1
|
Winroth A, Andersson M, Fjällström P, Johansson AF, Lind A. Automated surveillance of antimicrobial consumption in intensive care, northern Sweden: an observational case study. Antimicrob Resist Infect Control 2024; 13:67. [PMID: 38890711 PMCID: PMC11186282 DOI: 10.1186/s13756-024-01424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/13/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The digitalization of information systems allows automatic measurement of antimicrobial consumption (AMC), helping address antibiotic resistance from inappropriate drug use without compromising patient safety. OBJECTIVES Describe and characterize a new automated AMC surveillance service for intensive care units (ICUs), with data stratified by referral clinic and linked with individual patient risk factors, disease severity, and mortality. METHODS An automated service collecting data from the electronic medical record was developed, implemented, and validated in a healthcare region in northern Sweden. We performed an observational study from January 1, 2018, to December 31, 2021, encompassing general ICU care for all ≥18-years-olds in a catchment population of 270000 in secondary care and 900000 in tertiary care. We used descriptive analyses to associate ICU population characteristics with AMC outcomes over time, including days of therapy (DOT), length of therapy, defined daily doses, and mortality. RESULTS There were 5608 admissions among 5190 patients with a median age of 65 (IQR 48-75) years, 41.2% females. The 30-day mortality was 18.3%. Total AMC was 1177 DOTs in secondary and 1261 DOTs per 1000 patient days and tertiary care. AMC varied significantly among referral clinics, with the highest total among 810 general surgery admissions in tertiary care at 1486 DOTs per 1000 patient days. Case-mix effects on the AMC were apparent during COVID-19 waves highlighting the need to account for case-mix. Patients exposed to more than three antimicrobial drug classes (N = 242) had a 30-day mortality rate of 40.6%, with significant variability in their expected rates based on admission scores. CONCLUSION We introduce a new service and instructions for automating local ICU-AMC data collection. The versatile long-term ICU-AMC metrics presented, covering patient factors, referral clinics and mortality outcomes, are expected to be beneficial in refining antimicrobial drug use.
Collapse
Affiliation(s)
- Andreas Winroth
- Department of Clinical Microbiology, Umeå University, SE-90187, Umeå, Sweden.
| | - Mattias Andersson
- Center for Intensive Care (IT unit), Norrlands universitetssjukhus, 90185, Umeå, SE, Sweden
| | - Peter Fjällström
- Department of Clinical Microbiology, Umeå University, SE-90187, Umeå, Sweden
- Department of Infection Prevention and Control Region Västerbotten, Norrlands universitetssjukhus, SE-90185, Umeå, Sweden
| | - Anders F Johansson
- Department of Clinical Microbiology, Umeå University, SE-90187, Umeå, Sweden
| | - Alicia Lind
- Department of Diagnostics and Intervention, Umeå University, SE-90187, Umeå, Sweden
| |
Collapse
|
2
|
Ohbe H, Shime N, Yamana H, Goto T, Sasabuchi Y, Kudo D, Matsui H, Yasunaga H, Kushimoto S. Hospital and regional variations in intensive care unit admission for patients with invasive mechanical ventilation. J Intensive Care 2024; 12:21. [PMID: 38840225 PMCID: PMC11155017 DOI: 10.1186/s40560-024-00736-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Patients who receive invasive mechanical ventilation (IMV) in the intensive care unit (ICU) have exhibited lower in-hospital mortality rates than those who are treated outside. However, the patient-, hospital-, and regional factors influencing the ICU admission of patients with IMV have not been quantitatively examined. METHODS This retrospective cohort study used data from the nationwide Japanese inpatient administrative database and medical facility statistics. We included patients aged ≥ 15 years who underwent IMV between April 2018 and March 2019. The primary outcome was ICU admission on the day of IMV initiation. Multilevel logistic regression analyses incorporating patient-, hospital-, or regional-level variables were used to assess cluster effects by calculating the intraclass correlation coefficient (ICC), median odds ratio (MOR), and proportional change in variance (PCV). RESULTS Among 83,346 eligible patients from 546 hospitals across 140 areas, 40.4% were treated in ICUs on their IMV start day. ICU admission rates varied widely between hospitals (median 0.7%, interquartile range 0-44.5%) and regions (median 28.7%, interquartile range 0.9-46.2%). Multilevel analyses revealed significant effects of hospital cluster (ICC 82.2% and MOR 41.4) and regional cluster (ICC 67.3% and MOR 12.0). Including patient-level variables did not change these ICCs and MORs, with a PCV of 2.3% and - 1.0%, respectively. Further adjustment for hospital- and regional-level variables decreased the ICC and MOR, with a PCV of 95.2% and 85.6%, respectively. Among the hospital- and regional-level variables, hospitals with ICU beds and regions with ICU beds had a statistically significant and strong association with ICU admission. CONCLUSIONS Our results revealed that primarily hospital and regional factors, rather than patient-related ones, opposed ICU admissions for patients with IMV. This has important implications for healthcare policymakers planning interventions for optimal ICU resource allocation.
Collapse
Affiliation(s)
- Hiroyuki Ohbe
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan.
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Hayato Yamana
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Data Science Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Tadahiro Goto
- TXP Medical Co., Ltd., 41-1 H1O Kanda 706, Kanda Higashimatsushita-Cho, Chiyoda-Ku, Tokyo, 101-0042, Japan
| | - Yusuke Sasabuchi
- Department of Real-World Evidence, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Daisuke Kudo
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Hiroki Matsui
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Shigeki Kushimoto
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| |
Collapse
|
3
|
Salimi-Bani M, Pandian V, Vahedian-Azimi A, Moradian ST, Bahramifar A. A respiratory critical care nurse training program for settings without a registered respiratory therapists: A protocol for a multimethod study. Intensive Crit Care Nurs 2024; 82:103662. [PMID: 38382240 DOI: 10.1016/j.iccn.2024.103662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The increasing elderly population and prevalence of chronic diseases have raised the need for ICU beds. However, limited bed availability often causes delays in admission, leading to wasted treatment time. OBJECTIVES This study aims to create and implement a training program for respiratory critical care nurses (RCCNs) in settings without registered respiratory therapists (RRTs). RESEARCH METHODOLOGY/DESIGN The study will use a multimethod sequential research design, including a scoping review, content analysis, Delphi methods, and a randomized clinical trial. The scoping review will gather extensive information on respiratory care for critically ill patients and the responsibilities of RCCNs. Content analysis and expert interviews will identify opportunities and challenges in RCCNs' provision of respiratory care. The Delphi method will integrate the results to develop a comprehensive training program for RCCNs. Subsequently, five RCCNs will undergo theoretical and practical examinations after completing the three-month training program, and the impact of RCCNs on critically ill patients' outcomes will be evaluated through a clinical trial. ANTICIPATED FINDINGS The study aims to provide a comprehensive training program for RCCNs and investigate its impact on the outcomes of critically ill patients through a clinical trial. CONCLUSION The training program will equip RCCNs with the necessary skills and knowledge to provide respiratory critical care from the emergency department to hospital discharge. This pioneering study aims to improve patient outcomes in settings without RRTs by offering a unique program for RCCNs. IMPLICATIONS FOR CLINICAL PRACTICE The development and implementation of this training program for RCCNs in settings without RRTs will address the gap in respiratory care and potentially improve patient outcomes. By empowering RCCNs with specialized training, healthcare facilities can ensure the provision of high-quality respiratory care throughout a patient's critical illness journey, enhancing the efficiency and effectiveness of healthcare teams, especially in resource-limited settings.
Collapse
Affiliation(s)
- Malihe Salimi-Bani
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Vinciya Pandian
- Center for Immersive Learning and Digital Innovation, Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Seyed Tayeb Moradian
- Atherosclerosis Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Bahramifar
- Trauma Research Center, Medicine Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Merola R, Vargas M. Economic Indicators, Quantity and Quality of Health Care Resources Affecting Post-surgical Mortality. J Epidemiol Glob Health 2024:10.1007/s44197-024-00249-x. [PMID: 38801492 DOI: 10.1007/s44197-024-00249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE to identify correlations between quality and quantity of health care resources, national economic indicators, and postoperative in-hospital mortality as reported in the EUSOS study. METHODS Different variables were identified from a series of publicly available database. Postoperative in-hospital mortality was identified as reported by EUSOS study. Spearman non-parametric and Coefficients of non-linear regression were calculated. RESULTS Quality of health care resources was strongly and negatively correlated to postoperative in-hospital mortality. Quantity of health care resources were negatively and moderately correlated to postoperative in-hospital mortality. National economic indicators were moderately and negatively correlated to postoperative in-hospital mortality. General mortality, as reported by WHO, was positively but very moderately correlated with postoperative in-hospital mortality. CONCLUSIONS Postoperative in-hospital mortality is strongly determined by quality of health care instead of quantity of health resources and health expenditures. We suggest that improving the quality of health care system might reduce postoperative in-hospital mortality.
Collapse
Affiliation(s)
- Raffaele Merola
- Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.
| | - Maria Vargas
- Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| |
Collapse
|
5
|
Pirani T, Wilson A, Brealey D, Low R, O'Neill S, Le J, Jhanji S, Bangash MN, Mathew A, Wright C, Latif AL, Irvine D, Kasipandian V, Singh N, Saha R, Metaxa V. Critical care utilisation for patients receiving chimeric antigen receptor (CAR) T cell therapy in the UK. Br J Anaesth 2024; 132:1004-1006. [PMID: 38521658 DOI: 10.1016/j.bja.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 03/25/2024] Open
Affiliation(s)
- Tasneem Pirani
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Anthony Wilson
- Department of Critical Care and Anaesthesia, Manchester Royal Infirmary, Manchester, UK
| | - David Brealey
- Critical Care Department, University College London Hospital NHS Foundation Trust, London, UK
| | - Ryan Low
- Division of Clinical Haematology, University College London Hospitals, London, UK
| | - Suzanne O'Neill
- Department of Critical Care and Anaesthesia, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Jenny Le
- Haematology Department, University Hospital Bristol and Weston, Bristol, UK
| | - Shaman Jhanji
- Critical Care Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Mansoor N Bangash
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Amrith Mathew
- Haematology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher Wright
- Department of Intensive Care, Greater Glasgow and Clyde NHS Foundation Trust, Glasgow, UK
| | - Anne-Louise Latif
- Haematology Department, Greater Glasgow and Clyde NHS Foundation Trust, Glasgow, UK
| | - David Irvine
- Haematology Department, Greater Glasgow and Clyde NHS Foundation Trust, Glasgow, UK
| | - Vidya Kasipandian
- Critical Care Department, The Christie NHS Foundation Trust, Manchester, UK
| | - Neeraj Singh
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Rohit Saha
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
| |
Collapse
|
6
|
Brinkman S, de Keizer NF, de Lange DW, Dongelmans DA, Termorshuizen F, van Bussel BCT. Strain on Scarce Intensive Care Beds Drives Reduced Patient Volumes, Patient Selection, and Worse Outcome: A National Cohort Study. Crit Care Med 2024; 52:574-585. [PMID: 38095502 PMCID: PMC10930373 DOI: 10.1097/ccm.0000000000006156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
OBJECTIVES Strain on ICUs during the COVID-19 pandemic required stringent triage at the ICU to distribute resources appropriately. This could have resulted in reduced patient volumes, patient selection, and worse outcome of non-COVID-19 patients, especially during the pandemic peaks when the strain on ICUs was extreme. We analyzed this potential impact on the non-COVID-19 patients. DESIGN A national cohort study. SETTING Data of 71 Dutch ICUs. PARTICIPANTS A total of 120,393 patients in the pandemic non-COVID-19 cohort (from March 1, 2020 to February 28, 2022) and 164,737 patients in the prepandemic cohort (from January 1, 2018 to December 31, 2019). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Volume, patient characteristics, and mortality were compared between the pandemic non-COVID-19 cohort and the prepandemic cohort, focusing on the pandemic period and its peaks, with attention to strata of specific admission types, diagnoses, and severity. The number of admitted non-COVID-19 patients during the pandemic period and its peaks were, respectively, 26.9% and 34.2% lower compared with the prepandemic cohort. The pandemic non-COVID-19 cohort consisted of fewer medical patients (48.1% vs. 50.7%), fewer patients with comorbidities (36.5% vs. 40.6%), and more patients on mechanical ventilation (45.3% vs. 42.4%) and vasoactive medication (44.7% vs. 38.4%) compared with the prepandemic cohort. Case-mix adjusted mortality during the pandemic period and its peaks was higher compared with the prepandemic period, odds ratios were, respectively, 1.08 (95% CI, 1.05-1.11) and 1.10 (95% CI, 1.07-1.13). CONCLUSIONS In non-COVID-19 patients the strain on healthcare has driven lower patient volume, selection of fewer comorbid patients who required more intensive support, and a modest increase in the case-mix adjusted mortality.
Collapse
Affiliation(s)
- Sylvia Brinkman
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- University Medical Center, University of Utrecht, Intensive Care Medicine, Utrecht, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Intensive Care Medicine, Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- University Medical Center, University of Utrecht, Intensive Care Medicine, Utrecht, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Intensive Care Medicine, Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Dylan W de Lange
- National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands
- University Medical Center, University of Utrecht, Intensive Care Medicine, Utrecht, The Netherlands
| | - Dave A Dongelmans
- National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Intensive Care Medicine, Amsterdam, The Netherlands
| | - Fabian Termorshuizen
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- University Medical Center, University of Utrecht, Intensive Care Medicine, Utrecht, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Intensive Care Medicine, Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Bas C T van Bussel
- National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
7
|
Mergulhão P, Pereira JG, Fernandes AV, Krystopchuk A, Ribeiro JM, Miranda D, Castro H, Eira C, Morais J, Lameirão C, Gomes S, Leal D, Duarte J, Pássaro L, Froes F, Martin-Loeches I. Epidemiology and Burden of Ventilator-Associated Pneumonia among Adult Intensive Care Unit Patients: A Portuguese, Multicenter, Retrospective Study (eVAP-PT Study). Antibiotics (Basel) 2024; 13:290. [PMID: 38666966 PMCID: PMC11047600 DOI: 10.3390/antibiotics13040290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
Ventilator-associated pneumonia (VAP) is a prevailing nosocomial infection in critically ill patients requiring invasive mechanical ventilation (iMV). The impact of VAP is profound, adversely affecting patient outcomes and placing a significant burden on healthcare resources. This study assessed for the first time the contemporary VAP epidemiology in Portugal and its burden on the healthcare system and clinical outcomes. Additionally, resource consumption (duration of iMV, intensive care unit (ICU), hospital length of stay (LOS)) and empirical antimicrobial therapy were also evaluated. This multicenter, retrospective study included patients admitted to the hospital between July 2016 and December 2017 in a participating ICU, who underwent iMV for at least 48 h. Patients with a VAP diagnosis were segregated for further analysis (n = 197). Control patients, ventilated for >48 h but without a VAP diagnosis, were also included in a 1:1 ratio. Cumulative VAP incidence was computed. All-cause mortality was assessed at 28, 90, and 365 days after ICU admission. Cumulative VAP incidence was 9.2% (95% CI 8.0-10.5). The all-cause mortality rate in VAP patients was 24.9%, 34.0%, and 40.6%, respectively, and these values were similar to those observed in patients without VAP diagnosis. Further, patients with VAP had significantly longer ICU (27.5 vs. 11.0 days, p < 0.001) and hospital LOS (61 vs. 35.9 days, p < 0.001), more time under iMV (20.7 vs. 8.0 days, p < 0.001) and were more often subjected to tracheostomy (36.5 vs. 14.2%; p < 0.001). Patients with VAP who received inappropriate empirical antimicrobials had higher 28-day mortality, 34.3% vs. 19.5% (odds ratio 2.16, 95% CI 1.10-4.23), although the same was not independently associated with 1-year all-cause mortality (p = 0.107). This study described the VAP impact and burden on the Portuguese healthcare system, with approximately 9% of patients undergoing iMV for >48 h developing VAP, leading to increased resource consumption (longer ICU and hospital LOS). An unexpectedly high incidence of inappropriate, empirical antimicrobial therapy was also noted, being positively associated with a higher mortality risk of these patients. Knowledge of the Portuguese epidemiology characterization of VAP and its multidimensional impact is essential for efficient treatment and optimized long-term health outcomes of these patients.
