, such as dexamethasone and remdesivir. Future improved clinical outcomes in ARDS of all causes depends upon individual patient physiological and biological endotyping in order to improve accuracy and timeliness of diagnosis as well as optimal targeting of future therapies in the right patient at the right time in their disease.
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Affiliation(s)
- Shayan Kassirian
- Division of Critical Care Medicine, Centre for Critical Illness Research, Lawson Health Research Institute, London Health Sciences Center, London, ON N6A 5W9, Canada; (S.K.); (R.T.)
- Department of Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON N6A 5W9, Canada
- Department of Anesthesia and Perioperative Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON N6A 5W9, Canada
| | - Ravi Taneja
- Division of Critical Care Medicine, Centre for Critical Illness Research, Lawson Health Research Institute, London Health Sciences Center, London, ON N6A 5W9, Canada; (S.K.); (R.T.)
- Department of Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON N6A 5W9, Canada
- Department of Anesthesia and Perioperative Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON N6A 5W9, Canada
| | - Sanjay Mehta
- Department of Medicine, Schulich Faculty of Medicine and Dentistry, Western University, London, ON N6A 5W9, Canada
- Division of Respirology, Centre for Critical Illness Research, Lawson Health Research Institute, London Health Sciences Center, London, ON N6A 5W9, Canada
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Schefold JC, Wollersheim T, Grunow JJ, Luedi MM, Z'Graggen WJ, Weber-Carstens S. Muscular weakness and muscle wasting in the critically ill. J Cachexia Sarcopenia Muscle 2020; 11:1399-1412. [PMID: 32893974 PMCID: PMC7749542 DOI: 10.1002/jcsm.12620] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/10/2020] [Accepted: 08/23/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Wollersheim
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Julius J Grunow
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Werner J Z'Graggen
- Department of Neurology and Neurosurgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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Nedergaard HK, Jensen HI, Olsen HT, Strøm T, Lauridsen JT, Sjøgaard G, Toft P. Effect of non-sedation on physical function in survivors of critical illness - A substudy of the NONSEDA randomized trial. J Crit Care 2020; 62:58-64. [PMID: 33276294 DOI: 10.1016/j.jcrc.2020.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/21/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Critical illness impairs physical function. The NONSEDA trial was a multicenter randomized trial, assessing non-sedation versus sedation during mechanical ventilation. The aim of this sub-study was to assess the effect of non-sedation on physical function. METHODS All patients from one NONSEDA trial site were included. At ICU discharge and three months thereafter, survivors were assessed for physical function. RESULTS 205 patients were included, 118 survived to follow-up, 116 participated (98%). PRIMARY OUTCOME Three months after ICU-discharge, health-related quality of life (SF-36, physical component score) was similar (non-sedated 38.3 vs sedated 36.6, mean difference 1.7, 95% CI -1.7 to 5.1), as was function in activities of daily living (Barthel Index, non-sedated 19.5 vs sedated 18, median difference 1.5, 95% CI -0.2 to 3.2). SECONDARY OUTCOMES Non-sedated patients had a better Barthel Index at ICU-discharge (median 9 vs 4, median difference 5, 95% CI 2.5 to 7.5). At three months post-ICU discharge, the two groups did not differ regarding handgrip strength, walking distance, muscle size or biomechanical data. CONCLUSION Non-sedation did not lead to improved quality of life regarding physical function or better function in activities of everyday living. Non-sedated patients had a better physical recovery at ICU discharge. TRIAL REGISTRATION Clinicaltrials.govNCT02034942, registered January 14., 2014.
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Affiliation(s)
- Helene K Nedergaard
- Department of Anesthesiology and Intensive Care, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Sygehusvej 24, 6000 Kolding, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000 Odense, Denmark.
| | - Hanne Irene Jensen
- Department of Anesthesiology and Intensive Care, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Sygehusvej 24, 6000 Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000 Odense, Denmark
| | - Hanne Tanghus Olsen
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000 Odense, Denmark; Department of Anesthesiology and Intensive Care, Odense University Hospital, Svendborg, Baagoees alle 15, 5700 Svendborg, Denmark
| | - Thomas Strøm
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsloevsvej 4, 5000 Odense, Denmark
| | - Jørgen T Lauridsen
- Department of Business and Economics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Gisela Sjøgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Palle Toft
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsloevsvej 4, 5000 Odense, Denmark
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Su H, Dreesmann NJ, Hough CL, Bridges E, Thompson HJ. Factors associated with employment outcome after critical illness: Systematic review, meta-analysis, and meta-regression. J Adv Nurs 2020; 77:653-663. [PMID: 33210753 DOI: 10.1111/jan.14631] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/16/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022]
Abstract
AIMS To synthesize data on prevalence and risk factors for return to work (RTW) in ICU survivors. DESIGN Systematic review and meta-analysis. DATA SOURCES PUBMED, CINAHL, EMBASE and PsycINFO databases were searched from 2000-Feb 2020. REVIEW METHODS Peer-reviewed articles that included adult ICU survivors and employment outcomes. Two investigators independently reviewed articles following the PRISMA protocol. Pooled prevalence for RTW was calculated. Meta-regression analyses were performed to assess the association between disability policies, temporal factors and RTW following ICU. RESULTS Twenty-eight studies (N = 8,168) met the inclusion criteria. All studies were scored as 'low risk of bias'. Using meta-analysis, the proportion (95% CI) of RTW following ICU was 29% (0.20,0.42), 59% (0.50,0.70), 56% (0.50,0.62), 63% (0.54,0.72), 58% (0.37,0.91), 58% (0.42,0.81), and 44% (0.25,0.76) at 3, 4-6, 7-12, 13-24, 25-36, 37-48, and 49-60 months, respectively. Time and disability policy support are factors associated with the proportion of ICU survivors who RTW. Through meta-regression, there is a 20% increase (95% CI: 0.06, 0.33) in the proportion of individuals who RTW per year. However, the average rate of increase slows by 4% (-0.07, -0.1) per year. In countries with high support policies, the proportion of RTW is 32% higher compared with countries with low support policies (0.08, 0.24). However, as subsequent years pass, the additional proportion of individuals RTW in high support countries declines (β = -0.06, CI: -0.1, -0.02). CONCLUSIONS Unemployment is common in ICU survivors. Countries with policies that give higher support for disabled workers have a higher RTW proportion to 3 years following ICU admission. However, from 3-5 years, there is a shift to countries with lower support policies having better employment outcomes. IMPACT Health care policies have an impact on RTW rate in survivors of ICU. Healthcare providers, including nurses, can function as public advocates to facilitate policy change.
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Affiliation(s)
- Han Su
- University of Washington School of Nursing, Seattle, WA, USA
| | | | | | - Elizabeth Bridges
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Hilaire J Thompson
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
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Neurogenic vs. Myogenic Origin of Acquired Muscle Paralysis in Intensive Care Unit (ICU) Patients: Evaluation of Different Diagnostic Methods. Diagnostics (Basel) 2020; 10:diagnostics10110966. [PMID: 33217953 PMCID: PMC7698781 DOI: 10.3390/diagnostics10110966] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction. The acquired muscle paralysis associated with modern critical care can be of neurogenic or myogenic origin, yet the distinction between these origins is hampered by the precision of current diagnostic methods. This has resulted in the pooling of all acquired muscle paralyses, independent of their origin, into the term Intensive Care Unit Acquired Muscle Weakness (ICUAW). This is unfortunate since the acquired neuropathy (critical illness polyneuropathy, CIP) has a slower recovery than the myopathy (critical illness myopathy, CIM); therapies need to target underlying mechanisms and every patient deserves as accurate a diagnosis as possible. This study aims at evaluating different diagnostic methods in the diagnosis of CIP and CIM in critically ill, immobilized and mechanically ventilated intensive care unit (ICU) patients. Methods. ICU patients with acquired quadriplegia in response to critical care were included in the study. A total of 142 patients were examined with routine electrophysiological methods, together with biochemical analyses of myosin:actin (M:A) ratios of muscle biopsies. In addition, comparisons of evoked electromyographic (EMG) responses in direct vs. indirect muscle stimulation and histopathological analyses of muscle biopsies were performed in a subset of the patients. Results. ICU patients with quadriplegia were stratified into five groups based on the hallmark of CIM, i.e., preferential myosin loss (myosin:actin ratio, M:A) and classified as severe (M:A < 0.5; n = 12), moderate (0.5 ≤ M:A < 1; n = 40), mildly moderate (1 ≤ M:A < 1.5; n = 49), mild (1.5 ≤ M:A < 1.7; n = 24) and normal (1.7 ≤ M:A; n = 19). Identical M:A ratios were obtained in the small (4–15 mg) muscle samples, using a disposable semiautomatic microbiopsy needle instrument, and the larger (>80 mg) samples, obtained with a conchotome instrument. Compound muscle action potential (CMAP) duration was increased and amplitude decreased in patients with preferential myosin loss, but deviations from this relationship were observed in numerous patients, resulting in only weak correlations between CMAP properties and M:A. Advanced electrophysiological methods measuring refractoriness and comparing CMAP amplitude after indirect nerve vs. direct muscle stimulation are time consuming and did not increase precision compared with conventional electrophysiological measurements in the diagnosis of CIM. Low CMAP amplitude upon indirect vs. direct stimulation strongly suggest a neurogenic lesion, i.e., CIP, but this was rarely observed among the patients in this study. Histopathological diagnosis of CIM/CIP based on enzyme histochemical mATPase stainings were hampered by poor quantitative precision of myosin loss and the impact of pathological findings unrelated to acute quadriplegia. Conclusion. Conventional electrophysiological methods are valuable in identifying the peripheral origin of quadriplegia in ICU patients, but do not reliably separate between neurogenic vs. myogenic origins of paralysis. The hallmark of CIM, preferential myosin loss, can be reliably evaluated in the small samples obtained with the microbiopsy instrument. The major advantage of this method is that it is less invasive than conventional muscle biopsies, reducing the risk of bleeding in ICU patients, who are frequently receiving anticoagulant treatment, and it can be repeated multiple times during follow up for monitoring purposes.
