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Gebremeskel GG, Tadesse DB, Haile TG. Mortality and morbidity in critically ill COVID-19 patients: A systematic review and meta-analysis. J Infect Public Health 2024; 17:102533. [PMID: 39243690 DOI: 10.1016/j.jiph.2024.102533] [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: 04/27/2024] [Revised: 07/13/2024] [Accepted: 08/25/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused 14.83 million deaths globally. This systematic review and meta-analysis aimed to provide a pooled estimate of the overall mortality and morbidity of critically ill COVID-19 patients. METHOD Four electronic databases, Medline/PubMed, the Cochrane Library, the WHO COVID-19 database, and the Web of Science, were used to identify relevant studies. Two authors independently screened the studies, evaluated the eligibility criteria and resolved discrepancies through discussion with the third author. The pooled effect size was computed using STATA software version 14. The Cochran Q test and I2 test were utilized to assess heterogeneity across the studies. Additionally, subgroup analysis, sensitivity analysis, and publication bias were evaluated. It is registered in Prospero with Prospero ID CRD42020212146. RESULTS A total of 1003 published articles were screened from various databases, and 24 studies involving a total of 142,291 critically ill COVID-19 participants were selected for inclusion in the review. Among the participants, 67 % were male, and the mean age was 63.43 + SD3.33 years. The mortality rate reported in the individual studies ranged from 4.5 % to 69.5 %. The findings from the analysis revealed that the overall pooled mortality rate was 34 % (95 % confidence interval: 31 %-37 %). Additionally, the findings showed that 62 % of critically ill COVID-19 patients required mechanical ventilation, while 68.7 % of these patients had chronic disease comorbidities. CONCLUSION Critically ill COVID-19 patients face a high-risk risk of death, with an estimate of about one in three patients dying from the virus. Notably, a substantial portion of critically ill COVID-19 patients (62 %) require mechanical ventilation; surprisingly, more than two-thirds of patients with COVID-19 have chronic disease comorbidities, highlighting the importance of managing comorbidities in this population.
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Affiliation(s)
| | - Degena Bahrey Tadesse
- Department of adult health nursing, school of nursing, college of health science, Aksum university, Axum, Tigray, Ethiopia
| | - Teklehaimanot Gereziher Haile
- Department of maternity and neonatal nursing, school of nursing, college of health science, Aksum university, Axum, Tigray, Ethiopia
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Zhao Y, Yao Z, Xu S, Yao L, Yu Z. Glucocorticoid therapy for acute respiratory distress syndrome: Current concepts. JOURNAL OF INTENSIVE MEDICINE 2024; 4:417-432. [PMID: 39310055 PMCID: PMC11411438 DOI: 10.1016/j.jointm.2024.02.002] [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: 10/23/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 09/25/2024]
Abstract
Acute respiratory distress syndrome (ARDS), a fatal critical disease, is induced by various insults. ARDS represents a major global public health burden, and the management of ARDS continues to challenge healthcare systems globally, especially during the pandemic of the coronavirus disease 2019 (COVID-19). There remains no confirmed specific pharmacotherapy for ARDS, despite advances in understanding its pathophysiology. Debate continues about the potential role of glucocorticoids (GCs) as a promising ARDS clinical therapy. Questions regarding GC agent, dose, and duration in patients with ARDS need to be answered, because of substantial variations in GC administration regimens across studies. ARDS heterogeneity likely affects the therapeutic actions of exogenous GCs. This review includes progress in determining the GC mechanisms of action and clinical applications in ARDS, especially during the COVID-19 pandemic.
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Affiliation(s)
- Yuanrui Zhao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhun Yao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Song Xu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Lan Yao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhui Yu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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3
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Goossen RL, van Vliet R, Bos LDJ, Buiteman-Kruizinga LA, Hollman MW, Myatra SN, Neto AS, Spronk PE, van der Woude MCE, van Meenen DMP, Paulus F, Schultz MJ. High PEEP/low FiO 2 ventilation is associated with lower mortality in COVID-19. J Crit Care 2024; 83:154854. [PMID: 38996499 DOI: 10.1016/j.jcrc.2024.154854] [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: 04/10/2024] [Revised: 06/07/2024] [Accepted: 06/23/2024] [Indexed: 07/14/2024]
Abstract
RATIONALE The positive end-expiratory pressure (PEEP) strategy in patients with coronavirus 2019 (COVID-19) acute respiratory distress syndrome (ARDS) remains debated. Most studies originate from the initial waves of the pandemic. Here we aimed to assess the impact of high PEEP/low FiO2 ventilation on outcomes during the second wave in the Netherlands. METHODS Retrospective observational study of invasively ventilated COVID-19 patients during the second wave. Patients were categorized based on whether they received high PEEP or low PEEP ventilation according to the ARDS Network tables. The primary outcome was ICU mortality, and secondary outcomes included hospital and 90-day mortality, duration of ventilation and length of stay, and the occurrence of kidney injury. Propensity matching was performed to correct for factors with a known relationship to ICU mortality. RESULTS This analysis included 790 COVID-ARDS patients. At ICU discharge, 32 (22.5%) out of 142 high PEEP patients and 254 (39.2%) out of 848 low PEEP patients had died (HR 0.66 [0.46-0.96]; P = 0.03). High PEEP was linked to improved secondary outcomes. Matched analysis did not change findings. CONCLUSIONS High PEEP ventilation was associated with improved ICU survival in patients with COVID-ARDS.
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Affiliation(s)
- Robin L Goossen
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands.
| | - Relin van Vliet
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Lieuwe D J Bos
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Laura A Buiteman-Kruizinga
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Department of Intensive Care, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Markus W Hollman
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Sheila N Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Peter E Spronk
- Department of Intensive Care, Gelre Hospitals, Apeldoorn, the Netherlands
| | | | - David M P van Meenen
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Faculty of Health, ACHIEVE, center of applied research, University of Applied Research, Amsterdam, the Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Medical University of Vienna, Vienna, Austria
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4
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Reizine F, Massart N, Mansour A, Fedun Y, Machut A, Vacheron CH, Savey A, Friggeri A, Lepape A. Relationship between SARS-CoV-2 infection and ICU-acquired candidemia in critically ill medical patients: a multicenter prospective cohort study. Crit Care 2024; 28:320. [PMID: 39334254 PMCID: PMC11429030 DOI: 10.1186/s13054-024-05104-w] [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: 08/19/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND While SARS-CoV2 infection has been shown to be a significant risk-factor for several secondary bacterial, viral and Aspergillus infections, its impact on intensive care unit (ICU)-acquired candidemia (ICAC) remains poorly explored. METHOD Using the REA-REZO network (French surveillance network of ICU-acquired infections), we included all adult patients hospitalized for a medical reason of admission in participating ICUs for at least 48 h from January 2020 to January 2023. To account for confounders, a non-parsimonious propensity score matching was performed. Rates of ICAC according to SARS-CoV2 status were compared in matched patients. Factors associated with ICAC in COVID-19 patients were also assessed using a Fine-Gray model. RESULTS A total of 55,268 patients hospitalized at least 48 h for a medical reason in 101 ICUs were included along the study period. Of those, 13,472 were tested positive for a SARS-CoV2 infection while 284 patients developed an ICAC. ICAC rate was higher in COVID-19 patients in both the overall population and the matched patients' cohort (0.8% (107/13,472) versus 0.4% (173/41,796); p < 0.001 and 0.8% (93/12,241) versus 0.5% (57/12,241); p = 0.004, respectively). ICAC incidence rate was also higher in those patients (incidence rate 0.51 per 1000 patients-days in COVID-19 patients versus 0.32 per 1000 patients-days; incidence rate ratio: 1.58 [95% CI:1.08-2.35]; p = 0.018). Finally, patients with ICAC had a higher ICU mortality rate (49.6% versus 20.2%; p < 0.001). CONCLUSION In this large multicenter cohort of ICU patients, although remaining low, the rate of ICAC was higher among COVID-19 patients.
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Affiliation(s)
- Florian Reizine
- Service de Réanimation Polyvalente, Centre Hospitalier de Vannes, 56000, Vannes, France.
| | - Nicolas Massart
- Service de Réanimation Polyvalente, Centre Hospitalier de Saint Brieuc, Saint-Brieuc, France
| | - Alexandre Mansour
- Service d'Anesthésie-Réanimation, CHU de Rennes, CHU Rennes, Rennes, France
| | - Yannick Fedun
- Service de Réanimation Polyvalente, Centre Hospitalier de Vannes, 56000, Vannes, France
| | - Anaïs Machut
- REA-REZO Infections Et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
| | - Charles-Hervé Vacheron
- REA-REZO Infections Et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
- Département d'Anesthésie Médecine Intensive Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
- PHE3ID, Centre International de Recherche en Infectiologie, Institut National de La Santé Et de La Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Anne Savey
- REA-REZO Infections Et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
- PHE3ID, Centre International de Recherche en Infectiologie, Institut National de La Santé Et de La Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Arnaud Friggeri
- REA-REZO Infections Et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
- Département d'Anesthésie Médecine Intensive Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
- PHE3ID, Centre International de Recherche en Infectiologie, Institut National de La Santé Et de La Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Alain Lepape
- REA-REZO Infections Et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
- Département d'Anesthésie Médecine Intensive Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
- PHE3ID, Centre International de Recherche en Infectiologie, Institut National de La Santé Et de La Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
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Elbaz M, Moshkovits I, Bar-On T, Goder N, Lichter Y, Ben-Ami R. Clinical prediction model for bacterial co-infection in hospitalized COVID-19 patients during four waves of the pandemic. Microbiol Spectr 2024:e0025124. [PMID: 39315820 DOI: 10.1128/spectrum.00251-24] [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: 01/26/2024] [Accepted: 08/14/2024] [Indexed: 09/25/2024] Open
Abstract
The reported estimates of bacterial co-infection in COVID-19 patients are highly variable. We aimed to determine the rates and risk factors of bacterial co-infection and develop a clinical prediction model to support early decision-making on antibiotic use. This is a retrospective cohort study conducted in a tertiary-level academic hospital in Israel between March 2020 and May 2022. All adult patients with severe COVID-19 who had a blood or lower respiratory specimen sent for microbiological analyses within 48 h of admission were included. The primary study endpoint was the prevalence of bacterial co-infection at the time of hospital admission. We created a prediction model using the R XGBoost package. The study cohort included 1,050 patients admitted with severe or critical COVID-19. Sixty-two patients (5.9%) had a microbiologically proven bacterial infection on admission. The variables with the greatest impact on the prediction model were age, comorbidities, functional capacity, and laboratory parameters. The model achieved perfect prediction on the training set (area under the curve = 1.0). When applied to the test dataset, the model achieved 56% and 78% specificity with the area under the receiver operating curve of 0.784. The negative and positive predictive values were 0.975 and 0.105, respectively. Applying the prediction model would have resulted in a 2.5-fold increase in appropriate antibiotic use and an 18% reduction in inappropriate use in patients with severe and critical COVID-19. The use of a clinical prediction model can support decisions to withhold empiric antimicrobial treatment at the time of hospital admission without adversely affecting patient outcomes. IMPORTANCE Estimates of bacterial coinfection in COVID-19 patients are highly variable and depend on many factors. Patients with severe or critical COVID-19 requiring intensive care unit admission have the highest risk of infection-related complications and death. Thus, the study of the incidence and risk factors for bacterial coinfection in this population is of special interest and may help guide empiric antibiotic therapy and avoid unnecessary antimicrobial treatment. The prediction model based on clinical criteria and simple laboratory tests may be a useful tool to predict bacterial co-infection in patients hospitalized with severe COVID-19.
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Affiliation(s)
- Meital Elbaz
- Infectious Disease Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itay Moshkovits
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Division of Anesthesia, Pain Management and Intensive Care, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Internal Medicine Department, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Tali Bar-On
- Internal Medicine Department, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Noam Goder
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Division of Anesthesia, Pain Management and Intensive Care, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Yael Lichter
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Division of Anesthesia, Pain Management and Intensive Care, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ronen Ben-Ami
- Infectious Disease Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Krisht AAH, Grapin K, de Beauchene RC, Bonnet B, Cassagnes L, Evrard B, Adda M, Souweine B, Dupuis C. SARS-CoV2 pneumonia patients admitted to the ICU: Analysis according to clinical and biological parameters and the extent of lung parenchymal lesions on chest CT scan, a monocentric observational study. PLoS One 2024; 19:e0308014. [PMID: 39298399 DOI: 10.1371/journal.pone.0308014] [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: 02/06/2024] [Accepted: 07/16/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND CT-scan and inflammatory and coagulation biomarkers could help in prognostication of COVID-19 in patients on ICU admission. OBJECTIVE The objectives of this study were to measure the prognostic value of the extent of lung parenchymal lesions on computed tomography (CT) and of several coagulation and inflammatory biomarkers, and to explore the characteristics of the patients depending on the extent of lung parenchymal lesions. DESIGN Retrospective monocentric observational study achieved on a dataset collected prospectively. SETTING Medical ICU of the university hospital of Clermont-Ferrand, France. PATIENTS All consecutive adult patients aged ≥18 years admitted between 20 March, 2020 and 31 August, 2021 for COVID-19 pneumonia. INTERVENTIONS Characteristics at baseline and during ICU stay, and outcomes at day 60 were recorded. The extent of lung parenchyma lesions observed on the chest CT performed on admission was established by artificial intelligence software. MEASUREMENTS Several clinical characteristics and laboratory features were collected on admission including plasma interleukin-6, HLA-DR monocytic-expression rate (mHLA-DR), and the extent of lung parenchymal lesions. Factors associated with day-60 mortality were investigated by uni- and multivariate survival analyses. RESULTS 270 patients were included. Inflammation biomarkers including the levels of neutrophils, CRP, ferritin and Il10 were the indices the most associated with the severity of the extent of the lung lesions. Patients with more extensive lung parenchymal lesions (≥ 75%) on admission had higher CRP serum levels. The extent of lung parenchymal lesions was associated with a decrease in the PaO2/FiO2 ratio(p<0.01), fewer ventilatory-free days (p = 0.03), and a higher death rate at day 60(p = 0.01). Extent of the lesion of more than 75% was independently associated with day-60 mortality (aHR = 1.72[1.06; 2.78], p = 0.03). The prediction of death at day 60 was improved when considering simultaneously biological and radiological markers obtained on ICU admission (AUC = 0.78). CONCLUSIONS The extent of lung parenchyma lesions on CT was associated with inflammation, and the combination of coagulation and inflammatory biomarkers and the extent of the lesions predicted the poorest outcomes.