Collapse
Affiliation(s)
- Paulo Mergulhão
- Intensive Care Unit, Hospital Lusíadas Porto, 4050-115 Porto, Portugal;
| | - João Gonçalves Pereira
- Intensive Care Unit, Hospital de Vila Franca de Xira, 2600-009 Vila Franca de Xira, Portugal;
| | | | - Andriy Krystopchuk
- Intensive Care Unit, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal;
| | - João Miguel Ribeiro
- Intensive Care Unit, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035 Lisbon, Portugal;
| | - Daniel Miranda
- Intensive Care Unit, Centro Hospitalar Vila Nova de Gaia e Espinho, 4434-502 Vila Nova de Gaia, Portugal;
| | - Heloísa Castro
- Intensive Care Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal;
| | - Carla Eira
- Intensive Care Unit, Centro Hospitalar Tondela Viseu, 3504-509 Viseu, Portugal;
| | - Juvenal Morais
- Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, 1449-005 Lisbon, Portugal;
| | - Cristina Lameirão
- Intensive Care Unit, Centro Hospitalar Trás-os-Montes e Alto Douro, 5000-508 Vila Real, Portugal;
| | - Sara Gomes
- Intensive Care Unit, Hospital Prof. Doutor Fernando Fonseca, 2720-276 Amadora, Portugal;
| | - Dina Leal
- Intensive Care Unit, Hospital de Braga, 4710-243 Braga, Portugal;
| | - Joana Duarte
- Medical Affairs Department, MSD Portugal, 2770-192 Oeiras, Portugal; (J.D.); (L.P.)
| | - Leonor Pássaro
- Medical Affairs Department, MSD Portugal, 2770-192 Oeiras, Portugal; (J.D.); (L.P.)
| | - Filipe Froes
- Intensive Care Unit, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, 1769-001 Lisbon, Portugal;
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James’ Hospital, D08NYH1 Dublin, Ireland
| |
Collapse
|
8
|
Phua J, Kulkarni AP, Mizota T, Hashemian SMR, Lee WY, Permpikul C, Chittawatanarat K, Nitikaroon P, Arabi YM, Fang WF, Konkayev A, Hashmi M, Palo JE, Faruq MO, Shrestha BR, KC B, Mat Nor MBB, Sann KK, Ling L, Haniffa R, Al Bahrani M, Mendsaikhan N, Chan YH. Critical care bed capacity in Asian countries and regions before and during the COVID-19 pandemic: an observational study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 44:100982. [PMID: 38143717 PMCID: PMC10733690 DOI: 10.1016/j.lanwpc.2023.100982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of critical care. The aim of the current study was to compare the number of adult critical care beds in relation to population size in Asian countries and regions before (2017) and during (2022) the pandemic. Methods This observational study collected data closest to 2022 on critical care beds (intensive care units and intermediate care units) in 12 middle-income and 7 high-income economies (using the 2022-2023 World Bank classification), through a mix of methods including government sources, national critical care societies, personal contacts, and data extrapolation. Data were compared with a prior study from 2017 of the same countries and regions. Findings The cumulative number of critical care beds per 100,000 population increased from 3.0 in 2017 to 9.4 in 2022 (p = 0.003). The median figure for middle-income economies increased from 2.6 (interquartile range [IQR] 1.7-7.8) to 6.6 (IQR 2.2-13.3), and that for high-income economies increased from 11.4 (IQR 7.3-22.8) to 13.9 (IQR 10.7-21.7). Only 3 countries did not see a rise in bed capacity. Where data were available in 2022, 10.9% of critical care beds were in single rooms (median 5.0% in middle-income and 20.3% in high-income economies), and 5.3% had negative pressure (median 0.7% in middle-income and 18.5% in high-income economies). Interpretation Critical care bed capacity in the studied Asian countries and regions increased close to three-fold from 2017 to 2022. Much of this increase was attributed to middle-income economies, but substantial heterogeneity exists. Funding None.
Collapse
Affiliation(s)
- Jason Phua
- Fast and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore
- Division of Respiratory and Critical Care Medicine, National University Hospital, National University Health System, Singapore
| | - Atul Prabhakar Kulkarni
- Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Toshiyuki Mizota
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chairat Permpikul
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kaweesak Chittawatanarat
- Faculty of Medicine, Department of Surgery, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand
| | - Phongsak Nitikaroon
- Health Administration Division, Ministry of Public Health, Nonthaburi, Thailand
| | - Yaseen M. Arabi
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Wen-Feng Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Aidos Konkayev
- Anaesthesiology and Intensive Care Department, Astana Medical University, Nur-Sultan, Kazakhstan
- National Science Center of Traumatology and Orthopedia Named Batpenov, Nur-Sultan, Kazakhstan
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
| | - Jose Emmanuel Palo
- Acute and Critical Care Institute, The Medical City, Pasig City, Philippines
| | - Mohammad Omar Faruq
- General Intensive Care Unit and Emergency Department, United Hospital Ltd, Dhaka, Bangladesh
| | - Babu Raja Shrestha
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Bijay KC
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | | | - Kyi Kyi Sann
- Department of Anaesthesiology and Intensive Care Unit, Yangon General Hospital, University of Medicine 1, Yangon, Myanmar
| | - Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
| | - Maher Al Bahrani
- Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman
| | - Naranpurev Mendsaikhan
- Mongolia-Japan Hospital, Mongolian National University Medical Sciences, Ulaanbaatar, Mongolia
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Asian Critical Care Clinical Trials (ACCCT) Group
- Fast and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore
- Division of Respiratory and Critical Care Medicine, National University Hospital, National University Health System, Singapore
- Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Faculty of Medicine, Department of Surgery, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand
- Health Administration Division, Ministry of Public Health, Nonthaburi, Thailand
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Anaesthesiology and Intensive Care Department, Astana Medical University, Nur-Sultan, Kazakhstan
- National Science Center of Traumatology and Orthopedia Named Batpenov, Nur-Sultan, Kazakhstan
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
- Acute and Critical Care Institute, The Medical City, Pasig City, Philippines
- General Intensive Care Unit and Emergency Department, United Hospital Ltd, Dhaka, Bangladesh
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
- International Islamic University Malaysia Medical Centre, Kuantan, Malaysia
- Department of Anaesthesiology and Intensive Care Unit, Yangon General Hospital, University of Medicine 1, Yangon, Myanmar
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
- Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman
- Mongolia-Japan Hospital, Mongolian National University Medical Sciences, Ulaanbaatar, Mongolia
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| |
Collapse
|
9
|
Rylander C, Sternley J, Petzold M, Oras J. Unit-to-unit transfer due to shortage of intensive care beds in Sweden 2015-2019 was associated with a lower risk of death but a longer intensive care stay compared to no transfer: a registry study. J Intensive Care 2024; 12:10. [PMID: 38409081 PMCID: PMC10898117 DOI: 10.1186/s40560-024-00722-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Intensive care unit-to-unit transfer due to temporary shortage of beds is increasing in Sweden. Transportation induces practical hazards, and the change of health care provider may prolong the length of stay in intensive care. We previously showed that the risk of death at 90 days did not differ between patients transferred due to a shortage of beds and non-transferred patients with a similar burden of illness in a tertiary intensive care unit. The aim of this study was to widen the analysis to a nation-wide cohort of critically ill patients transferred to another intensive care unit in Sweden due to shortage of intensive care beds. METHODS Retrospective comparison between capacity transferred and non-transferred patients, based on data from the Swedish Intensive Care Registry during a 5-year period before the COVID-19 pandemic. Patients with insufficient data entries or a recurring capacity transfer within 90 days were excluded. To assess the association between capacity transfer and death as well as intensive care stay within 90 days after ICU admission, logistic regression models with step-wise adjustment for SAPS3 score, primary ICD-10 ICU diagnosis and the number of days in the intensive care unit before transfer were applied. RESULTS From 161,140 eligible intensive care admissions, 2912 capacity transfers were compared to 135,641 discharges or deaths in the intensive care unit. Ninety days after ICU admission, 28% of transferred and 21% of non-transferred patients were deceased. In the fully adjusted model, capacity transfer was associated with a lower risk of death within 90 days than no transfer; OR (95% CI) 0.71 (0.65-0.69) and the number of days spent in intensive care was longer: 12.4 [95% CI 12.2-12.5] vs 3.3 [3.3-3.3]. CONCLUSIONS Intensive care unit-to-unit transfer due to shortage of bed capacity as compared to no transfer during a 5-year period preceding the COVID-19 pandemic in Sweden was associated with lower risk of death within 90 days but with longer stay in intensive care.
Collapse
Affiliation(s)
- Christian Rylander
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University and Uppsala University Hospital, 715 85, Uppsala, Sweden.
| | - Jesper Sternley
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University and Uppsala University Hospital, 715 85, Uppsala, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jonatan Oras
- Department of Anaesthesiology and Intensive Care Medicine, Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
10
|
Tamayo Medel G, Ramasco Rueda F, Ferrando Ortolá C, González de Castro R, Ferrandis Comes R, Pastorini C, Méndez Hernández R, García Fernández J. Description of Intensive Care and Intermediate Care resources managed by Anaesthesiology Departments in Spain and their adaptation capacity during the COVID-19 pandemic. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:76-89. [PMID: 38280420 DOI: 10.1016/j.redare.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/18/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION It is essential to understand the strategic importance of intensive care resources in the sustainable organisation of healthcare systems. Our objective has been to identify the intensive and intermediate care beds managed by Anaesthesiology and Resuscitation Services (A-ICU and A-IMCU) in Spain, their human and technical resources, and the changes made to these resources during the COVID-19 pandemic. MATERIAL AND METHODS Prospective observational study performed between December 2020 and July 2021 to register the number and characteristics of A-ICU and A-IMCU beds in hospitals listed in the catalogue published by the Spanish Ministry of Health. RESULTS Data were obtained from 313 hospitals (98% of all hospitals with more than 500 beds, 70% of all hospitals with more than 100 beds). One hundred and forty seven of these hospitals had an A-ICU with a total of 1702 beds. This capacity increased to 2107 (124%) during the COVID-19 pandemic. Three hundred and eight hospitals had an A-IMCU with a total of 3470 beds, 52.9% (2089) of which provided long-term care. The hospitals had 1900 ventilators, at a ratio of 1.07 respirators per A-ICU; 1559 anaesthesiologists dedicated more than 40% of their working time to intensive care. The nurse-to-bed ratio in A-ICUs was 2.8. DISCUSSION A large proportion of fully-equipped ICU and IMCU beds in Spanish hospitals are managed by the anaesthesiology service. A-ICU and A-IMCUs have shown an extraordinary capacity to adapt their resources to meet the increased demand for intensive care during the COVID-19 pandemic.
Collapse
Affiliation(s)
- G Tamayo Medel
- Hospital Universitario Cruces, ISS BioCruces, Bizkaia, Spain.
| | | | - C Ferrando Ortolá
- Hospital Clínic, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | | | - R Ferrandis Comes
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | | | | | | |
Collapse
|
11
|
Oliveira A, Vieira T, Rodrigues A, Jorge N, Tavares L, Costa L, Paiva JA, Gonçalves Pereira J. Critically ill patients with high predicted mortality: Incidence and outcome. Med Intensiva 2024; 48:85-91. [PMID: 37985339 DOI: 10.1016/j.medine.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/16/2023] [Accepted: 10/08/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE As calculated by the severity scores, an unknown number of patients are admitted to the Intensive Care Unit (ICU) with a very high risk of death. Clinical studies have poorly addressed this population, and their prognosis is largely unknown. DESIGN Post hoc analysis of a multicenter, cohort, longitudinal, observational, retrospective study (CIMbA). SETTING Sixteen Portuguese multipurpose ICUs. PATIENTS Patients with a Simplified Acute Physiology Score II (SAPS II) predicted hospital mortality above 80% on admission to the ICU (high-risk group); A comparison with the remaining patients was obtained. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Hospital, 30 days, 1 year mortality. RESULTS We identified 4546 patients (59.9% male), 12.2% of the whole population. Their SAPS II predicted hospital mortality was 89.0±5.8%, whilst the observed mortality was lower, 61.0%. This group had higher mortality, both during the first 30 days (aHR 3.52 [95% CI 3.34-3.71]) and from day 31 to day 365 after ICU admission (aHR 1.14 [95%CI 1.04-1.26]), respectively. However, their hospital standardized mortality ratio was similar to the other patients (0.69 vs. 0.69, P=.92). At one year of follow-up, 30% of patients in the high-risk group were alive. CONCLUSIONS Roughly 12% of patients admitted to the ICU for more than 24h had a SAPS II score predicted mortality above 80%. Their hospital standardized mortality was similar to the less severe population and 30% were alive after one year of follow-up.
Collapse
Affiliation(s)
- André Oliveira
- Intensive Care Medicine Department, Hospital de Vila Franca de Xira, Estrada Carlos Lima Costa Nº2, 2600-009 Vila Franca de Xira, Portugal
| | - Tatiana Vieira
- Intensive Care Medicine Department, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ana Rodrigues
- Intensive Care Medicine Department, Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Núria Jorge
- Intensive Care Medicine Department, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Luís Tavares
- Intensive Care Medicine Department, Hospital Santo Espírito, Av. D. Manuel I, 9500-370 Ponta Delgada, Portugal
| | - Laura Costa
- Intensive Care Medicine Department, Hospital de Braga, R. das Comunidades Lusíadas 133, Braga, Portugal
| | - José Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Grupo de Investigação e Desenvolvimento em Infeção e Sépsis (GISID), Rua Heróis de África, 381, Leça da Palmeira, 4450-681 Matosinhos, Portugal; Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200 - 319 Porto, Portugal
| | - João Gonçalves Pereira
- Intensive Care Medicine Department, Hospital de Vila Franca de Xira, Estrada Carlos Lima Costa Nº2, 2600-009 Vila Franca de Xira, Portugal; Grupo de Investigação e Desenvolvimento em Infeção e Sépsis (GISID), Rua Heróis de África, 381, Leça da Palmeira, 4450-681 Matosinhos, Portugal; Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
| |
Collapse
|
12
|
Ohbe H, Hashimoto S, Ogura T, Nishikimi M, Kudo D, Shime N, Kushimoto S. Association between regional critical care capacity and the incidence of invasive mechanical ventilation for coronavirus disease 2019: a population-based cohort study. J Intensive Care 2024; 12:6. [PMID: 38287432 PMCID: PMC10826037 DOI: 10.1186/s40560-024-00718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has exposed critical care supply shortages worldwide. This study aimed to investigate the association between regional critical care capacity and the incidence of invasive mechanical ventilation following novel COVID-19 during the pandemic in Japan, a country with a limited intensive care unit (ICU) bed capacity of a median of 5.1 ICU beds per 100,000 individuals. METHODS This population-based cohort study used data from the CRoss Icu Searchable Information System database and publicly available databases provided by the Japanese government and Japanese Society of Intensive Care Medicine. We identified patients recently diagnosed with COVID-19, those who received invasive mechanical ventilation, and those who received extracorporeal membrane oxygenation (ECMO) between February 2020 and March 2023. We analyzed the association between regional critical care capacity (ICU beds, high-dependency care unit (HDU) beds, resource-rich ICU beds, and intensivists) and the incidence of invasive mechanical ventilation, ECMO, and risk-adjusted mortality across 47 Japanese prefectures. RESULTS Among the approximately 127 million individuals residing in Japan, 33,189,809 were recently diagnosed with COVID-19, with 12,203 and 1,426 COVID-19 patients on invasive mechanical ventilation and ECMO, respectively, during the study period. Prefecture-level linear regression analysis revealed that the addition of ICU beds, resource-rich ICU beds, and intensivists per 100,000 individuals increased the incidence of IMV by 5.37 (95% confidence interval, 1.99-8.76), 7.27 (1.61-12.9), and 13.12 (3.48-22.76), respectively. However, the number of HDU beds per 100,000 individuals was not statistically significantly associated with the incidence of invasive mechanical ventilation. None of the four indicators of regional critical care capacity was statistically significantly associated with the incidence of ECMO and risk-adjusted mortality. CONCLUSIONS The results of prefecture-level analyses demonstrate that increased numbers of ICU beds, resource-rich ICU beds, and intensivists are associated with the incidence of invasive mechanical ventilation among patients recently diagnosed with COVID-19 during the pandemic. These findings have important implications for healthcare policymakers, aiding in efficiently allocating critical care resources during crises, particularly in regions with limited ICU bed capacities. Registry and the registration no. of the study/trial The approval date of the registry was August 20, 2020, and the registration no. of the study was lUMIN000041450.
