201
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Dale CR, Starcher RW, Chang SC, Robicsek A, Parsons G, Goldman JD, Vovan A, Hotchkin D, Gluckman TJ. Surge effects and survival to hospital discharge in critical care patients with COVID-19 during the early pandemic: a cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:70. [PMID: 33596975 PMCID: PMC7887411 DOI: 10.1186/s13054-021-03504-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
Background The early months of the COVID-19 pandemic were fraught with much uncertainty and some resource constraint. We assessed the change in survival to hospital discharge over time for intensive care unit patients with COVID-19 during the first 3 months of the pandemic and the presence of any surge effects on patient outcomes. Methods Retrospective cohort study using electronic medical record data for all patients with laboratory-confirmed COVID-19 admitted to intensive care units from February 25, 2020, to May 15, 2020, at one of 26 hospitals within an integrated delivery system in the Western USA. Patient demographics, comorbidities, and severity of illness were measured along with medical therapies and hospital outcomes over time. Multivariable logistic regression models were constructed to assess temporal changes in survival to hospital discharge during the study period. Results Of 620 patients with COVID-19 admitted to the ICU [mean age 63.5 years (SD 15.7) and 69% male], 403 (65%) survived to hospital discharge and 217 (35%) died in the hospital. Survival to hospital discharge increased over time, from 60.0% in the first 2 weeks of the study period to 67.6% in the last 2 weeks. In a multivariable logistic regression analysis, the risk-adjusted odds of survival to hospital discharge increased over time (biweekly change, adjusted odds ratio [aOR] 1.22, 95% CI 1.04–1.40, P = 0.02). Additionally, an a priori-defined explanatory model showed that after adjusting for both hospital occupancy and percent hospital capacity by COVID-19-positive individuals and persons under investigation (PUI), the temporal trend in risk-adjusted patient survival to hospital discharge remained the same (biweekly change, aOR 1.18, 95% CI 1.00–1.38, P = 0.04). The presence of greater rates of COVID-19 positive/PUI as a percentage of hospital capacity was, however, significantly and inversely associated with survival to hospital discharge (aOR 0.95, 95% CI 0.92–0.98, P < 0.01). Conclusions During the early COVID-19 pandemic, risk-adjusted survival to hospital discharge increased over time for critical care patients. An association was also seen between a greater COVID-19-positive/PUI percentage of hospital capacity and a lower survival rate to hospital discharge.
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Affiliation(s)
- Christopher R Dale
- Swedish Health Services, 600 Broadway, Suite 610, Seattle, WA, 98122, USA. .,School of Public Health, University of Washington, Seattle, WA, USA.
| | | | - Shu Ching Chang
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, OR, USA
| | | | | | | | - Andre Vovan
- Providence Health & Services, Portland, OR, USA.,The Oregon Clinic, Portland, OR, USA
| | | | - Tyler J Gluckman
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, OR, USA
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202
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Hernández-Platero L, Solé-Ribalta A, Pons M, Jordan I, Cambra FJ. [A paediatric intensive care unit's experience in managing adult patients with COVID-19 disease]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00018-7. [PMID: 33648865 PMCID: PMC8908388 DOI: 10.1016/j.anpedi.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/18/2020] [Accepted: 01/06/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Lluisa Hernández-Platero
- Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España; Institut de Recerca Sant Joan de Déu, Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Anna Solé-Ribalta
- Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España; Institut de Recerca Sant Joan de Déu, Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Martí Pons
- Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España; Institut de Recerca Sant Joan de Déu, Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Iolanda Jordan
- Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España; Institut de Recerca Sant Joan de Déu, Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España; Universitat de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, España.
| | - Francisco J Cambra
- Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España; Institut de Recerca Sant Joan de Déu, Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España; Universitat de Barcelona, Barcelona, España
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203
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Abstract
PURPOSE OF REVIEW The recent COVID-19 outbreak has clearly shown how epidemics/pandemics can challenge developed countries' healthcare systems. Proper management of equipment and human resources is critical to provide adequate medical care to all patients admitted to the hospital and the ICU for both pandemic-related and unrelated reasons. RECENT FINDINGS Appropriate separate paths for infected and noninfected patients and prompt isolation of infected critical patients in dedicated ICUs play a pivotal role in limiting the contagions and optimizing resources during pandemics. The key to handle these challenging events is to learn from past experiences and to be prepared for future occurrences. Hospital space should be redesigned to quickly increase medical and critical care capacity, and healthcare workers (critical and noncritical) should be trained in advance. SUMMARY A targeted improvement of hospital and ICU protocols will increase medical care quality for patients admitted to the hospital for any clinical reasons during a pandemic.
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Affiliation(s)
- Gaetano Florio
- Department of Pathophysiology and Transplantation, University of Milan
| | - Alberto Zanella
- Department of Pathophysiology and Transplantation, University of Milan
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Pesenti
- Department of Pathophysiology and Transplantation, University of Milan
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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204
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Vincent JL, Wendon J, Martin GS, Juffermans NP, Creteur J, Cecconi M. COVID-19: What we've done well and what we could or should have done better-the 4 Ps. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:40. [PMID: 33509218 PMCID: PMC7841973 DOI: 10.1186/s13054-021-03467-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/13/2021] [Indexed: 12/15/2022]
Abstract
The current coronavirus pandemic has impacted heavily on ICUs worldwide. Although many hospitals and healthcare systems had plans in place to manage multiple casualties as a result of major natural disasters or accidents, there was insufficient preparation for the sudden, massive influx of severely ill patients with COVID-19. As a result, systems and staff were placed under immense pressure as everyone tried to optimize patient management. As the pandemic continues, we must apply what we have learned about our response, both good and bad, to improve organization and thus patient care in the future.
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Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
| | - Julia Wendon
- Department of Critical Care, Kings College Hospital Foundation Trust, London, UK
| | - Greg S Martin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicole P Juffermans
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centre, Location Academic Medical Centre, Amsterdam, The Netherlands.,Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Maurizio Cecconi
- Department of Anesthesiology and Intensive Care, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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205
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Ho EP, Neo HY. COVID 19: prioritise autonomy, beneficence and conversations before score-based triage. Age Ageing 2021; 50:11-15. [PMID: 32975564 PMCID: PMC7543287 DOI: 10.1093/ageing/afaa205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/31/2020] [Indexed: 12/14/2022] Open
Abstract
At the start of the COVID-19 pandemic, mounting demand overwhelmed critical care surge capacities, triggering implementation of triage protocols to determine ventilator allocation. Relying on triage scores to ration care, while relieving clinicians from making morally distressing decisions under high situational pressure, distracts clinicians from what is essentially deeply humanistic issues entrenched in this protracted public health crisis. Such an approach will become increasingly untenable as countries flatten their epidemic curves. Decisions regarding ICU admission are particularly challenging in older people, who are most likely to require critical care, but for whom benefits are most uncertain. Before applying score-based triage, physicians must first discern if older people will benefit from critical care (beneficence) and second, if he wants critical care (autonomy). When deliberating beneficence, physicians should steer away from solely using age-stratified survival probabilities from epidemiological data. Instead, decisions must be based on individualised risk-stratification that encompasses evidence-based predictors of adverse outcomes specific to older adults. Survival will also need to be weighed against burden of treatment, as well as longer-term functional deficits and quality-of-life. By identifying the robust older people who may benefit from critical care, clinicians should proceed to elicit his values and preferences that would determine the treatment most aligned with his best interest. During these dialogues, physicians must truthfully convey the emergent clinical reality, discern the older person’s therapeutic goals and discuss the feasibility of achieving them. Given that COVID-19 is here to stay, these conversations aimed at achieving goal-cordant care must become a new clinical norm.
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Affiliation(s)
| | - Han-Yee Neo
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore
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206
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Tsang JLY, Binnie A, Fowler RA. Twenty articles that critical care clinicians should read about COVID-19. Intensive Care Med 2021; 47:337-341. [PMID: 33392643 PMCID: PMC7779107 DOI: 10.1007/s00134-020-06329-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Jennifer L Y Tsang
- Niagara Health, St. Catharines, Ontario, Canada. .,Department of Medicine, McMaster University, Hamilton, Ontario, Canada. .,Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ontario, Canada.
| | - Alexandra Binnie
- Intensive Care Department, William Osler Health System, Etobicoke, Ontario, Canada. .,Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal. .,Algarve Biomedical Centre, Faro, Portugal.
| | - Robert A Fowler
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,University of Toronto Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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207
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Waldner D, Harrison R, Johnstone J, Saxinger L, Webster D, Sligl W. COVID-19 epidemiology in Canada from January to December 2020: the pre-vaccine era. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This paper summarizes COVID-19 disease epidemiology in Canada in the pre-vaccine era—from January through to December 2020. Canadian case numbers, risk factors, disease presentations (including severe and critical disease), and outcomes are described. Differences between provinces and territories in geography, population size and density, health demographics, and pandemic impact are highlighted. Key concepts in public health response and mitigation are reviewed, including masking, physical distancing, hand washing, and the promotion of outdoor interactions. Adequate investment in public health infrastructure is stressed, and regional differences in screening and testing strategies are highlighted. The spread of COVID-19 in Canadian workplaces, long-term care homes, and schools is described and lessons learned emphasized. The impact of COVID-19 on vulnerable populations in Canada—including Indigenous Peoples, ethnic minorities and newcomers, people who use drugs, people who are homeless, people who are incarcerated, and people with disabilities—is described. Sex and gender disparities are also highlighted. Author recommendations include strategies to reduce transmission (such as test–trace–isolate), the establishment of nationally standardized definitions and public reporting, the protection of high risk and vulnerable populations, and the development of a national strategy on vaccine allocation.