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Affiliation(s)
- Abed Al Hadi Krisht
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | - Kévin Grapin
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | | | - Benjamin Bonnet
- CHU Clermont-Ferrand, Service d'Immunologie, Clermont-Ferrand, France
- Université Clermont Auvergne, Laboratoire d'Immunologie, ECREIN, UMR1019 UNH, UFR Médecine de Clermont-Ferrand, Clermont-Ferrand, France
| | - Lucie Cassagnes
- CHU Clermont-Ferrand, Service de Radiologie, Clermont-Ferrand, France
- Université Clermont Auvergne, Unité de Nutrition Humaine, INRAe, CRNH Auvergne, Clermont Ferrand, France
| | - Bertrand Evrard
- CHU Clermont-Ferrand, Service d'Immunologie, Clermont-Ferrand, France
- Université Clermont Auvergne, Laboratoire d'Immunologie, ECREIN, UMR1019 UNH, UFR Médecine de Clermont-Ferrand, Clermont-Ferrand, France
| | - Mireille Adda
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | - Bertrand Souweine
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS, LMGE, Clermont-Ferrand, France
| | - Claire Dupuis
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
- Université Clermont Auvergne, Unité de Nutrition Humaine, INRAe, CRNH Auvergne, Clermont Ferrand, France
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Liu S, Yu C, Tu Q, Zhang Q, Fu Z, Huang Y, He C, Yao L. Bacterial co-infection in COVID-19: a call to stay vigilant. PeerJ 2024; 12:e18041. [PMID: 39308818 PMCID: PMC11416760 DOI: 10.7717/peerj.18041] [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] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 08/13/2024] [Indexed: 09/25/2024] Open
Abstract
Co-infection with diverse bacteria is commonly seen in patients infected with the novel coronavirus, SARS-CoV-2. This type of co-infection significantly impacts the occurrence and development of novel coronavirus infection. Bacterial co-pathogens are typically identified in the respiratory system and blood culture, which complicates the diagnosis, treatment, and prognosis of COVID-19, and even exacerbates the severity of disease symptoms and increases mortality rates. However, the status and impact of bacterial co-infections during the COVID-19 pandemic have not been properly studied. Recently, the amount of literature on the co-infection of SARS-CoV-2 and bacteria has gradually increased, enabling a comprehensive discussion on this type of co-infection. In this study, we focus on bacterial infections in the respiratory system and blood of patients with COVID-19 because these infection types significantly affect the severity and mortality of COVID-19. Furthermore, the progression of COVID-19 has markedly elevated the antimicrobial resistance among specific bacteria, such as Klebsiella pneumoniae, in clinical settings including intensive care units (ICUs). Grasping these resistance patterns is pivotal for the optimal utilization and stewardship of antibiotics, including fluoroquinolones. Our study offers insights into these aspects and serves as a fundamental basis for devising effective therapeutic strategies. We primarily sourced our articles from PubMed, ScienceDirect, Scopus, and Google Scholar. We queried these databases using specific search terms related to COVID-19 and its co-infections with bacteria or fungi, and selectively chose relevant articles for inclusion in our review.
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Affiliation(s)
- Shengbi Liu
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Chao Yu
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Qin Tu
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Qianming Zhang
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Zuowei Fu
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Yifeng Huang
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Chuan He
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Lei Yao
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
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8
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Lai C, Shi R, Jelinski L, Lardet F, Fasan M, Ayed S, Belotti H, Biard N, Guérin L, Fage N, Fossé Q, Gobé T, Pavot A, Roger G, Yhuel A, Teboul JL, Pham T, Monnet X. Respiratory effects of prone position in COVID-19 acute respiratory distress syndrome differ according to the recruitment-to-inflation ratio: a prospective observational study. Ann Intensive Care 2024; 14:146. [PMID: 39292429 PMCID: PMC11411043 DOI: 10.1186/s13613-024-01375-2] [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: 03/07/2024] [Accepted: 09/01/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Improvements in oxygenation and lung mechanics with prone position (PP) in patients with acute respiratory distress syndrome (ARDS) are inconstant. The objectives of the study were (i) to identify baseline variables, including the recruitment-to-inflation ratio (R/I), associated with a positive response to PP in terms of oxygenation (improvement of the ratio of arterial oxygen partial pressure over the inspired oxygen fraction (PaO2/FiO2) ≥ 20 mmHg) and lung mechanics; (ii) to evaluate whether the response to the previous PP session is associated with the response to the next session. METHODS In this prospective, observational, single-center study in patients who underwent PP for ARDS due to COVID-19, respiratory variables were assessed just before PP and at the end of the session. Respiratory variables included mechanical ventilation settings and respiratory mechanics variables, including R/I, an estimate of the potential for lung recruitment compared to lung overinflation. RESULTS In 50 patients, 201 PP sessions lasting 19 ± 3 h were evaluated. Neuromuscular blockades were used in 116 (58%) sessions. The PaO2/FiO2 ratio increased from 109 ± 31 mmHg to 165 ± 65 mmHg, with an increase ≥ 20 mmHg in 142 (71%) sessions. In a mixed effect logistic regression, only pre-PP PaO2/FiO2 (OR 1.12 (95% CI [1.01-1.24])/every decrease of 10 mmHg, p = 0.034) in a first model and improvement in oxygenation at the previous PP session (OR 3.69 (95% CI [1.27-10.72]), p = 0.017) in a second model were associated with an improvement in oxygenation with PP. The R/I ratio (n = 156 sessions) was 0.53 (0.30-0.76), separating lower- and higher-recruiters. Whereas PaO2/FiO2 improved to the same level in both subgroups, driving pressure and respiratory system compliance improved only in higher-recruiters (from 14 ± 4 to 12 ± 4 cmH2O, p = 0.027, and from 34 ± 11 to 38 ± 13 mL/cmH2O, respectively, p = 0.014). CONCLUSIONS A lower PaO2/FiO2 at baseline and a positive O2-response at the previous PP session are associated with a PP-induced improvement in oxygenation. In higher-recruiters, lung mechanics improved along with oxygenation. Benefits of PP could thus be greater in these patients.
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Affiliation(s)
- Christopher Lai
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
- Inserm UMR S_999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, University Paris-Saclay, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.
| | - Rui Shi
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR S_999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, University Paris-Saclay, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Ludwig Jelinski
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Florian Lardet
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Marta Fasan
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Department of Surgery, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Veneto, Italy
| | - Soufia Ayed
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Hugo Belotti
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Nicolas Biard
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Laurent Guérin
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Nicolas Fage
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Quentin Fossé
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Thibaut Gobé
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Arthur Pavot
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Guillaume Roger
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Alex Yhuel
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Jean-Louis Teboul
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR S_999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, University Paris-Saclay, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Tai Pham
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP,, Université Paris-Saclay (UVSQ)-Université Paris-Sud, Villejuif, 94807, France
| | - Xavier Monnet
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR S_999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, University Paris-Saclay, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
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9
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Engelbogen B, Donaldson L, McAuley S, Fourlanos S. SARS-CoV-2 booster vaccination does not worsen glycemia in people with type 1 diabetes using insulin pumps: an observational study. Acta Diabetol 2024:10.1007/s00592-024-02372-4. [PMID: 39254746 DOI: 10.1007/s00592-024-02372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/28/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Despite an increased risk for adverse outcomes from SARS-CoV-2 infection among individuals with type 1 diabetes (T1D), vaccine hesitancy persists due to safety concerns including dysglycemia. The impact of booster vaccination on individuals using automated insulin delivery (AID) systems remains unclear. METHODS We used continuous glucose monitoring (CGM) data from 53 individuals with T1D using insulin pump therapy who received their third and/or fourth COVID-19 vaccination. CGM data from the 14 days before and 3 and 7 days after each vaccination were compared. The primary outcome was glucose time in range (TIR) (70-180 mg/dL) 3 and 7 days post-vaccination compared with the 14 days prior. Secondary outcomes included other CGM metrics such as time below range (< 70 mg/dL), time above range (> 180 mg/dL), mean glucose, co-efficient of variation and average total daily insulin. RESULTS The cohort comprised 53 adults (64% women, 64% AID), totaling 74 vaccination periods (84% Pfizer-BioNTech boosters), mean ± SD age 40.0 ± 15.9 years, duration of diabetes 26.0 ± 15.4 years. There was no significant difference between pre-vaccination TIR (61.0%±18.5) versus 3 (60.5%±22.8) and 7 days post-vaccination (60.2%±21.8; p = 0.79). Level 1 hypoglycemia, time in range 54-69 mg/dL, was lower 3 (1.1%±1.7) and 7 days post-vaccination (1.1%±1.6), compared with 14 days pre-vaccination (1.4%±1.4; p = 0.021). CONCLUSION The study provides evidence that SARS-CoV-2 booster vaccination does not acutely worsen glycemia in people with T1D receiving insulin pump therapy.
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Affiliation(s)
- Braden Engelbogen
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, Australia.
| | - Laura Donaldson
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Sybil McAuley
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, Australia
| | - Spiros Fourlanos
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, Melbourne, Australia
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10
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Jandric M, Zlojutro B, Momcicevic D, Dragic S, Kovacevic T, Djajic V, Stojiljkovic MP, Loncar-Stojiljkovic D, Skrbic R, Djuric DM, Kovacevic P. Do dynamic changes in haematological and biochemical parameters predict mortality in critically ill COVID-19 patients? Technol Health Care 2024:THC241006. [PMID: 39302399 DOI: 10.3233/thc-241006] [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: 09/22/2024]
Abstract
BACKGROUND Critically ill COVID-19 patients are usually subjected to clinical, laboratory, and radiological diagnostic procedures resulting in numerous findings. Utilizing these findings as indicators for disease progression or outcome prediction is particularly intriguing. OBJECTIVES Exploring the significance of dynamic changes in haematological and biochemical parameters in predicting the mortality of critically ill COVID-19 patients. METHODS The present study was a prospective and observational study involving mechanically ventilated 75 critically ill adult COVID-19 patients with hypoxemic respiratory failure. The collected data included baseline patient characteristics, treatment options, outcome, and laboratory findings at admission and 7 days after. The dynamics of the obtained findings were compared between survivors and non-survivors. RESULTS The 28-day survival rate was 61.3%. In the group of non-survivors significant dynamic changes were found for C-reactive protein (p= 0.001), interleukin-6 (p< 0.001), lymphocyte (p= 0.003), neutrophil-lymphocyte ratio (p= 0.003), platelets (p< 0.001), haemoglobin (p< 0.001), iron (p= 0.012), and total iron-binding capacity (p< 0.001). Statistically significant changes over time were found for ferritin (p= 0.010), D-dimer (p< 0.001), hs-troponin T (p< 0.002), lactate dehydrogenase (p= 0.001), glucose (p= 0.023), unsaturated iron-binding capacity (p= 0.008), and vitamin D (p< 0.001). CONCLUSION The dynamic changes in inflammatory, haematological and biochemical parameters can predict disease severity, and outcome.
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Affiliation(s)
- Milka Jandric
- University Clinical Centre of the Republic of Srpska, Dvanaest beba bb, Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- University Clinical Centre of the Republic of Srpska, Dvanaest beba bb, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Danica Momcicevic
- University Clinical Centre of the Republic of Srpska, Dvanaest beba bb, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Sasa Dragic
- University Clinical Centre of the Republic of Srpska, Dvanaest beba bb, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Tijana Kovacevic
- University Clinical Centre of the Republic of Srpska, Dvanaest beba bb, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Vlado Djajic
- University Clinical Centre of the Republic of Srpska, Dvanaest beba bb, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Milos P Stojiljkovic
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | | | - Ranko Skrbic
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Dragan M Djuric
- Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Pedja Kovacevic
- University Clinical Centre of the Republic of Srpska, Dvanaest beba bb, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
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11
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Helms J, Catoire P, Abensur Vuillaume L, Bannelier H, Douillet D, Dupuis C, Federici L, Jezequel M, Jozwiak M, Kuteifan K, Labro G, Latournerie G, Michelet F, Monnet X, Persichini R, Polge F, Savary D, Vromant A, Adda I, Hraiech S. Oxygen therapy in acute hypoxemic respiratory failure: guidelines from the SRLF-SFMU consensus conference. Ann Intensive Care 2024; 14:140. [PMID: 39235690 PMCID: PMC11377397 DOI: 10.1186/s13613-024-01367-2] [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: 06/17/2024] [Accepted: 08/09/2024] [Indexed: 09/06/2024] Open
Abstract
INTRODUCTION Although largely used, the place of oxygen therapy and its devices in patients with acute hypoxemic respiratory failure (ARF) deserves to be clarified. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and the French Emergency Medicine Society (Société Française de Médecine d'Urgence, SFMU) organized a consensus conference on oxygen therapy in ARF (excluding acute cardiogenic pulmonary oedema and hypercapnic exacerbation of chronic obstructive diseases) in December 2023. METHODS A committee without any conflict of interest (CoI) with the subject defined 7 generic questions and drew up a list of sub questions according to the population, intervention, comparison and outcomes (PICO) model. An independent work group reviewed the literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Fifteen experts in the field from both societies proposed their own answers in a public session and answered questions from the jury (a panel of 16 critical-care and emergency medicine physicians, nurses and physiotherapists without any CoI) and the public. The jury then met alone for 48 h to write its recommendations. RESULTS The jury provided 22 statements answering 11 questions: in patients with ARF (1) What are the criteria for initiating oxygen therapy? (2) What are the targets of oxygen saturation? (3) What is the role of blood gas analysis? (4) When should an arterial catheter be inserted? (5) Should standard oxygen therapy, high-flow nasal cannula oxygen therapy (HFNC) or continuous positive airway pressure (CPAP) be preferred? (6) What are the indications for non-invasive ventilation (NIV)? (7) What are the indications for invasive mechanical ventilation? (8) Should awake prone position be used? (9) What is the role of physiotherapy? (10) Which criteria necessarily lead to ICU admission? (11) Which oxygenation device should be preferred for patients for whom a do-not-intubate decision has been made? CONCLUSION These recommendations should optimize the use of oxygen during ARF.
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Affiliation(s)
- Julie Helms
- Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France.
- UMR 1260, Regenerative Nanomedicine (RNM), FMTS, INSERM (French National Institute of Health and Medical Research), Strasbourg, France.
| | - Pierre Catoire
- Emergency Medicine Department, University Hospital of Bordeaux, 1 Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Laure Abensur Vuillaume
- SAMU57, Service d'Accueil des Urgences, Centre Hospitalier Régional Metz-Thionville, 57530, Ars-Laquenexy, France
| | - Héloise Bannelier
- Service d'Accueil des Urgences - SMUR Hôpital Pitié Salpêtrière Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Delphine Douillet
- Department of Emergency Medicine, University Hospital of Angers, Angers, France
- UNIV Angers, UMR MitoVasc CNRS 6215 INSERM 1083, Angers, France
| | - Claire Dupuis
- CHU Clermont-Ferrand, Service de Réanimation Médicale, Clermont-Ferrand, France
- Unité de Nutrition Humaine, Université Clermont Auvergne, INRAe, CRNH Auvergne, 63000, Clermont-Ferrand, France
| | - Laura Federici
- Service d'Anesthésie Réanimation, Centre Hospitalier D'Ajaccio, Ajaccio, France
| | - Melissa Jezequel
- Unité de Soins Intensifs Cardiologiques, Hôpital de Saint Brieuc, Saint-Brieuc, France
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, CHU de Nice, 151 Route Saint Antoine de Ginestière, 06200, Nice, France
- UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | | | - Guylaine Labro
- Service de Réanimation Médicale GHRMSA, 68100, Mulhouse, France
| | - Gwendoline Latournerie
- Pole de Médecine d'Urgence- CHU Toulouse, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
| | - Fabrice Michelet
- Service de Réanimation, Hôpital de Saint Brieuc, Saint-Brieuc, France
| | - Xavier Monnet
- AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU 4 CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMAS, Université Paris-Saclay, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Romain Persichini
- Service de Réanimation et Soins Continus, CH de Saintes, Saintes, France
| | - Fabien Polge
- Hôpitaux Universitaires de Paris Centre Site Cochin APHP, Paris, France
| | - Dominique Savary
- Département de Médecine d'Urgences, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France
- IRSET Institut de Recherche en Santé, Environnement et Travail/Inserm EHESP - UMR_S1085, CAPTV CDC, 49000, Angers, France
| | - Amélie Vromant
- Service d'Accueil des Urgences, Hôpital La Pitié Salpetrière, Paris, France
| | - Imane Adda
- Department of Research, One Clinic, Paris, France
- PointGyn, Paris, France
| | - Sami Hraiech
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
- Faculté de Médecine, Centre d'Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
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12
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Beurton A, Kooistra EJ, De Jong A, Schiffl H, Jourdain M, Garcia B, Vimpère D, Jaber S, Pickkers P, Papazian L. Specific and Non-specific Aspects and Future Challenges of ICU Care Among COVID-19 Patients with Obesity: A Narrative Review. Curr Obes Rep 2024; 13:545-563. [PMID: 38573465 DOI: 10.1007/s13679-024-00562-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Since the end of 2019, the coronavirus disease 2019 (COVID-19) pandemic has infected nearly 800 million people and caused almost seven million deaths. Obesity was quickly identified as a risk factor for severe COVID-19, ICU admission, acute respiratory distress syndrome, organ support including mechanical ventilation and prolonged length of stay. The relationship among obesity; COVID-19; and respiratory, thrombotic, and renal complications upon admission to the ICU is unclear. RECENT FINDINGS The predominant effect of a hyperinflammatory status or a cytokine storm has been suggested in patients with obesity, but more recent studies have challenged this hypothesis. Numerous studies have also shown increased mortality among critically ill patients with obesity and COVID-19, casting doubt on the obesity paradox, with survival advantages with overweight and mild obesity being reported in other ICU syndromes. Finally, it is now clear that the increase in the global prevalence of overweight and obesity is a major public health issue that must be accompanied by a transformation of our ICUs, both in terms of equipment and human resources. Research must also focus more on these patients to improve their care. In this review, we focused on the central role of obesity in critically ill patients during this pandemic, highlighting its specificities during their stay in the ICU, identifying the lessons we have learned, and identifying areas for future research as well as the future challenges for ICU activity.