Collapse
Affiliation(s)
- Hiroyuki Ohbe
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Satoru Hashimoto
- Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan
| | - Takayuki Ogura
- Tochigi Prefectural Emergency and Critical Care Centre, Imperil Gift Foundation SAISEIKAI, Utsunomiya Hospital, 911-1 Takebayashi-Machi, Utsunomiya, 321-0974, Japan
| | - Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Daisuke Kudo
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Shigeki Kushimoto
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan.
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan.
| |
Collapse
|
13
|
Heydari F, Karimpour-razkenari E, Azadtarigheh P, Vahdatinia A, Salahshoor A, Alipour A, Moosazadeh M, Gholipour Baradari A, Monajati M, Naderi-Behdani F. Evaluating the factors affecting clinical outcomes in critically ill COVID-19 unvaccinated patients admitted to the intensive care unit in a lower-middle-income country. Ann Med Surg (Lond) 2024; 86:42-49. [PMID: 38222708 PMCID: PMC10783397 DOI: 10.1097/ms9.0000000000001379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/25/2023] [Indexed: 01/16/2024] Open
Abstract
Background COVID-19, the most destructive pandemic of this century, caused the highest mortality rate among ICU patients. The evaluation of these patients is insufficient in lower-middle-income countries with limited resources during pandemics. As a result, our primary goal was to examine the characteristics of patients at baseline as well as their survival outcomes, and propose mortality predictors for identifying and managing the most vulnerable patients more effectively and quickly. Methods A prospective analysis of COVID-19 ICU-admitted patients was conducted in our healthcare centre in Iran, from 1 April until 20 May 2020. Ninety-three patients were included in the study, and all were unvaccinated. A multi-variate logistic regression was conducted to evaluate mortality-associated factors. Results There were 53 non-survivors among our ICU-admitted patients. The mean duration from symptoms' onset to hospitalization was 6.92 ± 4.27 days, and from hospitalization to ICU admission was 2.52 ± 3.61 days. The average hospital stay for patients was 13.23 ± 10.43 days, with 8.84 ± 7.53 days in the ICU. Non-survivors were significantly older, had significantly lower haemoglobin levels and higher creatine phosphokinase levels compared to survivors. They had marginally lower SpO2 levels at admission, higher vasopressor administrations, and were intubated more significantly during their ICU stay. The use of immunosuppressive drugs was also significantly higher in non-survivors. Logistic regression revealed that a one-point increase in APACHE II score at ICU admission increased mortality by 6%, and the presence of underlying diseases increased mortality by 4.27 times. Conclusion The authors presented clinical mortality prediction factors for critically ill patients infected with COVID-19. Additional studies are necessary to identify more generalized mortality indicators for these patients in lower-middle-income countries.
Collapse
Affiliation(s)
- Fatemeh Heydari
- Department of Anesthesiology and Critical Care Medicine, Imam Khomeini Hospital
| | | | | | | | - Ali Salahshoor
- Department of Anesthesiology and Critical Care Medicine, Imam Khomeini Hospital
- Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Mahmood Moosazadeh
- Gastrointestitional Cancer Research Center, Non-communicable Disease Institute, Mazandaran University of Medical Sciences, Sari
| | | | - Mahila Monajati
- Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fahimeh Naderi-Behdani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ramsar Campus, Mazandaran University of Medical Sciences, Ramsar, Mazandaran Province
| |
Collapse
|
14
|
Hovland IS, Skogstad L, Stafseth S, Hem E, Diep LM, Ræder J, Ekeberg Ø, Lie I. Prevalence of psychological distress in nurses, physicians and leaders working in intensive care units during the COVID-19 pandemic: a national one-year follow-up study. BMJ Open 2023; 13:e075190. [PMID: 38135308 PMCID: PMC10897841 DOI: 10.1136/bmjopen-2023-075190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To report and compare psychological distress as symptoms of anxiety, depression and post-traumatic stress among intensive care units' (ICU) nurses, physicians and leaders at 12 months after the baseline survey (spring 2020), during the COVID-19 pandemic in Norway. Furthermore, to analyse which baseline demographic and COVID ICU-related factors have a significant impact on psychological distress at 12 months. DESIGN Prospective, longitudinal, observational cohort study. SETTING Nationwide, 27 of 28 hospitals with COVID ICUs in Norway. PARTICIPANTS Nurses, physicians and their leaders. At 12 month follow-up 287 (59.3%) of 484 baseline participants responded. PRIMARY AND SECONDARY OUTCOME MEASURES Symptoms of anxiety and depression using the Hopkins Symptoms Checklist-10 (HSCL-10). Symptoms of post-traumatic stress using the post-traumatic stress disease checklist for the Diagnostic and Statistical Manual of Mental Disorders 5 (PCL-5).Demographics (included previous symptoms of anxiety and depression) and COVID ICU-related factors (professional preparations, emotional experience and support) impacting distress at 12 months. RESULTS Psychological distress, defined as caseness on either or both HSCL-10 and PCL-5, did not change significantly and was present for 13.6% of the participants at baseline and 13.2% at 12 month follow-up. Nurses reported significantly higher levels of psychological distress than physicians and leaders. Adjusted for demographics and the COVID ICU-related factors at baseline, previous symptoms of depression and fear of infection were significantly associated with higher levels of anxiety and depression at 12 months. Previous symptoms of depression, fear of infection and feeling of loneliness was significantly associated with more symptoms of post-traumatic stress. CONCLUSION One year into the COVID-19 pandemic 13.2% of the ICUs professionals reported psychological distress, more frequently among the nurses. Fear of infection, loneliness and previous symptoms of depression reported at baseline were associated with higher levels of distress. Protective equipment and peer support are recommended to mitigate distress. TRIAL REGISTRATION NUMBER ClinicalTrials.gov. Identifier: NCT04372056.
Collapse
Affiliation(s)
- Ingvild Strand Hovland
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of the Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
- Centre for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Laila Skogstad
- Centre for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Siv Stafseth
- Centre for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
- Department of MEVU, Lovisenberg Diaconal University College, Oslo, Norway
| | - Erlend Hem
- Department of the Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institue of Studies of the Medical Profession, Oslo, Norway
| | - Lien M Diep
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Johan Ræder
- Department of Anesthesiology, Intitute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - Øivind Ekeberg
- Psychosomatic and CL psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Irene Lie
- Centre for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
- Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
| |
Collapse
|
15
|
Skei NV, Nilsen TIL, Mohus RM, Prescott HC, Lydersen S, Solligård E, Damås JK, Gustad LT. Trends in mortality after a sepsis hospitalization: a nationwide prospective registry study from 2008 to 2021. Infection 2023; 51:1773-1786. [PMID: 37572240 PMCID: PMC10665235 DOI: 10.1007/s15010-023-02082-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Few studies have reported on mortality beyond one year after sepsis. We aim to describe trends in short- and long-term mortality among patients admitted with sepsis, and to describe the association between clinical characteristics and mortality for improved monitoring, treatment and prognosis. METHODS Patients ≥ 18 years admitted to all Norwegian hospitals (2008-2021) with a first sepsis episode were identified using Norwegian Patient Registry and International Classification of Diseases 10th Revision codes. Sepsis was classified as implicit (known infection site plus organ dysfunction), explicit (unknown infection site), or COVID-19-related sepsis. The outcome was all-cause mortality. We describe age-standardized 30-day, 90-day, 1-, 5- and 10-year mortality for each admission year and estimated the annual percentage change with 95% confidence interval (CI). The association between clinical characteristics and all-cause mortality is reported as hazard ratios (HRs) adjusted for age, sex and calendar year in Cox regression. RESULTS The study included 222,832 patients, of whom 127,059 (57.1%) had implicit, 92,928 (41.7%) had explicit, and 2,845 (1.3%) had COVID-19-related sepsis (data from 2020 and 2021). Trends in overall age-standardized 30-day, 90-day, 1- and 5-year mortality decreased by 0.29 (95% CI - 0.39 to - 0.19), 0.43 (95% CI - 0.56 to - 0.29), 0.61 (95% CI - 0.73 to - 0.49) and 0.66 (95% CI - 0.84 to - 0.48) percent per year, respectively. The decrease was observed for all infections sites but was largest among patients with respiratory tract infections. Implicit, explicit and COVID-19-related sepsis had largely similar overall mortality, with explicit sepsis having an adjusted HR of 0.980 (95% CI 0.969 to 0.991) and COVID-19-related sepsis an adjusted HR of 0.916 (95% CI 0.836 to 1.003) compared to implicit sepsis. Patients with respiratory tract infections have somewhat higher mortality than those with other infection sites. Number of comorbidities was positively associated with mortality, but mortality varied considerably between different comorbidities. Similarly, number of acute organ dysfunctions was strongly associated with mortality, whereas the risk varied for each type of organ dysfunction. CONCLUSION Overall mortality has declined over the past 14 years among patients with a first sepsis admission. Comorbidity, site of infection, and acute organ dysfunction are patient characteristics that are associated with mortality. This could inform health care workers and raise the awareness toward subgroups of patients that needs particular attention to improve long-term mortality.
Collapse
Affiliation(s)
- Nina Vibeche Skei
- Department of Anesthesia and Intensive Care, Nord-Trondelag Hospital Trust, Levanger, Norway.
- Department of Circulation and Medical Imaging, Mid Norway Sepsis Research Center, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Randi Marie Mohus
- Department of Circulation and Medical Imaging, Mid Norway Sepsis Research Center, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
| | - Hallie C Prescott
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, (NTNU), Trondheim, Norway
| | - Erik Solligård
- Department of Circulation and Medical Imaging, Mid Norway Sepsis Research Center, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jan Kristian Damås
- Department of Circulation and Medical Imaging, Mid Norway Sepsis Research Center, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research, Institute for Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Infectious Diseases, St. Olav's University Hospital, Trondheim, Norway
| | - Lise Tuset Gustad
- Department of Circulation and Medical Imaging, Mid Norway Sepsis Research Center, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| |
Collapse
|
16
|
Hedberg P, Baltzer N, Granath F, Fored M, Mårtensson J, Nauclér P. Clinical outcomes during and beyond different COVID-19 critical illness variant periods compared with other lower respiratory tract infections. Crit Care 2023; 27:427. [PMID: 37932793 PMCID: PMC10629059 DOI: 10.1186/s13054-023-04722-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND It is yet to be better understood how outcomes during and after the critical illness potentially differ between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants from other lower respiratory tract infections (LRTIs). We aimed to compare outcomes in adults admitted to an intensive care unit (ICU) with coronavirus disease 2019 (COVID-19) during the Wild-type, Alpha, Delta, and Omicron periods with individuals admitted with other LRTI. METHODS Population-based cohort study in Stockholm, Sweden, using health registries with high coverage, including ICU-admitted adults from 1 January 2016 to 15 September 2022. Outcomes were in-hospital mortality, 180-day post-discharge mortality, 180-day hospital readmission, 180-day days alive and at home (DAAH), and incident diagnoses registered during follow-up. RESULTS The number of ICU admitted individuals were 1421 Wild-type, 551 Alpha, 190 Delta, 223 Omicron, and 2380 LRTI. In-hospital mortality ranged from 28% (n = 665) in the LRTI cohort to 35% (n = 77) in the Delta cohort. The adjusted cause-specific hazard ratio (CSHR) compared with the LRTI cohort was 1.33 (95% confidence interval [CI] 1.16-1.53) in the Wild-type cohort, 1.53 (1.28-1.82) in the Alpha cohort, 1.70 (1.30-2.24) in the Delta cohort, and 1.59 (1.24-2.02) in the Omicron cohort. Among patients discharged alive from their COVID-19 hospitalization, the post-discharge mortality rates were lower (1-3%) compared with the LRTI cohort (9%), and the risk of hospital readmission was lower (CSHRs ranging from 0.42 to 0.68). Moreover, all COVID-19 cohorts had compared with the LRTI cohort more DAAH after compared with before the critical illness. CONCLUSION Overall, COVID-19 critical was associated with an increased hazard of in-hospital mortality, but among those discharged alive from the hospital, less severe long-term outcomes were observed compared with other LRTIs.
Collapse
Affiliation(s)
- Pontus Hedberg
- Department of Medicine, Huddinge, Karolinska Institutet, H7 Medicin, Huddinge, H7 Infektion och Hud Sönnerborg, 171 77, Stockholm, Sweden.
| | - Nicholas Baltzer
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Granath
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Michael Fored
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mårtensson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
17
|
Vergnano B, Signori D, Benini A, Calcinati S, Bettini F, Verga L, Borin LM, Cavalca F, Gambacorti-Passerini C, Bellani G, Foti G. Safety and Effectiveness of Intensive Treatments Administered Outside the Intensive Care Unit to Hematological Critically Ill Patients: An Intensive Care without Walls Trial. J Clin Med 2023; 12:6281. [PMID: 37834926 PMCID: PMC10573388 DOI: 10.3390/jcm12196281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Historically, the admission of hematological patients in the ICU shortly after the start of a critical illness is associated with better survival rates. Early intensive interventions administered by MET could play a role in the management of hematological critically ill patients, eventually reducing the ICU admission rate. In this retrospective and monocentric study, we evaluate the safety and effectiveness of intensive treatments administered by the MET in a medical ward frame. The administered interventions were mainly helmet CPAP and pharmacological cardiovascular support. Frequent reassessment by the MET at least every 8 to 12 h was guaranteed. We analyzed data from 133 hematological patients who required MET intervention. In-hospital mortality was 38%; mortality does not increase in patients not immediately transferred to the ICU. Only three patients died without a former admission to the ICU; in these cases, mortality was not related to the acute illness. Moreover, 37% of patients overcame the critical episode in the hematological ward. Higher SOFA and MEWS scores were associated with a worse survival rate, while neutropenia and pharmacological immunosuppression were not. The MET approach seems to be safe and effective. SOFA and MEWS were confirmed to be effective tools for prognostication.