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Affiliation(s)
| | | | | | | | | | - Wendy Sligl
- University of Alberta, Edmonton, AB T6G 2B7, Canada
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208
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Bologheanu R, Maleczek M, Laxar D, Kimberger O. Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic : A retrospective propensity score-matched analysis. Wien Klin Wochenschr 2021; 133:942-950. [PMID: 33909109 PMCID: PMC8080479 DOI: 10.1007/s00508-021-01857-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/18/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. METHODS The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. RESULTS A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2-6) compared to 2020: 4 days (IQR 2-7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. CONCLUSION In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.
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Affiliation(s)
- Răzvan Bologheanu
- Department of Anaesthesiology and General Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Mathias Maleczek
- Department of Anaesthesiology and General Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Daniel Laxar
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Oliver Kimberger
- Department of Anaesthesiology and General Intensive Care, Medical University of Vienna, Vienna, Austria
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209
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Keene AB, Shiloh AL, Eisen L, Berger J, Karwa M, Fein D, Orsi D, Gong M. Critical Care Surge During the COVID-19 Pandemic: Implementation and Feedback From Frontline Providers. J Intensive Care Med 2020; 36:233-240. [DOI: 10.1177/0885066620973175] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: Montefiore Medical Center (MMC) in the Bronx, New York, was subjected to an unprecedented surge of critically ill patients with COVID-19 disease during the initial outbreak of the pandemic in New York State in the spring of 2020. It is important to describe our experience in order to assist hospitals in other areas of the country that may soon be subjected to similar surges. Materials and Methods: We retrospectively reviewed the expansion of critical care medicine services at Montefiore during the COVID-19 surge in terms of space, staff, stuff, and systems. In addition, we report on a debriefing session held with a multidisciplinary group of frontline CCM providers at Montefiore. Findings: The surge of critically ill patients from COVID-19 disease necessitated a tripling of critical care bed capacity at (MMC), with attendant increased needs for staffing, equipment, and systematic innovations to increase efficiency and effectiveness. Feedback from a multidisciplinary group of frontline providers revealed multiple opportunities for improvement for the next potential surge at MMC as well as guidance for other hospitals. Conclusions: Given increasing cases and burden of critical illness from COVID-19 across the US, engineering safe and effective expansions of critical care capacity will be crucial. We hope that our description of what worked and what did not at MMC will help guide other hospitals in their pandemic preparedness.
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Affiliation(s)
- Adam B. Keene
- Department of Medicine, Division of Critical Care Medicine, Montefiore Medical Center, Yeshiva University's Albert Einstein College of Medicine, New York, NY, USA
| | - Ariel L. Shiloh
- Department of Medicine, Division of Critical Care Medicine, Montefiore Medical Center, Yeshiva University's Albert Einstein College of Medicine, New York, NY, USA
| | - Lewis Eisen
- Department of Medicine, Division of Critical Care Medicine, Montefiore Medical Center, Yeshiva University's Albert Einstein College of Medicine, New York, NY, USA
| | - Jay Berger
- Department of Medicine, Division of Critical Care Medicine, Montefiore Medical Center, Yeshiva University's Albert Einstein College of Medicine, New York, NY, USA
| | - Manoj Karwa
- Department of Medicine, Division of Critical Care Medicine, Montefiore Medical Center, Yeshiva University's Albert Einstein College of Medicine, New York, NY, USA
| | - Daniel Fein
- Department of Medicine, Division of Critical Care Medicine, Montefiore Medical Center, Yeshiva University's Albert Einstein College of Medicine, New York, NY, USA
| | - Deborah Orsi
- Department of Medicine, Division of Critical Care Medicine, Montefiore Medical Center, Yeshiva University's Albert Einstein College of Medicine, New York, NY, USA
| | - Michelle Gong
- Department of Medicine, Division of Critical Care Medicine, Montefiore Medical Center, Yeshiva University's Albert Einstein College of Medicine, New York, NY, USA
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210
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Hammond NE, Crowe L, Abbenbroek B, Elliott R, Tian DH, Donaldson LH, Fitzgerald E, Flower O, Grattan S, Harris R, Sayers L, Delaney A. Impact of the coronavirus disease 2019 pandemic on critical care healthcare workers' depression, anxiety, and stress levels. Aust Crit Care 2020; 34:146-154. [PMID: 33632606 PMCID: PMC7762707 DOI: 10.1016/j.aucc.2020.12.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/03/2020] [Accepted: 12/13/2020] [Indexed: 01/17/2023] Open
Abstract
Aim The aim of the study was to determine levels of depression, anxiety, and stress symptoms and factors associated with psychological burden amongst critical care healthcare workers in the early stages of the coronavirus disease 2019 pandemic. Methods An anonymous Web-based survey distributed in April 2020. All healthcare workers employed in a critical care setting were eligible to participate. Invitations to the survey were distributed through Australian and New Zealand critical care societies and social media platforms. The primary outcome was the proportion of healthcare workers who reported moderate to extremely severe scores on the Depression, Anxiety, and Stress Scale-21 (DASS-21). Results Of the 3770 complete responses, 3039 (80.6%) were from Australia. A total of 2871 respondents (76.2%) were women; the median age was 41 years. Nurses made up 2269 (60.2%) of respondents, with most (2029 [53.8%]) working in intensive care units. Overall, 813 (21.6%) respondents reported moderate to extremely severe depression, 1078 (28.6%) reported moderate to extremely severe anxiety, and 1057 (28.0%) reported moderate to extremely severe stress scores. Mean ± standard deviation values of DASS-21 depression, anxiety, and stress scores amongst woman vs men was as follows: 8.0 ± 8.2 vs 7.1 ± 8.2 (p = 0.003), 7.2 ± 7.5 vs 5.0 ± 6.7 (p < 0.001), and 14.4 ± 9.6 vs 12.5 ± 9.4 (p < 0.001), respectively. After adjusting for significant confounders, clinical concerns associated with higher DASS-21 scores included not being clinically prepared (β = 4.2, p < 0.001), an inadequate workforce (β = 2.4, p = 0.001), having to triage patients owing to lack of beds and/or equipment (β = 2.6, p = 0.001), virus transmission to friends and family (β = 2.1, p = 0.009), contracting coronavirus disease 2019 (β = 2.8, p = 0.011), being responsible for other staff members (β = 3.1, p < 0.001), and being asked to work in an area that was not in the respondents' expertise (β = 5.7, p < 0.001). Conclusion In this survey of critical care healthcare workers, between 22 and 29% of respondents reported moderate to extremely severe depression, anxiety, and stress symptoms, with women reporting higher scores than men. Although female gender appears to play a role, modifiable factors also contribute to psychological burden and should be studied further.
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Affiliation(s)
- Naomi E Hammond
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia.
| | - Liz Crowe
- The University of Queensland, Australia; Queensland Children's Hospital, Brisbane, Australia
| | - Brett Abbenbroek
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Rosalind Elliott
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
| | - David H Tian
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia
| | - Lachlan H Donaldson
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
| | - Emily Fitzgerald
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
| | - Oliver Flower
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
| | - Sarah Grattan
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Roger Harris
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
| | - Louise Sayers
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
| | - Anthony Delaney
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
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211
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Take-Home Messages from the COVID-19 Pandemic: Strengths and Pitfalls of the Italian National Health Service from a Medico-Legal Point of View. Healthcare (Basel) 2020; 9:healthcare9010017. [PMID: 33375544 PMCID: PMC7824087 DOI: 10.3390/healthcare9010017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 01/28/2023] Open
Abstract
The World Health Organization (WHO) declared the outbreak of the Coronavirus disease-2019 (COVID-19) infection a pandemic on 11 March 2020. As of the end of October 2020, there were 50 million cases of infection and over one million deaths recorded worldwide, over 45,000 of which occurred in Italy. In Italy, the demand for intensive care over the course of this pandemic crisis has been exceptionally high, resulting in a severe imbalance between the demand for and availability of the necessary resources. This paper focuses on elements of preventive medicine and medical treatments in emergency and non-emergency situations which, based on the international scientific literature, may prove to be useful to physicians on a behavioral level and avert professional liability problems. In order to achieve this objective, we have performed a search on MEDLINE to find published articles related to the risks associated with the pandemic that contain useful suggestions and strategies for mitigating risks and protecting the safety of the population. The results have been collocated in line with these specific study areas.