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71
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Şan İ, Yıldırım Ç, Bekgöz B, Gemcioğlu E. Transport of awake hypoxemic probable COVID 19 patients in the prone position. Am J Emerg Med 2020; 46:420-423. [PMID: 33139142 PMCID: PMC7583615 DOI: 10.1016/j.ajem.2020.10.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/02/2020] [Accepted: 10/19/2020] [Indexed: 01/30/2023] Open
Abstract
Objective We aimed to investigate the effects of transport with prone position on hypoxemia in hypoxemic and awake probable COVID 19 pneumonia patients. Methods Hypoxic and awake patients with probable COVID 19 pneumonia who were referred to the Ankara City Hospital Emergency Department from 1 April to 31 May 2020 were included in this prospective study. Patients were transported in prone position and fixed on the stretcher. During the transport, patients continued receiving 2 l per minute oxygen with nasal cannula. Arterial blood gases were obtained from the patients before and after transport. The transport time was recorded as minutes. The primary outcome of the study is the increase of partial oxygen value in the arterial blood gas of patients after transport. Results It was found that pO2 and SpO2 end values were statistically significantly higher in the patient group compared to the initial values. In the group with transport duration of more than 15 min, a difference was found between the initial and end values in pO2 and SpO2 parameters similar to the whole group. However, there was no statistically significant difference between the initial and end values in the group with transport duration of 15 min or below. Conclusions Awake hypoxemic patients can be transported without complications in prone position during transport. Transports more than 15 min, prone position may be recommended because the partial oxygen pressure of the patients increases.
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Affiliation(s)
- İshak Şan
- Department of Emergency Medicine, University of health Sciences, Ankara, Turkey; Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Çağdaş Yıldırım
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey; Department of Emergency Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
| | - Burak Bekgöz
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Emin Gemcioğlu
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
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Value of mesenchymal stem cell therapy for patients with septic shock: an early health economic evaluation. Int J Technol Assess Health Care 2020; 36:525-532. [PMID: 33059782 DOI: 10.1017/s0266462320000781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND. This study estimates the maximum price at which mesenchymal stem cell (MSC) therapy is deemed cost-effective for septic shock patients and identifies parameters that are most important in making treatment decisions. METHODS We developed a probabilistic Markov model according to the sepsis care trajectory to simulate costs and quality-adjusted life years (QALYs) of septic shock patients receiving either MSC therapy or usual care over their lifetime. We calculated the therapeutic headroom by multiplying the gains attributable to MSCs with willingness-to-pay (WTP) threshold and derived the maximum reimbursable price (MRP) from the expected net monetary benefit and savings attributable to MSCs. We performed scenario analyses to assess the impact of changes to assumptions on the study findings. A value of information analysis is performed to identify parameters with greatest impact on the uncertainty around the cost-effectiveness of MSC therapy. RESULTS At a WTP threshold of $50,000 per QALY, the therapeutic headroom and MRP of MSC therapy were $20,941 and $16,748, respectively; these estimates increased with the larger WTP values and the greater impact of MSCs on in-hospital mortality and hospital discharge rates. The parameters with greatest information value were MSC's impact on in-hospital mortality and the baseline septic shock in-hospital mortality. CONCLUSION At a common WTP of $50,000/QALY, MSC therapy is deemed to be economically attractive if its unit cost does not exceed $16,748. This ceiling price can be increased to $101,450 if the therapy significantly reduces both in-hospital mortality and increases hospital discharge rates.
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Approaches to Addressing Post-Intensive Care Syndrome among Intensive Care Unit Survivors. A Narrative Review. Ann Am Thorac Soc 2020; 16:947-956. [PMID: 31162935 DOI: 10.1513/annalsats.201812-913fr] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Critical illness can be lethal and devastating to survivors. Improvements in acute care have increased the number of intensive care unit (ICU) survivors. These survivors confront a range of new or worsened health states that collectively are commonly denominated post-intensive care syndrome (PICS). These problems include physical, cognitive, psychological, and existential aspects, among others. Burgeoning interest in improving long-term outcomes for ICU survivors has driven an array of potential interventions to improve outcomes associated with PICS. To date, the most promising interventions appear to relate to very early physical rehabilitation. Late interventions within aftercare and recovery clinics have yielded mixed results, although experience in heart failure programs suggests the possibility that very early case management interventions may help improve intermediate-term outcomes, including mortality and hospital readmission. Predictive models have tended to underperform, complicating study design and clinical referral. The complexity of the health states associated with PICS suggests that careful and rigorous evaluation of multidisciplinary, multimodality interventions-tied to the specific conditions of interest-will be required to address these important problems.
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74
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Nunna K, Al-Ani A, Nikooie R, Friedman LA, Raman V, Wadood Z, Vasishta S, Colantuoni E, Needham DM, Dinglas VD. Participant Retention in Follow-Up Studies of Acute Respiratory Failure Survivors. Respir Care 2020; 65:1382-1391. [PMID: 32234765 PMCID: PMC7906609 DOI: 10.4187/respcare.07461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND With an increasing number of follow-up studies of acute respiratory failure survivors, there is need for a better understanding of participant retention and its reporting in this field of research. Hence, our objective was to synthesize participant retention data and associated reporting for this field. METHODS Two screeners independently searched for acute respiratory failure survivorship studies within a published scoping review to evaluate subject outcomes after hospital discharge in critical illness survivors. RESULTS There were 21 acute respiratory failure studies (n = 4,342 survivors) over 47 follow-up time points. Six-month follow-up (range: 2-60 months) was the most frequently reported time point, in 81% of studies. Only 1 study (5%) reported accounting for loss to follow-up in sample-size calculation. Retention rates could not be calculated for 5 (24%) studies. In 16 studies reporting on retention across all time points, retention ranged from 32% to 100%. Pooled retention rates at 3, 6, 12, and 24 months were 85%, 89%, 82%, and 88%, respectively. Retention rates did not significantly differ by publication year, participant mean age, or when comparing earlier (3 months) versus each later follow-up time point (6, 12, or 24 months). CONCLUSIONS Participant retention was generally high but varied greatly across individual studies and time points, with 24% of studies reporting inadequate data to calculate retention rate. High participant retention is possible, but resources for optimizing retention may help studies retain participants. Improved reporting guidelines with greater adherence would be beneficial.
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Affiliation(s)
- Krishidhar Nunna
- Department of Critical Care Medicine, Baylor College of Medicine, Houston, Texas
| | - Awsse Al-Ani
- MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Roozbeh Nikooie
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Lisa Aronson Friedman
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Zerka Wadood
- Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, Florida
| | - Sumana Vasishta
- Mandya Institute of Medical Sciences, Rajiv Gandhi University of Health Sciences, Karnataka, India
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland and with the School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland.