Collapse
Affiliation(s)
- Beatrice Vergnano
- Department of Anesthesia and Intensive Care Medicine, Asst Monza, San Gerardo Hospital, 20900 Monza, Italy
| | - Davide Signori
- Department of Medicine and Surgery, University of Milan-Bicocca, Piazza Ateneo Nuovo 1, 20126 Milano, Italy
| | - Annalisa Benini
- Department of Anesthesia and Intensive Care Medicine, Asst Monza, San Gerardo Hospital, 20900 Monza, Italy
| | - Serena Calcinati
- Department of Anesthesia and Intensive Care Medicine, Asst Monza, San Gerardo Hospital, 20900 Monza, Italy
| | - Francesca Bettini
- Department of Anesthesia and Intensive Care Medicine, Asst Monza, San Gerardo Hospital, 20900 Monza, Italy
| | - Luisa Verga
- Department of Hematology, Asst Monza, San Gerardo Hospital, 20900 Monza, Italy
| | - Lorenza Maria Borin
- Department of Hematology, Asst Monza, San Gerardo Hospital, 20900 Monza, Italy
| | - Fabrizio Cavalca
- Department of Medicine and Surgery, University of Milan-Bicocca, Piazza Ateneo Nuovo 1, 20126 Milano, Italy
| | - Carlo Gambacorti-Passerini
- Department of Medicine and Surgery, University of Milan-Bicocca, Piazza Ateneo Nuovo 1, 20126 Milano, Italy
- Department of Hematology, Asst Monza, San Gerardo Hospital, 20900 Monza, Italy
| | - Giacomo Bellani
- Department of Anesthesia and Intensive Care Medicine, Asst Monza, San Gerardo Hospital, 20900 Monza, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Piazza Ateneo Nuovo 1, 20126 Milano, Italy
| | - Giuseppe Foti
- Department of Anesthesia and Intensive Care Medicine, Asst Monza, San Gerardo Hospital, 20900 Monza, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Piazza Ateneo Nuovo 1, 20126 Milano, Italy
| |
Collapse
|
18
|
Bruyneel A, Larcin L, Martins D, Van Den Bulcke J, Leclercq P, Pirson M. Cost comparisons and factors related to cost per stay in intensive care units in Belgium. BMC Health Serv Res 2023; 23:986. [PMID: 37705056 PMCID: PMC10500739 DOI: 10.1186/s12913-023-09926-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/16/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Given the variability of intensive care unit (ICU) costs in different countries and the importance of this information for guiding clinicians to effective treatment and to the organisation of ICUs at the national level, it is of value to gather data on this topic for analysis at the national level in Belgium. The objectives of the study were to assess the total cost of ICUs and the factors that influence the cost of ICUs in hospitals in Belgium. METHODS This was a retrospective cohort study using data collected from the ICUs of 17 Belgian hospitals from January 01 to December 31, 2018. A total of 18,235 adult ICU stays were included in the study. The data set was a compilation of inpatient information from analytical cost accounting of hospitals, medical discharge summaries, and length of stay data. The costs were evaluated as the expenses related to the management of hospital stays from the hospital's point of view. The cost from the hospital perspective was calculated using a cost accounting analytical methodology in full costing. We used multivariate linear regression to evaluate factors associated with total ICU cost per stay. The ICU cost was log-transformed before regression and geometric mean ratios (GMRs) were estimated for each factor. RESULTS The proportion of ICU beds to ward beds was a median [p25-p75] of 4.7% [4.4-5.9]. The proportion of indirect costs to total costs in the ICU was 12.1% [11.4-13.3]. The cost of nurses represented 57.2% [55.4-62.2] of direct costs and this was 15.9% [12.0-18.2] of the cost of nurses in the whole hospital. The median cost per stay was €4,267 [2,050-9,658] and was €2,160 [1,545-3,221] per ICU day. The main factors associated with higher cost per stay in ICU were Charlson score, mechanical ventilation, ECMO, continuous hemofiltration, length of stay, readmission, ICU mortality, hospitalisation in an academic hospital, and diagnosis of coma/convulsions or intoxication. CONCLUSIONS This study demonstrated that, despite the small proportion of ICU beds in relation to all services, the ICU represented a significant cost to the hospital. In addition, this study confirms that nursing staff represent a significant proportion of the direct costs of the ICU. Finally, the total cost per stay was also important but highly variable depending on the medical factors identified in our results.
Collapse
Affiliation(s)
- Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
| | - Lionel Larcin
- Research Centre for Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Dimitri Martins
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Van Den Bulcke
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Pol Leclercq
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
19
|
Schell CO, Wellhagen A, Lipcsey M, Kurland L, Bjurling-Sjöberg P, Stålsby Lundborg C, Castegren M, Baker T. The burden of critical illness among adults in a Swedish region-a population-based point-prevalence study. Eur J Med Res 2023; 28:322. [PMID: 37679836 PMCID: PMC10483802 DOI: 10.1186/s40001-023-01279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Patients with critical illness have a high risk of mortality. Key decision-making in the health system affecting the outcomes of critically ill patients requires epidemiological evidence, but the burden of critical illness is largely unknown. This study aimed to estimate the prevalence of critical illness in a Swedish region. Secondary objectives were to estimate the proportion of hospital inpatients who are critically ill and to describe the in-hospital location of critically ill patients. METHODS A prospective, multi-center, population-based, point-prevalence study on specific days in 2017-2018. All adult (> 18 years) in-patients, regardless of admitting specially, in all acute hospitals in Sörmland, and the patients from Sörmland who had been referred to university hospitals, were included. Patients in the operating theatres, with a psychiatric cause of admission, women in active labor and moribund patients, were excluded. All participants were examined by trained data collectors. Critical illness was defined as "a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and a potential for reversibility". The presence of one or more severely deranged vital signs was used to classify critical illness. The prevalence of critical illness was calculated as the number of critically ill patients divided by the number of adults in the region. RESULTS A total of 1269 patients were included in the study. Median age was 74 years and 50% of patients were female. Critical illness was present in 133 patients, resulting in an adult population prevalence of critical illness per 100,000 people of 19.4 (95% CI 16.4-23.0). The proportion of patients in hospital who were critically ill was 10.5% (95% CI 8.8-12.3%). Among the critically ill, 125 [95% CI 94.0% (88.4-97.0%)] were cared for in general wards. CONCLUSIONS The prevalence of critical illness was higher than previous, indirect estimates. One in ten hospitalized patients were critically ill, the large majority of which were cared for in general wards. This suggests a hidden burden of critical illness of potential public health, health system and hospital management significance.
Collapse
Affiliation(s)
- Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
- Department of Medicine, Nyköping Hospital, Sörmland Region, Nyköping, Sweden.
| | - Andreas Wellhagen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Anaesthesia and Intensive Care, Nyköping Hospital, Sörmland Region, Nyköping, Sweden
| | - Miklós Lipcsey
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
| | - Lisa Kurland
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Emergency Medicine, Örebro University, Örebro University Hospital, Örebro, Sweden
| | - Petronella Bjurling-Sjöberg
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Patient Safety, Region Sörmland, Eskilstuna, Sweden
| | | | - Markus Castegren
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology (FyFa), Karolinska Institutet, Stockholm, Sweden
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| |
Collapse
|
20
|
Tack J, Bruyneel A, Bouillon Y, Taton O, Taccone F, Pirson M. Analysis of Nursing Staff Management for a Semi-intensive Pulmonology Unit During the COVID-19 Pandemic Using the Nursing Activities Score. Dimens Crit Care Nurs 2023; 42:286-294. [PMID: 37523728 DOI: 10.1097/dcc.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES During the COVID-19 pandemic, a shortage of intensive care unit beds was encountered across Europe. Opening a semi-intensive pulmonary ward freed up intensive care unit beds. This study aimed to determine the appropriate nurse staffing level for a semi-intensive pulmonology unit (SIPU) for patients with COVID-19 and to identify factors associated with an increase in nursing workload in this type of unit. METHODS This was a retrospective study of the SIPU of the Erasme university clinics in Belgium. Nursing staff was determined with the Nursing Activities Score (NAS) during the second wave of COVID-19 in Belgium. RESULTS During the study period, 59 patients were admitted to the SIPU, and a total of 416 NAS scores were encoded. The mean (±SD) NAS was 70.3% (±16.6%). Total NAS varied significantly depending on the reason for admission: respiratory distress (mean [SD] NAS, 71.6% [±13.9%]) or critical illness-related weakness (65.1% ± 10.9%). The items encoded were significantly different depending on the reason for admission. In multivariate analysis, body mass index > 30 (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.07-3.30) and higher Simplified Acute Physiology Score II score (OR, 1.05; 95 CI, 1.02-1.11) were associated with higher NAS. Patients admitted via the emergency department (OR, 2.45; 95% CI, 1.15-5.22) had higher NAS. Patients on noninvasive ventilation (OR, 13.65; 95% CI, 3.76-49.5) and oxygen therapy (OR, 4.29; 95% CI, 1.27-14.48) had higher NAS. High peripheral venous oxygen saturation (OR, 0.86; 95% CI, 0.78-0.94) was a predictor of lower workload. CONCLUSION A ratio of 2 nurses to 3 patients is necessary for SIPU care of patients with COVID-19. Factors associated with higher workload were high Simplified Acute Physiology Score II score, body mass index > 30, admission via emergency room, patients on oxygen, and noninvasive ventilation.
Collapse
|
21
|
Violaris IG, Lampros T, Kalafatakis K, Ntritsos G, Kostikas K, Giannakeas N, Tsipouras M, Glavas E, Tsalikakis D, Tzallas A. Modelling the COVID-19 pandemic: Focusing on the case of Greece. Epidemics 2023; 44:100706. [PMID: 37423142 DOI: 10.1016/j.epidem.2023.100706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023] Open
Abstract
The SARS-CoV-2 infection (COVID-19) pandemic created an unprecedented chain of events at a global scale, with European counties initially following individual pathways on the confrontation of the global healthcare crisis, before organizing coordinated public vaccination campaigns, when proper vaccines became available. In the meantime, the viral infection outbreaks were determined by the inability of the immune system to retain a long-lasting protection as well as the appearance of SARS-CoV-2 variants with differential transmissibility and virulence. How do these different parameters regulate the domestic impact of the viral epidemic outbreak? We developed two versions of a mathematical model, an original and a revised one, able to capture multiple factors affecting the epidemic dynamics. We tested the original one on five European countries with different characteristics, and the revised one in one of them, Greece. For the development of the model, we used a modified version of the classical SEIR model, introducing various parameters related to the estimated epidemiology of the pathogen, governmental and societal responses, and the concept of quarantine. We estimated the temporal trajectories of the identified and overall active cases for Cyprus, Germany, Greece, Italy and Sweden, for the first 250 days. Finally, using the revised model, we estimated the temporal trajectories of the identified and overall active cases for Greece, for the duration of the 1230 days (until June 2023). As shown by the model, small initial numbers of exposed individuals are enough to threaten a large percentage of the population. This created an important political dilemma in most countries. Force the virus to extinction with extremely long and restrictive measures or merely delay its spread and aim for herd immunity. Most countries chose the former, which enabled the healthcare systems to absorb the societal pressure, caused by the increased numbers of patients, requiring hospitalization and intensive care.
Collapse
Affiliation(s)
- Ioannis G Violaris
- Faculty of Informatics & Telecommunications, University of Ioannina, Arta, Greece
| | - Theodoros Lampros
- Faculty of Informatics & Telecommunications, University of Ioannina, Arta, Greece
| | - Konstantinos Kalafatakis
- Faculty of Informatics & Telecommunications, University of Ioannina, Arta, Greece; Institute of Health Sciences Education, Barts and the London School of Medicine & Dentistry (Malta campus), Queen Mary University of London, Victoria, Malta.
| | - Georgios Ntritsos
- Faculty of Informatics & Telecommunications, University of Ioannina, Arta, Greece
| | - Konstantinos Kostikas
- Department of Respiratory Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Nikolaos Giannakeas
- Faculty of Informatics & Telecommunications, University of Ioannina, Arta, Greece
| | - Markos Tsipouras
- Department of Electrical and Computer Engineering, University of Western Macedonia, Kozani, Greece
| | - Evripidis Glavas
- Faculty of Informatics & Telecommunications, University of Ioannina, Arta, Greece
| | - Dimitrios Tsalikakis
- Department of Electrical and Computer Engineering, University of Western Macedonia, Kozani, Greece
| | - Alexandros Tzallas
- Faculty of Informatics & Telecommunications, University of Ioannina, Arta, Greece
| |
Collapse
|
22
|
Lafuente JL, González S, Puertas E, Gómez-Tello V, Avilés E, Albo N, Mateo C, Beunza JJ. Development of a urinometer for automatic measurement of urine flow in catheterized patients. PLoS One 2023; 18:e0290319. [PMID: 37651353 PMCID: PMC10470914 DOI: 10.1371/journal.pone.0290319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
Urinary flow measurement and colorimetry are vital medical indicators for critically ill patients in intensive care units. However, there is a clinical need for low-cost, continuous urinary flow monitoring devices that can automatically and in real-time measure urine flow. This need led to the development of a non-invasive device that is easy to use and does not require proprietary disposables. The device operates by detecting urine flow using an infrared barrier that returns an unequivocal pattern, and it is capable of measuring the volume of liquid in real-time, storing the history with a precise date, and returning alarms to detect critical trends. The device also has the ability to detect the color of urine, allowing for extended data and detecting problems in catheterized patients such as hematuria. The device is proposed as an automated clinical decision support system that utilizes the concept of the Internet of Medical Things. It works by using a LoRa communication method with the LoRaWAN protocol to maximize the distance to access points, reducing infrastructure costs in massive deployments. The device can send data wirelessly for remote monitoring and allows for the collection of data on a dashboard in a pseudonymous way. Tests conducted on the device using a gold standard medical grade infusion pump and fluid densities within the 1.005 g/ml to 1.030 g/ml urine density range showed that droplets were satisfactorily captured in the range of flows from less than 1 ml/h to 500 ml/h, which are acceptable ranges for urinary flow. Errors ranged below 15%, when compared to the values obtained by the hospital infusion pump used as gold standard. Such values are clinically adequate to detect changes in diuresis patterns, specially at low urine output ranges, related to renal disfunction. Additionally, tests carried out with different color patterns indicate that it detects different colors of urine with a precision in detecting RGB values <5%. In conclusion, the results suggest that the device can be useful in automatically monitoring diuresis and colorimetry in real-time, which can facilitate the work of nursing and provide automatic decision-making support to intensive care physicians.
Collapse
Affiliation(s)
- José-Luis Lafuente
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Engineering Department, School of Architecture, Engineering, & Design, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Samuel González
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Intensive Care Unit, Hospital Universitario HLA Moncloa, Madrid, Spain
- Department of Medicine, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Enrique Puertas
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Science, Computing and Technology, School of Engineering, Architecture & Design, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Vicente Gómez-Tello
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Department of Medicine, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Emergency Department, Hospital Universitario HLA Moncloa, Madrid, Spain
| | - Eva Avilés
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Engineering Department, School of Architecture, Engineering, & Design, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Niza Albo
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Engineering Department, School of Architecture, Engineering, & Design, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Claudia Mateo
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Engineering Department, School of Architecture, Engineering, & Design, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Juan-Jose Beunza
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Department of Medicine, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Research and Doctorate School, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| |
Collapse
|
23
|
Rubulotta F, DeVita MA. Measuring surge capacity: preparing for the unexpected. Intern Emerg Med 2023; 18:1487-1489. [PMID: 37115420 PMCID: PMC10144892 DOI: 10.1007/s11739-023-03285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Francesca Rubulotta
- Department of critical care medicine, McGill University, 1400 Rue des Pins, Montreal, H3G 1B1 Canada
- iWIN Foundation, International Women in Intensive and Critical Care Medicine Network, Canada, Canada
| | - Michael A. DeVita
- Palliative Care Services, Harlem Hospital Medical Center, NY, NY USA
- Columbia Vagelos College of Physicians and Surgeons, NY, NY USA
| |
Collapse
|
24
|
Beresford S, Tandon A, Farina S, Johnston B, Crews M, Welters ID. Who to escalate during a pandemic? A retrospective observational study about decision-making during the COVID-19 pandemic in the UK. Emerg Med J 2023:emermed-2022-212505. [PMID: 37328261 DOI: 10.1136/emermed-2022-212505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/05/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Optimal decision-making regarding who to admit to critical care in pandemic situations remains unclear. We compared age, Clinical Frailty Score (CFS), 4C Mortality Score and hospital mortality in two separate COVID-19 surges based on the escalation decision made by the treating physician. METHODS A retrospective analysis of all referrals to critical care during the first COVID-19 surge (cohort 1, March/April 2020) and a late surge (cohort 2, October/November 2021) was undertaken. Patients with confirmed or high clinical suspicion of COVID-19 infection were included. A senior critical care physician assessed all patients regarding their suitability for potential intensive care unit admission. Demographics, CFS, 4C Mortality Score and hospital mortality were compared depending on the escalation decision made by the attending physician. RESULTS 203 patients were included in the study, 139 in cohort 1 and 64 in cohort 2. There were no significant differences in age, CFS and 4C scores between the two cohorts. Patients deemed suitable for escalation by clinicians were significantly younger with significantly lower CFS and 4C scores compared with patients who were not deemed to benefit from escalation. This pattern was observed in both cohorts. Mortality in patients not deemed suitable for escalation was 61.8% in cohort 1 and 47.4% in cohort 2 (p<0.001). CONCLUSIONS Decisions who to escalate to critical care in settings with limited resources pose moral distress on clinicians. 4C score, age and CFS did not change significantly between the two surges but differed significantly between patients deemed suitable for escalation and those deemed unsuitable by clinicians. Risk prediction tools may be useful in a pandemic to supplement clinical decision-making, even though escalation thresholds require adjustments to reflect changes in risk profile and outcomes between different pandemic surges.