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212
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Thomson RJ, Hunter J, Dutton J, Schneider J, Khosravi M, Casement A, Dhadwal K, Martin D. Clinical characteristics and outcomes of critically ill patients with COVID-19 admitted to an intensive care unit in London: A prospective observational cohort study. PLoS One 2020; 15:e0243710. [PMID: 33320904 PMCID: PMC7737956 DOI: 10.1371/journal.pone.0243710] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/29/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cohorts of severely ill patients with COVID-19 have been described in several countries around the globe, but to date there have been few published reports from the United Kingdom (UK). Understanding the characteristics of the affected population admitted to intensive care units (ICUs) in the UK is crucial to inform clinical decision making, research and planning for future waves of infection. METHODS We conducted a prospective observational cohort study of all patients with COVID-19 admitted to a large UK ICU from March to May 2020 with follow-up to June 2020. Data were collected from health records using a standardised template. We used multivariable logistic regression to analyse the factors associated with ICU survival. RESULTS Of the 156 patients included, 112 (72%) were male, 89 (57%) were overweight or obese, 68 (44%) were from ethnic minorities, and 89 (57%) were aged over 60 years of age. 136 (87%) received mechanical ventilation, 77 (57% of those intubated) were placed in the prone position and 95 (70% of those intubated) received neuromuscular blockade. 154 (99%) patients required cardiovascular support and 44 (28%) required renal replacement therapy. Of the 130 patients with completed ICU episodes, 38 (29%) died and 92 (71%) were discharged alive from ICU. In multivariable models, age (OR 1.13 [95% CI 1.07-1.21]), obesity (OR 3.06 [95% CI 1.16-8.74]), lowest P/F ratio on the first day of admission (OR 0.82 [95% CI 0.67-0.98]) and PaCO2 (OR 1.52 [95% CI 1.01-2.39]) were independently associated with ICU death. CONCLUSIONS Age, obesity and severity of respiratory failure were key determinants of survival in this cohort. Multiorgan failure was prevalent. These findings are important for guiding future research and should be taken into consideration during future healthcare planning in the UK.
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Affiliation(s)
- Ross J. Thomson
- Department of Intensive Care Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
- William Harvey Research Institute, Queen Mary, University of London, London, United Kingdom
| | - Jennifer Hunter
- Department of Anaesthesia, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jonathan Dutton
- Department of Anaesthesia, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - James Schneider
- Department of Anaesthesia, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Maryam Khosravi
- Department of Intensive Care Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
- Department of Nephrology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Alisha Casement
- Department of Intensive Care Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Kulwant Dhadwal
- Department of Intensive Care Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
- Department of Anaesthesia, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Daniel Martin
- Department of Intensive Care Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
- Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
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213
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Tuominen J, Hällberg V, Oksala N, Palomäki A, Lukkarinen T, Roine A. NYU-EDA in modelling the effect of COVID-19 on patient volumes in a Finnish emergency department. BMC Emerg Med 2020; 20:97. [PMID: 33308165 PMCID: PMC7729695 DOI: 10.1186/s12873-020-00392-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency departments (EDs) worldwide have been in the epicentre of the novel coronavirus disease (COVID-19). However, the impact of the pandemic and national emergency measures on the number of non-COVID-19 presentations and the assessed acuity of those presentations remain uncertain. METHODS We acquired a retrospective cohort containing all ED visits in a Finnish secondary care hospital during years 2018, 2019 and 2020. We compared the number of presentations in 2020 during the national state of emergency, i.e. from March 16 to June 11, with numbers from 2018 and 2019. Presentations were stratified using localized New York University Emergency Department Algorithm (NYU-EDA) to evaluate changes in presentations with different acuity levels. RESULTS A total of 27,526 presentations were observed. Compared to previous two years, total daily presentations were reduced by 23% (from 113 to 87, p < .001). In NYU-EDA classes, Non-Emergent visits were reduced the most by 42% (from 18 to 10, p < .001). Emergent presentations were reduced by 19 to 28% depending on the subgroup (p < .001). Number of injuries were reduced by 25% (from 27 to 20, p < .001). The NYU-EDA distribution changed statistically significantly with 4% point reduction in Non-Emergent visits (from 16 to 12%, p < .001) and 0.9% point increase in Alcohol-related visits (from 1.6 to 2.5%, p < .001). CONCLUSIONS We observed a significant reduction in total ED visits in the course of national state of emergency. Presentations were reduced in most of the NYU-EDA groups irrespective of the assessed acuity. A compensatory increase in presentations was not observed in the course of the 3 month lockdown. This implies either reduction in overall morbidity caused by decreased societal activity or widespread unwillingness to seek required medical advice.
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Affiliation(s)
- Jalmari Tuominen
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland.
| | - Ville Hällberg
- Emergency Department, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Niku Oksala
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland.,Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland
| | - Ari Palomäki
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland.,Emergency Department, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Timo Lukkarinen
- City of Helsinki, Social Services and Health Care, Helsinki, Finland
| | - Antti Roine
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
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214
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Long-Term Acute Care Hospitals Extend ICU Capacity for COVID-19 Response and Recovery. Chest 2020; 159:1894-1901. [PMID: 33309523 PMCID: PMC7832791 DOI: 10.1016/j.chest.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/23/2020] [Accepted: 12/03/2020] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic has presented novel challenges for the entire health-care continuum, requiring transformative changes to hospital and post-acute care, including clinical, administrative, and physical modifications to current standards of operations. Innovative use and adaptation of long-term acute care hospitals (LTACHs) can safely and effectively care for patients during the ongoing COVID-19 pandemic. A framework for the rapid changes, including increasing collaboration with external health-care organizations, creating new methods for enhanced communication, and modifying processes focused on patient safety and clinical outcomes, is described for a network of 94 LTACHs. When managed and modified correctly, LTACHs can play a vital role in managing the national health-care pandemic crisis.
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215
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Imbriaco G, Scelsi S. It is not just about equipment and beds: Critical care nursing meeting the challenge of the second COVID-19 wave in Italy. Nurs Crit Care 2020; 26:300-302. [PMID: 33615632 DOI: 10.1111/nicc.12580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 11/28/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Guglielmo Imbriaco
- Intensive Care Unit, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.,Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
| | - Silvia Scelsi
- Director of Nursing and Health Professions Department, Giannina Gaslini Institute, National Public Children's Hospital and Research Institute, Genoa, Italy.,President of Aniarti, Italian association of critical care nurses, Genoa, Italy
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216
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Gutiérrez‐Zarate D, Rosas‐Sánchez K, Flores‐Carrillo JC, Medrano‐Ahumada S, Martínez‐Franco M. Early management of critically ill patients with COVID-19. J Am Coll Emerg Physicians Open 2020; 1:1418-1426. [PMID: 33392546 PMCID: PMC7771738 DOI: 10.1002/emp2.12294] [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] [Received: 08/13/2020] [Revised: 09/23/2020] [Accepted: 10/01/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is associated with a severe acute respiratory condition requiring respiratory support and mechanical ventilation. Based on the pathophysiology and clinical course of the disease, a therapeutic approach can be adapted. Three phases have been identified, in which different strategies are recommended in a stepwise invasiveness approach. In the second or acute phase, patients are frequently admitted to the ICU for severe pneumonia and hypoxemia with evidence of a proinflammatory and hypercoagulable state. This stage is an opportunity to intervene early in the disease. Medical strategies and mechanical ventilation should be individualized to improve outcomes.
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217
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Najafi M. SORT maneuver: ease and safety for the practitioner and the patient. Ann Intensive Care 2020; 10:160. [PMID: 33258062 PMCID: PMC7703506 DOI: 10.1186/s13613-020-00778-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/21/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Mahdi Najafi
- Department of Medical Biophysics, Western University, Room M402, Medical Sciences Building, 1151 Richmond St, London, ON, N6A 3K7, Canada. .,Department of Anesthesiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
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218
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Ten reasons for focusing on the care we provide for family members of critically ill patients with COVID-19. Intensive Care Med 2020; 47:230-233. [PMID: 33231733 PMCID: PMC7685190 DOI: 10.1007/s00134-020-06319-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/03/2020] [Indexed: 11/06/2022]
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219
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Veldtman GR, Pirisi M, Storti E, Roomi A, Fadl-Elmula FEM, Vriz O, Bokhari S, Ammash N, Salam Y, Liu GZ, Spinelli S, Barbieri G, Hashmi S. Management principles in patients with COVID-19: perspectives from a growing global experience with emphasis on cardiovascular surveillance. Open Heart 2020; 7:openhrt-2020-001357. [PMID: 33168640 PMCID: PMC7653968 DOI: 10.1136/openhrt-2020-001357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/07/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022] Open
Abstract
The COVID-19, due to SARS-CoV-2, has uncovered many real-world issues when it comes to healthcare management and has led to a widespread mortality. Observations thus far from the reports of COVID-19 have indicated that certain risk groups for example, those with pre-existing cardiovascular (CV) disease, hypertension, diabetes, chronic kidney disease and tobacco use are prone to disease development and specifically development of severe disease and possible fatality. It is increasingly evident that many CV conditions occur frequently. These include myopericarditis, acute coronary syndromes, thrombosis, arrhythmias, hypertension and heart failure. Many professional organisations and societies related to cardiology have produced guidelines or recommendations on most of the above-mentioned aspects. Given these rapid developments, the aims of this review manuscript were to summarise and integrate recent publications with newly developed guidelines and with the first-hand experience of frontline physicians and to yield a pragmatic insight and approach to CV complications of COVID-19. We emphasise on a strategic tier-based approach for initial assessment and management of COVID-19, and then delve into focused areas within CV domains, and additionally highlighting the role of point-of-care ultrasound especially lung ultrasound, echocardiography and electrocardiography, in the management of these patients. We hope this paper will serve as a useful tool in the CV management of COVID-19 for clinicians practicing in both developing and developed countries.