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Hill A, Arora RC, Engelman DT, Stoppe C. Preoperative Treatment of Malnutrition and Sarcopenia in Cardiac Surgery: New Frontiers. Crit Care Clin 2020; 36:593-616. [PMID: 32892816 DOI: 10.1016/j.ccc.2020.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cardiac surgery is performed more often in a population with an increasing number of comorbidities. Although these surgeries can be lifesaving, they disturb homeostasis and may induce a temporary overall loss of physiologic function. The required postoperative intensive care unit and hospital stay often lead to a mid- to long-term decline of nutritional and physical status, mental health, and health-related quality of life. Prehabilitation before elective surgery might be an opportunity to optimize the state of the patient. This article discusses current evidence and potential effects of preoperative optimization of nutrition and physical status before cardiac surgery.
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Affiliation(s)
- Aileen Hill
- Department of Intensive Care Medicine, 3CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen D-52074, Germany.
| | - Rakesh C Arora
- Cardiac Sciences Program, St. Boniface Hospital, CR3015-369 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada; Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health and University of Massachusetts Medical School-Baystate, 759 Chestnut Street, Springfield, MA 01199, USA
| | - Christian Stoppe
- Department of Intensive Care Medicine, 3CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen D-52074, Germany; Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Würzburg, Würzburg, Germany
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Shah H, Mansuri U, Pagad S, Adupa R, Singh J, Tun K, Shah C, Tuonuur S, Shah PJ, Ali Khan MZ, Grewal GS, Goswami R, Solanki S. Rate and Modifiable Predictors of 30-Day Readmission in Patients with Acute Respiratory Distress Syndrome in the United States. Cureus 2020; 12:e8922. [PMID: 32760623 PMCID: PMC7392362 DOI: 10.7759/cureus.8922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The 30-day readmission rates are being used as a quality measure by Centers for Medicare and Medicaid Services (CMS) for specific medical and surgical conditions. Acute respiratory distress syndrome (ARDS) is one of the important causes of morbidity and mortality in the United States (US). The characteristics and predictors of 30-day readmission in ARDS patients in the US are not widely known, which we have depicted in our study. Objective The aim of this study is to identify 30-day readmission rates, characteristics, and predictors of ARDS patients using the largest publicly available nationwide database. Methods We used the National Readmission Database from the year 2013 to extract the patients with ARDS by primary discharge diagnosis with ICD9-CM codes. All-cause unplanned 30-day readmission rates were calculated for patients admitted between January and November 2013. The independent predictors for unplanned 30-day readmission were identified by survey logistic regression. Results After excluding elective readmission, the all-cause unplanned 30-day readmission rate for ARDS patients was 18%. Index admissions readmitted within 30-day had a significantly higher baseline burden of comorbidities with a Charlson Comorbidity Index (CCI) ≥1 as compared to those who were not readmitted within 30 days. In multivariate regression analysis, several predictors associated with 30-day readmission were self-pay/no charge/other (OR 1.19, 95%CI: 1.02-1.38; p = 0.02), higher-income class (OR 0.86, 95%CI:0.79-0.99; p = 0.03), private insurance (OR 0.81, 95%CI:0.67-0.94; p = 0.01), and teaching metropolitan hospital (OR 0.72, 95%CI:0.61-0.94; p = 0.01). Conclusion The unplanned 30-day readmission rates are higher in ARDS patients in the US. Several modifiable factors such as insurance, socioeconomic status, and hospital type are associated with 30-day readmission among ARDS patients.
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Affiliation(s)
- Harshil Shah
- Internal Medicine, Independent Researcher, Sayre, USA
| | - Uvesh Mansuri
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA
| | - Sukrut Pagad
- Internal Medicine, Larkin Community Hospital, Hialeah, USA
| | - Reshmi Adupa
- Internal Medicine, Garden City Hospital, Garden City, USA
| | - Jagmeet Singh
- Nephrology, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Khin Tun
- Pediatrics, Independent Researcher, Yangon, MMR
| | - Chail Shah
- Internal Medicine, Brooklyn Cancer Care, Brooklyn, USA.,Internal Medicine, Mahatma Gandhi Medical College and Research Institute, Navi Mumbai, IND
| | | | - Priyal J Shah
- Internal Medicine, The Medical Center, Navicent Health, Macon, USA
| | - Mir Z Ali Khan
- Internal Medicine, Mercy Catholic Medical Center, Darby, USA
| | - Gurjot S Grewal
- Medicine, Christian Medical College & Hospital, Ludhiana, IND
| | - Ruchir Goswami
- Epidemiology and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Shantanu Solanki
- Hospital-Based Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
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Impact of Critical Illness on Resource Utilization: A Comparison of Use in the Year Before and After ICU Admission. Crit Care Med 2020; 47:1497-1504. [PMID: 31517693 PMCID: PMC6798747 DOI: 10.1097/ccm.0000000000003970] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Supplemental Digital Content is available in the text. Increasingly, patients admitted to an ICU survive to hospital discharge; many with ongoing medical needs. The full impact of an ICU admission on an individual’s resource utilization and survivorship trajectory in the United States is not clear. We sought to compare healthcare utilization among ICU survivors in each year surrounding an ICU admission.
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78
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Early Mobilization of Patients Receiving Vasoactive Drugs in Critical Care Units: A Systematic Review. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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79
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Yang KT, Yin CH, Hung YM, Huang SJ, Lee CC, Kuo TJ. Continuity of Care Is Associated with Medical Costs and Inpatient Days in Children with Cerebral Palsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082913. [PMID: 32340141 PMCID: PMC7215569 DOI: 10.3390/ijerph17082913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/05/2023]
Abstract
Background: Children with cerebral palsy (CP) place a considerable burden on medical costs and add to an increased number of inpatient days in Taiwan. Continuity of care (COC) has not been investigated in this population thus far. Materials and Methods: We designed a retrospective population-based cohort study using Taiwan’s National Health Insurance Research Database. Patients aged 0 to 18 years with CP catastrophic illness certificates were enrolled. We investigated the association of COC index (COCI) with medical costs and inpatient days. We also investigated the possible clinical characteristics affecting the outcome. Results: Over five years, children with CP with low COCI levels had higher medical costs and more inpatient days than did those with high COCI levels. Younger age at CP diagnosis, more inpatient visits one year before obtaining a catastrophic illness certificate, pneumonia, and nasogastric tube use increased medical expenses and length of hospital stay. Conclusions: Improving COC reduces medical costs and the number of inpatient days in children with CP. Certain characteristics also influence these outcomes.
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Affiliation(s)
- Kuang-Tsu Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Chun-Hao Yin
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
- Yuh-Ing Junior College of Health Care and Management, Kaohsiung 80776, Taiwan
| | - Shih-Ju Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 11221, Taiwan
| | - Tsu-Jen Kuo
- Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Department of Dental Technology, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan
- Correspondence: ; Tel.: +886-7-346-8214; Fax: +886-7-346-8392
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80
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Gustavson AM, Falvey JR, Forster JE, Stevens-Lapsley JE. Predictors of Functional Change in a Skilled Nursing Facility Population. J Geriatr Phys Ther 2020. [PMID: 28650398 DOI: 10.1519/jpt.0000000000000137] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Inability to obtain sufficient gains in function during a skilled nursing facility (SNF) stay impacts patients' functional trajectories and susceptibility to adverse events. The purpose of this study was to identify predictors of functional change in patients temporarily residing in an SNF following hospitalization. METHODS One hundred forty patients admitted to a single SNF from the hospital who had both evaluation and discharge measures of physical function documented were included. Data from the Minimum Data Set 3.0 and electronic medical record were extracted to record clinical and demographic characteristics. The Short Physical Performance Battery (SPPB) was administered by rehabilitation therapists at evaluation and discharge. The SPPB consists of balance tests, gait speed, and a timed 5-time sit-to-stand test. RESULTS AND DISCUSSION The Patient Health Questionnaire (PHQ-9) Screening Tool for Depression was the only significant predictor of change in gait speed over an SNF stay. Eighty-seven percent of patients achieved a clinically meaningful change in the SPPB of 1 point or greater from evaluation to discharge, with 78% demonstrating a clinically meaningful change of 0.1 m/s or greater on gait speed. However, 69% of patients demonstrated SPPB scores of 6 points or less and 57% ambulated less than 0.65 m/s at the time of discharge from the SNF, which indicates severe disability. CONCLUSIONS Poor physical function following an SNF stay places older adult at significant risk for adverse events including rehospitalization, future disability, and institutionalization. Understanding the predictors of functional change from evaluation to discharge may direct efforts toward developing innovative and effective interventions to improve function trajectories for older adults following an acute hospitalization.