Collapse
Affiliation(s)
- Stephanie Beresford
- Department of Critical Care, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Aditi Tandon
- Department of Critical Care, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Anaesthesia, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sofia Farina
- Department of Critical Care, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Brian Johnston
- Department of Critical Care, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Faculty of Health and Life Sciences, Liverpool, UK
| | - Maryam Crews
- Department of Critical Care, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ingeborg Dorothea Welters
- Department of Critical Care, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Faculty of Health and Life Sciences, Liverpool, UK
| |
Collapse
|
25
|
Jalal A, Iwamoto K, Gedik G, Ravaghi H, Kodama C. Health workforce capacity of intensive care units in the Eastern Mediterranean Region. PLoS One 2023; 18:e0286980. [PMID: 37327195 PMCID: PMC10275434 DOI: 10.1371/journal.pone.0286980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 05/27/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVE The onset of COVID-19 pandemic increased the need for functioning and equipped intensive care units (ICUs) with staff trained in operating them. In the Eastern Mediterranean Region, this also triggered the need for assessing the available capacities of ICUs and health workforce so that appropriate strategies can be developed to address emerging challenges of staff shortages in the wake of COVID-19. To address this need, a scoping review on the health workforce capacity of intensive care units in the Eastern Mediterranean Region was conducted. METHODS A scoping review methodology as outlined by Cochrane was followed. Available literature and different data sources were reviewed. Database includes Pubmed (medline,Plos included), IMEMR, Google Scholar for peer-reviewed literature, and Google for grey literature such as relevant website of ministries, national and international organization. The search was performed for publications on intensive care unit health workers for each of the EMR countries in the past 10 years (2011-2021). Data from included studies was charted, analysed and reported in a narrative format. A brief country survey was also conducted to supplement the findings of the review. It included quantitative and qualitative questions about number of ICU beds, physicians and nurses, training programs as well as challenges faced by ICU health workforce. RESULTS Despite limited data availability, this scoping review was able to capture information important for the Eastern Mediterranean Region. Following major themes appeared in findings and results were synthesized for each category: facility and staffing, training and qualification, working conditions/environment and performance appraisal. Shortage of intensive care specialist physicians and nurses were in majority of countries. Some countries offer training programmes, mostly for physicians, at post-graduate level and through short courses. High level of workload, emotional and physical burnout and stress were a consistent finding across all countries. Gaps in knowledge were found regarding procedures common for managing critically ill patients as well as lack of compliance with guidelines and recommendations. CONCLUSION The literature on ICU capacities in EMR is limited, however, our study identified valuable information on health workforce capacity of ICUs in the region. While well-structured, up-to-date, comprehensive and national representative data is still lacking in literature and in countries, there is a clearly emerging need for scaling up the health workforce capacities of ICUs in EMR. Further research is necessary to understand the situation of ICU capacity in EMR. Plans and efforts should be made to build current and future health workforce.
Collapse
Affiliation(s)
- Arooj Jalal
- Health Workforce Development, World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt
| | - Kazuyo Iwamoto
- Health Emergencies Programme, World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt
| | - Gulin Gedik
- Health Workforce Development, World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt
| | - Hamid Ravaghi
- Hospital Care Management, World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt
| | - Chiori Kodama
- Health Emergencies Programme, World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt
| |
Collapse
|
26
|
Zajic P, Hiesmayr M, Bauer P, Baron DM, Gruber A, Joannidis M, Posch M, Metnitz PGH. Nationwide analysis of hospital admissions and outcomes of patients with SARS-CoV-2 infection in Austria in 2020 and 2021. Sci Rep 2023; 13:8548. [PMID: 37236991 DOI: 10.1038/s41598-023-35349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
This retrospective study evaluated temporal and regional trends of patient admissions to hospitals, intensive care units (ICU), and intermediate care units (IMCU) as well as outcomes during the COVID-19 pandemic in Austria. We analysed anonymous data from patients admitted to Austrian hospitals with COVID-19 between January 1st, 2020 and December 31st, 2021. We performed descriptive analyses and logistic regression analyses for in-hospital mortality, IMCU or ICU admission, and in-hospital mortality following ICU admission. 68,193 patients were included, 8304 (12.3%) were primarily admitted to ICU, 3592 (5.3%) to IMCU. Hospital mortality was 17.3%; risk factors were male sex (OR 1.67, 95% CI 1.60-1.75, p < 0.001) and high age (OR 7.86, 95% CI 7.07-8.74, p < 0.001 for 90+ vs. 60-64 years). Mortality was higher in the first half of 2020 (OR 1.15, 95% CI 1.04-1.27, p = 0.01) and the second half of 2021 (OR 1.11, 95% CI 1.05-1.17, p < 0.001) compared to the second half of 2020 and differed regionally. ICU or IMCU admission was most likely between 55 and 74 years, and less likely in younger and older age groups. We find mortality in Austrian COVID-19-patients to be almost linearly associated with age, ICU admission to be less likely in older individuals, and outcomes to differ between regions and over time.
Collapse
Affiliation(s)
- Paul Zajic
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Michael Hiesmayr
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Peter Bauer
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - David M Baron
- Department of Anaesthesiology, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Anastasiia Gruber
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Posch
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Philipp G H Metnitz
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| |
Collapse
|
27
|
Heller AR, Bartenschlager C, Brunner JO, Marckmann G. [German "Triage Act"-Regulation with fatal consequences]. DIE ANAESTHESIOLOGIE 2023:10.1007/s00101-023-01286-0. [PMID: 37233790 DOI: 10.1007/s00101-023-01286-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 05/27/2023]
Abstract
With the coming into force of § 5c of the Infection Protection Act (IfSG), the so-called Triage Act, on 14 December 2022, a protracted discussion has come to a provisional conclusion, the result of which physicians and social associations but also lawyers and ethicists are equally dissatisfied. The explicit exclusion of the discontinuation of treatment that has already begun in favor of new patients with better chances of success (so-called tertiary or ex-post triage) prevents allocation decisions with the aim of enabling as many patients as possible to beneficially participate in medical care under crisis conditions. The result of the new regulation is de facto a first come first served allocation, which is associated with the highest mortality even among individuals with limitations or disabilities and was rejected by a large margin as unfair in a population survey. Mandating allocation decisions based on the likelihood of success but which are not permitted to be consistently implemented and prohibiting, for example the use of age and frailty as prioritization criteria, although both factors most strongly determine the short-term probability of survival according to evident data, shows the contradictory and dogmatic nature of the regulation. The only remaining possibility is the consistent termination of treatment that is no longer indicated or desired by the patient, regardless of the current resource situation; however, if a different decision is made in a crisis situation than in a situation without a lack of resources, this practice would not be justified and would be punishable. Accordingly, the highest efforts must be set on legally compliant documentation, especially in the stage of decompensated crisis care in a region. The goal of enabling as many patients as possible to beneficially participate in medical care under crisis conditions is in any case thwarted by the new German Triage Act.
Collapse
Affiliation(s)
- A R Heller
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - C Bartenschlager
- Health Care Operations/Health Information Management, Wirtschaftswissenschaftliche und Medizinische Fakultät, Universität Augsburg, Augsburg, Deutschland
| | - J O Brunner
- Zentrum für Interdisziplinäre Gesundheitsforschung, Universität Augsburg, Augsburg, Deutschland
| | - G Marckmann
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Deutschland
| |
Collapse
|
28
|
Streit S, Johnston-Webber C, Mah J, Prionas A, Wharton G, Paulino J, Franca A, Mossialos E, Papalois V. Lessons From the Portuguese Solid Organ Donation and Transplantation System: Achieving Success Despite Challenging Conditions. Transpl Int 2023; 36:11008. [PMID: 37305338 PMCID: PMC10249494 DOI: 10.3389/ti.2023.11008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/14/2023] [Indexed: 06/13/2023]
Abstract
Over the past two decades, Portugal has become one of the world leaders in organ donation and transplantation despite significant financial constraints. This study highlights how Portugal achieved success in organ donation and transplantation and discusses how this information might be used by other countries that are seeking to reform their national programs. To accomplish this goal, we performed a narrative review of relevant academic and grey literature and revised our results after consultation with two national experts. Our findings were then synthesized according to a conceptual framework for organ donation and transplantation programs. Our results revealed several key strategies used by the Portuguese organ donation and transplantation program, including collaboration with Spain and other European nations, a focus on tertiary prevention, and sustained financial commitment. This report also explores how cooperative efforts were facilitated by geographical, governmental, and cultural proximity to Spain, a world leader in organ donation and transplantation. In conclusion, our review of the Portuguese experience provides insight into the development of organ donation and transplantation systems. However, other countries seeking to reform their national transplant systems will need to adapt these policies and practices to align with their unique cultures and contexts.
Collapse
Affiliation(s)
- Simon Streit
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Charlotte Johnston-Webber
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Jasmine Mah
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Apostolos Prionas
- Department of Surgery, Imperial College, London, United Kingdom
- Department of General Surgery, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom
| | - George Wharton
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Jorge Paulino
- Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital, Lisbon, Portugal
| | - Ana Franca
- Instituto Português do Sangue e da Transplantação, Lisbon, Portugal
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Institute of Global Health Innovation, Imperial College, London, United Kingdom
| | - Vassilios Papalois
- Department of Surgery, Imperial College, London, United Kingdom
- Renal and Transplant Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| |
Collapse
|
29
|
Kvåle R, Möller MH, Porkkala T, Varpula T, Enlund G, Engerstrôm L, Sigurdsson MI, Thormar K, Garde K, Christensen S, Buanes EA, Sverrisson K. The Nordic perioperative and intensive care registries-Collaboration and research possibilities. Acta Anaesthesiol Scand 2023. [PMID: 37096912 DOI: 10.1111/aas.14255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND The Nordic perioperative and intensive care registries have been built up during the last 25 years to improve quality in intensive and perioperative care. We aimed to describe the Nordic perioperative and intensive care registries and to highlight possibilities and challenges in future research collaboration between these registries. MATERIAL AND METHOD We present an overview of the following Nordic registries: Swedish Perioperative Registry (SPOR), the Danish Anesthesia Database (DAD), the Finnish Perioperative Database (FIN-AN), the Icelandic Anesthesia Database (IS-AN), the Danish Intensive Care Database (DID), the Swedish Intensive Care Registry (SIR), the Finnish Intensive Care Consortium, the Norwegian Intensive Care and Pandemic Registry (NIPaR), and the Icelandic Intensive Care Registry (IS-ICU). RESULTS Health care systems and patient populations are similar in the Nordic countries. Despite certain differences in data structure and clinical variables, the perioperative and intensive care registries have enough in common to enable research collaboration. In the future, even a common Nordic registry could be possible. CONCLUSION Collaboration between the Nordic perioperative and intensive care registries is both possible and likely to produce research of high quality. Research collaboration between registries may have several add-on effects and stimulate international standardization regarding definitions, scoring systems, and benchmarks, thereby improving overall quality of care.
Collapse
Affiliation(s)
- Reidar Kvåle
- The Norwegian Intensive Care and Pandemic Registry (NIPaR), Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Morten Hylander Möller
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Timo Porkkala
- Department of Cardiac Anesthesia and Intensive Care, Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Tero Varpula
- The Finnish Intensive Care Consortium (FICC), Department of Anaesthesia and Critical Care, Helsinki University Hospital, Espoo, Finland
| | - Gunnar Enlund
- The Swedish Perioperative Registry (SPOR), Department of Anaesthesia and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Lars Engerstrôm
- The Swedish Intensive care Registry (SIR), Department of Cardiothoracic Surgery, Anaesthesia and Intensive care; Linköping University Hospital, Linköping and Department of Anaesthesia and Intensive care, Vrinnevi Hospital, Norrköping, Sweden
| | - Martin Ingi Sigurdsson
- Department of Anaesthesia and Critical Care, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Katrin Thormar
- Department of Anaesthesia and Critical Care, Landspitali University Hospital, Reykjavik, Iceland
| | - Kim Garde
- Chief Quality Officer The Danish Anaesthesia Database (DAD) Dept. of Quality Improvement, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steffen Christensen
- The Danish Intensive Care Database (DID), Dept. of Anesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Eirik Alnes Buanes
- The Norwegian Intensive Care and Pandemic Registry (NIPaR), Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Kristinn Sverrisson
- Department of Anaesthesia and Critical Care, Landspitali University Hospital, Reykjavik, Iceland
| |
Collapse
|
30
|
Benoit DD, Vanheule S, Manesse F, Anseel F, De Soete G, Goethals K, Lievrouw A, Vansteelandt S, De Haan E, Piers R. Coaching doctors to improve ethical decision-making in adult hospitalised patients potentially receiving excessive treatment: Study protocol for a stepped wedge cluster randomised controlled trial. PLoS One 2023; 18:e0281447. [PMID: 36943825 PMCID: PMC10030010 DOI: 10.1371/journal.pone.0281447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/18/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Fast medical progress poses a significant challenge to doctors, who are asked to find the right balance between life-prolonging and palliative care. Literature indicates room for enhancing openness to discuss ethical sensitive issues within and between teams, and improving decision-making for benefit of the patient at end-of-life. METHODS Stepped wedge cluster randomized trial design, run across 10 different departments of the Ghent University Hospital between January 2022 and January 2023. Dutch speaking adult patients and one of their relatives will be included for data collection. All 10 departments were randomly assigned to start a 4-month coaching period. Junior and senior doctors will be coached through observation and debrief by a first coach of the interdisciplinary meetings and individual coaching by the second coach to enhance self-reflection and empowering leadership and managing group dynamics with regard to ethical decision-making. Nurses, junior doctors and senior doctors anonymously report perceptions of excessive treatment via the electronic patient file. Once a patient is identified by two or more different clinicians, an email is sent to the second coach and the doctor in charge of the patient. All nurses, junior and senior doctors will be invited to fill out the ethical decision making climate questionnaire at the start and end of the 12-months study period. Primary endpoints are (1) incidence of written do-not-intubate and resuscitate orders in patients potentially receiving excessive treatment and (2) quality of ethical decision-making climate. Secondary endpoints are patient and family well-being and reports on quality of care and communication; and clinician well-being. Tertiairy endpoints are quantitative and qualitative data of doctor leadership quality. DISCUSSION This is the first randomized control trial exploring the effects of coaching doctors in self-reflection and empowering leadership, and in the management of team dynamics, with regard to ethical decision-making about patients potentially receiving excessive treatment.