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Affiliation(s)
- Alexandra Beurton
- Department of Intensive Care, Hôpital Tenon, APHP, Paris, France.
- UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France.
| | - Emma J Kooistra
- Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
| | - Audrey De Jong
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, Montpellier, France
- Phymed Exp INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Helmut Schiffl
- Division of Nephrology, Department of Internal Medicine IV, University Hospital LMU Munich, Munich, Germany
| | - Mercedes Jourdain
- CHU Lille, Univ-Lille, INSERM UMR 1190, ICU Department, F-59037, Lille, France
| | - Bruno Garcia
- CHU Lille, Univ-Lille, INSERM UMR 1190, ICU Department, F-59037, Lille, France
| | - Damien Vimpère
- Anesthesia and Critical Care Department, Hôpital Necker, APHP, Paris, France
| | - Samir Jaber
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, Montpellier, France
- Phymed Exp INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
| | - Laurent Papazian
- Intensive Care Unit, Centre Hospitalier de Bastia, Bastia, Corsica, France
- Aix-Marseille University, Marseille, France
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13
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Zochios V, Yusuff H, Antonini MV. Prone Positioning and Right Ventricular Protection During Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. ASAIO J 2024; 70:e119-e122. [PMID: 38941486 DOI: 10.1097/mat.0000000000002261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Affiliation(s)
- Vasileios Zochios
- From the University Hospitals of Leicester National Health Service Trust, Glenfield Hospital Extracorporeal Membrane Oxygenation Unit, Leicester, United Kingdom
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Hakeem Yusuff
- From the University Hospitals of Leicester National Health Service Trust, Glenfield Hospital Extracorporeal Membrane Oxygenation Unit, Leicester, United Kingdom
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
| | - Marta Velia Antonini
- Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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14
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Gesser AF, Campos ML, Artismo RS, Karloh M, Matte DL. Impact of COVID-19 critical illness on functional status, fatigue symptoms, and health-related quality of life one-year after hospital discharge: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:4086-4097. [PMID: 37818936 DOI: 10.1080/09638288.2023.2266365] [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: 06/30/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE To estimate the prevalence and severity of impairments in functional status, fatigue, and health-related quality of life (HRQoL) among critical COVID-19 survivors one-year after hospital discharge. METHODS A systematic review was conducted following PRISMA statement and registered in PROSPERO (CRD42021258356), with searches in eight databases. Observational studies were selected. The prevalence meta-analysis of abnormalities was performed using random-effects models. Risk of bias was evaluated using the National Heart, Lung, and Blood Institute tool. RESULTS Twenty studies were included, with data collected between 12 and 13.5 months after hospital discharge and a total of 1828 participants. Of these, 71% were men, and 77.7% were intubated in the intensive care unit (ICU). Impairments and sequelae were identified in varying prevalence and degrees, with greater impact on functional capacity and physical components of fatigue and HRQoL. The prevalence of abnormalities of 32.3% [95% CI 23.9; 41.9] found in the meta-analysis is substantially high. Most studies were classified as having fair and poor quality. CONCLUSION Critical COVID-19 survivors experience impairments in functional status, fatigue, and HRQoL to varying degrees one-year after hospital discharge, particularly among patients who stayed in the ICU and on MV for a prolonged period.
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Affiliation(s)
- Ana Flávia Gesser
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Mariana Lanzoni Campos
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Regiana Santos Artismo
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
- Postgraduate Program in Human Movement Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Manuela Karloh
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
- Department of Physiotherapy, Center of Health and Sport Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Darlan Laurício Matte
- Master's Program in Physiotherapy, University of the State of Santa Catarina, Florianópolis, Brazil
- Postgraduate Program in Human Movement Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
- Department of Physiotherapy, Center of Health and Sport Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
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15
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Goury A, Houlla Z, Jozwiak M, Urbina T, Turpin M, Lavalard A, Laghlam D, Voicu S, Rosman J, Coutureau C, Mourvillier B. Effect of noninvasive ventilation on mortality and clinical outcomes among patients with severe hypoxemic COVID-19 pneumonia after high-flow nasal oxygen failure: a multicenter retrospective French cohort with propensity score analysis. Respir Res 2024; 25:279. [PMID: 39010097 PMCID: PMC11251296 DOI: 10.1186/s12931-024-02873-4] [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: 12/01/2023] [Accepted: 06/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND We assessed the effect of noninvasive ventilation (NIV) on mortality and length of stay after high flow nasal oxygenation (HFNO) failure among patients with severe hypoxemic COVID-19 pneumonia. METHODS In this multicenter, retrospective study, we enrolled COVID-19 patients admitted in intensive care unit (ICU) for severe COVID-19 pneumonia with a HFNO failure from December 2020 to January 2022. The primary outcome was to compare the 90-day mortality between patients who required a straight intubation after HFNO failure and patients who received NIV after HFNO failure. Secondary outcomes included ICU and hospital length of stay. A propensity score analysis was performed to control for confounding factors between groups. Exploratory outcomes included a subgroup analysis for 90-day mortality. RESULTS We included 461 patients with HFNO failure in the analysis, 233 patients in the straight intubation group and 228 in the NIV group. The 90-day mortality did not significantly differ between groups, 58/228 (25.4%) int the NIV group compared with 59/233 (25.3%) in the straight intubation group, with an adjusted hazard ratio (HR) after propensity score weighting of 0.82 [95%CI, 0.50-1.35] (p = 0.434). ICU length of stay was significantly shorter in the NIV group compared to the straight intubation group, 10.0 days [IQR, 7.0-19.8] versus 18.0 days [IQR,11.0-31.0] with a propensity score weighted HR of 1.77 [95%CI, 1.29-2.43] (p < 0.001). A subgroup analysis showed a significant increase in mortality rate for intubated patients in the NIV group with 56/122 (45.9%), compared to 59/233 (25.3%) for patients in the straight intubation group (p < 0.001). CONCLUSIONS In severely hypoxemic COVID-19 patients, no significant differences were observed on 90-day mortality between patients receiving straight intubation and those receiving NIV after HFNO failure. NIV strategy was associated with a significant reduction in ICU length of stay, despite an increase in mortality in the subgroup of patients finally intubated.
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Affiliation(s)
- Antoine Goury
- Unité de Médecine Intensive et Réanimation Polyvalente, CHU Reims, Reims, F-51100, France.
| | - Zeyneb Houlla
- Unité de Médecine Intensive et Réanimation Polyvalente, CHU Reims, Reims, F-51100, France
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet 1, Nice, France
- UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Matthieu Turpin
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alexandra Lavalard
- Unité de Réanimation Polyvalente, Centre Hospitalier de Troyes, Troyes, France
| | - Driss Laghlam
- Service de Médecine Intensive et Réanimation, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sebastian Voicu
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jeremy Rosman
- Unité de Soins Intensifs et Réanimation, Groupe Hospitalier de Territoire Nord-Ardennes, Charleville-Mézières, France
| | - Claire Coutureau
- Université de Reims Champagne-Ardenne, VieFra, Reims, F-51100, France
- Unité d'Aide Méthodologique, CHU Reims, Reims, F-51100, France
| | - Bruno Mourvillier
- Unité de Médecine Intensive et Réanimation Polyvalente, CHU Reims, Reims, F-51100, France
- Université de Reims Champagne-Ardenne, EA-4684 CardioVir, Reims, F-51100, France
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16
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Seow D, Khor YH, Khung SW, Smallwood DM, Ng Y, Pascoe A, Smallwood N. High-flow nasal oxygen therapy compared with conventional oxygen therapy in hospitalised patients with respiratory illness: a systematic review and meta-analysis. BMJ Open Respir Res 2024; 11:e002342. [PMID: 39009460 PMCID: PMC11268052 DOI: 10.1136/bmjresp-2024-002342] [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: 01/26/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND High-flow nasal oxygen therapy (HFNO) is used in diverse hospital settings to treat patients with acute respiratory failure (ARF). This systematic review aims to summarise the evidence regarding any benefits HFNO therapy has compared with conventional oxygen therapy (COT) for patients with ARF. METHODS Three databases (Embase, Medline and CENTRAL) were searched on 22 March 2023 for studies evaluating HFNO compared with COT for the treatment of ARF, with the primary outcome being hospital mortality and secondary outcomes including (but not limited to) escalation to invasive mechanical ventilation (IMV) or non-invasive ventilation (NIV). Risk of bias was assessed using the Cochrane risk-of-bias tool (randomised controlled trials (RCTs)), ROBINS-I (non-randomised trials) or Newcastle-Ottawa Scale (observational studies). RCTs and observational studies were pooled together for primary analyses, and secondary analyses used RCT data only. Treatment effects were pooled using the random effects model. RESULTS 63 studies (26 RCTs, 13 cross-over and 24 observational studies) were included, with 10 230 participants. There was no significant difference in the primary outcome of hospital mortality (risk ratio, RR 1.08, 95% CI 0.93 to 1.26; p=0.29; 17 studies, n=5887) between HFNO and COT for all causes ARF. However, compared with COT, HFNO significantly reduced the overall need for escalation to IMV (RR 0.85, 95% CI 0.76 to 0.95 p=0.003; 39 studies, n=8932); and overall need for escalation to NIV (RR 0.70, 95% CI 0.50 to 0.98; p=0.04; 16 studies, n=3076). In subgroup analyses, when considering patients by illness types, those with acute-on-chronic respiratory failure who received HFNO compared with COT had a significant reduction in-hospital mortality (RR 0.58, 95% CI 0.37 to 0.91; p=0.02). DISCUSSION HFNO was superior to COT in reducing the need for escalation to both IMV and NIV but had no impact on the primary outcome of hospital mortality. These findings support recommendations that HFNO may be considered as first-line therapy for ARF. PROSPERO REGISTRATION NUMBER CRD42021264837.
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Affiliation(s)
- Daniel Seow
- Department of Internal Medicine, Sengkang General Hospital, Singapore
| | - Yet H Khor
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Su-Wei Khung
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - David M Smallwood
- Department of Respiratory Medicine, Western Health, Footscray, Victoria, Australia
- Department of Medical Education, University of Melbourne, Parkville, Victoria, Australia
| | - Yvonne Ng
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
| | - Amy Pascoe
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Natasha Smallwood
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
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Fernandes Lira JG, Alves de Olinda R, Correia Basto da Silva G, Leal de Oliveira L, de Alencar Neta RL, Vilar Cardoso N, Adami F, da Silva Paiva L. Sociodemographic Profile and Risk Factors for the Evolution of Patients with COVID-19 in ICUs in Brazil: A Cross-Sectional Study. ScientificWorldJournal 2024; 2024:2927407. [PMID: 39040155 PMCID: PMC11262879 DOI: 10.1155/2024/2927407] [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: 03/25/2024] [Revised: 06/24/2024] [Accepted: 07/01/2024] [Indexed: 07/24/2024] Open
Abstract
This is a cross-sectional study, with secondary data from Brazilian hospitals in the state of Paraíba, between January 2021 and January 2022. The evolution of clinical cases configured the dependent variable (cure or death), while the predictive variables were sociodemographic data, risk factors, use of ventilatory support, and vaccination against COVID-19. With the help of R software, the following tests were used: chi-square, Pearson's chi-square, and Fisher's exact adherence. Simple logistic regression models were constructed, and odds ratios (95% CI) were estimated using the LR test and Wald test. 7373 cases were reported, with a mean age of 58.1. Of the reported cases, 63.8% died. The most frequent sociodemographic profile included male people, of mixed race, with less than eight years of schooling. Chronic cardiovascular disease (OR 1.28; 95% CI: 1.13-1.45), diabetes (OR 1.41; 95% CI: 1.24-1.61), lung disease (OR 1.52; 95% CI: 1.11-2.09), and the use of invasive ventilatory support (OR 14.1; 95% CI: 10.56-18.59) were all associated with increased mortality. Nonvaccination was associated with a decreased risk of death (OR 0.74; 95% CI: 0.65-0.84). Male patients, nonwhite, and those with low education were more likely to have a worse clinical outcome. The risk factors studied were related to deaths, and those who did not require ventilatory support were related to cure.