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Affiliation(s)
- Allison M Gustavson
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora
| | - Jason R Falvey
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora.,Denver Veterans Affairs Medical Center, Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver, Colorado.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Jennifer E Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora
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Abstract
Introduction: Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury common in critically ill patients and characterized by significant morbidity and mortality. It frequently manifests long-lasting effects beyond hospitalization, from cognitive impairment to physical weakness.Areas covered: Several complications of ARDS have been identified in patients after hospital discharge. The authors conducted literature searches to identify observational studies, randomized clinical trials, systematic reviews, and guidelines. A summary of is presented here to outline the sequelae of ARDS and their risk factors with a focus on the limited but growing research into possible therapies. Long term sequelae of ARDS commonly identified in the literature include long-term cognitive impairment, psychological morbidities, neuromuscular weakness, pulmonary dysfunction, and ongoing healthcare utilization with reduced quality of life.Expert opinion: Given the public health significance of long-term complications following ARDS, the development of new therapies for prevention and treatment is of vital importance. Furthering knowledge of the pathophysiology of these impairments will provide a framework to develop new therapeutic targets to fuel future clinical trials in this area of critical care medicine.
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Affiliation(s)
- Matthew F Mart
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lorraine B Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Meyers EE, McCurley J, Lester E, Jacobo M, Rosand J, Vranceanu AM. Building Resiliency in Dyads of Patients Admitted to the Neuroscience Intensive Care Unit and Their Family Caregivers: Lessons Learned From William and Laura. COGNITIVE AND BEHAVIORAL PRACTICE 2020; 27:321-335. [PMID: 32863700 DOI: 10.1016/j.cbpra.2020.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Sustaining a stroke, regardless of its severity, is a life-changing and often traumatizing event that can lead to chronic depression, anxiety, and posttraumatic stress in both survivors and their family caregivers. Psychosocial interventions for emotional distress after stroke are limited, have emphasized psychoeducation rather than skills, treatment of chronic emotional distress rather than prevention, and have targeted either the patient or their caregiver without accounting for the context of their interpersonal relationship. Here we discuss "Recovering Together," a novel program for dyads of patients with stroke and their family caregivers aimed at preventing chronic emotional distress by using cognitive behavioral principles to teach resiliency and interpersonal communication skills beginning during hospitalization in a neuroscience intensive care unit and continuing after discharge via telehealth. We illustrate the case of a pilot dyad enrolled in the Recovering Together program, to showcase how patients and caregivers can engage with and benefit from it. This dyad's experience suggests that Recovering Together is credible, feasible, and useful. The potential dyadic benefit of this intervention lies not only in providing the opportunity to optimize recovery and prevent long-term emotional distress, but also in creating the space to come together as a pair and make meaning from critical illness.
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Affiliation(s)
- Emma E Meyers
- Massachusetts General Hospital and Harvard Medical School
| | | | - Ethan Lester
- Massachusetts General Hospital and Harvard Medical School
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The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome. Crit Care Med 2020; 47:e198-e205. [PMID: 30779719 DOI: 10.1097/ccm.0000000000003617] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Despite strong evidence supporting proning in acute respiratory distress syndrome, few eligible patients receive it. This study determines the cost-effectiveness of interventions to increase utilization of proning for severe acute respiratory distress syndrome. DESIGN We created decision trees to model severe acute respiratory distress syndrome from ICU admission through death (societal perspective) and hospital discharge (hospital perspective). We assumed patients received low tidal volume ventilation. We used short-term outcome estimates from the PROSEVA trial and longitudinal cost and benefit data from cohort studies. In probabilistic sensitivity analyses, we used distributions for each input that included the fifth to 95th percentile of its CI. SETTING ICUs that care for patients with acute respiratory distress syndrome. SUBJECTS Patients with moderate to severe acute respiratory distress syndrome. INTERVENTIONS The implementation of a hypothetical intervention to increase the appropriate utilization of prone positioning. MEASUREMENTS AND MAIN RESULTS In the societal perspective model, an intervention that increased proning utilization from 16% to 65% yielded an additional 0.779 (95% CI, 0.088-1.714) quality-adjusted life years at an additional long-term cost of $31,156 (95% CI, -$158 to $92,179) (incremental cost-effectiveness ratio = $38,648 per quality-adjusted life year [95% CI, $1,695-$98,522]). If society was willing to pay $100,000 per quality-adjusted life year, any intervention costing less than $51,328 per patient with moderate to severe acute respiratory distress syndrome would represent good value. From a hospital perspective, the intervention yielded 0.072 (95% CI, 0.008-0.147) more survivals-to-discharge at a cost of $5,242 (95% CI, -$19,035 to $41,019) (incremental cost-effectiveness ratio = $44,615 per extra survival [95% CI, -$250,912 to $558,222]). If hospitals were willing to pay $100,000 per survival-to-discharge, any intervention costing less than $5,140 per patient would represent good value. CONCLUSIONS Interventions that increase utilization of proning would be cost-effective from both societal and hospital perspectives under many plausible cost and benefit assumptions.
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Rai R, Singh R, Azim A, Agarwal A, Mishra P, Singh PK. Impact of Critical Illness on Quality of Life after Intensive Care Unit Discharge. Indian J Crit Care Med 2020; 24:299-306. [PMID: 32728319 PMCID: PMC7358873 DOI: 10.5005/jp-journals-10071-23433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the quality of life (QoL) following intensive care unit (ICU) discharge using 6 months’ prospective follow-up and to analyze the risk factors affecting quality-of-life post-discharge. Design A prospective observational cohort study. Conducted on adult patients, discharged from ICU after more than 7 days’ stay. Study duration is from January 2017 to October 2018. Patients <18 years, nonconsenting, preexisting neurological illness, and lost to follow-up were excluded. Follow-up was done at 1 and 6 months using the SF-36 questionnaire. The pre-ICU functional status, patient demographics, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE II) score, New York Health Evaluation (NYHA) classification, and details of ICU stay were collected. Results One hundred patients (M = 60, F = 40) with ICU stay (13.64 ± 3.75 days), days of mechanical ventilation (7.93 ± 3.89 days), admission APACHE II (18.88 ± 4.34) and SOFA (7.73 ± 1.54) scores. Comparison showed physical component summary (PCS) score and mental component summary (MCS) score at pre-ICU were 55.12 and 55.09 which decreased to 39.59 and 35.49 (p < 0.05) at 1 month post-discharge and 47.93 and 37.46 at 6 months. Age, APACHE II, and SOFA scores are the significant factors affecting PCS and MCS. Length of ICU stay and duration of mechanical ventilation did not affect significantly at 6 months. When compared with general population PCS and MCS showed significant deterioration at 1 and 6 months. Conclusion Post-ICU discharge patients have significant functional impairment and compromised health-related QoL (HRQoL). Age and severity of illness significantly affects health quality parameters and decline is below the normal data of general population. How to cite this article Rai R, Singh R, Azim A, et al. Impact of Critical Illness on Quality of Life after Intensive Care Unit Discharge. Indian J Crit Care Med 2020;24(5):299–306.
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Affiliation(s)
- Richa Rai
- Department of Anesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ritu Singh
- Department of Anesthesia and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arti Agarwal
- Department of Anesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhat K Singh
- Department of Anesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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85
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Korupolu R, Francisco G, Levin H, Needham D. Rehabilitation of critically Ill COVID-19 survivors. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2020. [DOI: 10.4103/jisprm.jisprm_8_20] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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86
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Dariano AP, Couto CF, Rubin BA, Viana MV, Friedman G. Caloric Adequacy in the First Week of Mechanically Ventilated Patients has No Impact on Long-term Daily Life Activities. Indian J Crit Care Med 2020; 24:1206-1212. [PMID: 33446974 PMCID: PMC7775931 DOI: 10.5005/jp-journals-10071-23674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim and objective The aim and objective of this study is to test the effect of an optimized caloric supply in the first week of intensive care unit (ICU) stay in mechanically ventilated patients on the ability to perform their activities of daily living (ADL) in the long-term. Materials and methods A prospective observational study comparing patients who achieved an adequate caloric target (≥80%) vs those whose target was inadequate (<80%). The primary outcome under study is the instrumental ADL (IADL) scale after 6 months of discharge. Results Ninety-two patients were evaluated in the ICU and 50 were alive at 6 months. Follow-up was lost for 3 patients and 47 patients were evaluated at ICU and after 6 months. Thirty-four patients reached the energetic target and 13 did not reach it. There was no significant variation in IADL. Conclusion The energy adequacy in the first week of hospitalization was achieved by most survivors; however, this conduct does not seem to have influenced the ability to perform ADL after 6 months of discharge. How to cite this article Dariano AP, Couto CFL, Rubin BA, Viana MV, Friedman G. Caloric Adequacy in the First Week of Mechanically Ventilated Patients has No Impact on Long-term Daily Life Activities. Indian J Crit Care Med 2020;24(12):1206–1212.