Collapse
Affiliation(s)
- Dominique D. Benoit
- Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
- Intensive Care Medicine, University Hospital Ghent, Gent, Belgium
| | - Stijn Vanheule
- Ghent University Faculty of Psychology and Educational Sciences, Gent, Belgium
| | - Frank Manesse
- Independent, Conversio, Gent, Belgium
- Kets de Vries Institute, London, United Kingdom
| | - Frederik Anseel
- Ghent University Faculty of Psychology and Educational Sciences, Gent, Belgium
| | - Geert De Soete
- Ghent University Faculty of Psychology and Educational Sciences, Gent, Belgium
| | | | - An Lievrouw
- Intensive Care Medicine, University Hospital Ghent, Gent, Belgium
- Ghent University Hospital Cancer Centre, Gent, Belgium
| | - Stijn Vansteelandt
- Faculty of Applied Mathematics, Computer Sciences and Statistics, Ghent University Faculty of Sciences, Gent, Belgium
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Erik De Haan
- Hult International Business School Ashridge Centre for Coaching, Berkhamsted, United Kingdom
- VU Amsterdam School of Business and Economics, Amsterdam, The Netherlands
| | - Ruth Piers
- Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
- Ghent University Hospital Geriatrics, Gent, Belgium
| | | |
Collapse
|
31
|
Mortality analysis among sepsis patients in and out of intensive care units using the Japanese nationwide medical claims database: a study by the Japan Sepsis Alliance study group. J Intensive Care 2023; 11:2. [PMID: 36611188 PMCID: PMC9826578 DOI: 10.1186/s40560-023-00650-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A substantial number of sepsis patients require specialized care, including multidisciplinary care, close monitoring, and artificial organ support in the intensive care unit (ICU). However, the efficacy of ICU management on clinical outcomes remains insufficiently researched. Therefore, we tested the hypothesis that ICU admission would increase the survival rate among sepsis patients. METHODS We conducted a retrospective study using the nationwide medical claims database of sepsis patients in Japan from 2010 to 2017 with propensity score matching to adjust for baseline imbalances. Patients aged over 20 years, with a combined diagnosis of presumed serious infection and organ failure, were included in this study. The primary outcome studied was the in-hospital mortality among non-ICU and ICU patients. In addition to propensity score matching, we performed a multivariable logistic regression analysis for the primary outcome. As the treatment policy was not extracted from the database, we performed sensitivity analyses to determine mortality differences in adults (20 ≤ age ≤ 64), independent patients, patients without malignant tumors, based on the assumption that treatment intensity is likely to increase in those population. RESULTS Among 1,167,901 sepsis patients (974,289 in non-ICU and 193,612 in ICU settings), the unadjusted in-hospital mortality was 22.5% among non-ICU patients and 26.2% among ICU patients (3.7% [95% CI 3.5-3.9]). After propensity score matching, the in-hospital mortality was 29.2% among non-ICU patients and 25.8% among ICU patients ([Formula: see text] 3.4% [95% CI [Formula: see text] 3.7 to [Formula: see text] 3.1]). In-hospital mortality with a multivariable regression analysis ([Formula: see text] 5.0% [95% CI [Formula: see text] 5.2 to [Formula: see text] 4.8]) was comparable with the results of the propensity score matching analysis. In the sensitivity analyses, the mortality differences between non-ICU and ICU in adults, independent patients, and patients without malignant tumors were [Formula: see text] 2.7% [95% CI [Formula: see text] 3.3 to [Formula: see text] 2.2], [Formula: see text] 5.8% [95% CI [Formula: see text] 6.4 to [Formula: see text] 5.2], and [Formula: see text] 1.3% [95% CI [Formula: see text] 1.7 to [Formula: see text] 1.0], respectively. CONCLUSIONS Herein, using the nationwide medical claims database, we demonstrated that ICU admission was potentially associated with decreasing in-hospital mortality among sepsis patients. Further investigations are warranted to validate these results and elucidate the mechanisms favoring ICU management on clinical outcomes.
Collapse
|
32
|
Lasithiotakis K, Kritsotakis EI, Kokkinakis S, Petra G, Paterakis K, Karali GA, Malikides V, Anastasiadis CS, Zoras O, Drakos N, Kehagias I, Kehagias D, Gouvas N, Kokkinos G, Pozotou I, Papatheodorou P, Frantzeskou K, Schizas D, Syllaios A, Palios IM, Nastos K, Perdikaris M, Michalopoulos NV, Margaris I, Lolis E, Dimopoulou G, Panagiotou D, Nikolaou V, Glantzounis GK, Pappas-Gogos G, Tepelenis K, Zacharioudakis G, Tsaramanidis S, Patsarikas I, Stylianidis G, Giannos G, Karanikas M, Kofina K, Markou M, Chrysos E. The Hellenic Emergency Laparotomy Study (HELAS): A Prospective Multicentre Study on the Outcomes of Emergency Laparotomy in Greece. World J Surg 2023; 47:130-139. [PMID: 36109368 PMCID: PMC9483423 DOI: 10.1007/s00268-022-06723-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Emergency laparotomy (EL) is accompanied by high post-operative morbidity and mortality which varies significantly between countries and populations. The aim of this study is to report outcomes of emergency laparotomy in Greece and to compare them with the results of the National Emergency Laparotomy Audit (NELA). METHODS This is a multicentre prospective cohort study undertaken between 01.2019 and 05.2020 including consecutive patients subjected to EL in 11 Greek hospitals. EL was defined according to NELA criteria. Demographics, clinical variables, and post-operative outcomes were prospectively registered in an online database. Multivariable logistic regression analysis was used to identify independent predictors of post-operative mortality. RESULTS There were 633 patients, 53.9% males, ASA class III/IV 43.6%, older than 65 years 58.6%. The most common operations were small bowel resection (20.5%), peptic ulcer repair (12.0%), adhesiolysis (11.8%) and Hartmann's procedure (11.5%). 30-day post-operative mortality reached 16.3% and serious complications occurred in 10.9%. Factors associated with post-operative mortality were increasing age and ASA class, dependent functional status, ascites, severe sepsis, septic shock, and diabetes. HELAS cohort showed similarities with NELA patients in terms of demographics and preoperative risk. Post-operative utilisation of ICU was significantly lower in the Greek cohort (25.8% vs 56.8%) whereas 30-day post-operative mortality was significantly higher (16.3% vs 8.7%). CONCLUSION In this study, Greek patients experienced markedly worse mortality after emergency laparotomy compared with their British counterparts. This can be at least partly explained by underutilisation of critical care by surgical patients who are at high risk for death.
Collapse
Affiliation(s)
- Konstantinos Lasithiotakis
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece. .,Department of General Surgery, University Hospital of Crete, 71110, Heraklion, Greece.
| | | | - Stamatios Kokkinakis
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece
| | - Georgia Petra
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece
| | - Konstantinos Paterakis
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece
| | - Garyfallia-Apostolia Karali
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece
| | - Vironas Malikides
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece
| | - Charalampos S. Anastasiadis
- Department of Surgical Oncology, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece
| | - Odysseas Zoras
- Department of Surgical Oncology, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece
| | - Nikolas Drakos
- Department of Surgery, School of Medicine, University General Hospital of Patras, University of Patras, Patras, Greece
| | - Ioannis Kehagias
- Department of Surgery, School of Medicine, University General Hospital of Patras, University of Patras, Patras, Greece
| | - Dimitrios Kehagias
- Department of Surgery, School of Medicine, University General Hospital of Patras, University of Patras, Patras, Greece
| | - Nikolaos Gouvas
- Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus
| | - Georgios Kokkinos
- Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus
| | - Ioanna Pozotou
- Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus
| | - Panayiotis Papatheodorou
- Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus
| | - Kyriakos Frantzeskou
- Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Syllaios
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ifaistion M. Palios
- Second Propaedeutic Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Nastos
- Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece
| | - Markos Perdikaris
- Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece
| | - Nikolaos V. Michalopoulos
- Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece
| | - Ioannis Margaris
- Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece
| | - Evangelos Lolis
- Department of Surgery, General Hospital of Volos, Volos, Greece
| | | | | | | | | | | | - Kostas Tepelenis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Georgios Zacharioudakis
- Department of Surgery, School of Medicine, Ippokrateio General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Savvas Tsaramanidis
- Department of Surgery, School of Medicine, Ippokrateio General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Patsarikas
- Department of Surgery, School of Medicine, Ippokrateio General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Georgios Giannos
- 2nd Department of Surgery, Evangelismos General Hospital, Athens, Greece
| | - Michael Karanikas
- Department of Surgery, School of Medicine, University General Hospital of Alexandroupolis, University of Thrace, Alexandroupolis, Greece
| | - Konstantinia Kofina
- Department of Surgery, School of Medicine, University General Hospital of Alexandroupolis, University of Thrace, Alexandroupolis, Greece
| | - Markos Markou
- Department of Surgery, School of Medicine, University General Hospital of Alexandroupolis, University of Thrace, Alexandroupolis, Greece
| | - Emmanuel Chrysos
- Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece
| |
Collapse
|
33
|
Alignment and authority: Federalism, social policy, and COVID-19 response. Health Policy 2023; 127:12-18. [PMID: 36435630 PMCID: PMC9674559 DOI: 10.1016/j.healthpol.2022.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 09/19/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
|
34
|
Pallarès N, Tebé C, Abelenda-Alonso G, Rombauts A, Oriol I, Simonetti AF, Rodríguez-Molinero A, Izquierdo E, Díaz-Brito V, Molist G, Gómez Melis G, Carratalà J, Videla S. Characteristics and Outcomes by Ceiling of Care of Subjects Hospitalized with COVID-19 During Four Waves of the Pandemic in a Metropolitan Area: A Multicenter Cohort Study. Infect Dis Ther 2023; 12:273-289. [PMID: 36495405 PMCID: PMC9736710 DOI: 10.1007/s40121-022-00705-w] [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: 07/12/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The profiles of patients with COVID-19 have been widely studied, but little is known about differences in baseline characteristics and in outcomes between subjects with a ceiling of care assigned at hospital admission and subjects without a ceiling of care. The aim of this study is to compare, by ceiling of care, clinical features and outcomes of hospitalized subjects during four waves of COVID-19 in a metropolitan area in Catalonia. METHODS Observational study conducted during the first (March-April 2020), second (October-November 2020), third (January-February 2021), and fourth wave (July-August 2021) of COVID-19 in five centers of Catalonia. All subjects were adults (> 18 years old) hospitalized with a proven SARS-CoV-2 infection and with therapeutic ceiling of care assessed by the attending physician at hospital admission. RESULTS A total of 5813 subjects were analyzed. Subjects with a ceiling of care were mainly older (difference in median age of 20 years), with more comorbidities (Charlson index 3 points higher) and with fewer clinical signs at baseline than patients without a ceiling of care. Some features of their clinical profiles changed among waves. There were differences in treatments received during hospital admission across waves, but not between subjects with and without a ceiling of care. Subjects with a ceiling of care had a death incidence more than four times the death incidence of subjects a without a ceiling of care (risk ratio (RR) ranging from 3.5 in the first wave to almost 6 in the third and fourth). Incidence of severe pneumonia and complications for subjects with a ceiling of care was around 1.5 times the incidence in subjects without a ceiling of care. DISCUSSION Analysis of hospitalized subjects with SARS-CoV-2 infection should be stratified according to therapeutic ceiling of care to avoid bias and outcome misestimation.
Collapse
Affiliation(s)
- Natàlia Pallarès
- grid.417656.7Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Avinguda de la Granvia de l’Hospitalet, 199, 08908 Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Cristian Tebé
- grid.417656.7Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Avinguda de la Granvia de l’Hospitalet, 199, 08908 Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Gabriela Abelenda-Alonso
- grid.411129.e0000 0000 8836 0780Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain ,grid.418284.30000 0004 0427 2257Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Alexander Rombauts
- grid.411129.e0000 0000 8836 0780Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain ,grid.418284.30000 0004 0427 2257Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Isabel Oriol
- grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain ,grid.418284.30000 0004 0427 2257Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain ,Department of Internal Medicine, Consorci Sanitari Integral, Barcelona, Spain
| | - Antonella F. Simonetti
- grid.413448.e0000 0000 9314 1427CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain ,Department of Internal Medicine, Consorci Sanitari Alt Penedès Garraf, Barcelona, Spain
| | | | | | - Vicens Díaz-Brito
- grid.466982.70000 0004 1771 0789Department Infectious Diseases, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain
| | - Gemma Molist
- grid.417656.7Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Avinguda de la Granvia de l’Hospitalet, 199, 08908 Barcelona, Spain
| | - Guadalupe Gómez Melis
- grid.6835.80000 0004 1937 028XDepartment of Statistics and Operations Research, Universitat Politècnica de Catalunya/Barcelonatech, Barcelona, Spain
| | - Jordi Carratalà
- grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain ,grid.411129.e0000 0000 8836 0780Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain ,grid.418284.30000 0004 0427 2257Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Sebastián Videla
- grid.411129.e0000 0000 8836 0780Department of Clinical Pharmacology, Bellvitge University Hospital, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | | |
Collapse
|
35
|
Ohbe H, Sasabuchi Y, Kumazawa R, Matsui H, Yasunaga H. Intensive Care Unit Occupancy in Japan, 2015-2018: A Nationwide Inpatient Database Study. J Epidemiol 2022; 32:535-542. [PMID: 33840654 PMCID: PMC9643790 DOI: 10.2188/jea.je20210016] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Detailed data on intensive care unit (ICU) occupancy in Japan are lacking. Using a nationwide inpatient database in Japan, we aimed to assess ICU bed occupancy to guide critical care utilization planning. METHODS We identified all ICU patients admitted from January 1, 2015 to December 31, 2018 to ICU-equipped hospitals participating in the Japanese Diagnosis Procedure Combination inpatient database. We assessed the trends in daily occupancy by counting the total number of occupied ICU beds on a given day divided by the total number of licensed ICU beds in the participating hospitals. We also assessed ICU occupancy for patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies. RESULTS Over the 4 study years, 1,379,618 ICU patients were admitted to 495 hospitals equipped with 5,341 ICU beds, accounting for 75% of all ICU beds in Japan. Mean ICU occupancy on any given day was 60%, with a range of 45.0% to 72.5%. Mean ICU occupancy did not change over the 4 years. Mean ICU occupancy was about 9% higher on weekdays than on weekends and about 5% higher in the coldest season than in the warmest season. For patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies, mean ICU occupancy was 24%, 0.5%, and 30%, respectively. CONCLUSION Only one-fourth of ICU beds were occupied by mechanically ventilated patients, suggesting that the critical care system in Japan has substantial surge capacity under normal temporal variation to care for critically ill patients.
Collapse
Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
36
|
Endo K, Mizuno K, Seki T, Joo WJ, Takeda C, Takeuchi M, Kawakami K. Intensive care unit versus high-dependency care unit admission on mortality in patients with septic shock: a retrospective cohort study using Japanese claims data. J Intensive Care 2022; 10:35. [PMID: 35869538 PMCID: PMC9306250 DOI: 10.1186/s40560-022-00627-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/09/2022] [Indexed: 12/13/2022] Open
Abstract
Background Septic shock is a common and life-threatening condition that requires intensive care. Intensive care units (ICUs) in Japan are classified into ICUs and high-dependency care units (HDUs), depending on presence of full-time certified intensivists and the number of assigned nurses. Compared with other developed countries, there are fewer intensive care beds and certified intensivists in Japan; therefore, non-intensivists often treat patients with septic shock in HDUs. It is unknown where we should treat patients with septic shock because no studies have compared the clinical outcomes between ICU and HDU treatment. This study aimed to elucidate which units should admit patients with septic shock by comparing mortality data and resource use between ICU and HDU admissions. Methods In this retrospective cohort study, we used a nationwide Japanese administrative database to identify adult patients with septic shock who were admitted to ICUs or HDUs between January 2010 and February 2021. The patients were divided into two groups, based on admittance to ICU or HDU on the day of hospitalization. The primary outcome was 30-day all-cause mortality adjusted for covariates using Cox regression analyses; the secondary outcomes were the length of ICU or HDU stay and length of hospital stay. Results Of the 10,818 eligible hospitalizations for septic shock, 6584 were in the ICU group, and 4234 were in the HDU group. Cox regression analyses revealed that patients admitted to the ICUs had lower 30-day mortality (adjusted hazard ratio: 0.89; 95% confidence interval: 0.83–0.96; P = 0.005). Linear regression analyses showed no significant difference in hospital length of stay or ICU or HDU length of stay. Conclusions An association was observed between ICU admission and lower 30-day mortality in patients with septic shock. These findings could provide essential insights for building a more appropriate treatment system.