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Affiliation(s)
| | - Ricardo Alves de Olinda
- State University of Paraíba, Baraúnas Street, 351-Universitário, Campina Grande, PB 58429-500, Brazil
| | | | - Luzibênia Leal de Oliveira
- Federal University of Campina Grande, Juvêncio Arruda Avenue, 795-Bodocongó, Campina Grande, PB 58429-600, Brazil
| | | | - Nívea Vilar Cardoso
- Federal University of Campina Grande, Juvêncio Arruda Avenue, 795-Bodocongó, Campina Grande, PB 58429-600, Brazil
| | - Fernando Adami
- ABC Medical School, Lauro Gomes Avenue, 2000-Vila Sacadura Cabral, Santo André, SP 09060-870, Brazil
| | - Laércio da Silva Paiva
- ABC Medical School, Lauro Gomes Avenue, 2000-Vila Sacadura Cabral, Santo André, SP 09060-870, Brazil
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18
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Oliva I, Ferré C, Daniel X, Cartanyà M, Villavicencio C, Salgado M, Vidaur L, Papiol E, de Molina FG, Bodí M, Herrera M, Rodríguez A. Risk factors and outcome of acute kidney injury in critically ill patients with SARS-CoV-2 pneumonia: a multicenter study. Med Intensiva 2024:S2173-5727(24)00176-0. [PMID: 39003118 DOI: 10.1016/j.medine.2024.06.022] [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: 02/11/2024] [Revised: 05/06/2024] [Accepted: 06/07/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE To assess incidence, risk factors and impact of acute kidney injury(AKI) within 48 h of intensive care unit(ICU) admission on ICU mortality in patients with SARS-CoV-2 pneumonia. To assess ICU mortality and risk factors for continuous renal replacement therapy (CRRT) in AKI I and II patients. DESIGN Retrospective observational study. SETTING Sixty-seven ICU from Spain, Andorra, Ireland. PATIENTS 5399 patients March 2020 to April 2022. MAIN VARIABLES OF INTEREST Demographic variables, comorbidities, laboratory data (worst values) during the first two days of ICU admission to generate a logistic regression model describing independent risk factors for AKI and ICU mortality. AKI was defined according to current international guidelines (kidney disease improving global outcomes, KDIGO). RESULTS Of 5399 patients included 1879 (34.8%) developed AKI. These patients had higher ICU mortality and AKI was independently associated with a higher ICU mortality (HR 1.32 CI 1.17-1.48; p < 0.001). Male gender, hypertension, diabetes, obesity, chronic heart failure, myocardial dysfunction, higher severity scores, and procalcitonine were independently associated with the development of AKI. In AKI I and II patients the need for CRRT was 12.6% (217/1710). In these patients, APACHE II, need for mechanical ventilation in the first 24 h after ICU admission and myocardial dysfunction were associated with risk of needing CRRT. AKI I and II patients had a high ICU mortality (38.5%), especially if CRRT were required (64.1% vs. 34,8%; p < 0.001). CONCLUSIONS Critically ill patients with SARS-CoV-2 pneumonia and AKI have a high ICU mortality. Even AKI I and II stages are associated with high risk of needing CRRT and ICU mortality.
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Affiliation(s)
- Iban Oliva
- Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain.
| | - Cristina Ferré
- Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain
| | - Xavier Daniel
- Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain
| | - Marc Cartanyà
- Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain
| | | | - Melina Salgado
- Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain
| | - Loreto Vidaur
- Critical Care Department, Donostia University Hospital, San Sebastian, Spain
| | - Elisabeth Papiol
- Critical Care Department, Vall d'Hebron Hospital, Barcelona, Spain
| | | | - María Bodí
- Critical Care Department, Joan XXIII University Hospital, Tarragona, Spain
| | - Manuel Herrera
- Critical Care Department, Regional University Hospital of Malaga, Malaga, Spain
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19
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Secco K, Baumann PM, Pöttler T, Aberer F, Cigler M, Elsayed H, Harer CM, Weitgasser R, Schütz-Fuhrmann I, Mader JK. Glycemic Control Assessed by Intermittently Scanned Glucose Monitoring in Type 1 Diabetes during the COVID-19 Pandemic in Austria. SENSORS (BASEL, SWITZERLAND) 2024; 24:4514. [PMID: 39065912 PMCID: PMC11280813 DOI: 10.3390/s24144514] [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: 06/12/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE The aim of this analysis was to assess glycemic control before and during the coronavirus disease (COVID-19) pandemic. METHODS Data from 64 (main analysis) and 80 (sensitivity analysis) people with type 1 diabetes (T1D) using intermittently scanned continuous glucose monitoring (isCGM) were investigated retrospectively. The baseline characteristics were collected from electronic medical records. The data were examined over three periods of three months each: from 16th of March 2019 until 16th of June 2019 (pre-pandemic), from 1st of December 2019 until 29th of February 2020 (pre-lockdown) and from 16th of March 2020 until 16th of June 2020 (lockdown 2020), representing the very beginning of the COVID-19 pandemic and the first Austrian-wide lockdown. RESULTS For the main analysis, 64 individuals with T1D (22 female, 42 male), who had a mean glycated hemoglobin (HbA1c) of 58.5 mmol/mol (51.0 to 69.3 mmol/mol) and a mean diabetes duration 13.5 years (5.5 to 22.0 years) were included in the analysis. The time in range (TIR[70-180mg/dL]) was the highest percentage of measures within all three studied phases, but the lockdown 2020 phase delivered the best data in all these cases. Concerning the time below range (TBR[<70mg/dL]) and the time above range (TAR[>180mg/dL]), the lockdown 2020 phase also had the best values. Regarding the sensitivity analysis, 80 individuals with T1D (26 female, 54 male), who had a mean HbA1c of 57.5 mmol/mol (51.0 to 69.3 mmol/mol) and a mean diabetes duration of 12.5 years (5.5 to 20.7 years), were included. The TIR[70-180mg/dL] was also the highest percentage of measures within all three studied phases, with the lockdown 2020 phase also delivering the best data in all these cases. The TBR[<70mg/dL] and the TAR[>180mg/dL] underscored the data in the main analysis. CONCLUSION Superior glycemic control, based on all parameters analyzed, was achieved during the first Austrian-wide lockdown compared to prior periods, which might be a result of reduced daily exertion or more time spent focusing on glycemic management.
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Affiliation(s)
- Katharina Secco
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Petra Martina Baumann
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Tina Pöttler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Monika Cigler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Hesham Elsayed
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Clemens Martin Harer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
| | - Raimund Weitgasser
- Department of Internal Medicine and Diabetology, Private Clinic Wehrle-Diakonissen, 5026 Salzburg, Austria;
| | - Ingrid Schütz-Fuhrmann
- 3rd Medical Division for Metabolic Diseases and Nephrology, Hospital Hietzing, 1130 Vienna, Austria;
- Institute for Metabolic Diseases and Nephrology, Karl-Landsteiner Institute, 1130 Vienna, Austria
| | - Julia Katharina Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (K.S.); (P.M.B.); (T.P.); (F.A.); (M.C.); (H.E.); (C.M.H.)
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20
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Pacheco-García U, Varela-López E, Serafín-López J. Immune Stimulation with Imiquimod to Best Face SARS-CoV-2 Infection and Prevent Long COVID. Int J Mol Sci 2024; 25:7661. [PMID: 39062904 PMCID: PMC11277483 DOI: 10.3390/ijms25147661] [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: 05/24/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Through widespread immunization against SARS-CoV-2 prior to or post-infection, a substantial segment of the global population has acquired both humoral and cellular immunity, and there has been a notable reduction in the incidence of severe and fatal cases linked to this virus and accelerated recovery times for those infected. Nonetheless, a significant demographic, comprising around 20% to 30% of the adult population, remains unimmunized due to diverse factors. Furthermore, alongside those recovered from the infection, there is a subset of the population experiencing persistent symptoms referred to as Long COVID. This condition is more prevalent among individuals with underlying health conditions and immune system impairments. Some Long COVID pathologies stem from direct damage inflicted by the viral infection, whereas others arise from inadequate immune system control over the infection or suboptimal immunoregulation. There are differences in the serum cytokines and miRNA profiles between infected individuals who develop severe COVID-19 or Long COVID and those who control adequately the infection. This review delves into the advantages and constraints associated with employing imiquimod in human subjects to enhance the immune response during SARS-CoV-2 immunization. Restoration of the immune system can modify it towards a profile of non-susceptibility to SARS-CoV-2. An adequate immune system has the potential to curb viral propagation, mitigate symptoms, and ameliorate the severe consequences of the infection.
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Affiliation(s)
- Ursino Pacheco-García
- Department of Cardio-Renal Pathophysiology, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City 14080, Mexico
| | - Elvira Varela-López
- Laboratory of Translational Medicine, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City 14080, Mexico;
| | - Jeanet Serafín-López
- Department of Immunology, Escuela Nacional de Ciencias Biológicas (ENCB), Instituto Politécnico Nacional (IPN), Mexico City 11340, Mexico;
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21
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Elrakaiby GB, Ghabashi AE, Sakhakhni AM, Allaf FM, Alamoudi SM, Khan MA. Clinical Characteristics and Risk Factors of Mechanical Ventilation Among COVID-19 Patients on High-Flow Nasal Oxygen (HFNO). Cureus 2024; 16:e65462. [PMID: 39184683 PMCID: PMC11345115 DOI: 10.7759/cureus.65462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/27/2024] Open
Abstract
INTRODUCTION COVID-19 is a viral infection affecting the respiratory system, primarily. It has spread globally ever since it first appeared in China in 2019. The use of high-flow nasal oxygen (HFNO) for the treatment of COVID-19 has not been well established. OBJECTIVES The primary objectives of this study are to observe the success of HFNO in preventing escalation to mechanical ventilation (MV) and to measure the prevalence of HFNO in King Abdulaziz Medical City (KAMC). The secondary objective is to describe patients who received HFNO clinically. METHODS This is a retrospective cohort study of all polymerase chain reaction (PCR)-confirmed COVID-19 patients who require oxygen therapy in KAMC, Jeddah between March 1st, 2020, and December 31st, 2020. Any patients requiring MV on admission were excluded. RESULTS 259 patients fit the inclusion criteria, and 25.5% of those included received HFNO. The number of non-survivors is 47 (18.1%). Mortality for HFNO, MV, and intensive care unit (ICU) are 30 (45.5%), 31 (60.8%), and 24 (32%), respectively. Their demographic was as follows; 160 were males, with a mean age of 60.93±15.01. Regarding the types of oxygen, low-flow nasal oxygen (LFNO) was administered to 243 out of the 259 patients, 66 received HFNO, 42 received MV, and 49 received other modes of ventilation. Additionally, 43.9% received HFNO escalated to MV. Patients who did not receive HFNO or MV were 178 (68.7%) in total. CONCLUSION The use of HFNO in COVID-19 patients could show better outcomes than MV in addition to preventing the use of MV. Larger studies are required to determine the efficacy of HFNO in COVID-19 patients.
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Affiliation(s)
- Galal B Elrakaiby
- Critical Care Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Alaa E Ghabashi
- Critical Care Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulrazak M Sakhakhni
- Critical Care Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Faris M Allaf
- Otolaryngology, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Saeed M Alamoudi
- Ophthalmology, King Faisal Specialist Hospital and Research Center, Riyadh, SAU
| | - Muhammad A Khan
- Medical Education, King Saud Bin Abdulaziz University, Jeddah, SAU
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22
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Peñuelas O, Lomelí M, Del Campo-Albendea L, Toledo SI, Arellano A, Chavarría U, Marín MC, Rosas K, Galván Merlos MA, Mercado R, García-Lerma HR, Monares E, González D, Pérez J, Esteban-Fernández A, Muriel A, Frutos-Vivar F, Esteban A. Frailty in severe COVID-19 survivors after ICU admission. A prospective and multicenter study in Mexico. Med Intensiva 2024; 48:377-385. [PMID: 38582715 DOI: 10.1016/j.medine.2024.03.002] [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: 10/29/2023] [Accepted: 02/19/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To analyze the presence of frailty in survivors of severe COVID-19 admitted in the Intensive Care Unit (ICU) and followed six months after discharge. DESIGN An observational, prospective and multicenter, nation-wide study. SETTING Eight adult ICU across eight academic acute care hospitals in Mexico. PATIENTS All consecutive adult COVID-19 patients admitted in the ICU with acute respiratory failure between March 8, 2020 to February 28, 2021 were included. Frailty was defined according to the FRAIL scale, and was obtained at ICU admission and 6-month after hospital discharge. INTERVENTIONS None. MAIN VARIABLES OF INTEREST The primary endpoint was the frailty status 6-months after discharge. A regression model was used to evaluate the predictors during ICU stay associated with frailty. RESULTS 196 ICU survivors were evaluated for basal frailty at ICU admission and were included in this analysis. After 6-months from discharge, 164 patients were evaluated for frailty: 40 patients (20.4%) were classified as non-frail, 67 patients (34.2%) as pre-frail and 57 patients (29.1%) as frail. After adjustment, the need of invasive mechanical ventilation was the only factor independently associated with frailty at 6 month follow-up (Odds Ratio [OR] 3.70, 95% confidence interval 1.40-9.81, P = .008). CONCLUSIONS Deterioration of frailty was reported frequently among ICU survivors with severe COVID-19 at 6-months. The need of invasive mechanical ventilation in ICU survivors was the only predictor independently associated with frailty.
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Affiliation(s)
- Oscar Peñuelas
- Servicio de Medicina Intensiva. Hospital Universitario de Getafe, Madrid, Spain. CIBER de Enfermedades Respiratorias, CIBERES, Spain.
| | | | - Laura Del Campo-Albendea
- Unidad de Bioestadística, Hospital Universitario Ramón y Cajal, Madrid, Spain. CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | | | | | | | | | | | | | | | | | | | | | - Juan Pérez
- Hospital H+ Los Cabos, Baja California Sur, México
| | | | - Alfonso Muriel
- Unidad de Bioestadística, Hospital Universitario Ramón y Cajal, Madrid, Spain. CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Fernando Frutos-Vivar
- Servicio de Medicina Intensiva. Hospital Universitario de Getafe, Madrid, Spain. CIBER de Enfermedades Respiratorias, CIBERES, Spain
| | - Andrés Esteban
- Servicio de Medicina Intensiva. Hospital Universitario de Getafe, Madrid, Spain. CIBER de Enfermedades Respiratorias, CIBERES, Spain
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Tunçay E, Moçin Ö, Ediboğdu Ö, Adıgüzel N, Güngör S, İşcanlı İ, Er B, Mendil NA, Usalan A, Yılmaz D, Keskin H, Dönmez GE, Yılmaz B, Kargın F, Saraçoğlu KT, Temel Ş, Dal HC, Turan S, Talan L, Hoşgün D, Aydemir S, Sungurtekin H. Evaluation of Long-Coronavirus Disease 2019 Cases Readmitted to Intensive Care Units Due to Acute Respiratory Failure: Point Prevalence Study. THORACIC RESEARCH AND PRACTICE 2024; 25:162-167. [PMID: 39128056 PMCID: PMC11363373 DOI: 10.5152/thoracrespract.2024.23117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/11/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) caused morbidity and mortality worldwide. Besides the acute effects, subacute and long-term effects are defined as long-COVID causing morbidity. The intensive care unit (ICU) data of long-COVID-19 cases were evaluated with the participation of 11 centers. MATERIAL AND METHODS Study was designed by Turkish Thoracic Society Respiratory Failure and Intensive Care Working Group to evaluate long COVID-19 patients. All patients followed up in the ICU with long-COVID diagnosis were included in point prevelance study. RESULTS A total of 41 long COVID-19 patients from 11 centers were included in the study. Half of the patients were male, mean age was 66 ± 14, body mass index was 27 ± 5. Hypertension, diabetes mellitus, lung cancer, malignancy, and heart failure rates were 27%, 51%, 34%, 34%, and 27%, respectively. Eighty percent had received COVID vaccine. Patients had moderate hypoxemic respiratory failure. APACHE II, SOFA score was 18 (14-26), 6 (3-8), respectively. Forty-six percent received invasive mechanical ventilator support, 42% were sepsis, 17% were septic shock. Bilateral (67%), interstitial involvement (37%) were most common in chest x-ray. Fibrosis (27%) was detected in thorax tomography. Seventy-one percent of patients received antibiotherapy (42% carbapenem, 22% linezolid). Sixty-one percent of the patients received corticosteroid treatment. CONCLUSION More than half of the patients had pneumonia and the majority of them used broad-spectrum antibiotics. Presence of comorbidities and malignancies, intensive care severity scores, intubation, and sepsis rates were high. Receiving corticosteroid treatment and extensive bilateral radiologic involvement due to COVID-19 might be the reasons for the high re-admission rate for the ICUs.