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Affiliation(s)
- Gruschen R Veldtman
- Adolescent and Adult Congenital Heart Disease Program, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Novara, Italy
| | - Enrico Storti
- Department of Critical Care, Maggiore Hospital, Lodi, Lodi, Italy
| | - Asad Roomi
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Riyadh, Saudi Arabia
| | - Fadl Elmula M Fadl-Elmula
- Cardiology, Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Riyadh, Saudi Arabia
| | - Olga Vriz
- Cardiology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Naser Ammash
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yezan Salam
- College of Medicine, Alfaisal University, Riyadh, Riyadh Province, Saudi Arabia
| | - Guang Zong Liu
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, Harbin, China
| | - Stefano Spinelli
- Emergency Medicine Unit, Pisa University Hospital, Pisa, Toscana, Italy
| | - Greta Barbieri
- Emergency Medicine Unit, Pisa University Hospital, Pisa, Toscana, Italy
| | - Shahrukh Hashmi
- Clinical Trials Unit, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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220
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Bels JLM, van Kuijk SMJ, Ghossein-Doha C, Tijssen FH, van Gassel RJJ, Tas J, Collaborators M, Schnabel RM, Aries MJH, van de Poll MCG, Bergmans DCJJ, Meex SJR, van Mook WNKA, van der Horst ICC, van Bussel BCT. Decreased serial scores of severe organ failure assessments are associated with survival in mechanically ventilated patients; the prospective Maastricht Intensive Care COVID cohort. J Crit Care 2020; 62:38-45. [PMID: 33246196 PMCID: PMC7669472 DOI: 10.1016/j.jcrc.2020.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023]
Abstract
Background The majority of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are admitted to the Intensive Care Unit (ICU) for mechanical ventilation. The role of multi-organ failure during ICU admission as driver for outcome remains to be investigated yet. Design and setting Prospective cohort of mechanically ventilated critically ill with SARS-CoV-2 infection. Participants and methods 94 participants of the MaastrICCht cohort (21% women) had a median length of stay of 16 days (maximum of 77). After division into survivors (n = 59) and non-survivors (n = 35), we analysed 1555 serial SOFA scores using linear mixed-effects models. Results Survivors improved one SOFA score point more per 5 days (95% CI: 4–8) than non-survivors. Adjustment for age, sex, and chronic lung, renal and liver disease, body-mass index, diabetes mellitus, cardiovascular risk factors, and Acute Physiology and Chronic Health Evaluation II score did not change this result. This association was stronger for women than men (P-interaction = 0.043). Conclusions The decrease in SOFA score associated with survival suggests multi-organ failure involvement during mechanical ventilation in patients with SARS-CoV-2. Surviving women appeared to improve faster than surviving men. Serial SOFA scores may unravel an unfavourable trajectory and guide decisions in mechanically ventilated patients with SARS-CoV-2.
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Affiliation(s)
- Julia L M Bels
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Chahinda Ghossein-Doha
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; Department of Cardiology, Maastricht University Medical Centre+, Maastricht, the Netherlands; School for Oncology & Developmental Biology (GROW), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
| | - Fabian H Tijssen
- Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Rob J J van Gassel
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
| | - Jeanette Tas
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - MaastrICCht Collaborators
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands
| | - Ronny M Schnabel
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands.
| | - Marcel J H Aries
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Marcel C G van de Poll
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
| | - Dennis C J J Bergmans
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands.
| | - Steven J R Meex
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
| | - Walther N K A van Mook
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; School of Health Professions Education, Maastricht University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands.
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
| | - Bas C T van Bussel
- Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
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221
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Intensive care for COVID-19 in low- and middle-income countries: research opportunities and challenges. Intensive Care Med 2020; 47:226-229. [PMID: 33184695 PMCID: PMC7661330 DOI: 10.1007/s00134-020-06285-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/06/2020] [Indexed: 01/06/2023]
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222
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Klein SJ, Bellmann R, Dejaco H, Eschertzhuber S, Fries D, Furtwängler W, Gasteiger L, Hasibeder W, Helbok R, Hochhold C, Hofer S, Kirchmair L, Krismer C, Ladner E, Lehner GF, Mathis S, Mayr A, Mittermayr M, Peer A, Preuß Hernández C, Reitter B, Ströhle M, Swoboda M, Thomé C, Joannidis M. Structured ICU resource management in a pandemic is associated with favorable outcome in critically ill COVID‑19 patients. Wien Klin Wochenschr 2020; 132:653-663. [PMID: 33170333 PMCID: PMC7653454 DOI: 10.1007/s00508-020-01764-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION On February 25, 2020, the first 2 patients were tested positive for severe acute respiratory syndrome coronavirus‑2 (SARS-CoV-2) in Tyrol, Austria. Rapid measures were taken to ensure adequate intensive care unit (ICU) preparedness for a surge of critically ill coronavirus disease-2019 (COVID-19) patients. METHODS This cohort study included all COVID-19 patients admitted to an ICU with confirmed or strongly suspected COVID-19 in the State of Tyrol, Austria. Patients were recorded in the Tyrolean COVID-19 intensive care registry. Date of final follow-up was July 17, 2020. RESULTS A total of 106 critically ill patients with COVID-19 were admitted to 1 of 13 ICUs in Tyrol from March 9 to July 17, 2020. Median age was 64 years (interquartile range, IQR 54-74 years) and the majority of patients were male (76 patients, 71.7%). Median simplified acute physiology score III (SAPS III) was 56 points (IQR 49-64 points). The median duration from appearance of first symptoms to ICU admission was 8 days (IQR 5-11 days). Invasive mechanical ventilation was required in 72 patients (67.9%) and 6 patients (5.6%) required extracorporeal membrane oxygenation treatment. Renal replacement therapy was necessary in 21 patients (19.8%). Median ICU length of stay (LOS) was 18 days (IQR 5-31 days), median hospital LOS was 27 days (IQR 13-49 days). The ICU mortality was 21.7% (23 patients), hospital mortality was 22.6%. There was no significant difference in ICU mortality in patients receiving invasive mechanical ventilation and in those not receiving it (18.1% vs. 29.4%, p = 0.284). As of July 17th, 2020, two patients are still hospitalized, one in an ICU, one on a general ward. CONCLUSION Critically ill COVID-19 patients in Tyrol showed high severity of disease often requiring complex treatment with increased lengths of ICU and hospital stay. Nevertheless, the mortality was found to be remarkably low, which may be attributed to our adaptive surge response providing sufficient ICU resources.