Collapse
|
37
|
Selection criteria and triage in extracorporeal membrane oxygenation during coronavirus disease 2019. Curr Opin Crit Care 2022; 28:674-680. [PMID: 36302196 DOI: 10.1097/mcc.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Coronavirus disease 2019 (COVID-19) pandemic changed the way we had to approach hospital- and intensive care unit (ICU)-related resource management, especially for demanding techniques required for advanced support, including extracorporeal membrane oxygenation (ECMO). RECENT FINDINGS Availability of ICU beds and ECMO machines widely varies around the world. In critical conditions, such a global pandemic, the establishment of contingency capacity tiers might help in defining to which conditions and subjects ECMO can be offered. A frequent reassessment of the resource saturation, possibly integrated within a regional healthcare coordination system, may be of help to triage the patients who most likely will benefit from advanced techniques, especially when capacities are limited. SUMMARY Indications to ECMO during the pandemic should be fluid and may be adjusted over time. Candidacy of patients should follow the same prepandemic rules, taking into account the acute disease, the burden of any eventual comorbidity and the chances of a good quality of life after recovery; but the current capacity of healthcare system should also be considered, and frequently reassessed, possibly within a wide hub-and-spoke healthcare system. VIDEO ABSTRACT http://links.lww.com/COCC/A43.
Collapse
|
38
|
Hermes C, Gaidys U, Blanck-Köster K, Rost E, Petersen-Ewert C. Influence of working conditions and salary on agency work for intermediate and intensive care units. Med Klin Intensivmed Notfmed 2022:10.1007/s00063-022-00969-7. [DOI: 10.1007/s00063-022-00969-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/13/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022]
Abstract
Abstract
Background
Agency work in nursing is used as a form of labor to counter vacant staff positions in hospitals. Both hospital owners and nurses view this critically for different reasons.
Aim
The aim of this study was to assess what personal net income nurses in German intensive care units and intermediate care units consider “fair and sufficient” for their work (addressed in Part 1 of the survey) and what influence—aside from the salary—the working conditions have on the willingness to change to temporary work or back to a permanent position.
Methods
From September to October 2020, an anonymous online survey was conducted among nurses of intermediate care units, intensive care units, and special care units in German-speaking countries. Descriptive statistics were used for the analysis.
Result
Of 1203 participants, 86% (n = 1036) could be evaluated. None of the job satisfaction factors queried received four or five stars (maximum five stars) from those participating in the survey. The most unsatisfied group proved to be regularly employed nurses with an additional part-time job. Key job satisfaction factors differed markedly between the groups, with regular employees favoring consistency and stability. Agency workers prefer gaining experience in a broader range of tasks. Unreliable duty rosters and poor nurse to patient ratios were common points of criticism.
Conclusion
For job satisfaction, making nurses feel appreciated and respected is essential. This includes a guaranteed nurse to patient ratio and reliable duty rosters that also include tasks outside direct patient care. In order for nurses to leave agency work, it is necessary to take into account the differences in interests in terms of the focus of activity.
Collapse
|
39
|
McAuliffe E, Mulcahy Symmons S, Conlon C, Rogers L, De Brún A, Mannion M, Keane N, Glynn L, Ryan J, Quinlan D. COVID-19 community assessment hubs in Ireland: A study of staff and patient perceptions of their value. Health Expect 2022; 26:119-131. [PMID: 36333948 PMCID: PMC9854303 DOI: 10.1111/hex.13603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/14/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Critical care bed capacity per capita in Ireland is among the lowest in Europe. The COVID-19 pandemic has put additional strain on an over-stretched healthcare system. COVID-19 community assessment hubs (CAHs) were established to prevent unnecessary admission to acute hospitals and to reduce infection spread. OBJECTIVE The aim of this study was to assess the effectiveness and acceptability of CAHs and identify how the service might be improved or adapted for possible future use. DESIGN This was a mixed methods study, incorporating co-design with clinical stakeholders. Data collection was via an online survey and semistructured telephone interviews with staff and patients conducted between January and May 2021. SETTING AND PARTICIPANTS Thirty-one patients completed the survey and nine were interviewed. Twenty interviews were conducted with staff. RESULTS The findings suggest that the CAH model was successful in providing a dedicated pathway for assessing patients with COVID-19 symptoms, whilst mitigating the risk of infection. Patients were particularly positive about the timely, comprehensive and holistic care they received, as well as the accessibility of the clinics and the friendly attitudes of the staff. Staff welcomed the training and clinical protocols which contributed to their feelings of safety and competency in delivering care to this cohort of patients. They also highlighted the benefits of working in a multidisciplinary environment. Both staff and patients felt that the hubs could be repurposed for alternative use, including the treatment of chronic diseases. DISCUSSION This study describes staff and patients' experiences of these hubs. An unexpected outcome of this study is its demonstration of the true value of effective multidisciplinary working, not only for the staff who were deployed to this service but also for the patients in receipt of care in these hubs. CONCLUSION This multidisciplinary patient-centred service may provide a useful model for the delivery of other services currently delivered in hospital settings. PATIENT OR PUBLIC CONTRIBUTION An earlier phase of this study involved interviews with COVID-19-positive patients on a remote monitoring programme. The data informed this phase. Several of the authors had worked in the CAHs and provided valuable input into the design of the staff and patient interviews.
Collapse
Affiliation(s)
- Eilish McAuliffe
- IRIS Centre, School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
| | - Sophie Mulcahy Symmons
- IRIS Centre, School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
| | - Ciara Conlon
- Academic AffairsTrinity College DublinDublinIreland
| | - Lisa Rogers
- IRIS Centre, School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
| | - Aoife De Brún
- IRIS Centre, School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
| | | | - Niamh Keane
- Midwest Community Healthcare Organisation (CHO3)LimerickIreland
| | - Liam Glynn
- School of Medicine, University of Limerick & HRB Prmary Care Clinical Trials Network IrelandGalawyIreland
| | | | | |
Collapse
|
40
|
Darnell R, Newell C, Edwards J, Gendall E, Harrison D, Sprinckmoller S, Mouncey P, Gould D, Thomas M. Critical illness-related cardiac arrest: Protocol for an investigation of the incidence and outcome of cardiac arrest within intensive care units in the United Kingdom. J Intensive Care Soc 2022; 23:493-497. [PMID: 36751345 PMCID: PMC9679899 DOI: 10.1177/17511437211055899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Critical illness-related cardiac arrest (CIRCA) as a distinct entity is not well described epidemiologically. There is currently a knowledge gap regarding how many occur in the UK or the impact on patient outcome. The CIRCA study is a prospective multi-centre observational cohort study of patients in the United Kingdom experiencing a cardiac arrest while in a Critical Care Unit embedded in the Case Mix Programme and National Cardiac Arrest Audit. The duration of data collection is 12 months, with surviving patients and family members receiving questionnaire follow-up at 90 days, 180 days and 12 months. This paper describes the protocol for the CIRCA study which received favourable ethical opinion from South Central - Berkshire Research Ethics Committee and approval from the Health Research Authority. Study registration is on clinicaltrials.gov (NCT04219384).
Collapse
Affiliation(s)
- Robert Darnell
- Clinical Trials Unit, Intensive Care National Audit & Research
Centre (ICNARC), London, UK
| | | | - Julia Edwards
- Clinical Trials Unit, Intensive Care National Audit & Research
Centre (ICNARC), London, UK
| | - Emma Gendall
- Clinical Research Centre, Southmead Hospital, Bristol, UK
| | - David Harrison
- Clinical Trials Unit, Intensive Care National Audit & Research
Centre (ICNARC), London, UK
| | - Stefan Sprinckmoller
- Clinical Trials Unit, Intensive Care National Audit & Research
Centre (ICNARC), London, UK
| | - Paul Mouncey
- Clinical Trials Unit, Intensive Care National Audit & Research
Centre (ICNARC), London, UK
| | - Doug Gould
- Clinical Trials Unit, Intensive Care National Audit & Research
Centre (ICNARC), London, UK
| | - Matt Thomas
- Department of Anaesthesia, Southmead Hospital, Bristol, UK,Matt Thomas, Department of Anaesthesia, Southmead
Hospital, Bristol BS10 5NB, UK.
| |
Collapse
|
41
|
The unmet need for critical care at a quaternary paediatric intensive care unit in South Africa. S Afr Med J 2022; 112:871-878. [DOI: 10.7196/samj.2022.v112i11.16452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Indexed: 11/12/2022] Open
Abstract
Background. Paediatric intensive care, a valuable resource that improves the outcomes of critically ill children, is often scarce.
Objective. To evaluate the need for paediatric intensive care beds and compare the outcomes of admitted and non-admitted deserving cases.
Methods. A prospective evaluation of all bed requests, in terms of need for intensive care and outcomes of those admitted and not admitted to a paediatric intensive care unit (PICU), was performed between July 2017 and June 2018. Factors for refusal and for poor outcomes were evaluated.
Results. Of the 811 bed requests, 32.6% (n=264, p<0.001) were denied access. Of the 231 deserving cases who were denied access, 85.7% (n=198) were due to unavailability of a PICU bed. Patients not admitted to PICU had a twofold increased risk of dying compared with those admitted (34.4% v. 15.5% respectively, p<0.001), even though the patient characteristics of both groups were similar (age, gender and nutritional status). In those admitted, risk factors for mortality were requiring transfusion of blood and platelets (56.0%, p<0.001), requiring two or more inotropes (52.5%, p<0.001), instability on admission (41.3%, p<0.001), prior cardiac arrest (32.0%, p=0.021), severe acute malnutrition (26.9%, p=0.043), fungal infection (22.2%, p=0.004) and emergency admission (18.0%, p<0.001). In those not admitted, prior cardiac arrest (100%, p<0.001) and emergency referral (42.3%, p<0.001) were associated with adverse outcomes.
Conclusion. The need for PICU beds exceeds availability, with a consequent twofold increase in mortality among cases not admitted to PICU. Paediatric critical care services have increased at appropriate sites of need following completion of this study.
Collapse
|
42
|
Basurto A, Dawid H, Harting P, Hepp J, Kohlweyer D. How to design virus containment policies? A joint analysis of economic and epidemic dynamics under the COVID-19 pandemic. JOURNAL OF ECONOMIC INTERACTION AND COORDINATION 2022; 18:311-370. [PMID: 36320631 PMCID: PMC9614772 DOI: 10.1007/s11403-022-00369-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
We analyze the impact of different designs of COVID-19-related lockdown policies on economic loss and mortality using a micro-level simulation model, which combines a multi-sectoral closed economy with an epidemic transmission model. In particular, the model captures explicitly the (stochastic) effect of interactions between heterogeneous agents during different economic activities on virus transmissions. The empirical validity of the model is established using data on economic and pandemic dynamics in Germany in the first 6 months after the COVID-19 outbreak. We show that a policy-inducing switch between a strict lockdown and a full opening-up of economic activity based on a high incidence threshold is strictly dominated by alternative policies, which are based on a low incidence threshold combined with a light lockdown with weak restrictions of economic activity or even a continuous weak lockdown. Furthermore, also the ex ante variance of the economic loss suffered during the pandemic is substantially lower under these policies. Keeping the other policy parameters fixed, a variation of the consumption restrictions during the lockdown induces a trade-off between GDP loss and mortality. Furthermore, we study the robustness of these findings with respect to alternative pandemic scenarios and examine the optimal timing of lifting containment measures in light of a vaccination rollout in the population.
Collapse
Affiliation(s)
- Alessandro Basurto
- Bielefeld Graduate School of Economics and Management (BiGSEM), Bielefeld University, Bielefeld, Germany
| | - Herbert Dawid
- ETACE and Center for Mathematical Economics, Bielefeld University, Bielefeld, Germany
| | | | - Jasper Hepp
- Bielefeld Graduate School of Economics and Management (BiGSEM), Bielefeld University, Bielefeld, Germany
- ETACE and Center for Mathematical Economics, Bielefeld University, Bielefeld, Germany
- ETACE, Bielefeld University, Bielefeld, Germany
| | - Dirk Kohlweyer
- ETACE and Center for Mathematical Economics, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
43
|
Investigation of turning points in the effectiveness of Covid-19 social distancing. Sci Rep 2022; 12:17783. [PMID: 36273235 PMCID: PMC9588076 DOI: 10.1038/s41598-022-22747-3] [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: 02/18/2022] [Accepted: 10/19/2022] [Indexed: 01/19/2023] Open
Abstract
Covid-19 is the first digitally documented pandemic in history, presenting a unique opportunity to learn how to best deal with similar crises in the future. In this study we have carried out a model-based evaluation of the effectiveness of social distancing, using Austria and Slovenia as examples. Whereas the majority of comparable studies have postulated a negative relationship between the stringency of social distancing (reduction in social contacts) and the scale of the epidemic, our model has suggested a varying relationship, with turning points at which the system changes its predominant regime from 'less social distancing-more cumulative deaths and infections' to 'less social distancing-fewer cumulative deaths and infections'. This relationship was found to persist in scenarios with distinct seasonal variation in transmission and limited national intensive care capabilities. In such situations, relaxing social distancing during low transmission seasons (spring and summer) was found to relieve pressure from high transmission seasons (fall and winter) thus reducing the total number of infections and fatalities. Strategies that take into account this relationship could be particularly beneficial in situations where long-term containment is not feasible.
Collapse
|
44
|
Dibiasi C, Kimberger O, Bologheanu R, Staudinger T, Heinz G, Zauner C, Sengölge G, Schaden E. External validation of the ProVent score for prognostication of 1-year mortality of critically ill patients with prolonged mechanical ventilation: a single-centre, retrospective observational study in Austria. BMJ Open 2022; 12:e066197. [PMID: 36127078 PMCID: PMC9490575 DOI: 10.1136/bmjopen-2022-066197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES In critically ill patients requiring mechanical ventilation for at least 21 days, 1-year mortality can be estimated using the ProVent score, calculated from four variables (age, platelet count, vasopressor use and renal replacement therapy). We aimed to externally validate discrimination and calibration of the ProVent score and, if necessary, to update its underlying regression model. DESIGN Retrospective, observational, single-centre study. SETTING 11 intensive care units at one tertiary academic hospital. PATIENTS 780 critically ill adult patients receiving invasive mechanical ventilation for at least 21 days. PRIMARY OUTCOME MEASURE 1-year mortality after intensive care unit discharge. RESULTS 380 patients (49%) had died after 1 year. One-year mortality for ProVent scores from 0 to 5 were: 15%, 27%, 57%, 66%, 72% and 76%. Area under the receiver operating characteristic curve of the ProVent probability model was 0.76 (95% CI 0.72 to 0.79), calibration intercept was -0.43 (95% CI -0.59 to -0.27) and calibration slope was 0.76 (95% CI 0.62 to 0.89). Model recalibration and extension by inclusion of three additional predictors (total bilirubin concentration, enteral nutrition and surgical status) improved model discrimination and calibration. Decision curve analysis demonstrated that the original ProVent model had negative net benefit, which was avoided with the extended ProVent model. CONCLUSIONS The ProVent probability model had adequate discrimination but was miscalibrated in our patient cohort and, as such, could potentially be harmful. Use of the extended ProVent score developed by us could possibly alleviate this concern.