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Affiliation(s)
- Angela P Dariano
- Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cecilia Fl Couto
- Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bibiana A Rubin
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marina V Viana
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gilberto Friedman
- Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Viola H, Chang J, Grunwell JR, Hecker L, Tirouvanziam R, Grotberg JB, Takayama S. Microphysiological systems modeling acute respiratory distress syndrome that capture mechanical force-induced injury-inflammation-repair. APL Bioeng 2019; 3:041503. [PMID: 31768486 PMCID: PMC6874511 DOI: 10.1063/1.5111549] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022] Open
Abstract
Complex in vitro models of the tissue microenvironment, termed microphysiological systems, have enormous potential to transform the process of discovering drugs and disease mechanisms. Such a paradigm shift is urgently needed in acute respiratory distress syndrome (ARDS), an acute lung condition with no successful therapies and a 40% mortality rate. Here, we consider how microphysiological systems could improve understanding of biological mechanisms driving ARDS and ultimately improve the success of therapies in clinical trials. We first discuss how microphysiological systems could explain the biological mechanisms underlying the segregation of ARDS patients into two clinically distinct phenotypes. Then, we contend that ARDS-mimetic microphysiological systems should recapitulate three critical aspects of the distal airway microenvironment, namely, mechanical force, inflammation, and fibrosis, and we review models that incorporate each of these aspects. Finally, we recognize the substantial challenges associated with combining inflammation, fibrosis, and/or mechanical force in microphysiological systems. Nevertheless, complex in vitro models are a novel paradigm for studying ARDS, and they could ultimately improve patient care.
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Affiliation(s)
| | - Jonathan Chang
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory School of Medicine, Atlanta, Georgia 30332, USA
| | - Jocelyn R. Grunwell
- Department of Pediatrics, Division of Critical Care Medicine, Children's Healthcare of Atlanta at Egleston, Emory University School of Medicine, Atlanta, Georgia 30322, USA
| | - Louise Hecker
- Division of Pulmonary, Allergy and Critical Care and Sleep Medicine, University of Arizona, Tucson, Arizona 85724, USA and Southern Arizona Veterans Affairs Health Care System, Tucson, Arizona 85723, USA
| | - Rabindra Tirouvanziam
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322, USA and Center for CF and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, Georgia 30322, USA
| | - James B. Grotberg
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
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Jagrosse ML, Dean DA, Rahman A, Nilsson BL. RNAi therapeutic strategies for acute respiratory distress syndrome. Transl Res 2019; 214:30-49. [PMID: 31401266 PMCID: PMC7316156 DOI: 10.1016/j.trsl.2019.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022]
Abstract
Acute respiratory distress syndrome (ARDS), replacing the clinical term acute lung injury, involves serious pathophysiological lung changes that arise from a variety of pulmonary and nonpulmonary injuries and currently has no pharmacological therapeutics. RNA interference (RNAi) has the potential to generate therapeutic effects that would increase patient survival rates from this condition. It is the purpose of this review to discuss potential targets in treating ARDS with RNAi strategies, as well as to outline the challenges of oligonucleotide delivery to the lung and tactics to circumvent these delivery barriers.
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Affiliation(s)
| | - David A Dean
- Department of Pediatrics and Neonatology, University of Rochester Medical Center, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Arshad Rahman
- Department of Pediatrics and Neonatology, University of Rochester Medical Center, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Bradley L Nilsson
- Department of Chemistry, University of Rochester, Rochester, New York.
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Parry SM, Nalamalapu SR, Nunna K, Rabiee A, Friedman LA, Colantuoni E, Needham DM, Dinglas VD. Six-Minute Walk Distance After Critical Illness: A Systematic Review and Meta-Analysis. J Intensive Care Med 2019; 36:343-351. [PMID: 31690160 DOI: 10.1177/0885066619885838] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Impaired physical functioning is common and long lasting after an intensive care unit (ICU) admission. The 6-minute walk test (6MWT) is a validated and widely used test of functional capacity. This systematic review synthesizes existing data in order to: (1) evaluate 6-minute walk distance (6MWD) in meters over longitudinal follow-up after critical illness, (2) compare 6MWD between acute respiratory distress syndrome (ARDS) versus non-ARDS survivors, and (3) evaluate patient- and ICU-related factors associated with 6MWD. DATA SOURCES Five databases (PubMed, EMBASE, Cumulative Index of Nursing and Allied Health Literature, PsychINFO, and Cochrane Controlled Trials Registry) were searched to identify studies reporting 6MWT after hospital discharge in survivors from general (ie, nonspeciality) ICUs. The last search was run on February 14, 2018. Databases were accessed via Johns Hopkins University Library. DATA EXTRACTION AND SYNTHESIS Pooled mean 6MWD were reported, with separate linear random effects models used to evaluate associations of 6MWD with ARDS status, and patient- and ICU-related variables. Twenty-six eligible articles on 16 unique participant groups were included. The pooled mean (95% confidence interval [CI]) 6MWD results at 3- and 12-months post discharge were 361 (321-401) and 436 (391-481) meters, respectively. There was a significant increase in 6MWD at 12 months compared to 3 months (P = .017). In ARDS versus non-ARDS survivors, the mean (95% CI) 6MWD difference over 3-, 6-, and 12-month follow-up was 73 [13-133] meters lower. Female sex and preexisting comorbidity also were significantly associated with lower 6MWD, with ICU-related variables having no consistent associations. CONCLUSIONS Compared to initial assessment at 3 months, significant improvement in 6MWD was reported at 12 months. Female sex, preexisting comorbidity, and ARDS (vs non-ARDS) were associated with lower 6MWT results. Such factors warrant consideration in the design of clinical research studies and in the interpretation of patient status using the 6MWT.
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Affiliation(s)
- Selina M Parry
- Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Anahita Rabiee
- Department of Medicine, 12228Yale School of Medicine, New Haven, CT, USA
| | - Lisa Aronson Friedman
- Outcomes After Critical Illness and Surgery Group, 1466Johns Hopkins University, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery Group, 1466Johns Hopkins University, Baltimore, MD, USA.,Department of Biostatistics, Bloomberg School of Public Health, 1466John Hopkins University, Baltimore, MD, USA
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery Group, 1466Johns Hopkins University, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery Group, 1466Johns Hopkins University, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
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Return to Employment after Critical Illness and Its Association with Psychosocial Outcomes. A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2019; 16:1304-1311. [DOI: 10.1513/annalsats.201903-248oc] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Moarbes V, Mayaki D, Huck L, Leblanc P, Vassilakopoulos T, Petrof BJ, Hussain SNA. Differential regulation of myofibrillar proteins in skeletal muscles of septic mice. Physiol Rep 2019; 7:e14248. [PMID: 31660704 PMCID: PMC6817996 DOI: 10.14814/phy2.14248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 12/12/2022] Open
Abstract
Sepsis elicits skeletal muscle atrophy as a result of decreased total protein synthesis and/or increased total protein degradation. It is unknown how and whether sepsis differentially affects the expression of specific myofibrillar proteins in respiratory and limb muscles. In this study, we measured the effects of sepsis myofibrillar mRNAs and their corresponding protein levels in the diaphragm (DIA) and tibialis anterior (TA) muscles in a murine cecal ligation and perforation (CLP) model of sepsis. Male mice (C57/BL6j) underwent CLP-induced sepsis. Sham-operated mice were subjected to the same surgical procedures, except for CLP. Mice were euthanized 24, 48, or 96 h postsurgery. Transcript and protein levels of autophagy-related genes, ubiquitin E3 ligases, and several myofibrillar genes were quantified. Sepsis elicited transient fiber atrophy in the DIA and prolonged atrophy in the TA. Atrophy was coincident with increased autophagy and ubiquitin E3 ligase expression. Myosin heavy chain isoforms decreased at 24 h in the DIA and across the time-course in the TA, myosin light chain isoforms decreased across the time-course in both muscles, and troponins T and C as well as tropomyosin decreased after 24 and 48 h in both the DIA and TA. α-Actin and troponin I were unaffected by sepsis. Sepsis-induced decreases in myofibrillar protein levels coincided with decreased mRNA expressions of these proteins, suggesting that transcriptional inhibition is involved. We hypothesize that sepsis-induced muscle atrophy is mediated by decreased transcription and enhanced degradation of specific myofibrillar proteins, including myosin heavy and light chains, troponin C, troponin T, and tropomyosin.