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Affiliation(s)
- Sebastian J Klein
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
- Doctoral College Medical Law and Healthcare, Faculty of Law, University Innsbruck, Innsbruck, Austria
| | - Romuald Bellmann
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Hannes Dejaco
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | - Dietmar Fries
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Wilhelm Furtwängler
- Department of Anesthesia and Intensive Care Medicine, Hospital Kufstein, Kufstein, Austria
| | - Lukas Gasteiger
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Walter Hasibeder
- Department of Anesthesiology and Critical Care Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Hochhold
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Stefanie Hofer
- Department of Internal Medicine, Hospital Hall, Hall, Austria
| | - Lukas Kirchmair
- Department of Anesthesia and Critical Care Medicine, Hospital Schwaz, Schwaz, Austria
| | - Christoph Krismer
- Department of Internal Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Eugen Ladner
- Department of Anesthesia and Intensive Care Medicine, Hospital Reutte, Reutte, Austria
| | - Georg F Lehner
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Simon Mathis
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Mayr
- Department of Anesthesia and Intensive Care Medicine, Hospital Lienz, Lienz, Austria
| | - Markus Mittermayr
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Peer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | | | - Bruno Reitter
- Department of Anesthesia and Intensive Care Medicine, Hospital St. Johann in Tyrol, St. Johann in Tyrol, Austria
| | - Mathias Ströhle
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Swoboda
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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Bruyneel A, Gallani MC, Tack J, d'Hondt A, Canipel S, Franck S, Reper P, Pirson M. Impact of COVID-19 on nursing time in intensive care units in Belgium. Intensive Crit Care Nurs 2020; 62:102967. [PMID: 33162312 PMCID: PMC7598359 DOI: 10.1016/j.iccn.2020.102967] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload. OBJECTIVE To assess the nurse-patient ratio required by COVID-19 patients and to identify the factors that influence nursing in this context. DESIGN This study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS). SETTING Three Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients. MEASUREMENTS AND MAIN RESULTS The study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p = <0.0001). In the COVID-19 group, these higher scores were also observed per shift and uniformly across the three hospitals. COVID-19 patients required more time in the activities of monitoring and titration (χ2 = 457.60, p = <0.0001), mobilisation (χ2 = 161.21, p = <0.0001), and hygiene (χ2 = 557.77, p = <0.0001). Factors influencing nursing time measured by NAS in the COVID-19 patients were age <65 years old (p = 0.23), the use of continuous venovenous hemofiltration (p = 0.002), a high APACHE II score (p = 0.006) and patient death (p = 0.002). A COVID-19 diagnosis was independently associated with an increase in nursing time (OR = 4.8, 95% CI:3.6-6.4). CONCLUSIONS Patients hospitalised in the ICU due to COVID-19 require significantly more nursing time and need an average ratio of almost 1:1.
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Affiliation(s)
- Arnaud Bruyneel
- Soins intensifs - Centre Hospitalier Universitaire Tivoli, Belgium; SIZ Nursing, A Society of Intensive Care Nurses, Belgium; Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium.
| | | | - Jérôme Tack
- SIZ Nursing, A Society of Intensive Care Nurses, Belgium; Soins intensifs - Cliniques Universitaire de Bruxelles - Hôpital Erasme, Belgium
| | - Alain d'Hondt
- Soins intensifs - Centre Hospitalier Universitaire Ambroise Paré, Belgium
| | - Sebastien Canipel
- SIZ Nursing, A Society of Intensive Care Nurses, Belgium; Soins intensifs - Centre Hospitalier Universitaire Ambroise Paré, Belgium
| | - Stéphane Franck
- Soins intensifs - Centre Hospitalier Universitaire Tivoli, Belgium
| | - Pascal Reper
- Soins intensifs - Centre Hospitalier de la Haute Senne, le Tilleriau, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
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225
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Freeman WD, Karnatovskaia LV, Dredla BK. How to Prepare and Protect Health-Care Teams During COVID-19: Know Thyself. Neurocrit Care 2020; 34:10-12. [PMID: 33108628 PMCID: PMC7590558 DOI: 10.1007/s12028-020-01135-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 11/23/2022]
Affiliation(s)
- W David Freeman
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA. .,Department of Neurology, Mayo Clinic, Jacksonville, FL, USA. .,Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | | | - Brynn K Dredla
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.,Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA
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Swol J, Shigemura N, Ichiba S, Steinseifer U, Anraku M, Lorusso R. Artificial lungs--Where are we going with the lung replacement therapy? Artif Organs 2020; 44:1135-1149. [PMID: 33098217 DOI: 10.1111/aor.13801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
Lung transplantation may be a final destination therapy in lung failure, but limited donor organ availability creates a need for alternative management, including artificial lung technology. This invited review discusses ongoing developments and future research pathways for respiratory assist devices and tissue engineering to treat advanced and refractory lung disease. An overview is also given on the aftermath of the coronavirus disease 2019 pandemic and lessons learned as the world comes out of this situation. The first order of business in the future of lung support is solving the problems with existing mechanical devices. Interestingly, challenges identified during the early days of development persist today. These challenges include device-related infection, bleeding, thrombosis, cost, and patient quality of life. The main approaches of the future directions are to repair, restore, replace, or regenerate the lungs. Engineering improvements to hollow fiber membrane gas exchangers are enabling longer term wearable systems and can be used to bridge lung failure patients to transplantation. Progress in the development of microchannel-based devices has provided the concept of biomimetic devices that may even enable intracorporeal implantation. Tissue engineering and cell-based technologies have provided the concept of bioartificial lungs with properties similar to the native organ. Recent progress in artificial lung technologies includes continued advances in both engineering and biology. The final goal is to achieve a truly implantable and durable artificial lung that is applicable to destination therapy.
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Affiliation(s)
- Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Intensive Care Medicine, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Nuremberg, Germany
| | - Norihisa Shigemura
- Division of Cardiovascular Surgery, Temple University Health System Inc., Philadelphia, PA, USA
| | - Shingo Ichiba
- Department of Surgical Intensive Care Medicine, Nippon Medical School Hospital, Bunkyo-ku, Japan
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Aachen, Germany
| | - Masaki Anraku
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo-ku, Japan
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department - Heart & Vascular Centre, Maastricht University Medical Hospital, Maastricht, The Netherlands
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227
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Richards-Belle A, Orzechowska I, Gould DW, Thomas K, Doidge JC, Mouncey PR, Christian MD, Shankar-Hari M, Harrison DA, Rowan KM. COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland. Intensive Care Med 2020; 46:2035-2047. [PMID: 33034689 PMCID: PMC7545019 DOI: 10.1007/s00134-020-06267-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/26/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To describe critical care patients with COVID-19 across England, Wales and Northern Ireland and compare them with a historic cohort of patients with other viral pneumonias (non-COVID-19) and with international cohorts of COVID-19. METHODS Extracted data on patient characteristics, acute illness severity, organ support and outcomes from the Case Mix Programme, the national clinical audit for adult critical care, for a prospective cohort of patients with COVID-19 (February to August 2020) are compared with a recent retrospective cohort of patients with other viral pneumonias (non-COVID-19) (2017-2019) and with other international cohorts of critical care patients with COVID-19, the latter identified from published reports. RESULTS 10,834 patients with COVID-19 (70.1% male, median age 60 years, 32.6% non-white ethnicity, 39.4% obese, 8.2% at least one serious comorbidity) were admitted across 289 critical care units. Of these, 36.9% had a PaO2/FiO2 ratio of ≤ 13.3 kPa (≤ 100 mmHg) consistent with severe ARDS and 72% received invasive ventilation. Acute hospital mortality was 42%, higher than for 5782 critical care patients with other viral pneumonias (non-COVID-19) (24.7%), and most COVID-19 deaths (88.7%) occurred before 30 days. Meaningful international comparisons were limited due to lack of standardised reporting. CONCLUSION Critical care patients with COVID-19 were disproportionately non-white, from more deprived areas and more likely to be male and obese. Conventional severity scoring appeared not to adequately reflect their acute severity, with the distribution across PaO2/FiO2 ratio categories indicating acutely severe respiratory disease. Critical care patients with COVID-19 experience high mortality and place a great burden on critical care services.
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Affiliation(s)
- Alvin Richards-Belle
- Intensive Care National Audit and Research Centre (ICNARC), Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - Izabella Orzechowska
- Intensive Care National Audit and Research Centre (ICNARC), Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - Doug W Gould
- Intensive Care National Audit and Research Centre (ICNARC), Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - Karen Thomas
- Intensive Care National Audit and Research Centre (ICNARC), Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - James C Doidge
- Intensive Care National Audit and Research Centre (ICNARC), Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - Paul R Mouncey
- Intensive Care National Audit and Research Centre (ICNARC), Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - Michael D Christian
- The Royal London Hospital, London's Air Ambulance, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK
| | - Manu Shankar-Hari
- Intensive Care Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - David A Harrison
- Intensive Care National Audit and Research Centre (ICNARC), Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre (ICNARC), Napier House, 24 High Holborn, London, WC1V 6AZ, UK.