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Affiliation(s)
- Eylem Tunçay
- Department of Intensive Care, University of Medical Sciences Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Özlem Moçin
- Department of Intensive Care, Health Sciences University Süreyyapaşa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, İstanbul, Turkey
| | - Özlem Ediboğdu
- Department of Intensive Care, Health Sciences University Dr. Suat Seren Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, İstanbul, Turkey
| | - Nalan Adıgüzel
- Department of Intensive Care, Health Sciences University Süreyyapaşa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, İstanbul, Turkey
| | - Sinem Güngör
- Department of Intensive Care, Health Sciences University Süreyyapaşa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, İstanbul, Turkey
| | - İnşa İşcanlı
- Department of Intensive Care, Health Sciences University Sultan Abdülhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Berrin Er
- Department of Intensive Care, TC Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | | | - Adnan Usalan
- Department of Intensive Care, Tarsus Medikalpark Hospital, Mersin, Turkey
| | - Didem Yılmaz
- Department of Intensive Care, Tarsus Medikalpark Hospital, Mersin, Turkey
| | - Hülya Keskin
- Department of Intensive Care, Health Sciences University Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Gül Erdal Dönmez
- Department of Intensive Care, Health Sciences University Süreyyapaşa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, İstanbul, Turkey
| | - Barış Yılmaz
- Department of Intensive Care, Health Sciences University Süreyyapaşa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, İstanbul, Turkey
| | - Feyza Kargın
- Department of Intensive Care, Health Sciences University Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Kemal Tolga Saraçoğlu
- Department of Intensive Care, Health Sciences University Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Şahin Temel
- Department of Intensive Care, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Hayriye Cankar Dal
- Department of Intensive Care, TC Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Sema Turan
- Department of Intensive Care, TC Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Leyla Talan
- Department of Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Derya Hoşgün
- Department of Intensive Care, Health Sciences University Ankara Atatürk Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, Ankara, Turkey
| | - Semih Aydemir
- Department of Intensive Care, Health Sciences University Ankara Atatürk Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, Ankara, Turkey
| | - Hülya Sungurtekin
- Department of Intensive Care, Pamukkale University Faculty of Medicine, Denizli, Turkey
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24
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Konsberg Y, Åneman A, Olsen F, Hessulf F, Nellgård B, Hård Af Segerstad M, Dalla K. Progressive changes in pulmonary gas exchange during invasive respiratory support for COVID-19 associated acute respiratory failure: A retrospective study of the association with 90-day mortality. Acta Anaesthesiol Scand 2024; 68:803-811. [PMID: 38563250 DOI: 10.1111/aas.14415] [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: 09/17/2023] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Ratio of arterial pressure of oxygen and fraction of inspired oxygen (P/F ratio) together with the fractional dead space (Vd/Vt) provides a global assessment of pulmonary gas exchange. The aim of this study was to assess the potential value of these variables to prognosticate 90-day survival in patients with COVID-19 associated ARDS admitted to the Intensive Care Unit (ICU) for invasive ventilatory support. METHODS In this single-center observational, retrospective study, P/F ratios and Vd/Vt were assessed up to 4 weeks after ICU-admission. Measurements from the first 2 weeks were used to evaluate the predictive value of P/F ratio and Vd/Vt for 90-day mortality and reported by the adjusted hazard ratio (HR) and 95% confidence intervals [95%CI] by Cox proportional hazard regression. RESULTS Almost 20,000 blood gases in 130 patients were analyzed. The overall 90-day mortality was 30% and using the data from the first ICU week, the HR was 0.85 [0.77-0.94] for every 10 mmHg increase in P/F ratio and 1.61 [1.20-2.16] for every 0.1 increase in Vd/Vt. In the second week, the HR for 90-day mortality was 0.82 [0.75-0.89] for every 10 mmHg increase in P/F ratio and 1.97 [1.42-2.73] for every 0.1 increase in Vd/Vt. CONCLUSION The progressive changes in P/F ratio and Vd/Vt in the first 2 weeks of invasive ventilatory support for COVID-19 ARDS were significant predictors for 90-day mortality.
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Affiliation(s)
- Ylva Konsberg
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Anders Åneman
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Intensive Care Unit, Liverpool Hospital, Southwestern Sydney Local Health District, Australia
- South Western Clinical School, University of New South Wales, Australia
- Ingham Institute for Applied Medical Science, Sydney, Australia
| | - Fredrik Olsen
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska, Sweden
| | - Fredrik Hessulf
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Mathias Hård Af Segerstad
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska, Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
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25
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Klompas M. Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nosocomial Respiratory Viral Infections on the Leeside of the Pandemic. Respir Care 2024; 69:854-868. [PMID: 38806219 DOI: 10.4187/respcare.11961] [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: 05/30/2024]
Abstract
The COVID-19 pandemic has had an unprecedented impact on population health and hospital operations. Over 7 million patients have been hospitalized for COVID-19 thus far in the United States alone. Mortality rates for hospitalized patients during the first wave of the pandemic were > 30%, but as we enter the fifth year of the pandemic hospitalizations have fallen and mortality rates for hospitalized patients with COVID-19 have plummeted to 5% or less. These gains reflect lessons learned about how to optimize respiratory support for different kinds of patients, targeted use of therapeutics for patients with different manifestations of COVID-19 including immunosuppressants and antivirals as appropriate, and high levels of population immunity acquired through vaccines and natural infections. At the same time, the pandemic has helped highlight some longstanding sources of harm for hospitalized patients including hospital-acquired pneumonia, ventilator-associated events (VAEs), and hospital-acquired respiratory viral infections. We are, thankfully, on the leeside of the pandemic at present; but the large increases in ventilator-associated pneumonia (VAP), VAEs, bacterial superinfections, and nosocomial respiratory viral infections associated with the pandemic beg the question of how best to prevent these complications moving forward. This paper reviews the burden of hospitalization for COVID-19, the intersection between COVID-19 and both VAP and VAEs, the frequency and impact of hospital-acquired respiratory viral infections, new recommendations on how best to prevent VAP and VAEs, and current insights into effective strategies to prevent nosocomial spread of respiratory viruses.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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26
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de Prost N, Audureau E, Guillon A, Handala L, Préau S, Guigon A, Uhel F, Le Hingrat Q, Delamaire F, Grolhier C, Tamion F, Moisan A, Darreau C, Thomin J, Contou D, Henry A, Daix T, Hantz S, Saccheri C, Giordanengo V, Pham T, Chaghouri A, Bay P, Pawlotsky JM, Fourati S. Clinical phenotypes and outcomes associated with SARS-CoV-2 Omicron sublineage JN.1 in critically ill COVID-19 patients: a prospective, multicenter cohort study in France, November 2022 to January 2024. Ann Intensive Care 2024; 14:101. [PMID: 38940865 PMCID: PMC11213836 DOI: 10.1186/s13613-024-01319-w] [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: 03/11/2024] [Accepted: 05/25/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND A notable increase in severe cases of COVID-19, with significant hospitalizations due to the emergence and spread of JN.1 was observed worldwide in late 2023 and early 2024. However, no clinical data are available regarding critically-ill JN.1 COVID-19 infected patients. METHODS The current study is a substudy of the SEVARVIR prospective multicenter observational cohort study. Patients admitted to any of the 40 participating ICUs between November 17, 2022, and January 22, 2024, were eligible for inclusion in the SEVARVIR cohort study (NCT05162508) if they met the following inclusion criteria: age ≥ 18 years, SARS-CoV-2 infection confirmed by a positive reverse transcriptase-polymerase chain reaction (RT-PCR) in nasopharyngeal swab samples, ICU admission for acute respiratory failure. The primary clinical endpoint of the study was day-28 mortality. Evaluation of the association between day-28 mortality and sublineage group was conducted by performing an exploratory multivariable logistic regression model, after systematically adjusting for predefined prognostic factors previously shown to be important confounders (i.e. obesity, immunosuppression, age and SOFA score) computing odds ratios (OR) along with their corresponding 95% confidence intervals (95% CI). RESULTS During the study period (November 2022-January 2024) 56 JN.1- and 126 XBB-infected patients were prospectively enrolled in 40 French intensive care units. JN.1-infected patients were more likely to be obese (35.7% vs 20.8%; p = 0.033) and less frequently immunosuppressed than others (20.4% vs 41.4%; p = 0.010). JN.1-infected patients required invasive mechanical ventilation support in 29.1%, 87.5% of them received dexamethasone, 14.5% tocilizumab and none received monoclonal antibodies. Only one JN-1 infected patient (1.8%) required extracorporeal membrane oxygenation support during ICU stay (vs 0/126 in the XBB group; p = 0.30). Day-28 mortality of JN.1-infected patients was 14.6%, not significantly different from that of XBB-infected patients (22.0%; p = 0.28). In univariable logistic regression analysis and in multivariable analysis adjusting for confounders defined a priori, we found no statistically significant association between JN.1 infection and day-28 mortality (adjusted OR 1.06 95% CI (0.17;1.42); p = 0.19). There was no significant between group difference regarding duration of stay in the ICU (6.0 [3.5;11.0] vs 7.0 [4.0;14.0] days; p = 0.21). CONCLUSIONS Critically-ill patients with Omicron JN.1 infection showed a different clinical phenotype than patients infected with the earlier XBB sublineage, including more frequent obesity and less immunosuppression. Compared with XBB, JN.1 infection was not associated with higher day-28 mortality.
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Affiliation(s)
- Nicolas de Prost
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France.
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France.
- Université Paris-Est-Créteil (UPEC), Créteil, France.
- INSERM U955, Team Viruses, Hepatology, Cancer, Créteil, France.
- Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Créteil, France.
| | - Etienne Audureau
- Université Paris-Est-Créteil (UPEC), Créteil, France
- Department of Public Health, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
- IMRB INSERM U955, Team CEpiA, Créteil, France
| | - Antoine Guillon
- Intensive Care Unit, Research Center for Respiratory Diseases (CEPR), INSERM U1100, Tours University Hospital, University of Tours, Tours, France
| | - Lynda Handala
- INSERM U1259, Université de Tours, Tours, France
- National Reference Center for HIV-Associated Laboratory, , CHRU de Tours, Tours, France
| | - Sébastien Préau
- U1167 - RID-AGE Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, 59000, Lille, France
| | - Aurélie Guigon
- Service de Virologie, CHU de Lille, 59000, Lille, France
| | - Fabrice Uhel
- DMU ESPRIT, Service de Médecine Intensive Réanimation, Université Paris Cité, APHP, Hôpital Louis Mourier, Colombes, France
- INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker-Enfants Malades (INEM), Université Paris Cité, Paris, France
| | - Quentin Le Hingrat
- IAME INSERM UMR 1137, Service de Virologie, Université Paris Cité, Hôpital Bichat-Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Flora Delamaire
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | | | - Fabienne Tamion
- Service de Médecine Intensive-Réanimation, CHU De Rouen, 76000, Rouen, France
| | - Alice Moisan
- INSERM DYNAMICURE UMR 1311 Department of Virology, Univ Rouen Normandie, Université de Caen Normandie, Normandie Univ, CHU Rouen, National Reference Center of HIV, 76000, Rouen, France
| | - Cédric Darreau
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier du Mans, Le Mans, France
| | - Jean Thomin
- Laboratoire de Microbiologie, Centre Hospitalier du Mans, Le Mans, France
| | - Damien Contou
- Service de Réanimation, Hôpital Victor Dupouy, Argenteuil, France
| | - Amandine Henry
- Service de Virologie, Hôpital Victor Dupouy, Argenteuil, France
| | - Thomas Daix
- INSERM CIC 1435 and UMR 1092, Réanimation Polyvalente, CHU Limoges, Limoges, France
| | - Sébastien Hantz
- Bacteriology, Virology, Hygiene Department, French National Reference Center for Herpesviruses, CHU Limoges, 87000, Limoges, France
- INSERM, RESINFIT, U1092, 87000, Limoges, France
| | | | | | - Tài Pham
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France
- Service de Médecine Intensive-Réanimation, DMU 4 CORREVE Maladies du Cœur Et Des Vaisseaux, Assistance Publique - Hôpitaux de Paris, Hôpital de Bicêtre, FHU Sepsis, Le Kremlin-Bicêtre, France
- Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France
| | - Amal Chaghouri
- Laboratoire de Virologie, Hôpital Paul Brousse, Assistance Publique - Hôpitaux de Paris, Villejuif, France
| | - Pierre Bay
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France
- Université Paris-Est-Créteil (UPEC), Créteil, France
- INSERM U955, Team Viruses, Hepatology, Cancer, Créteil, France
| | - Jean-Michel Pawlotsky
- Université Paris-Est-Créteil (UPEC), Créteil, France
- INSERM U955, Team Viruses, Hepatology, Cancer, Créteil, France
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Slim Fourati
- Université Paris-Est-Créteil (UPEC), Créteil, France
- INSERM U955, Team Viruses, Hepatology, Cancer, Créteil, France
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
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Sáez de la Fuente I, Marcos Morales A, Muñoz Calahorro R, Álvaro Valiente E, Sánchez-Bayton Griffith M, Chacón Alves S, Molina Collado Z, González de Aledo AL, Martín Badía I, González Fernández M, Orejón García L, Arribas López P, Temprano Vázquez S, Sánchez Izquierdo Riera JÁ. Optimal Prone Position Duration in Patients With ARDS Due to COVID-19: The Omelette Pilot Trial. Respir Care 2024; 69:806-818. [PMID: 38531637 DOI: 10.4187/respcare.11192] [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: 03/28/2024]
Abstract
BACKGROUND Prone position (PP) has been widely used in the COVID-19 pandemic for ARDS management. However, the optimal length of a PP session is still controversial. This study aimed to evaluate the effects of prolonged versus standard PP duration in subjects with ARDS due to COVID-19. METHODS This was a single-center, randomized controlled, parallel, and open pilot trial including adult subjects diagnosed with severe ARDS due to COVID-19 receiving invasive mechanical ventilation that met criteria for PP between March-September 2021. Subjects were randomized to the intervention group of prolonged PP (48 h) versus the standard of care PP (∼16 h). The primary outcome variable for the trial was ventilator-free days (VFDs) to day 28. RESULTS We enrolled 60 subjects. VFDs were not significantly different in the standard PP group (18 [interquartile range [IQR] 0-23] VFDs vs 7.5 [IQR 0-19.0] VFDs; difference, -10.5 (95% CI -3.5 to 19.0, P = .08). Prolonged PP was associated with longer time to successful extubation in survivors (13.00 [IQR 8.75-26.00] d vs 8.00 [IQR 5.00-10.25] d; difference, 5 [95% CI 0-15], P = .001). Prolonged PP was also significantly associated with longer ICU stay (18.5 [IQR 11.8-25.3] d vs 11.50 [IQR 7.75-25.00] d, P = .050) and extended administration of neuromuscular blockers (12.50 [IQR 5.75-20.00] d vs 5.0 [IQR 2.0-14.5] d, P = .005). Prolonged PP was associated with significant muscular impairment according to lower Medical Research Council values (59.6 [IQR 59.1-60.0] vs 56.5 [IQR 54.1-58.9], P = .02). CONCLUSIONS Among subjects with severe ARDS due to COVID-19, there was no difference in 28-d VFDs between prolonged and standard PP strategy. However, prolonged PP was associated with a longer ICU stay, increased use of neuromuscular blockers, and greater muscular impairment. This suggests that prolonged PP is not superior to the current recommended standard of care.