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Affiliation(s)
- Vanessa Moarbes
- Meakins‐Christie Laboratories and Translational Research in Respiratory Diseases ProgramResearch Institute of the McGill University Health CentreMontréalQuébecCanada
- Department of Critical CareMcGill University Health CentreMontréalQuébecCanada
| | - Dominique Mayaki
- Meakins‐Christie Laboratories and Translational Research in Respiratory Diseases ProgramResearch Institute of the McGill University Health CentreMontréalQuébecCanada
- Department of Critical CareMcGill University Health CentreMontréalQuébecCanada
| | - Laurent Huck
- Meakins‐Christie Laboratories and Translational Research in Respiratory Diseases ProgramResearch Institute of the McGill University Health CentreMontréalQuébecCanada
- Department of Critical CareMcGill University Health CentreMontréalQuébecCanada
| | - Philippe Leblanc
- Meakins‐Christie Laboratories and Translational Research in Respiratory Diseases ProgramResearch Institute of the McGill University Health CentreMontréalQuébecCanada
- Department of Critical CareMcGill University Health CentreMontréalQuébecCanada
| | - Theodoros Vassilakopoulos
- Critical Care Department, National & Kapodistrian University of Athens, Medical School, Evgenideion HospitalAthensGreece
- Department of MedicineMcGill University Health CentreMontréalQuébecCanada
| | - Basil J. Petrof
- Meakins‐Christie Laboratories and Translational Research in Respiratory Diseases ProgramResearch Institute of the McGill University Health CentreMontréalQuébecCanada
- Department of Critical CareMcGill University Health CentreMontréalQuébecCanada
| | - Sabah N. A. Hussain
- Meakins‐Christie Laboratories and Translational Research in Respiratory Diseases ProgramResearch Institute of the McGill University Health CentreMontréalQuébecCanada
- Department of Critical CareMcGill University Health CentreMontréalQuébecCanada
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Kosilek RP, Baumeister SE, Ittermann T, Gründling M, Brunkhorst FM, Felix SB, Abel P, Friesecke S, Apfelbacher C, Brandl M, Schmidt K, Hoffmann W, Schmidt CO, Chenot JF, Völzke H, Gensichen JS. The association of intensive care with utilization and costs of outpatient healthcare services and quality of life. PLoS One 2019; 14:e0222671. [PMID: 31539397 PMCID: PMC6754134 DOI: 10.1371/journal.pone.0222671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/04/2019] [Indexed: 12/18/2022] Open
Abstract
Background Little is known about outpatient health services use following critical illness and intensive care. We examined the association of intensive care with outpatient consultations and quality of life in a population-based sample. Methods Cross-sectional analysis of data from 6,686 participants of the Study of Health in Pomerania (SHIP), which consists of two independent population-based cohorts. Statistical modeling was done using Poisson regression, negative binomial and generalized linear models for consultations, and a fractional response model for quality of life (EQ-5D-3L index value), with results expressed as prevalence ratios (PR) or percent change (PC). Entropy balancing was used to adjust for observed confounding. Results ICU treatment in the previous year was reported by 139 of 6,686 (2,1%) participants, and was associated with a higher probability (PR 1.05 [CI:1.03;1.07]), number (PC +58.0% [CI:22.8;103.2]) and costs (PC +64.1% [CI:32.0;103.9]) of annual outpatient consultations, as well as with a higher number of medications (PC +37.8% [CI:17.7;61.5]). Participants with ICU treatment were more likely to visit a specialist (PR 1.13 [CI:1.09; 1.16]), specifically internal medicine (PR 1.67 [CI:1.45;1.92]), surgery (PR 2.42 [CI:1.92;3.05]), psychiatry (PR 2.25 [CI:1.30;3.90]), and orthopedics (PR 1.54 [CI:1.11;2.14]). There was no significant effect regarding general practitioner consultations. ICU treatment was also associated with lower health-related quality of life (EQ-5D index value: PC -13.7% [CI:-27.0;-0.3]). Furthermore, quality of life was inversely associated with outpatient consultations in the previous month, more so for participants with ICU treatment. Conclusions Our findings suggest that ICU treatment is associated with an increased utilization of outpatient specialist services, higher medication intake, and impaired quality of life.
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Affiliation(s)
- Robert P. Kosilek
- Institute of General Practice and Family Medicine, LMU München, Munich, Germany
- * E-mail:
| | - Sebastian E. Baumeister
- Chair of Epidemiology, LMU München, UNIKA-T Augsburg, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Gründling
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Frank M. Brunkhorst
- Integrated Research and Treatment Center Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Stephan B. Felix
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Peter Abel
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine Greifswald, Greifswald, Germany
| | - Sigrun Friesecke
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine Greifswald, Greifswald, Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Magdalena Brandl
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Carsten O. Schmidt
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jean-François Chenot
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
- German Center for Diabetes Research, Site Greifswald, Greifswald, Germany
| | - Jochen S. Gensichen
- Institute of General Practice and Family Medicine, LMU München, Munich, Germany
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Differential contractile response of critically ill patients to neuromuscular electrical stimulation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:308. [PMID: 31506074 PMCID: PMC6737711 DOI: 10.1186/s13054-019-2540-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/15/2019] [Indexed: 12/22/2022]
Abstract
Background Neuromuscular electrical stimulation (NMES) has been investigated as a preventative measure for intensive care unit-acquired weakness. Trial results remain contradictory and therefore inconclusive. As it has been shown that NMES does not necessarily lead to a contractile response, our aim was to characterise the response of critically ill patients to NMES and investigate potential outcome benefits of an adequate contractile response. Methods This is a sub-analysis of a randomised controlled trial investigating early muscle activating measures together with protocol-based physiotherapy in patients with a SOFA score ≥ 9 within the first 72 h after admission. Included patients received protocol-based physiotherapy twice daily for 20 min and NMES once daily for 20 min, bilaterally on eight muscle groups. Electrical current was increased up to 70 mA or until a contraction was detected visually or on palpation. Muscle strength was measured by a blinded assessor at the first adequate awakening and ICU discharge. Results One thousand eight hundred twenty-four neuromuscular electrical stimulations in 21 patients starting on day 3.0 (2.0/6.0) after ICU admission were included in this sub-analysis. Contractile response decreased from 64.4% on day 1 to 25.0% on day 7 with a significantly lower response rate in the lower extremities and proximal muscle groups. The electrical current required to elicit a contraction did not change over time (day 1, 50.2 [31.3/58.8] mA; day 7, 45.3 [38.0/57.5] mA). The electrical current necessary for a contractile response was higher in the lower extremities. At the first awakening, patients presented with significant weakness (3.2 [2.5/3.8] MRC score). When dividing the cohort into responders and non-responders (> 50% vs. ≤ 50% contractile response), we observed a significantly higher SOFA score in non-responders. The electrical current necessary for a muscle contraction in responders was significantly lower (38.0 [32.8/42.9] vs. 54.7 [51.3/56.0] mA, p < 0.001). Muscle strength showed higher values in the upper extremities of responders at ICU discharge (4.4 [4.1/4.6] vs. 3.3 [2.8/3.8] MRC score, p = 0.036). Conclusion Patients show a differential contractile response to NMES, which appears to be dependent on the severity of illness and also relevant for potential outcome benefits. Trial registration ISRCTN ISRCTN19392591, registered 17 February 2011 Electronic supplementary material The online version of this article (10.1186/s13054-019-2540-4) contains supplementary material, which is available to authorized users.