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228
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Elevated eosinophil count is related with lower anti-factor Xa activity in COVID-19 patients. J Hematop 2020; 13:249-258. [PMID: 33046998 PMCID: PMC7541761 DOI: 10.1007/s12308-020-00419-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Abstract
Despite prophylactic anticoagulant treatments, thrombotic complications may develop in patients with coronavirus disease 2019 (COVID-19). This study aimed to evaluate the factors influencing anti-factor Xa activity in COVID-19 patients receiving low molecular weight heparin (LMWH). We prospectively evaluated 80 COVID-19 patients, diagnosed using polymerase chain reaction test, who were admitted to our clinic and administered LMWH; LMWH (enoxaparin) was applied according to the weight, D-dimer levels, and clinical condition of patients. Anti-factor Xa activity in blood, drawn 4 h after the 3rd dose of LMWH, was measured and an activity of < 0.2 IU/mL was considered subprophylactic. Patients were followed up clinically, and anti-factor Xa activity was re-examined before discharge. Groups 1 and 2 included 13 and 67 patients with subprophylactic (mean ± SD: 0.18 ± 0.06) and prophylactic (mean ± SD: 0.43 ± 0.23) anti-factor Xa activity, respectively. The proportion of eosinophils in patients was significantly higher in group 1 than in group 2 (mean ± SD; 2.96 ± 2.55 vs 0.90 ± 1.28; p = 0.001). At the time of discharge, the eosinophilic proportion of patients was significantly higher (eosinophil %, mean ± SD; 3.06 ± 1.49 vs 2.07 ± 1.92; p = 0.001), but the activated partial thromboplastin time was significantly lower (22.34 ± 1.38 vs 24.38 ± 3.58; p = 0.01) in group 1 than in group 2. Of 14 patients with eosinophil content > 4%, 6 were in group 1 ((6/13) 46.2%), while 8 were in group 2 ((8/63) 11.9%); (p = 0.009), and all had a D-dimer level < 1 μg/mL (p = 0.03). ROC analysis for the presence of anticoagulation at subprophylactic level revealed an area under curve of 0.79 (95% CI: 0.64-0.93); p = 0.001). In conclusion; Elevated eosinophil count is related to lower anti-factor Xa activity in patients with COVID-19 receiving LMWH. The clinical significance of the subprophylactic anti-factor Xa activity should be studied in COVID-19 patients (NCT04507282).
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229
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Gupta A, Bahl B, Rabadi S, Mebane A, Levey R, Vasudevan V. Value of Advance Care Directives for Patients With Serious Illness in the Era of COVID Pandemic: A Review of Challenges and Solutions. Am J Hosp Palliat Care 2020; 38:191-198. [PMID: 33021094 DOI: 10.1177/1049909120963698] [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] [Indexed: 11/16/2022] Open
Abstract
Advance care directives (ACDs) are instructions regarding what types of medical treatments a patient desires and/or who they would like to designate as a healthcare surrogate to make important healthcare decisions when the patient is mentally incapacitated. At end-of-life, when faced with poor prognosis for a meaningful health-related quality of life, most patients indicate their preference to abstain from aggressive, life-sustaining treatments. Patients whose wishes are left unsaid often receive burdensome life sustain therapy by default, prolonging patient suffering. The CoVID pandemic has strained our healthcare resources and raised the need for prioritization of life-sustaining therapy. This highlights the urgency of ACDs more than ever. Despite ACDs' potential to provide patients with care that aligns with their values and preferences and reduce resource competition, there has been relatively little conversation regarding the overlap of ACDs and CoVID-19. There is low uptake among patients, lack of training for healthcare professionals, and inequitable adoption in vulnerable populations. However, solutions are forthcoming and may include electronic medical record completion, patient outreach efforts, healthcare worker programs to increase awareness of at-risk minority patients, and restructuring of incentives and reimbursement policies. This review carefully describes the above challenges and unique opportunities to address them in the CoVID-19 era. If solutions are leveraged appropriately, ACDs have the potential to address the described challenges and ethically resolve resource conflicts during the current crisis and beyond.
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Affiliation(s)
- Amol Gupta
- 24508The Brooklyn Hospital Center, NY, USA
| | | | - Saher Rabadi
- 12340University of Texas Health Sciences Center, Houston, TX, USA
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230
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Rimmelé T, Pascal L, Polazzi S, Duclos A. Organizational aspects of care associated with mortality in critically ill COVID-19 patients. Intensive Care Med 2020; 47:119-121. [PMID: 33021683 PMCID: PMC7537377 DOI: 10.1007/s00134-020-06249-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Thomas Rimmelé
- Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.,Pathophysiology of Injury-Induced Immunosuppression (Pi3, EA 7426), Université Claude Bernard Lyon 1, Lyon, France
| | - Léa Pascal
- Health Data Department, Hospices Civils de Lyon, Lyon, France.,Health Services and Performance Research Lab (HeSPeR, EA 7425), Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphanie Polazzi
- Health Data Department, Hospices Civils de Lyon, Lyon, France.,Health Services and Performance Research Lab (HeSPeR, EA 7425), Université Claude Bernard Lyon 1, Lyon, France
| | - Antoine Duclos
- Health Data Department, Hospices Civils de Lyon, Lyon, France. .,Health Services and Performance Research Lab (HeSPeR, EA 7425), Université Claude Bernard Lyon 1, Lyon, France.
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231
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Hajeb M, Singh TD, Sakusic A, Graff-Radford J, Gajic O, Rabinstein AA. Functional outcome after critical illness in older patients: a population-based study. Neurol Res 2020; 43:103-109. [PMID: 33012281 DOI: 10.1080/01616412.2020.1831302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the prevalence of disability among ICU survivors one year after admission, and which factors influence functional outcome. METHODS We examined consecutive patients enrolled in the population-based Mayo Clinic Olmsted Study of Aging and then admitted to medical or surgical adult ICUs at Mayo Clinic, Rochester between January 1, 2006, and December 31, 2014 to determine one-year functional outcomes. RESULTS 831cases were included. Mean age was 84 years (IQR 79-88). 569 (68.5%) patients were alive one year after ICU admission. Of them, 546 patients had functional assessment at one year and 367 (67.2%) had good functional outcome. On multivariable analysis, poor one-year functional outcome (death or disability) was more common among women, older patients, and patients with baseline cognitive impairment (mild cognitive impairment or dementia), higher Carlson scores, and longer ICU stay (all P <.01). After excluding deceased patients, these associations remained unchanged. In addition, 120 (32.3%) of 372 patients who had post-ICU cognitive evaluation experienced cognitive decline after the ICU admission. CONCLUSIONS On a population-based cohort of older, predominantly elderly patients, approximately two-thirds of survivors maintained or regained good functional status 1 year after ICU hospitalization. However, older age, female sex, greater comorbidities, abnormal baseline cognition, and longer ICU stay were associated with poor functional recovery and cognitive decline was common.
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Affiliation(s)
- Mania Hajeb
- Departments of Neurology, Mayo Clinic , Rochester, MN, USA
| | - Tarun D Singh
- Departments of Neurology, Mayo Clinic , Rochester, MN, USA
| | - Amra Sakusic
- University Clinical Center Tuzla, Bosnia and Herzegovina; and Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Mayo Clinic , Rochester, MN, USA
| | | | - Ognjen Gajic
- Pulmonary Medicine and Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Mayo Clinic , Rochester, MN, USA
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232
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Raffiq A, Seng LB, San LS, Zakaria Z, Yee AS, Fitzrol DN, Hassan WMNW, Idris Z, Ghani ARI, Rosman AK, Abdullah JM. COVID-19 Pandemic and Its Impact on Neurosurgery Practice in Malaysia: Academic Insights, Clinical Experience and Protocols from March till August 2020. Malays J Med Sci 2020; 27:141-195. [PMID: 33154710 PMCID: PMC7605837 DOI: 10.21315/mjms2020.27.5.14] [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] [Received: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 12/02/2022] Open
Abstract
The newly discovered coronavirus disease 2019 (COVID-19) is an infectious disease introduced to humans for the first time. Following the pandemic of COVID-19, there is a major shift of practices among surgical departments in response to an unprecedented surge in reducing the transmission of disease. With pooling and outsourcing of more health care workers to emergency rooms, public health care services and medical services, further in-hospital resources are prioritised to those in need. It is imperative to balance the requirements of caring for COVID-19 patients with imminent risk of delay to others who need care. As Malaysia now approaches the recovery phase following the pandemic, the crisis impacted significantly on neurosurgical services throughout the country. Various emergency measures taken at the height of the crisis may remain as the new normal in the provision of neurosurgical services and practices in Malaysia. The crisis has certainly put a strain on the effective delivery of services and as we approach the recovery era, what may have been a strain may prove to be a silver lining in neurosurgical services in Malaysia. The following details are various measures put in place as the new operational protocols for neurosurgical services in Malaysia.