Collapse
Affiliation(s)
- Christoph Dibiasi
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Oliver Kimberger
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Razvan Bologheanu
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Thomas Staudinger
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Gottfried Heinz
- Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gürkan Sengölge
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Eva Schaden
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| |
Collapse
|
45
|
Wernly B, Rezar R, Flaatten H, Beil M, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Wolff G, Marsh B, Andersen FH, Moreno R, Leaver S, Wernly S, Boumendil A, De Lange DW, Guidet B, Jung C. Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe. J Intern Med 2022; 292:438-449. [PMID: 35398948 PMCID: PMC9115222 DOI: 10.1111/joim.13492] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe. OBJECTIVES The purpose of this post-hoc analysis of the prospective multicentre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019 pandemic. METHODS A total of 3105 critically ill patients aged 70 years and older were enrolled in this study (Central Europe: n = 1573; Northern Europe: n = 821; Southern Europe: n = 711). Generalised estimation equations were used to calculate adjusted odds ratios (aORs) to population averages. Data were adjusted for patient-specific variables (demographic, disease-specific) and health economic data (gross domestic product, health expenditure per capita). The primary outcome was any treatment limitation, and 90-day mortality was a secondary outcome. RESULTS The frequency of the primary endpoint (treatment limitation) was highest in Northern Europe (48%), intermediate in Central Europe (39%) and lowest in Southern Europe (24%). The likelihood for treatment limitations was lower in Southern than in Central Europe (aOR 0.39; 95% confidence interval [CI] 0.21-0.73; p = 0.004), even after multivariable adjustment, whereas no statistically significant differences were observed between Northern and Central Europe (aOR 0.57; 95%CI 0.27-1.22; p = 0.15). After multivariable adjustment, no statistically relevant mortality differences were found between Northern and Central Europe (aOR 1.29; 95%CI 0.80-2.09; p = 0.30) or between Southern and Central Europe (aOR 1.07; 95%CI 0.66-1.73; p = 0.78). CONCLUSION This study shows a north-to-south gradient in rates of treatment limitation in Europe, highlighting the heterogeneity of EoLC practices across countries. However, mortality rates were not affected by these results.
Collapse
Affiliation(s)
- Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jesper Fjølner
- Department of Anesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Raphael R Bruno
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Bernardo B Pinto
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Malte Kelm
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Sviri Sigal
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter V van Heerden
- Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Georg Wolff
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Brian Marsh
- Department of Critical Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department Of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, FCSaude-Universidade da Beira Interior, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive Care, St. George's University Hospital NHS Foundation Trust, London, UK
| | - Sarah Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Ariane Boumendil
- Inserm, Service de réanimation, Institut Pierre-Louis d'épidémiologie et de santé publique, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Inserm, Service de réanimation, Institut Pierre-Louis d'épidémiologie et de santé publique, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Christian Jung
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | -
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| |
Collapse
|
46
|
Hajjar LA, Quintão VC, Vieira AP, Nakada LN, Pearse RM, Ramirez MB, la Medina AR, Alvarez A, McLoghlin S, Boccalatte L, Padmore G, Feraudy I, Martinez M, Villablanca N, Pérez C, Calvache JA, Lincango E, Sosa R, Shu S, Riva J, Godinez L, Frias M, Major D, Licea M, Batista S, Charles S, Vaca M, Rosado ID, Borunda D, Zaky OB, Cardona CM, Carmona MJ, Stefani LC. Latin American surgical outcomes study: study protocol for a multicentre international observational cohort study of patient outcomes after surgery in Latin American countries. BJA OPEN 2022; 3:100030. [PMID: 37588582 PMCID: PMC10430816 DOI: 10.1016/j.bjao.2022.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/05/2022] [Indexed: 08/18/2023]
Abstract
Background Reported data suggest that 4.2 million deaths will occur within 30 days of surgery worldwide each year, half of which are in low- and middle-income countries. Postoperative complications are a leading cause of long-term morbidity and mortality. Patients who survive and leave the hospital after surgical complications regularly experience reductions in long-term survival and functional independence, resulting in increased costs. With a high volume of surgery performed, there is a growing perception of the substantial impact of even minor enhancements in perioperative care. The Latin American Surgical Outcomes Study (LASOS) is an international, multicentre, prospective cohort study of adults submitted to in-patient surgery in Latin America aiming to provide detailed data describing postoperative complications and surgical mortality. Methods LASOS is a 7 day cohort study of adults undergoing surgery in Latin America. Details of preoperative risk factors, intraoperative care, and postoperative outcomes will be collected. The primary outcome will be in-hospital postoperative complications of any cause. Secondary outcomes include in-hospital all-cause mortality, duration of hospital stay after surgery, and admission to a critical care unit within 30 days after surgery during the index hospitalisation. Results The LASOS results will be published in peer-reviewed journals, reported and presented at international meetings, and widely disseminated to patients and public in participating countries via mainstream and social media. Conclusions The LASOS may augment our understanding of postoperative complications and surgial mortality in Latin America. Clinical trial registration NCT05169164.
Collapse
Affiliation(s)
- Ludhmila A. Hajjar
- Academic Research Organization, Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Department of Cardiopneumology, Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vinícius C. Quintão
- Academic Research Organization, Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Discipline of Anaesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandra P.Z. Vieira
- Academic Research Organization, Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Letícia N. Nakada
- Department of Cardiopneumology, Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rupert M. Pearse
- Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Martha B.D. Ramirez
- Department of Clinical Epidemiology and Biostatistics, Anesthesiology Department, Pontificia Universidad Javeriana School of Medicine, Hospital Universitario San Ignacio, Bogota, Colombia
| | - Antonio R. la Medina
- Research Center for Global Surgery of Veracruz Hospital Español, Veracruz, Mexico
| | - Adrian Alvarez
- Department of Anaesthesiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Santiago McLoghlin
- Department of Anaesthesiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luis Boccalatte
- Department of Anaesthesiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Greg Padmore
- Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | | | | | | | | | | | | | - Rodrigo Sosa
- Hospital de Especialides Quirúrgicas del Instituto de Prevision Social, Assuncion, Paraguay
| | - Sebastian Shu
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Juan Riva
- Sanatorio Americano, Montevideo, Uruguay
| | - Lisbeth Godinez
- Hospital General de Enfermedades del Instituto Guatemalteco de Seguridad Social, Ciudad da Guatemala, Guatemala
| | - Melba Frias
- Hospital Nacional en Ciudad de Panama, Ciudad de Panama, Panama
| | - Don Major
- University of the West Indies, Nassau, Bahamas
| | - Miguel Licea
- Hospital Clínico Quirúrgico Hermanos Ameijeiras, La Habana, Cuba
| | - Sylvia Batista
- Centro de Diagnostico y Medicina Avanzada Telemedicina, Santo Domingo, Dominican Republic
| | - Shane Charles
- San Fernando General Hospital, San Fernando, Trinidad and Tobago
| | - Mayra Vaca
- Asociación de Médicos Anestesiólogos de Costa Rica, San José, Costa Rica
| | - Ismael D. Rosado
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de Mexico, Mexico
| | - Delia Borunda
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de Mexico, Mexico
| | | | | | - Maria J.C. Carmona
- Discipline of Anaesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luciana C. Stefani
- Department of Surgery, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
47
|
Kondziella D, Amiri M, Othman MH, Beghi E, Bodien YG, Citerio G, Giacino JT, Mayer SA, Lawson TN, Menon DK, Rass V, Sharshar T, Stevens RD, Tinti L, Vespa P, McNett M, Venkatasubba Rao CP, Helbok R. Incidence and prevalence of coma in the UK and the USA. Brain Commun 2022; 4:fcac188. [PMID: 36132425 PMCID: PMC9486895 DOI: 10.1093/braincomms/fcac188] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/19/2022] [Accepted: 07/14/2022] [Indexed: 11/14/2022] Open
Abstract
The epidemiology of coma is unknown because case ascertainment with traditional methods is difficult. Here, we used crowdsourcing methodology to estimate the incidence and prevalence of coma in the UK and the USA. We recruited UK and US laypeople (aged ≥18 years) who were nationally representative (i.e. matched for age, gender and ethnicity according to census data) of the UK and the USA, respectively, utilizing a crowdsourcing platform. We provided a description of coma and asked survey participants if they-'right now' or 'within the last year'-had a family member in coma. These participants (UK n = 994, USA n = 977) provided data on 30 387 family members (UK n = 14 124, USA n = 16 263). We found more coma cases in the USA (n = 47) than in the UK (n = 20; P = 0.009). We identified one coma case in the UK (0.007%, 95% confidence interval 0.00-0.04%) on the day of the survey and 19 new coma cases (0.13%, 95% confidence interval 0.08-0.21%) within the preceding year, resulting in an annual incidence of 135/100 000 (95% confidence interval 81-210) and a point prevalence of 7 cases per 100 000 population (95% confidence interval 0.18-39.44) in the UK. We identified five cases in the USA (0.031%, 95% confidence interval 0.01-0.07%) on the day of the survey and 42 new cases (0.26%, 95% confidence interval 0.19-0.35%) within the preceding year, resulting in an annual incidence of 258/100 000 (95% confidence interval 186-349) and a point prevalence of 31 cases per 100 000 population (95% confidence interval 9.98-71.73) in the USA. The five most common causes were stroke, medically induced coma, COVID-19, traumatic brain injury and cardiac arrest. To summarize, for the first time, we report incidence and prevalence estimates for coma across diagnosis types and settings in the UK and the USA using crowdsourcing methods. Coma may be more prevalent in the USA than in the UK, which requires further investigation. These data are urgently needed to expand the public health perspective on coma and disorders of consciousness.
Collapse
Affiliation(s)
- Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2100, Denmark
| | - Moshgan Amiri
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Marwan H Othman
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Ettore Beghi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan 20156, Italy
| | - Yelena G Bodien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Giuseppe Citerio
- NeuroIntensive Care, ASST di Monza, Monza 20900, Italy
- School of Medicine and Surgery, Università Milano Bicocca, Milan 20100, Italy
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Stephan A Mayer
- Department of Neurology, New York Medical College, Valhalla, NY 10595, USA
| | - Thomas N Lawson
- College of Nursing, The Ohio State University, Columbus, OH 43210, USA
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge CB2 2QQ, UK
| | - Verena Rass
- Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck, Innsbruck 6020, Austria
| | - Tarek Sharshar
- Neuro-anesthesiology and Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, Paris 75006, France
- Experimental Neuropathology, Infection and Epidemiology Department, Institut Pasteur, Paris 75015, France
| | - Robert D Stevens
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore 21287, MD, USA
| | - Lorenzo Tinti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan 20156, Italy
| | - Paul Vespa
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Molly McNett
- College of Nursing, The Ohio State University, Columbus, OH 43210, USA
| | - Chethan P Venkatasubba Rao
- Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine and CHI Baylor St Luke's Medical Center, Houston, TX 77030, USA
| | - Raimund Helbok
- Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck, Innsbruck 6020, Austria
| |
Collapse
|
48
|
Jha A, Ward T, Walker S, Goodwin AT, Chalmers JD. Review of the British Thoracic Society Winter Meeting 2021, 24-26 November 2021. Thorax 2022; 77:1030-1035. [PMID: 35907640 DOI: 10.1136/thorax-2022-219150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/13/2022] [Indexed: 11/04/2022]
Abstract
The Winter Meeting of the British Thoracic Society (BTS) is a platform for the latest clinical and scientific research in respiratory medicine. This review summarises the key symposia and presentations from the BTS Winter Meeting 2021 held online due to the COVID-19 pandemic.
Collapse
Affiliation(s)
- Akhilesh Jha
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Tom Ward
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Steven Walker
- School of Clinical Sciences, University of Bristol Academic Respiratory Unit, Westbury on Trym, UK
| | - Amanda T Goodwin
- Nottingham NIHR Respiratory Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| |
Collapse
|
49
|
Bruyneel A, Larcin L, Tack J, Van Den Bulke J, Pirson M. Association between nursing cost and patient outcomes in intensive care units: A retrospective cohort study of Belgian hospitals. Intensive Crit Care Nurs 2022; 73:103296. [PMID: 35871959 DOI: 10.1016/j.iccn.2022.103296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/07/2022] [Accepted: 06/28/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Hospitals with better nursing resources report more favourable patient outcomes with almost no difference in cost as compared to those with worse nursing resources. The aim of this study was to assess the association between nursing cost per intensive care unit bed and patient outcomes (mortality, readmission, and length of stay). METHODOLOGY This was a retrospective cohort study using data collected from the intensive care units of 17 Belgian hospitals from January 01 to December 31, 2018. Hospitals were dichotomized using median annual nursing cost per bed. A total of 18,235 intensive care unit stays were included in the study with 5,664 stays in the low-cost nursing group and 12,571 in the high-cost nursing group. RESULTS The rate of high length of stay outliers in the intensive care unit was significantly lower in the high-cost nursing group (9.2% vs 14.4%) compared to the low-cost nursing group. Intensive care unit readmission was not significantly different in the two groups. Mortality was lower in the high-cost nursing group for intensive care unit (9.9% vs 11.3%) and hospital (13.1% vs 14.6%) mortality. The nursing cost per intensive care bed was different in the two groups, with a median [IQR] cost of 159,387€ [140,307-166,690] for the low-cost nursing group and 214,032€ [198,094-230,058] for the high-cost group. In multivariate analysis, intensive care unit mortality (OR = 0.80, 95% CI: 0.69-0.92, p < 0.0001), in-hospital mortality (OR = 0.82, 95% CI: 0.72-0.93, p < 0.0001), and high length of stay outliers (OR = 0.48, 95% CI: 0.42-0.55, p < 0.0001) were lower in the high-cost nursing group. However, there was no significant effect on intensive care readmission between the two groups (OR = 1.24, 95% CI: 0.97-1.51, p > 0.05). CONCLUSIONS This study found that higher-cost nursing per bed was associated with significantly lower intensive care unit and in-hospital mortality rates, as well as fewer high length of stay outliers, but had no significant effect on readmission to the intensive care unit. .
Collapse
Affiliation(s)
- Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium; CHU Tivoli, La Louvière, Belgium. https://twitter.com/@ArnaudBruyneel
| | - Lionel Larcin
- Research Centre for Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Jérôme Tack
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium
| | - Julie Van Den Bulke
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| |
Collapse
|
50
|
Incidence and Outcomes of Cardiopulmonary Resuscitation in ICUs: Retrospective Cohort Analysis. Crit Care Med 2022; 50:1503-1512. [PMID: 35834661 DOI: 10.1097/ccm.0000000000005624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We aim to describe incidence and outcomes of cardiopulmonary resuscitation (CPR) efforts and their outcomes in ICUs and their changes over time. DESIGN Retrospective cohort analysis. SETTING Patient data documented in the Austrian Center for Documentation and Quality Assurance in Intensive Care database. PATIENTS Adult patients (age ≥ 18 yr) admitted to Austrian ICUs between 2005 and 2019. INTERVENTIONS None. MEASUREMENTS ANDN MAIN RESULTS Information on CPR was deduced from the Therapeutic Intervention Scoring System. End points were overall occurrence rate of CPR in the ICU and CPR for unexpected cardiac arrest after the first day of ICU stay as well as survival to discharge from the ICU and the hospital. Incidence and outcomes of ICU-CPR were compared between 2005 and 2009, 2010 and 2014, and 2015 and 2019 using chi-square test. A total of 525,518 first admissions and readmissions to ICU of 494,555 individual patients were included; of these, 72,585 patients (14.7%) died in hospital. ICU-CPR was performed in 20,668 (3.9%) admissions at least once; first events occurred on the first day of ICU admission in 15,266 cases (73.9%). ICU-CPR was first performed later during ICU stay in 5,402 admissions (1.0%). The incidence of ICU-CPR decreased slightly from 4.4% between 2005 and 2009, 3.9% between 2010 and 2014, and 3.7% between 2015 and 2019 (p < 0.001). A total of 7,078 (34.5%) of 20,499 patients who received ICU-CPR survived until hospital discharge. Survival rates varied slightly over the observation period; 59,164 (12.0%) of all patients died during hospital stay without ever receiving CPR in the ICU. CONCLUSIONS The incidence of ICU-CPR is approximately 40 in 1,000 admissions overall and approximately 10 in 1,000 admissions after the day of ICU admission. Short-term survival is approximately four out of 10 patients who receive ICU-CPR.
Collapse
|