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94
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Heyland DK, Day A, Clarke GJ, Hough CT, Files DC, Mourtzakis M, Deutz N, Needham DM, Stapleton R. Nutrition and Exercise in Critical Illness Trial (NEXIS Trial): a protocol of a multicentred, randomised controlled trial of combined cycle ergometry and amino acid supplementation commenced early during critical illness. BMJ Open 2019; 9:e027893. [PMID: 31371287 PMCID: PMC6678006 DOI: 10.1136/bmjopen-2018-027893] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Survivors of critical illness often experience significant morbidities, including muscle weakness and impairments in physical functioning. This muscle weakness is associated with longer duration mechanical ventilation, greater hospital costs and increased postdischarge impairments in physical function, quality of life and survival. Compared with standard of care, the benefits of greater protein intake combined with structured exercise started early after the onset of critical illness remain uncertain. However, the combination of protein supplementation and exercise in other populations has demonstrated positive effects on strength and function. In the present study, we will evaluate the effects of a combination of early implementation of intravenous amino acid supplementation and in-bed cycle ergometry exercise versus a 'usual care' control group in patients with acute respiratory failure requiring mechanical ventilation in an intensive care unit (ICU). METHODS AND ANALYSIS In this multicentre, assessor-blinded, randomised controlled trial, we will randomise 142 patients in a 1:1 ratio to usual care (which commonly consists of minimal exercise and under-achievement of guideline-recommended caloric and protein intake goals) versus a combined intravenous amino acid supplementation and in-bed cycle ergometery exercise intervention. We hypothesise that this novel combined intervention will (1) improve physical functioning at hospital discharge; (2) reduce muscle wasting with improved amino acid metabolism and protein synthesis in-hospital and (3) improve patient-reported outcomes and healthcare resource utilisation at 6 months after enrolment. Key cointerventions will be standardised. In-hospital outcome assessments will be conducted at baseline, ICU discharge and hospital discharge. An intent-to-treat analysis will be used to analyse all data with additional per-protocol analyses. ETHICS AND DISSEMINATION The trial received ethics approval at each institution and enrolment has begun. These results will inform both clinical practice and future research in the area. We plan to disseminate trial results in peer-reviewed journals, at national and international conferences, and via nutritional and rehabilitation-focused electronic education and knowledge translation platforms. TRIAL REGISTRATION NUMBER NCT03021902; Pre-results.
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Affiliation(s)
- Daren K Heyland
- Critical Care, Queen's University, Kingston, Ontario, Canada
| | - Andrew Day
- Department of Community Health and Epidemiology and CERU, Queen's Unversity, Kingston, Ontario, Canada
| | - G John Clarke
- Critical Evalulation Research Unit, Queen's University, Kingston, Ontario, Canada
| | - Catherine Terri Hough
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - D Clark Files
- Pulmonary, Critical Care, Allergy and Immunology Division, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Marina Mourtzakis
- University of Waterloo Faculty of Applied Health Sciences, Waterloo, Ontario, Canada
| | - Nicolaas Deutz
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, John Hopkins University, Baltimore, Maryland, USA
| | - Renee Stapleton
- Pulmonary and Critical Care, University of Vermont, Burlington, Vermont, USA
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95
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Sylvestre A, Adda M, Maltese F, Lannelongue A, Daviet F, Parzy G, Coiffard B, Roch A, Loundou A, Baumstarck K, Papazian L. Long-term neurocognitive outcome is not worsened by of the use of venovenous ECMO in severe ARDS patients. Ann Intensive Care 2019; 9:82. [PMID: 31312911 PMCID: PMC6635548 DOI: 10.1186/s13613-019-0556-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/06/2019] [Indexed: 01/19/2023] Open
Abstract
Background Venovenous extracorporeal membrane oxygenation (VV-ECMO) is associated with a significant morbidity. There is the need to investigate long-term cognitive outcome among ARDS survivors treated with VV-ECMO. We aimed to compare the prevalence of long-term cognitive dysfunction and neuropsychological impairment using a highly specific test in severe ARDS survivors treated or not treated with VV-ECMO. Methods Severe ARDS survivors treated between 2011 and 2017 in an ECMO Regional Referral Center were prospectively evaluated 2 years after their ICU discharge. Patients underwent an in-person interview and examination. The primary outcome was cognitive function, assessed by the Wechsler Adult Intelligence Scale 4th edition (WAIS-IV). Secondary outcomes included anxiety, depression, post-traumatic stress disorder (PTSD) and quality-of-life. Results We investigated 40 consecutive patients surviving from severe ARDS treated (N = 22) or not (N = 18) with VV-ECMO at a median [interquartile range] of 20 [17–22] and 22 [18–23] months after ICU discharge, respectively. Regarding the main outcome, cognitive function was below normal ranges in 12 (55%) ECMO patients and 10 (56%) non-ECMO patients (p = 0.95). Eight (36%) ECMO patients had moderate-to-severe depressive symptoms as compared with 7 (39%) non-ECMO patients (p = 0.87). Twelve (55%) ECMO patients and eight (44%) non-ECMO patients had moderate-to-severe anxiety symptoms (p = 0.53). Seven (33%) ECMO patients and eight (44%) non-ECMO patients presented a PTSD (p = 0.48). Health-related quality of life did not differ between the two groups. Conclusions Using the WAIS-IV, VV-ECMO treatment does not appear to worsen long-term cognitive and neuropsychological outcomes in severe ARDS patients. Electronic supplementary material The online version of this article (10.1186/s13613-019-0556-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aude Sylvestre
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin des Bourrely, 13015, Marseille, France.,Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Mélanie Adda
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin des Bourrely, 13015, Marseille, France.,Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - François Maltese
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin des Bourrely, 13015, Marseille, France.,Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Ariane Lannelongue
- Département d'Anesthésie Réanimation, Centre Hospitalo Universitaire Caremeau, 30029, Nîmes, France
| | - Florence Daviet
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin des Bourrely, 13015, Marseille, France.,Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Gabriel Parzy
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin des Bourrely, 13015, Marseille, France.,Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Benjamin Coiffard
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin des Bourrely, 13015, Marseille, France.,Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Antoine Roch
- Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France.,Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Service des Urgences, 13015, Marseille, France
| | - Anderson Loundou
- Unité d'Aide Méthodologique à la Recherche Clinique - Assistance Publique - Hôpitaux de Marseille, Marseille, France.,EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Karine Baumstarck
- Unité d'Aide Méthodologique à la Recherche Clinique - Assistance Publique - Hôpitaux de Marseille, Marseille, France.,EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Laurent Papazian
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin des Bourrely, 13015, Marseille, France. .,Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France.
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Brandstetter S, Dodoo-Schittko F, Brandl M, Blecha S, Bein T, Apfelbacher C. Ambulatory and stationary healthcare use in survivors of ARDS during the first year after discharge from ICU: findings from the DACAPO cohort. Ann Intensive Care 2019; 9:70. [PMID: 31201576 PMCID: PMC6570725 DOI: 10.1186/s13613-019-0544-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/04/2019] [Indexed: 12/25/2022] Open
Abstract
Background For many survivors of acute respiratory distress syndrome (ARDS), the process from discharge from intensive care unit (ICU) to recovery is long and difficult. However, healthcare use after discharge from ICU has received only little attention by research. This study sets out to investigate the extent of ambulatory and stationary healthcare use among survivors of ARDS in Germany (multicenter DACAPO cohort) and to analyze predictors of stationary healthcare use. Results A total of 396 survivors of ARDS provided data at 1 year after discharge from ICU. Fifty percent of 1-year survivors were hospitalized for 48 days or longer after discharge from ICU, with 10% spending more than six out of 12 months in stationary care. The duration of hospitalization increased significantly by the length of the initial ICU stay. All participants reported at least one outpatient visit (including visits to general practitioners), and 50% contacted four or more different medical specialties within the first year after discharge from ICU. Conclusions For most of the patients, the first year after ARDS is characterized by an extensive amount of healthcare utilization, especially with regard to stationary health care. These findings shed light on the substantial morbidity of patients after ARDS and contribute to a better understanding of the situation of patients following discharge from ICU.
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Affiliation(s)
- Susanne Brandstetter
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany.
| | - Frank Dodoo-Schittko
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
| | - Magdalena Brandl
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
| | - Sebastian Blecha
- Department of Anesthesia and Operative Intensive Care, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Thomas Bein
- Department of Anesthesia and Operative Intensive Care, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany.,Institute of Social Medicine and Health Economics (ISMHE), University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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97
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McCurley JL, Funes CJ, Zale EL, Lin A, Jacobo M, Jacobs JM, Salgueiro D, Tehan T, Rosand J, Vranceanu AM. Preventing Chronic Emotional Distress in Stroke Survivors and Their Informal Caregivers. Neurocrit Care 2019; 30:581-589. [PMID: 30421266 PMCID: PMC6958510 DOI: 10.1007/s12028-018-0641-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Chronic emotional distress (e.g., depression, anxiety, post-traumatic stress) is common after stroke and interdependent between patients and their informal caregivers. We measured stroke survivors', caregivers', and neurocritical care nurses' views of primary drivers of distress during the stroke experience, and needs and preferences for the structure, topics, mode of delivery, and timing of an intervention to promote emotional recovery. METHODS We conducted semi-structured interviews with 24 patient-caregiver dyads within the Neuroscience Intensive Care Unit (Neuro-ICU). Additionally, we conducted two focus groups with 15 nurses. Interviews and focus groups were audio-recorded, transcribed, and coded using NVivo 11 (QSR International) software. RESULTS AND CONCLUSIONS The challenges and impacts of stroke most commonly reported by dyads were: uncertainty about future health, fear of recurrent strokes, negative emotions, and role changes post-stroke. Dyads and nurses agreed that resiliency skills such as mindfulness/focusing on the present, problem solving, gratitude/optimism, self-care, interpersonal communication and developing a supportive team of family, friends, and medical staff are beneficial to optimize recovery. The potential barrier to intervention delivery was accessibility, due to challenges of time and travel to appointments. Participants agreed that starting the intervention at hospitalization and continuing via live video after discharge is an ideal delivery modality. Stroke survivors, caregivers, and Neuro-ICU nurses believe that a resiliency skills-based intervention to prevent chronic emotional distress is necessary and urgent. This qualitative study provides valuable information on the challenges faced by dyads, intervention topics to prioritize, and strategies to maximize feasibility, acceptability, and effect.