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Affiliation(s)
- Azman Raffiq
- Department of Neurosurgery, Penang General Hospital, Pulau Pinang, Malaysia
| | - Liew Boon Seng
- Department of Neurosurgery, Hospital Sungai Buloh, Selangor, Malaysia
| | - Lim Swee San
- Department of Neurosurgery, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Zaitun Zakaria
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ang Song Yee
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Diana Noma Fitzrol
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Wan Mohd Nazaruddin Wan Hassan
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Abdul Rahman Izaini Ghani
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Azmin Kass Rosman
- National Head/Coordinator for Neurosurgical Services, Ministry of Health, Malaysia Care of Department of Neurosurgery, Hospital Sungai Buloh, Selangor, Malaysia
| | - Jafri Malin Abdullah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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233
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Salluh JIF, Lisboa T, Bozza FA. Challenges for the care delivery for critically ill COVID-19 patients in developing countries: the Brazilian perspective. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:593. [PMID: 32998757 PMCID: PMC7526707 DOI: 10.1186/s13054-020-03278-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/04/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Jorge I F Salluh
- Department of Critical Care and Postgraduate Program in Translational Medicine, D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30 - 3º andar, Rio de Janeiro, 22281-100, Brazil. .,Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Thiago Lisboa
- Critical Care Department and Programa de Pós-Graduação em Ciencias Pneumologicas, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Instituto de Pesquisa Hospital do Coração - HCor, São Paulo, Brazil
| | - Fernando A Bozza
- Department of Critical Care and Postgraduate Program in Translational Medicine, D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30 - 3º andar, Rio de Janeiro, 22281-100, Brazil.,Critical Care Lab, National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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234
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Dos Santos MJ, Martins MS, Santana FLP, Furtado MCSPC, Miname FCBR, Pimentel RRDS, Brito ÁN, Schneider P, Dos Santos ES, da Silva LH. COVID-19: instruments for the allocation of mechanical ventilators-a narrative review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:582. [PMID: 32993736 PMCID: PMC7522926 DOI: 10.1186/s13054-020-03298-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/17/2020] [Indexed: 01/11/2023]
Abstract
After the World Health Organization declared COVID-19 to be a pandemic, the elaboration of comprehensive and preventive public policies became important in order to stop the spread of the disease. However, insufficient or ineffective measures may have placed health professionals and services in the position of having to allocate mechanical ventilators. This study aimed to identify instruments, analyze their structures, and present the main criteria used in the screening protocols, in order to help the development of guidelines and policies for the allocation of mechanical ventilators in the COVID-19 pandemic. The instruments have a low level of scientific evidence, and, in general, are structured by various clinical, non-clinical, and tiebreaker criteria that contain ethical aspects. Few instruments included public participation in their construction or validation. We believe that the elaboration of these guidelines cannot be restricted to specialists as this question involves ethical considerations which make the participation of the population necessary. Finally, we propose seventeen elements that can support the construction of screening protocols in the COVID-19 pandemic.
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Affiliation(s)
- Marcelo José Dos Santos
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil. .,Departamento de Orientação Profissional, Escola de Enfermagem da Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 419, CEP - 05403-000 Cerqueira Cesar, São Paulo, SP, Brazil.
| | - Maristela Santini Martins
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Fabiana Lopes Pereira Santana
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Rafael Rodrigo da Silva Pimentel
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Ágata Nunes Brito
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Patrick Schneider
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Edson Silva Dos Santos
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Luciane Hupalo da Silva
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
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235
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Haji JY, Subramaniam A, Kumar P, Ramanathan K, Rajamani A. State of Personal Protective Equipment Practice in Indian Intensive Care Units amidst COVID-19 Pandemic: A Nationwide Survey. Indian J Crit Care Med 2020; 24:809-816. [PMID: 33132565 PMCID: PMC7584819 DOI: 10.5005/jp-journals-10071-23550] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Optimal personal protective equipment (PPE) preparedness is key to minimize healthcare workers (HCW) infection with COVID-19. This two-phase survey evaluated PPE preparedness (adherence to Ministry of Health India (MoH) PPE-recommendations; HCW-training; PPE-inventory; PPE-breach management) in Indian intensive care units (ICU). MATERIALS AND METHODS The phase 1 survey was distributed electronically to intensivists from 481 Indian hospitals between March 25, 2020, and April 06, 2020, as part of a multinational survey. Phase 2 was repeated in 320 Indian hospitals between April 20, 2020, and April 30, 2020. RESULTS Response rate was 25% from 22 states. PPE practice varied between states and between private, government, and medical colleges. Between phase 1 and phase 2, all aspects of PPE training improved: donning/doffing 43% vs 66%, respectively; p value <0.01); safe waste disposal practices (38% vs 52%; p value = 0.09); intubation training (18% vs 31%; p value = 0.05); and transport (18% vs 31%; p value = 0.05). Perception of confidence for adequate PPE-training improved from 39 to 53% (p value = 0.26). In all, 47 to 60% ICUs adhered to MoH recommendations. Wearing N95-masks at all times increased from 47 to 60% (p value = 0.89). Very few ICUs provided quantitative/qualitative N95 masks fit testing (12% vs 29%; p value <0.01). Low-cost practices like "buddy-system" for donning-doffing (27% vs 44%; p value = 0.02) and showering after PPE breach (10% vs 8%; p value = 0.63) were underutilized. There was reluctance to PPE reuse. In all, 71% were unaware/diffident about PPE inventory. CONCLUSION Despite interstate variability, most ICUs conformed to MoH recommendations. This survey conducted during initial pandemic phase demonstrated improved PPE preparedness uniformly across India with scope for further improvement. We suggest implementation of quality improvement measures to improve pandemic preparedness and minimize HCW infection rates, focused on regular PPE training, buddy system, and PPE-breach management. HOW TO CITE THIS ARTICLE Haji JY, Subramaniam A, Kumar P, Ramanathan K, Rajamani A. State of Personal Protective Equipment Practice in Indian Intensive Care Units amidst COVID-19 Pandemic: A Nationwide Survey. Indian J Crit Care Med 2020;24(9):809-816.
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Affiliation(s)
- Jumana Yusuf Haji
- Department of Anesthesia and Critical Care, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Ashwin Subramaniam
- Department of Intensive Care, Frankston Hospital, VIC Monash University VIC, Frankston, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Prashant Kumar
- Department of Critical Care Medicine, Kailash Hospital Neuro Institute, Noida, Uttar Pradesh, India
| | | | - Arvind Rajamani
- Department of Intensive Care, University of Sydney, Nepean Clinical School and Nepean Hospital, Kingswood, NSW, Australia
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236
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Burry LD, Barletta JF, Williamson D, Kanji S, Maves RC, Dichter J, Christian MD, Geiling J, Erstad BL. It Takes a Village…: Contending With Drug Shortages During Disasters. Chest 2020; 158:2414-2424. [PMID: 32805237 PMCID: PMC7426714 DOI: 10.1016/j.chest.2020.08.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/27/2022] Open
Abstract
Critical drug shortages have been widely documented during the coronavirus disease 2019 (COVID-19) pandemic, particularly for IV sedatives used to facilitate mechanical ventilation. Surges in volume of patients requiring mechanical ventilation coupled with prolonged ventilator days and the high sedative dosing requirements observed quickly led to the depletion of “just-in-time” inventories typically maintained by institutions. This manuscript describes drug shortages in the context of global, manufacturing, regional and institutional perspectives in times of a worldwide crisis such as a pandemic. We describe etiologic factors that lead to drug shortages including issues related to supply (eg, manufacturing difficulties, supply chain breakdowns) and variables that influence demand (eg, volatile prescribing practices, anecdotal or low-level data, hoarding). In addition, we describe methods to mitigate drug shortages as well as conservation strategies for sedatives, analgesics and neuromuscular blockers that could readily be applied at the bedside. The COVID-19 pandemic has accentuated the need for a coordinated, multi-pronged approach to optimize medication availability as individual or unilateral efforts are unlikely to be successful.
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Affiliation(s)
- Lisa D Burry
- Department of Pharmacy and Medicine, Sinai Health System, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
| | | | - David Williamson
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal-Hôpital du Sacré-Cœur de Montréal, Faculté de pharmacie, Université de Montréal, Montréal, QC, Canada
| | - Salmaan Kanji
- The Ottawa Hospital and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ryan C Maves
- Department of Medicine, Naval Medical Center, San Diego, CA; Department of Medicine, Uniformed Services University, Bethesda, MD
| | - Jeffrey Dichter
- Pulmonary, Allergy, Critical Care, and Sleep Medicine Division, University of Minnesota, Minneapolis, MN
| | - Michael D Christian
- London's Air Ambulance, Royal London Hospital, Barts NHS Health Trust, London, England
| | | | - Brian L Erstad
- The University of Arizona College of Pharmacy, Tucson, AZ
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237
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Azoulay E, De Waele J, Ferrer R, Staudinger T, Borkowska M, Povoa P, Iliopoulou K, Artigas A, Schaller SJ, Hari MS, Pellegrini M, Darmon M, Kesecioglu J, Cecconi M. Symptoms of burnout in intensive care unit specialists facing the COVID-19 outbreak. Ann Intensive Care 2020; 10:110. [PMID: 32770449 PMCID: PMC7414284 DOI: 10.1186/s13613-020-00722-3] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in an unprecedented healthcare crisis with a high prevalence of psychological distress in healthcare providers. We sought to document the prevalence of burnout syndrome amongst intensivists facing the COVID-19 outbreak. METHODS Cross-sectional survey among intensivists part of the European Society of Intensive Care Medicine. Symptoms of severe burnout, anxiety and depression were collected. Factors independently associated with severe burnout were assessed using Cox model. RESULTS Response rate was 20% (1001 completed questionnaires were returned, 45 years [39-53], 34% women, from 85 countries, 12 regions, 50% university-affiliated hospitals). The prevalence of symptoms of anxiety and depression or severe burnout was 46.5%, 30.2%, and 51%, respectively, and varied significantly across regions. Rating of the relationship between intensivists and other ICU stakeholders differed significantly according to the presence of anxiety, depression, or burnout. Similar figures were reported for their rating of the ethical climate or the quality of the decision-making. Factors independently associated with anxiety were female gender (HR 1.85 [1.33-2.55]), working in a university-affiliated hospital (HR 0.58 [0.42-0.80]), living in a city of > 1 million inhabitants (HR 1.40 [1.01-1.94]), and clinician's rating of the ethical climate (HR 0.83 [0.77-0.90]). Independent determinants of depression included female gender (HR 1.63 [1.15-2.31]) and clinician's rating of the ethical climate (HR 0.84 [0.78-0.92]). Factors independently associated with symptoms of severe burnout included age (HR 0.98/year [0.97-0.99]) and clinician's rating of the ethical climate (HR 0.76 [0.69-0.82]). CONCLUSIONS The COVID-19 pandemic has had an overwhelming psychological impact on intensivists. Follow-up, and management are warranted to assess long-term psychological outcomes and alleviate the psychological burden of the pandemic on frontline personnel.