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Affiliation(s)
| | - Adrián Marcos Morales
- Department of Critical Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Reyes Muñoz Calahorro
- Department of Critical Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Álvaro Valiente
- Department of Critical Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Silvia Chacón Alves
- Department of Critical Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Zaira Molina Collado
- Department of Critical Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Isaías Martín Badía
- Department of Critical Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Lidia Orejón García
- Department of Critical Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
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Le Terrier C, Walter T, Lebbah S, Hajage D, Sigaud F, Guérin C, Desmedt L, Primmaz S, Joussellin V, Della Badia C, Ricard JD, Pugin J, Terzi N. Impact of intensive prone position therapy on outcomes in intubated patients with ARDS related to COVID-19. Ann Intensive Care 2024; 14:100. [PMID: 38935175 PMCID: PMC11211313 DOI: 10.1186/s13613-024-01340-z] [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: 04/18/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Previous retrospective research has shown that maintaining prone positioning (PP) for an average of 40 h is associated with an increase of survival rates in intubated patients with COVID-19-related acute respiratory distress syndrome (ARDS). This study aims to determine whether a cumulative PP duration of more than 32 h during the first 2 days of intensive care unit (ICU) admission is associated with increased survival compared to a cumulative PP duration of 32 h or less. METHODS This study is an ancillary analysis from a previous large international observational study involving intubated patients placed in PP in the first 48 h of ICU admission in 149 ICUs across France, Belgium and Switzerland. Given that PP is recommended for a 16-h daily duration, intensive PP was defined as a cumulated duration of more than 32 h during the first 48 h, whereas standard PP was defined as a duration equal to or less than 32 h. Patients were followed-up for 90 days. The primary outcome was mortality at day 60. An Inverse Probability Censoring Weighting (IPCW) Cox model including a target emulation trial method was used to analyze the data. RESULTS Out of 2137 intubated patients, 753 were placed in PP during the first 48 h of ICU admission. The intensive PP group (n = 79) had a median PP duration of 36 h, while standard PP group (n = 674) had a median of 16 h during the first 48 h. Sixty-day mortality rate in the intensive PP group was 39.2% compared to 38.7% in the standard PP group (p = 0.93). Twenty-eight-day and 90-day mortality as well as the ventilator-free days until day 28 were similar in both groups. After IPCW, there was no significant difference in mortality at day 60 between the two-study groups (HR 0.95 [0.52-1.74], p = 0.87 and HR 1.1 [0.77-1.57], p = 0.61 in complete case analysis or in multiple imputation analysis, respectively). CONCLUSIONS This secondary analysis of a large multicenter European cohort of intubated patients with ARDS due to COVID-19 found that intensive PP during the first 48 h did not provide a survival benefit compared to standard PP.
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Affiliation(s)
- Christophe Le Terrier
- Division of Intensive Care, Faculty of Medicine, Geneva University Hospitals and the University of Geneva, Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Thaïs Walter
- Division of Intensive Care, Saint-Louis Hospital, Greater Paris Hospital, Paris, France
| | - Said Lebbah
- Département de Santé Publique, Centre de Pharmaco-épidémiologie, AP-HP, Paris, France
| | - David Hajage
- Département de Santé Publique, Centre de Pharmaco-épidémiologie, AP-HP, Paris, France
| | - Florian Sigaud
- Division of Intensive Care, Grenoble Alpes University Hospital, Grenoble, France
| | - Claude Guérin
- Division of Intensive Care, Edouard Herriot University Hospital, Lyon, France
| | - Luc Desmedt
- Medical Intensive Care Unit, Nantes Hôtel-Dieu University Hospital, Nantes, France
| | - Steve Primmaz
- Division of Intensive Care, Faculty of Medicine, Geneva University Hospitals and the University of Geneva, Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Vincent Joussellin
- Medical Intensive Care Unit, University Hospital of Rennes, Rennes, France
| | - Chiara Della Badia
- Division of Intensive Care, Faculty of Medicine, Geneva University Hospitals and the University of Geneva, Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Jean-Damien Ricard
- UMR1137 IAME, INSERM, Université Paris Cité, 75018, Paris, France
- DMU ESPRIT, Service de Médecine Intensive Réanimation, Université Paris Cité, AP-HP, Hôpital Louis Mourier, 92700, Colombes, France
| | - Jérôme Pugin
- Division of Intensive Care, Faculty of Medicine, Geneva University Hospitals and the University of Geneva, Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Nicolas Terzi
- Medical Intensive Care Unit, University Hospital of Rennes, Rennes, France
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29
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Schortgen F, Tabra Osorio C, Demiri S, Dzogang C, Jung C, Lavenu A, Lecarpentier E. Management of pregnant women in tertiary maternity hospitals in the Paris area referred to the intensive care unit for acute hypoxaemic respiratory failure related to SARS-CoV-2: which practices for which outcomes? Ann Intensive Care 2024; 14:94. [PMID: 38890164 PMCID: PMC11189363 DOI: 10.1186/s13613-024-01313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Evidence for the management of pregnant women with acute hypoxaemic respiratory failure (AHRF) is currently lacking. The likelihood of avoiding intubation and the risks of continuing the pregnancy under invasive ventilation remain undetermined. We report the management and outcome of pregnant women with pneumonia related to SARS-CoV-2 admitted to the ICU of tertiary maternity hospitals of the Paris area. METHODS We studied a retrospective cohort of pregnant women admitted to 15 ICUs with AHRF related to SARS-CoV-2 defined by the need for O2 ≥ 6 L/min, high-flow nasal oxygen (HFNO), non-invasive or invasive ventilation. Trajectories were assessed to determine the need for intubation and the possibility of continuing the pregnancy on invasive ventilation. RESULTS One hundred and seven pregnant women, 34 (IQR: 30-38) years old, at a gestational age of 27 (IQR: 25-30) weeks were included. Obesity was present in 37/107. Intubation was required in 47/107 (44%). Intubation rate according to respiratory support was 14/19 (74%) for standard O2, 17/36 (47%) for non-invasive ventilation and 16/52 (31%) for HFNO. Factors significantly associated with intubation were pulmonary co-infection: adjusted OR: 3.38 (95% CI 1.31-9.21), HFNO: 0.11 (0.02-0.41) and non-invasive ventilation: 0.20 (0.04-0.80). Forty-six (43%) women were delivered during ICU stay, 39/46 (85%) for maternal pulmonary worsening, 41/46 (89%) at a preterm stage. Fourteen non-intubated women were delivered under regional anaesthesia; 9/14 ultimately required emergency intubation. Four different trajectories were identified: 19 women were delivered within 2 days after ICU admission while not intubated (12 required prolonged intubation), 23 women were delivered within 2 days after intubation, in 11 intubated women pregnancy was continued allowing delivery after ICU discharge in 8/11, 54 women were never intubated (53 were delivered after discharge). Timing of delivery after intubation was mainly dictated by gestational age. One maternal death and one foetal death were recorded. CONCLUSION In pregnant women with AHRF related to SARS-CoV-2, HFNO and non-invasive mechanical ventilation were associated with a reduced rate of intubation, while pulmonary co-infection was associated with an increased rate. Pregnancy was continued on invasive mechanical ventilation in one-third of intubated women. Study registration retrospectively registered in ClinicalTrials (NCT05193526).
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Affiliation(s)
- Frédérique Schortgen
- Department of Adult Intensive Care, Service de médecine intensive réanimation, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France.
| | - Cecilia Tabra Osorio
- Department of Adult Intensive Care, Service de médecine intensive réanimation, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France
| | - Suela Demiri
- Department of Adult Intensive Care, Service de médecine intensive réanimation, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France
| | - Cléo Dzogang
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Camille Jung
- Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Université Paris Est Créteil (UPEC), Créteil, France
| | - Audrey Lavenu
- IRMAR, Mathematical Research Institute, University of Rennes, Rennes, France
- Clinical Investigation Centre, INSERM CIC 1414, University of Rennes, Rennes, France
| | - Edouard Lecarpentier
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Université Paris Est Créteil (UPEC), Créteil, France
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Sales G, Montrucchio G, Sanna V, Collino F, Fanelli V, Filippini C, Simonetti U, Bonetto C, Morscio M, Verderosa I, Urbino R, Brazzi L. Outcomes and Impact of Pre-ECMO Clinical Course in Severe COVID-19-Related ARDS Treated with VV-ECMO: Data from an Italian Referral ECMO Center. J Clin Med 2024; 13:3545. [PMID: 38930073 PMCID: PMC11204940 DOI: 10.3390/jcm13123545] [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: 04/21/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The efficacy of veno-venous extracorporeal membrane oxygenation (VV-ECMO) as rescue therapy for refractory COVID-19-related ARDS (C-ARDS) is still debated. We describe the cohort of C-ARDS patients treated with VV-ECMO at our ECMO center, focusing on factors that may affect in-hospital mortality and describing the time course of lung mechanics to assess prognosis. Methods: We performed a prospective observational study in the intensive care unit at the "Città della Salute e della Scienza" University Hospital in Turin, Italy, between March 2020 and December 2021. Indications and management of ECMO followed the Extracorporeal Life Support Organization (ELSO) guidelines. Results: The 60-day in-hospital mortality was particularly high (85.4%). Non-survivor patients were more frequently treated with non-invasive ventilatory support and steroids before ECMO (95.1% vs. 57.1%, p = 0.018 and 73.2% vs. 28.6%, p = 0.033, respectively), while hypertension was the only pre-ECMO factor independently associated with in-hospital mortality (HR: 2.06, 95%CI: 1.06-4.00). High rates of bleeding (85.4%) and superinfections (91.7%) were recorded during ECMO, likely affecting the overall length of ECMO (18 days, IQR: 10-24) and the hospital stay (32 days, IQR: 24-47). Static lung compliance was lower in non-survivors (p = 0.031) and differed over time (p = 0.049), decreasing by 48% compared to initial values in non-survivors. Conclusions: Our data suggest the importance of considering NIS among the common ECMO eligibility criteria and changes in lung compliance during ECMO as a prognostic marker.
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Affiliation(s)
- Gabriele Sales
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (G.M.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, “Città Della Salute e Della Scienza” Hospital, 10126 Turin, Italy
| | - Giorgia Montrucchio
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (G.M.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, “Città Della Salute e Della Scienza” Hospital, 10126 Turin, Italy
| | - Valentina Sanna
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (G.M.); (L.B.)
| | - Francesca Collino
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (G.M.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, “Città Della Salute e Della Scienza” Hospital, 10126 Turin, Italy
| | - Vito Fanelli
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (G.M.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, “Città Della Salute e Della Scienza” Hospital, 10126 Turin, Italy
| | - Claudia Filippini
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (G.M.); (L.B.)
| | - Umberto Simonetti
- Department of Anesthesia, Intensive Care and Emergency, “Città Della Salute e Della Scienza” Hospital, 10126 Turin, Italy
| | - Chiara Bonetto
- Department of Anesthesia, Intensive Care and Emergency, “Città Della Salute e Della Scienza” Hospital, 10126 Turin, Italy
| | - Monica Morscio
- Department of Anesthesia, Intensive Care and Emergency, “Città Della Salute e Della Scienza” Hospital, 10126 Turin, Italy
| | - Ivo Verderosa
- Department of Anesthesia, Intensive Care and Emergency, “Città Della Salute e Della Scienza” Hospital, 10126 Turin, Italy
| | - Rosario Urbino
- Department of Anesthesia, Intensive Care and Emergency, “Città Della Salute e Della Scienza” Hospital, 10126 Turin, Italy
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (G.M.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, “Città Della Salute e Della Scienza” Hospital, 10126 Turin, Italy
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Khattar G, Asmar S, Aoun L, Saliba F, Almardini S, Abu Baker S, Hong C, El Chamieh C, Haddadin F, Habib T, Mourad O, Morcos Z, Arafa F, Mina J, El Gharib K, Aldalahmeh M, Khan S, Bou Sanayeh E. Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes: A retrospective cohort study. World J Clin Cases 2024; 12:2966-2975. [PMID: 38898846 PMCID: PMC11185405 DOI: 10.12998/wjcc.v12.i17.2966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/28/2024] [Accepted: 05/14/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND The impact of type 2 diabetes mellitus (T2DM) on acute respiratory distress syndrome (ARDS) is debatable. T2DM was suspected to reduce the risk and complications of ARDS. However, during coronavirus disease 2019 (COVID-19), T2DM predisposed patients to ARDS, especially those who were on insulin at home. AIM To evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes. METHODS We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database. Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus (DM) (IDDM) and non-insulin-dependent DM (NIDDM) groups. After applying exclusion criteria and matching over 20 variables, we compared cohorts for mortality, duration of mechanical ventilation, incidence of acute kidney injury (AKI), length of stay (LOS), hospitalization costs, and other clinical outcomes. RESULTS Following 1:1 propensity score matching, the analysis included 274 patients in each group. Notably, no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates (32.8% vs 31.0%, P = 0.520), median hospital LOS (10 d, P = 0.537), requirement for mechanical ventilation, incidence rates of sepsis, pneumonia or AKI, median total hospitalization costs, or patient disposition upon discharge. CONCLUSION Compared to alternative anti-diabetic medications, outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.
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Affiliation(s)
- Georges Khattar
- Department of Medicine, Holy Spirit University of Kaslik, Jounieh 00000, Lebanon
| | - Samer Asmar
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Laurence Aoun
- Department of Medicine, Holy Spirit University of Kaslik, Jounieh 00000, Lebanon
| | - Fares Saliba
- Department of Medicine, Holy Spirit University of Kaslik, Jounieh 00000, Lebanon
| | - Shaza Almardini
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Saif Abu Baker
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Catherine Hong
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Carolla El Chamieh
- Public Heath and Biostatistics, Independent Research, Beirut 0000, Lebanon
| | - Fadi Haddadin
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Toni Habib
- Department of Medicine, Lebanese University, Beirut 00000, Lebanon
| | - Omar Mourad
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Zeina Morcos
- Department of Medicine, University of Balamand, Beirut 00000, Lebanon
| | - Fatema Arafa
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Jonathan Mina
- Department of Medicine, Lebanese American University, Beirut 00000, Lebanon
| | - Khalil El Gharib
- Department of Medicine, Northwell Health Staten Island University Hospital, New York, NY 10305, United States
| | - Mohammad Aldalahmeh
- Department of Medicine, Northwell Health Staten Island University Hospital, New York, NY 10305, United States
| | - Salman Khan
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Elie Bou Sanayeh
- Department of Medicine, Holy Spirit University of Kaslik, Jounieh 00000, Lebanon
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
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Chalkias A, Huang Y, Ismail A, Pantazopoulos I, Papagiannakis N, Bitterman B, Anderson E, Catalan T, Erne GK, Tilley CR, Alaka A, Amadi KM, Presswalla F, Blakely P, Bernal-Morell E, Cebreiros López I, Eugen-Olsen J, García de Guadiana Romualdo L, Giamarellos-Bourboulis EJ, Loosen SH, Reiser J, Tacke F, Skoulakis A, Laou E, Banerjee M, Pop-Busui R, Hayek SS. Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study. Crit Care Med 2024; 52:930-941. [PMID: 38391282 DOI: 10.1097/ccm.0000000000006229] [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] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To evaluate the impact of intubation timing, guided by severity criteria, on mortality in critically ill COVID-19 patients, amidst existing uncertainties regarding optimal intubation practices. DESIGN Prospective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022. SETTING Ten academic institutions in the United States and Europe. PATIENTS Adults (≥ 18 yr old) confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalized specifically for COVID-19, requiring intubation postadmission. Exclusion criteria included patients hospitalized for non-COVID-19 reasons despite a positive SARS-CoV-2 test. INTERVENTIONS Early invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pa o2 /F io2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pa o2 /F io2 ratio less than or equal to 250. MEASUREMENTS AND MAIN RESULTS The primary outcome was mortality within 30 days of hospital admission. Among 4464 patients, 854 (19.1%) required mechanical ventilation (mean age 60 yr, 61.7% male, 19.3% Black). Of those, 621 (72.7%) were categorized in the EIMV group and 233 (27.3%) in the LIMV group. Death within 30 days after admission occurred in 278 patients (42.2%) in the EIMV and 88 patients (46.6%) in the LIMV group ( p = 0.28). An inverse probability-of-treatment weighting analysis revealed a statistically significant association with mortality, with patients in the EIMV group being 32% less likely to die either within 30 days of admission (adjusted hazard ratio [HR] 0.68; 95% CI, 0.52-0.90; p = 0.008) or within 30 days after intubation irrespective of its timing from admission (adjusted HR 0.70; 95% CI, 0.51-0.90; p = 0.006). CONCLUSIONS In severe COVID-19 cases, an early intubation strategy, guided by specific severity criteria, is associated with a reduced risk of death. These findings underscore the importance of timely intervention based on objective severity assessments.