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Affiliation(s)
- Jessica L McCurley
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Christopher J Funes
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
| | - Emily L Zale
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Ann Lin
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
| | - Michelle Jacobo
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Jamie M Jacobs
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Danielle Salgueiro
- Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Tara Tehan
- Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, USA
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA.
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA.
- Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, USA.
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98
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Formenti P, Umbrello M, Coppola S, Froio S, Chiumello D. Clinical review: peripheral muscular ultrasound in the ICU. Ann Intensive Care 2019; 9:57. [PMID: 31101987 PMCID: PMC6525229 DOI: 10.1186/s13613-019-0531-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/10/2019] [Indexed: 12/14/2022] Open
Abstract
Muscular weakness developing from critical illness neuropathy, myopathy and muscle atrophy has been characterized as intensive care unit-acquired weakness (ICUAW). This entity occurs commonly during and after critical care stay. Various causal factors for functional incapacity have been proposed. Among these, individual patient characteristics (such as age, comorbidities and nutritional status), acting in association with sustained bed rest and pharmacological interventions (included the metabolic support approach), seem influential in reducing muscular mass. Long-term outcomes in heterogeneous ICUAW populations include transient disability in 30% of patients and persistent disabilities that may occur even in patients with nearly complete functional recovery. Currently available tools for the assessment of skeletal muscle mass are imprecise and difficult to perform in the ICU setting. A valid alternative to these imaging modalities is muscular ultrasonography, which allows visualization and classification of muscle characteristics by cross-sectional area, muscle layer thickness, echointensity by grayscale and the pennation angle). The aim of this narrative review is to describe the current literature addressing muscular ultrasound for the detection of muscle weakness and its potential impact on treatment and prognosis of critically ill patients when combined with biomarkers of muscle catabolism/anabolism and bioenergetic state. In addition, we suggest a practical flowchart for establishing an early diagnosis.
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Affiliation(s)
- Paolo Formenti
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy. .,Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy.
| | - Michele Umbrello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.,Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy
| | - Silvia Coppola
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.,Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy
| | - Sara Froio
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.,Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy
| | - Davide Chiumello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy
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Al-Fares A, Fan E, Husain S, Di Nardo M, Cypel M, Keshavjee S, Herridge MS, Del Sorbo L. Veno-venous extracorporeal life support for blastomycosis-associated acute respiratory distress syndrome. Perfusion 2019; 34:660-670. [PMID: 31027465 DOI: 10.1177/0267659119844391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Blastomyces is a dimorphic fungus endemic to regions of North America, which can lead to pneumonia and fatal severe acute respiratory diseases syndrome in up to 89% of patients. Extracorporeal life support can provide adequate oxygenation while allowing the lungs to rest and heal, which might be an ideal therapy in this patient group, although long-term clinical and radiological outcomes are not known. CLINICAL FEATURES We report on five consecutive patients admitted to Toronto General Hospital intensive care unit between January 2012 and September 2016, with progressive respiratory failure requiring veno-venous extracorporeal life support within 24-96 hours following mechanical ventilation. Ultra-lung protective mechanical ventilation was achieved within 24 hours. Recovery was the initial goal in all patients. Extracorporeal life support was provided for a prolonged period (up to 49 days), and four patients were successfully discharged from the intensive care unit. Long-term radiological assessment in three patients showed major improvement within 2 years of follow-up with some persistent disease-related changes (bronchiectasis, fibrosis, and cystic changes). In two patients, long-term functional and neuropsychological outcomes showed similar limitations to what is seen in acute respiratory distress syndrome patients who are not supported with extracorporeal life support and in acute respiratory distress syndrome patients without blastomycosis, but worse pulmonary function outcomes in the form of obstructive and restrictive changes that correlated with the radiological imaging. CONCLUSION Veno-venous extracorporeal life support can effectively provide prolonged support for patients with blastomycosis-associated acute respiratory distress syndrome that is safe and associated with favorable long-term outcomes.
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Affiliation(s)
- Abdulrahman Al-Fares
- Adult Critical Care Medicine Fellowship Program, University of Toronto, Toronto, ON, Canada.,Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait.,Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Extracorporeal Life Support Program, Toronto General Hospital, Toronto, ON, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Extracorporeal Life Support Program, Toronto General Hospital, Toronto, ON, Canada
| | - Shahid Husain
- Division of Infectious Diseases and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Matteo Di Nardo
- Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Pediatric Critical Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Marcelo Cypel
- Extracorporeal Life Support Program, Toronto General Hospital, Toronto, ON, Canada.,Division of Thoracic Surgery and Lung Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- Extracorporeal Life Support Program, Toronto General Hospital, Toronto, ON, Canada.,Division of Thoracic Surgery and Lung Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Extracorporeal Life Support Program, Toronto General Hospital, Toronto, ON, Canada
| | - Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Extracorporeal Life Support Program, Toronto General Hospital, Toronto, ON, Canada
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Ahmed MEH, Hamed G, Fawzy S, Taema KM. Lung injury prediction scores: Clinical validation and C-reactive protein involvement in high risk patients. Med Intensiva 2019; 44:267-274. [PMID: 30987877 DOI: 10.1016/j.medin.2019.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE A study was made to validate two previously derived lung injury prediction scores (LIPS) for the prediction of acute respiratory distress syndrome (ARDS) in high risk intensive care patients, with the incorporation of C-reactive protein (CRP) for improving score accuracy. DESIGN A prospective, observational cohort study was carried out. PATIENTS A total of 200 patients with APACHE II score ≥15 and at least one ARDS risk factor upon ICU admission were included. INTERVENTIONS Calculation of LIPS using formulas developed by Cartin-Ceba et al. (2009) and Trillo-Alvarez et al. (2011) (LIPS-2009 and LIPS-2011). C-reactive protein was measured upon admission (CRP-0) and after 48h (CRP-48). MAIN VARIABLES OF INTEREST Independent variables: LIPS-2009, LIPS-2011 and CRP values. Dependent variable: development of ARDS. RESULTS Eighty-eight patients (44%) developed ARDS after a median (Q1-Q3) of 2.5 (1.3-6.8) days. The LIPS-2009 and LIPS-2011 scores were 4 (3-6) and 5 (3.6-6.5) in ARDS patients compared to 2 (1-4) and 3.5 (1.5-4.5) in non-ARDS patients (p<0.001). CRP-48 was 96 (67.5-150.3)mg/L and 48 (24-96)mg/L in the two groups, respectively (p<0.001). ΔCRP (i.e., CRP-48 minus CRP-0) was significantly higher in the ARDS patients (p<0.001). The AUC was 0.740 and 0.738 for LIPS-2011 and LIPS-2009, respectively - the difference being nonsignificant (p=0.9, 0.9 and 0.8 for pairwise comparison of the different ROC curves). Integrating ΔCRP with LIPS-2011 using binary logistic regression analysis identified a new score (LIPS-N) with AUC 0.803, which was significantly higher than the AUC of LIPS-2011 (p=0.01). CONCLUSIONS Both LIPS scores are equally effective in predicting ARDS in high risk ICU patients. Integrating the change in CRP within the score might improve its accuracy.
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Affiliation(s)
- M E-H Ahmed
- Critical Care Medicine Department, Al-Haram Hospital, Cairo, Egypt
| | - G Hamed
- Critical Care Medicine Department, Cairo University, Cairo, Egypt
| | - S Fawzy
- Critical Care Medicine Department, Cairo University, Cairo, Egypt
| | - K M Taema
- Critical Care Medicine Department, Cairo University, Cairo, Egypt.
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