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Affiliation(s)
- Elie Azoulay
- Médecine Intensive et Réanimation, PHP, Hôpital Saint-Louis, Paris University, Paris, France.
| | - Jan De Waele
- Department of Critical Care Medicine, Ghent University Hospital, 9000, Gent, The Netherlands
| | - Ricard Ferrer
- Shock, Organ Dysfunction, and Resuscitation Research Group (SODIR), Instituto de Investigación de Vall d'Hebron, Barcelona, Spain
- Departmento de Medicina Intensiva, Hospital Universitario de Vall d́Hebron, Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias, Barcelona, Spain
| | - Thomas Staudinger
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Marta Borkowska
- Department of Critical Care Medicine, Ghent University Hospital, 9000, Gent, The Netherlands
| | - Pedro Povoa
- NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
- Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, CHLO, Estrada Do Forte Do Alto Do Duque, 1449-005, Lisbon, Portugal
| | | | - Antonio Artigas
- Critical Care Center, Sabadell Hospital, University Institute Parc Taulí, Autonomous University of Barcelona, Ciberes, Barcelona, Spain
| | - Stefan J Schaller
- Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Manu Shankar Hari
- School of Immunology and Microbial Science, Kings College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, London, UK
| | - Mariangela Pellegrini
- Department of Surgical Sciences and Central Intensive Care Unit, Department of Anesthesia, Operation, and Intensive Care and Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Darmon
- Médecine Intensive et Réanimation, PHP, Hôpital Saint-Louis, Paris University, Paris, France
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maurizio Cecconi
- Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
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238
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Azoulay E, de Waele J, Ferrer R, Staudinger T, Borkowska M, Povoa P, Iliopoulou K, Artigas A, Schaller SJ, Shankar-Hari M, Pellegrini M, Darmon M, Kesecioglu J, Cecconi M. International variation in the management of severe COVID-19 patients. Crit Care 2020; 24:486. [PMID: 32758266 PMCID: PMC7403819 DOI: 10.1186/s13054-020-03194-w] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/20/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There is little evidence to support the management of severe COVID-19 patients. METHODS To document this variation in practices, we performed an online survey (April 30-May 25, 2020) on behalf of the European Society of Intensive Care Medicine (ESICM). A case vignette was sent to ESICM members. Questions investigated practices for a previously healthy 39-year-old patient presenting with severe hypoxemia from COVID-19 infection. RESULTS A total of 1132 ICU specialists (response rate 20%) from 85 countries (12 regions) responded to the survey. The survey provides information on the heterogeneity in patient's management, more particularly regarding the timing of ICU admission, the first line oxygenation strategy, optimization of management, and ventilatory settings in case of refractory hypoxemia. Practices related to antibacterial, antiviral, and anti-inflammatory therapies are also investigated. CONCLUSIONS There are important practice variations in the management of severe COVID-19 patients, including differences at regional and individual levels. Large outcome studies based on multinational registries are warranted.
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Affiliation(s)
- Elie Azoulay
- Médecine Intensive et Réanimation, Department of the St-Louis Hospital, APHP, Hôpital Saint-Louis, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France.
| | - Jan de Waele
- Department of Critical Care Medicine, Ghent University Hospital, 9000, Gent, Netherlands
| | - Ricard Ferrer
- Shock, Organ Dysfunction, and Resuscitation Research Group (SODIR), Instituto de Investigación de Vall d'Hebron, Barcelona, Spain
- Departmento de Medicina Intensiva, Hospital Universitario de Vall d́Hebron, Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias, Barcelona, Spain
| | - Thomas Staudinger
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Marta Borkowska
- Department of Critical Care Medicine, Ghent University Hospital, 9000, Gent, Netherlands
| | - Pedro Povoa
- NOVA Medical School, CHRC, New University of Lisbon, Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, CHLO, Estrada Do Forte Do Alto Do Duque, 1449-005, Lisbon, Portugal
| | | | - Antonio Artigas
- Critical Care Center, Sabadell Hospital, University Institute Parc Taulí, Autonomous University of Barcelona, Ciberes, Barcelona, Spain
| | - Stefan J Schaller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Surgical Intensive Care, Berlin, Germany
| | - Manu Shankar-Hari
- School of Immunology and Microbial Science, Kings College London. Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, London, UK
| | - Mariangela Pellegrini
- Department of Surgical Sciences and Central Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anesthesia, Operation, and Intensive Care; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Darmon
- Médecine Intensive et Réanimation, Department of the St-Louis Hospital, APHP, Hôpital Saint-Louis, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maurizio Cecconi
- Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
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239
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Cecconi M, Forni G, Mantovani A. Ten things we learned about COVID-19. Intensive Care Med 2020; 46:1590-1593. [PMID: 32504103 PMCID: PMC7273118 DOI: 10.1007/s00134-020-06140-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Maurizio Cecconi
- Humanitas Clinical and Research Center, via Manzoni 56, Rozzano, 20089, Milan, Italy. .,Humanitas University, via Rita Levi Montalcini, Pieve Emanuele, 20090, Milan, Italy.
| | | | - Alberto Mantovani
- Humanitas Clinical and Research Center, via Manzoni 56, Rozzano, 20089, Milan, Italy.,Humanitas University, via Rita Levi Montalcini, Pieve Emanuele, 20090, Milan, Italy.,The William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
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240
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Khasne RW, Dhakulkar BS, Mahajan HC, Kulkarni AP. Burnout among Healthcare Workers during COVID-19 Pandemic in India: Results of a Questionnaire-based Survey. Indian J Crit Care Med 2020; 24:664-671. [PMID: 33024372 PMCID: PMC7519601 DOI: 10.5005/jp-journals-10071-23518] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Burnout, a state of physical and emotional exhaustion, in healthcare workers (HCWs) is a major concern. The prevalence of burnout, due to COVID-19 pandemic in India, is unknown. We therefore conducted this survey. Materials and methods A questionnaire-based survey using Copenhagen Burnout Inventory was carried out among HCWs looking after COVID-19 patients. Questionnaire was sent to the HCWs, using WhatsApp Messenger, and voluntary participation was sought. We received responses from 2026 HCWs. Burnout was assessed in personal, work, and client-related (COVID-19 pandemic-related) domains. Burnout was defined at a cut-off score of 50 for each domain. Results The prevalence of personal burnout was 44.6% (903), work-related burn-out was only 26.9% (544), while greater than half of the respondents (1,069, 52.8%) had pandemic-related burnout. Younger respondents (21-30 years) had higher personal and work-related burnout. The prevalence of personal and work-related burnout was significantly (p < 0.01) higher among females. The doctors were 1.64 times, and the support staff were 5 times more likely to experience pandemic-related burnout. Conclusion There is a significant prevalence of burnout during the COVID-19 pandemic among HCWs, in particular, doctors and support staff. Female respondents had higher prevalence. We suggest that the management should be proactive and supportive in improving working conditions and providing assurance to the HCWs. The long-term effects of the current pandemic need to be assessed later. How to cite this article Khasne RW, Dhakulkar BS, Mahajan HC, Kulkarni AP. Burnout among Healthcare Workers during COVID-19 Pandemic in India: Results of a Questionnaire-based Survey. Indian J Crit Care Med 2020;24(8):664-671.
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Affiliation(s)
- Ruchira W Khasne
- Department of Critical Care Medicine, Ashoka Medicover Hospital, Wadala, Nashik, Maharashtra, India
| | - Bhagyashree S Dhakulkar
- Department of Critical Care Medicine, Ashoka Medicover Hospital, Wadala, Nashik, Maharashtra, India
| | - Hitendra C Mahajan
- Department of Anesthesiology, Ashoka Medicover Hospital, Wadala, Nashik, Maharashtra, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Parel (E), Mumbai, Maharashtra, India
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241
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Imanipour M, Kiwanuka F. Family nursing practice and family importance in care – Attitudes of nurses working in intensive care units. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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