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Affiliation(s)
- Athanasios Chalkias
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Outcomes Research Consortium, Cleveland, OH
| | - Yiyuan Huang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Anis Ismail
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | | | | - Brayden Bitterman
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Elizabeth Anderson
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Tonimarie Catalan
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Grace K Erne
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Caroline R Tilley
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Abiola Alaka
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Kingsley M Amadi
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Feriel Presswalla
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Pennelope Blakely
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Enrique Bernal-Morell
- Infectious Diseases Unit, Department of Internal Medicine, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Iria Cebreiros López
- Department of Laboratory Medicine, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | | | - Sven H Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jochen Reiser
- Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Campus Charité Mitte and Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Eleni Laou
- Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Mousumi Banerjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Salim S Hayek
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Lahmer T, Salmanton-García J, Marchesi F, El-Ashwah S, Nucci M, Besson C, Itri F, Jaksic O, Čolović N, Weinbergerová B, Seval GC, Adžić-Vukičević T, Szotkowski T, Sili U, Dargenio M, van Praet J, van Doesum J, Schönlein M, Ráčil Z, Žák P, Poulsen CB, Magliano G, Jiménez M, Bonuomo V, Piukovics K, Dragonetti G, Demirkan F, Blennow O, Valković T, Gomes Da Silva M, Maertens J, Glenthøj A, Fernández N, Bergantim R, Verga L, Petzer V, Omrani AS, Méndez GA, Machado M, Ledoux MP, Bailén R, Duarte RF, Del Principe MI, Farina F, Martín-Pérez S, Dávila-Valls J, Marchetti M, Bilgin YM, Fracchiolla NS, Cattaneo C, Espigado I, Cordoba R, Collins GP, Labrador J, Falces-Romero I, Prezioso L, Meers S, Passamonti F, Buquicchio C, López-García A, Kulasekararaj A, Ormazabal-Vélez I, Cuccaro A, Garcia-Vidal C, Busca A, Navrátil M, de Jonge N, Biernat MM, Guidetti A, Abu-Zeinah G, Samarkos M, Anastasopoulou A, de Ramón C, González-López TJ, Hoenigl M, Finizio O, Pinczés LI, Ali N, Vena A, Tascini C, Stojanoski Z, Merelli M, Emarah Z, Kohn M, Barać A, Mladenović M, Mišković B, Ilhan O, Çolak GM, Čerňan M, Gräfe SK, Ammatuna E, Hanakova M, Víšek B, Cabirta A, Nordlander A, Nunes Rodrigues R, Hersby DS, Zambrotta GPM, Wolf D, Núñez-Martín-Buitrago L, Arellano E, Aiello TF, García-Sanz R, Prattes J, Egger M, Limongelli A, Bavastro M, Cvetanoski M, Dibos M, Rasch S, Rahimli L, Cornely OA, Pagano L. Need for ICU and outcome of critically ill patients with COVID-19 and haematological malignancies: results from the EPICOVIDEHA survey. Infection 2024; 52:1125-1141. [PMID: 38388854 PMCID: PMC11143019 DOI: 10.1007/s15010-023-02169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/23/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Tobias Lahmer
- Medizinische Klinik II, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Jon Salmanton-García
- Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Herderstraße 52-54, 50931, Cologne, Germany.
- Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Marcio Nucci
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caroline Besson
- Centre Hospitalier de Versailles, Le Chesnay, France; Université Paris-Saclay, UVSQ, Inserm, Équipe "Exposome et Hérédité", CESP, Villejuif, France
| | - Federico Itri
- San Luigi Gonzaga Hospital - Orbassano, Orbassano, Italy
| | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Natasha Čolović
- University Clinical Center Serbia, Medical Faculty University Belgrade, Belgrade, Serbia
| | - Barbora Weinbergerová
- Department of Internal Medicine - Hematology and Oncology, Masaryk University Hospital Brno, Brno, Czech Republic
| | | | | | | | - Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Michelina Dargenio
- Hematology and Stem Cell Transplan Unit, Vito Fazzi Hospital, Lecce, Italy
| | - Jens van Praet
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | | | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zdeněk Ráčil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Pavel Žák
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | | | | | - Moraima Jiménez
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Valentina Bonuomo
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Klára Piukovics
- Department of Internal Medicine, South Division Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Giulia Dragonetti
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Fatih Demirkan
- Division of Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Toni Valković
- University Hospital Centre Rijeka, Rijeka, Croatia
- Croatian Cooperative Group for Hematological Diseases (CROHEM), Faculty of Medicine and Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
| | | | - Johan Maertens
- Department of Microbiology, Immunology, and Transplantation, KULeuven, Leuven and Department of Hematology, UZ Leuven, Louvain, Belgium
| | - Andreas Glenthøj
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Noemí Fernández
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Rui Bergantim
- Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Luisa Verga
- Azienda Ospedaliera San Gerardo - Monza, Monza, Italy
- Università Milano-Bicocca, Milan, Italy
| | - Verena Petzer
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Ali S Omrani
- Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Rebeca Bailén
- Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | - Monia Marchetti
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Yavuz M Bilgin
- Department of Internal Medicine, ADRZ, Goes, Netherlands
| | | | | | - Ildefonso Espigado
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS / CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | - Raul Cordoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Graham P Collins
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos, Spain
- Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain
| | - Iker Falces-Romero
- La Paz University Hospital, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Lucia Prezioso
- Hospital University of Parma - Hematology and Bone Marrow Unit, Parma, Italy
| | | | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | | | - Alberto López-García
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | | | | | - Annarosa Cuccaro
- Hematology Unit, Center for Translational Medicine, Azienda USL Toscana NordOvest, Leghorn, Italy
| | | | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Milan Navrátil
- Head of the ICU and Transplant Unit, Department of Hematooncology, University Hospital of Ostrava, Ostrava-Poruba, Czech Republic
| | - Nick de Jonge
- Amsterdam UMC, location VUmc, Amsterdam, Netherlands
| | - Monika M Biernat
- Department of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Guidetti
- University of Milan and Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Ghaith Abu-Zeinah
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, USA
| | | | | | - Cristina de Ramón
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
- IBSAL, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | | | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
| | | | - László Imre Pinczés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | - Carlo Tascini
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | | | - Maria Merelli
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Ziad Emarah
- Oncology Center, Mansoura University, Mansoura, Egypt
| | - Milena Kohn
- Centre Hospitalier de Versailles, Versailles, France
| | - Aleksandra Barać
- Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miloš Mladenović
- COVID hospital ""Batajnica"", Belgrade, Serbia
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Bojana Mišković
- Center for Radiology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Gökçe Melis Çolak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Martin Čerňan
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Stefanie K Gräfe
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Michaela Hanakova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Benjamín Víšek
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Alba Cabirta
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Anna Nordlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Ditte Stampe Hersby
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Dominik Wolf
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elena Arellano
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS / CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | | | - Ramón García-Sanz
- Head of Molecular Biology an HLA Unit, Department of Hematology, University Hospital of Salamanca (HUS/IBSAL/CIBERONC), Salamanca, Spain
| | | | - Matthias Egger
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | | | | | - Miriam Dibos
- Medizinische Klinik II, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Sebastian Rasch
- Medizinische Klinik II, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Laman Rahimli
- Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Herderstraße 52-54, 50931, Cologne, Germany
- Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Oliver A Cornely
- Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Herderstraße 52-54, 50931, Cologne, Germany
- Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
- Faculty of Medicine, and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
- Faculty of Medicine, and University Hospital Cologne, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Livio Pagano
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
- Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
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Bobot M, Heim X, Max H, Boucraut J, Simeone P, Stein C, Velly L, Bruder N, Forel JM, Hraiech S, Guervilly C, Carvelli J, Gainnier M, Mège JL, Chopinet S, Jourde-Chiche N, Papazian L, Burtey S. Prospective Multicenter Study on Early Proximal Tubular Injury in COVID-19-Related Acute Respiratory Distress Syndrome. Kidney Int Rep 2024; 9:1641-1653. [PMID: 38899195 PMCID: PMC11184390 DOI: 10.1016/j.ekir.2024.03.011] [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: 10/31/2023] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction During COVID-19, renal impairment is associated with poor prognosis in intensive care unit (ICU). We aimed to assess the existence and incidence of early renal dysfunction and its prognostic value in patients with COVID-19-related acute respiratory distress syndrome (ARDS). Methods In this prospective multicenter study, patients aged over 18 years with invasive mechanical ventilation (MV) for ARDS were enrolled in 3 ICUs. Precise evaluation of renal dysfunction markers, including urinary protein electrophoresis (UPE) and quantification, was performed within 24 hours after MV onset. Results From March 2020 to December 2021, 135 patients were enrolled as follows: 100 with COVID-19 ARDS and 35 with non-COVID-19 ARDS. UPE found more tubular dysfunction in patients with COVID-19 (68% vs. 21.4%, P < 0.0001) and more normal profiles in patients without COVID-19 (65.0% vs. 11.2%, P = 0.0003). Patients with COVID-19 significantly displayed early urinary leakage of tubular proteins such as beta-2-microglobulin (ß2m) and free light chains, tended to display acute kidney injury (AKI) more frequently (51.0% vs. 34.3%, P = 0.088), had longer MV (20 vs. 9 days, P < 0.0001) and longer ICU stay (26 vs. 15 days, P < 0.0001). In COVID-19 ARDS, leakage of free lambda light chain was associated with the onset of Kidney Disease: Improving Global Outcomes (KDIGO) ≥2 AKI (odds ratio [OR]: 1.014, 95% confidence interval [CI] 1.003-1.025, P = 0.011). Conclusion Patients with COVID-19-related ARDS display a proximal tubular dysfunction before the onset of AKI, which predicts AKI. Proximal tubular damage seems an important mechanism of COVID-19-induced nephropathy. Analysis of urinary proteins is a reliable noninvasive tool to assess proximal tubular dysfunction in the ICU.
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Affiliation(s)
- Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- INSERM, INRAE, C2VN, Aix-Marseille Université, Marseille, France
- CERIMED, Aix-Marseille Université, Marseille, France
| | - Xavier Heim
- INSERM, INRAE, C2VN, Aix-Marseille Université, Marseille, France
- Laboratoire d’Immunologie, Hôpital de la Conception, AP-HM, France
| | - Howard Max
- Département d’Anesthésie-Réanimation, AP-HM, CHU Timone, Aix-Marseille Université, Marseille, France
| | - José Boucraut
- Département d’Anesthésie-Réanimation, AP-HM, CHU Timone, Aix-Marseille Université, Marseille, France
- INT UMR CNRS 7286, Aix-Marseille Université, Marseille, France
| | - Pierre Simeone
- Département d’Anesthésie-Réanimation, AP-HM, CHU Timone, Aix-Marseille Université, Marseille, France
- CNRS, Institut des Neurosciences de la Timone, UMR7289, Marseille, France
| | - Claire Stein
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation; Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, France
| | - Lionel Velly
- Département d’Anesthésie-Réanimation, AP-HM, CHU Timone, Aix-Marseille Université, Marseille, France
- CNRS, Institut des Neurosciences de la Timone, UMR7289, Marseille, France
| | - Nicolas Bruder
- Département d’Anesthésie-Réanimation, AP-HM, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Jean-Marie Forel
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation; Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, France
| | - Sami Hraiech
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation; Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, France
| | - Christophe Guervilly
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation; Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, France
| | - Julien Carvelli
- Service de Réanimation et Surveillance Continue, Hôpital de la Timone, AP-HM, Marseille, France
| | - Marc Gainnier
- INSERM, INRAE, C2VN, Aix-Marseille Université, Marseille, France
- Service de Réanimation et Surveillance Continue, Hôpital de la Timone, AP-HM, Marseille, France
| | - Jean-Louis Mège
- Laboratoire d’Immunologie, Hôpital de la Conception, AP-HM, France
| | - Sophie Chopinet
- Service de Chirurgie Générale et Transplantation Hépatique, Hôpital de la Timone, LIIE, CERIMED, Aix-Marseille Université, Marseille, France
| | - Noémie Jourde-Chiche
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- INSERM, INRAE, C2VN, Aix-Marseille Université, Marseille, France
| | - Laurent Papazian
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation; Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, France
| | - Stéphane Burtey
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- INSERM, INRAE, C2VN, Aix-Marseille Université, Marseille, France
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Lockhart-Bouron M, Vanel N, Levy M, Briant AR, Javouhey E, Breinig S, Dina J, Caseris M, Angoulvant F, Leteurtre S, Recher M, Brossier DW. Severe acute respiratory syndrome coronavirus-2-related and imputable deaths in children: results from the French pediatric national registry. World J Pediatr 2024; 20:611-620. [PMID: 38506979 DOI: 10.1007/s12519-023-00791-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/14/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for an important mortality rate worldwide. We aimed to evaluate the actual imputability of SARS-CoV-2 on the mortality rate associated with SARS-CoV-2-related illnesses in the pediatric intensive care unit (PICU). Secondary objectives were to identify risk factors for death. METHODS This national multicenter comparative study comprised all patients under 18 years old with positive SARS-CoV-2 polymerase chain reactions (PCRs) [acute corona virus disease 2019 (COVID-19) or incidental SARS-CoV-2 infection] and/or pediatric inflammatory multisystem syndrome (PIMS) recorded in the French PICU registry (PICURe) between September 1, 2021, and August 31, 2022. Included patients were classified and compared according to their living status at the end of their PICU stay. Deceased patients were evaluated by four experts in the field of pediatric infectiology and/or pediatric intensive care. The imputability of SARS-CoV-2 as the cause of death was classified into four categories: certain, very probable, possible, or unlikely, and was defined by any of the first three categories. RESULTS There were 948 patients included of which 43 died (4.5%). From this, 26 deaths (67%) could be attributed to SARS-CoV-2 infection, with an overall mortality rate of 2.8%. The imputability of death to SARS-CoV-2 was considered certain in only one case (0.1%). Deceased patients suffered more often from comorbidities, especially heart disease, neurological disorders, hematological disease, cancer, and obesity. None of the deceased patients were admitted for pediatric inflammatory multisystem syndrome (PIMS). Mortality risk factors were male gender, cardiac comorbidities, cancer, and acute respiratory distress syndrome. CONCLUSIONS SARS-CoV-2 mortality in the French pediatric population was low. Even though the imputability of SARS-CoV-2 on mortality was considered in almost two-thirds of cases, this imputability was considered certain in only one case.
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Affiliation(s)
- Marguerite Lockhart-Bouron
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Noémie Vanel
- Pediatric Intensive Care Unit, CHU de Marseille, Marseille, France
| | - Michael Levy
- Pediatric Intensive Care Unit, CHU Robert-Debré, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris-Cité, Paris, France
| | - Anaïs R Briant
- Biostatistics and Clinical Research Unit, CHU de Caen Normandie, 14000, Caen, France
| | | | - Sophie Breinig
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, Toulouse, France
| | - Julia Dina
- Virology Department, INSERM U1311 Dynamicure, Univ CAEN Normandie, CHU de Caen, 14000, Caen, France
- Medical School, Université Caen Normandie, 14000, Caen, France
| | - Marion Caseris
- Department of Pediatrics, CHU Robert-Debré, Assistance Publique Hôpitaux de Paris, Paris, France
| | - François Angoulvant
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stéphane Leteurtre
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Morgan Recher
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - David W Brossier
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France.
- Medical School, Université Caen Normandie, 14000, Caen, France.
- Pediatric Intensive Care Unit, Réanimation Et Soins Intensifs Pédiatriques, CHU de CAEN, Avenue de La Côte de Nacre, 14000, Caen, France.
- CHU Sainte Justine Research Center, Montréal, Canada.
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Morimoto S, Muranishi K, Izutani Y, Maruyama J, Kato R, Ninomiya S, Nakamura Y, Kitamura T, Takata T, Ishikura H. Assessment of the prognosis, frequency, and isolated bacteria in ventilator-associated pneumonia among patients with severe coronavirus disease 2019 pneumonia: A single-center retrospective observational study. J Infect Chemother 2024; 30:499-503. [PMID: 38097039 DOI: 10.1016/j.jiac.2023.12.003] [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: 12/09/2022] [Revised: 10/23/2023] [Accepted: 12/07/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Acute respiratory distress syndrome (ARDS) due to severe coronavirus disease 2019 (COVID-19) pneumonia is associated with a high incidence of ventilator-associated pneumonia (VAP). We aimed to evaluate the epidemiology of VAP associated with severe COVID-19 pneumonia. METHODS This retrospective observational study recruited patients with COVID-19-associated ARDS admitted to our center from April 1, 2020, to September 30, 2021. The primary outcome was the survival-to-discharge rate. The secondary outcomes were the VAP rate, time to VAP, length of ICU stay, length of ventilator support, and isolated bacteria. RESULTS Sixty-eight patients were included in this study; 23 developed VAP. The survival-to-discharge rate was 60.9 % in the VAP group and 84.4 % in the non-VAP group. The median time to VAP onset was 16 days. The median duration of ventilator support and of ICU stay were higher in the VAP group than in the non-VAP group. The VAP rate was 33.8 %. The most common isolated species was Stenotrophomonas maltophilia. On admission, carbapenems were used in a maximum number of cases (75 %). Furthermore, the median body mass index (BMI) was lower and the median sequential organ failure assessment (SOFA) score on admission was higher in the VAP group than in the non-VAP group. CONCLUSIONS The survival-to-discharge rate in VAP patients was low. Moreover, VAP patients tended to have long ICU stays, low BMI, and high SOFA scores on admission. Unusually, S. maltophilia was the most common isolated bacteria, which may be related to the frequent use of carbapenems.
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Affiliation(s)
- Shinichi Morimoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Kentaro Muranishi
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Yoshito Izutani
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Junichi Maruyama
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Reijiro Kato
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Shun Ninomiya
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Taisuke Kitamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Tohru Takata
- Department of Oncology, Hematology and Infectious Disease, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
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Haber R, Ghezzawi M, Puzantian H, Haber M, Saad S, Ghandour Y, El Bachour J, Yazbeck A, Hassanieh G, Mehdi C, Ismail D, Abi-Kharma E, El-Zein O, Khamis A, Chakhtoura M, Mantzoros C. Mortality risk in patients with obesity and COVID-19 infection: a systematic review and meta-analysis. Metabolism 2024; 155:155812. [PMID: 38360130 DOI: 10.1016/j.metabol.2024.155812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
Obesity is a risk factor for severe respiratory diseases, including COVID-19 infection. Meta-analyses on mortality risk were inconsistent. We systematically searched 3 databases (Medline, Embase, CINAHL) and assessed the quality of studies using the Newcastle-Ottawa tool (CRD42020220140). We included 199 studies from US and Europe, with a mean age of participants 41.8-78.2 years, and a variable prevalence of metabolic co-morbidities of 20-80 %. Exceptionally, one third of the studies had a low prevalence of obesity of <20 %. Compared to patients with normal weight, those with obesity had a 34 % relative increase in the odds of mortality (p-value 0.002), with a dose-dependent relationship. Subgroup analyses showed an interaction with the country income. There was a high heterogeneity in the results, explained by clinical and methodologic variability across studies. We identified one trial only comparing mortality rate in vaccinated compared to unvaccinated patients with obesity; there was a trend for a lower mortality in the former group. Mortality risk in COVID-19 infection increases in parallel to an increase in BMI. BMI should be included in the predictive models and stratification scores used when considering mortality as an outcome in patients with COVID-19 infections. Furthermore, patients with obesity might need to be prioritized for COVID-19 vaccination.
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Affiliation(s)
- Rachelle Haber
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malak Ghezzawi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Houry Puzantian
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Hariri School of Nursing, American University of Beirut, Beirut, Lebanon.
| | - Marc Haber
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sacha Saad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Yara Ghandour
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Anthony Yazbeck
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Celine Mehdi
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Dima Ismail
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Elias Abi-Kharma
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ola El-Zein
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
| | - Assem Khamis
- Hull York Medical School, University of Hull, York, United Kingdom
| | - Marlene Chakhtoura
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Christos Mantzoros
- Beth Israel Deaconess Medical Center and Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA
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Chen Y, Li H, Lin J, Su Z, Lin T. Association between (ΔPaO2/FiO2)/PEEP and in-hospital mortality in patients with COVID-19 pneumonia: A secondary analysis. PLoS One 2024; 19:e0304518. [PMID: 38820377 PMCID: PMC11142544 DOI: 10.1371/journal.pone.0304518] [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: 02/01/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The arterial pressure of oxygen (PaO2)/inspiratory fraction of oxygen (FiO2) is associated with in-hospital mortality in patients with Coronavirus Disease 2019 (COVID-19) pneumonia. ΔPaO2/FiO2 [the difference between PaO2/FiO2 after 24 h of invasive mechanical ventilation (IMV) and PaO2/FiO2 before IMV] is associated with in-hospital mortality. However, the value of PaO2 can be influenced by the end-expiratory pressure (PEEP). To the best of our knowledge, the relationship between the ratio of (ΔPaO2/FiO2)/PEEP and in-hospital mortality remains unclear. This study aimed to evaluate their association. METHODS The study was conducted in southern Peru from April 2020 to April 2021. A total of 200 patients with COVID-19 pneumonia requiring IMV were included in the present study. We analyzed the association between (ΔPaO2/FiO2)/PEEP and in-hospital mortality by Cox proportional hazards regression models. RESULTS The median (ΔPaO2/FiO2)/PEEP was 11.78 mmHg/cmH2O [interquartile range (IQR) 8.79-16.08 mmHg/cmH2O], with a range of 1 to 44.36 mmHg/cmH2O. Patients were divided equally into two groups [low group (< 11.80 mmHg/cmH2O), and high group (≥ 11.80 mmHg/cmH2O)] according to the (ΔPaO2/FiO2)/PEEP ratio. In-hospital mortality was lower in the high (ΔPaO2/FiO2)/PEEP group than in the low (ΔPaO2/FiO2)/PEEP group [18 (13%) vs. 38 (38%)]; hazard ratio (HR), 0.33 [95% confidence intervals (CI), 0.17-0.61, P < 0.001], adjusted HR, 0.32 (95% CI, 0.11-0.94, P = 0.038). The finding that the high (ΔPaO2/FiO2)/PEEP group exhibited a lower risk of in-hospital mortality compared to the low (ΔPaO2/FiO2)/PEEP group was consistent with the results from the sensitivity analysis. After adjusting for confounding variables, we found that each unit increase in (ΔPaO2/FiO2)/PEEP was associated with a 12% reduction in the risk of in-hospital mortality (HR, 0.88, 95%CI, 0.80-0.97, P = 0.013). CONCLUSIONS The (ΔPaO2/FiO2)/PEEP ratio was associated with in-hospital mortality in patients with COVID-19 pneumonia. (ΔPaO2/FiO2)/PEEP might be a marker of disease severity in COVID-19 patients.
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Affiliation(s)
- Youli Chen
- Intensive Care Unit, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, Fujian, PR China
| | - Huangen Li
- Intensive Care Unit, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, Fujian, PR China
| | - Jinhuang Lin
- Intensive Care Unit, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, Fujian, PR China
| | - Zhiwei Su
- Intensive Care Unit, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, Fujian, PR China
| | - Tianlai Lin
- Intensive Care Unit, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, Fujian, PR China
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Saconato M, Maselli-Schoueri JH, Malaque CMS, Marcusso RM, de Oliveira ACP, Batista LAN, Ultramari G, Lindoso JAL, Gonçalves MIR, Sztajnbok J. Postorotracheal intubation dysphagia in patients with COVID-19: A retrospective study. SAO PAULO MED J 2024; 142:e2022608. [PMID: 38808794 PMCID: PMC11126317 DOI: 10.1590/1516-3180.2022.0608.r3.14032024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/09/2023] [Accepted: 03/14/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The cause of oropharyngeal dysphagia in patients with coronavirus disease (COVID-19) can be multifactorial and may underly limitations in swallowing rehabilitation. OBJECTIVE Analyze the factors related to dysphagia in patients with COVID-19 immediately after orotracheal extubation and the factors that influence swallowing rehabilitation. DESIGN AND SETTING A retrospective study. METHODS The presence of dysphagia was evaluated using the American Speech-Language Hearing Association National Outcome Measurement System (ASHA NOMS) scale and variables that influenced swallowing rehabilitation in 140 adult patients who required invasive mechanical ventilation for >48 h. RESULTS In total, 46.43% of the patients scored 1 or 2 on the ASHA NOMS (severe dysphagia) and 39.29% scored 4 (single consistency delivered orally) or 5 (exclusive oral diet with adaptations). Both the length of mechanical ventilation and the presence of neurological disorders were associated with lower ASHA NOMS scores (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.74-0.87 P < 0.05; and OR: 0.13, 95% CI: 0.61-0.29; P < 0.05, respectively). Age and the presence of tracheostomy were negatively associated with speech rehabilitation (OR: 0.92; 95% CI: 0.87--0.96; OR: 0.24; 95% CI: 0.80--0.75), and acute post-COVID-19 kidney injury requiring dialysis and lower scores on the ASHA NOMS were associated with longer time for speech therapy outcomes (β: 1.62, 95% CI, 0.70-3.17, P < 0.001; β: -1.24, 95% CI: -1.55--0.92; P < 0.001). CONCLUSION Prolonged orotracheal intubation and post-COVID-19 neurological alterations increase the probability of dysphagia immediately after extubation. Increased age and tracheostomy limited rehabilitation.
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Affiliation(s)
- Mariana Saconato
- PhD. Speech therapist, Technical manager of the Speech Therapy team, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | | | - Ceila Maria Sant’Ana Malaque
- PhD. Physician, Intensive Care Unit Physician, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | - Rosa Maria Marcusso
- MSc. Statistician, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | | | | | - Graziela Ultramari
- MSc. Physiotherapist, Head of the Diagnostic and Therapeutic Support Department, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | - José Angelo Lauletta Lindoso
- PhD. Physician, Director of the Diagnostic and Therapeutic Support Department, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | - Maria Inês Rebelo Gonçalves
- PhD. Speech therapist and Professor, Department of Speech Therapy, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Jaques Sztajnbok
- MD. Physician, Head of the Intensive Care Unit, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
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Cañas A, Wolf A, Mak A, Ruddy J, El-Sadek S, Gomez L, Furfaro D, Fullilove R, Burkart KM, Zelnick J, O'Donnell MR. Racial and ethnic disparities post-hospitalization for COVID-19: barriers to access to care for survivors of COVID-19 acute respiratory distress syndrome. Sci Rep 2024; 14:11556. [PMID: 38773184 PMCID: PMC11109289 DOI: 10.1038/s41598-024-61097-0] [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: 12/20/2023] [Accepted: 04/30/2024] [Indexed: 05/23/2024] Open
Abstract
Racial and ethnic health disparities in the incidence and severity of Coronavirus Disease 2019 (COVID-19) have been observed globally and in the United States. Research has focused on transmission, hospitalization, and mortality among racial and ethnic minorities, but Long COVID-19 health disparities research is limited. This study retrospectively evaluated 195 adults who survived COVID-19 associated acute respiratory distress syndrome (C-ARDS) in New York City from March-April 2020. Among survivors, 54% met the criteria for Long COVID syndrome. Hispanic/Latinx patients, were more likely to be uninsured (p = 0.027) and were less frequently discharged to rehabilitation facilities (p < 0.001). A cross-sectional telephone survey and interview were conducted with a subset of survivors (n = 69). Among these, 11% reported a lack of follow-up primary care post-discharge and 38% had subsequent emergency room visits. Notably, 38% reported poor treatment within the health care system, with 67% attributing this to racial or ethnic bias. Thematic analysis of interviews identified four perceived challenges: decline in functional status, discrimination during hospitalization, healthcare system inequities, and non-healthcare-related structural barriers. Sources of resilience included survivorship, faith, and family support. This study highlights structural and healthcare-related barriers rooted in perceived racism and poverty as factors impacting post-COVID-19 care.
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Affiliation(s)
- Alicia Cañas
- Department of Medicine, Columbia University Medical Center, New York City, USA
| | - Allison Wolf
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York City, USA
| | - Angela Mak
- School of Global Health, Dahdaleh Institute of Global Health Research, York University, Toronto, Canada
| | - Jacob Ruddy
- Department of Medicine, Columbia University Medical Center, New York City, USA
| | - Sal El-Sadek
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York City, USA
| | - Laura Gomez
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York City, USA
| | - David Furfaro
- Division of Pulmonary, Allergy, and Critical Care Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, USA
| | - Robert Fullilove
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Medical Center, New York City, USA
| | - Kristin M Burkart
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York City, USA
| | - Jennifer Zelnick
- Graduate School of Social Work, Touro University, New York City, USA
| | - Max R O'Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Epidemiology, Columbia University Medical Center, Suite E101, 8th Floor, PH building, 622 W. 168th street, New York City, NY, 10032, USA.
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Meyer HJ, Mödl L, Unruh O, Xiang W, Berger S, Müller-Plathe M, Rohde G, Pletz MW, Rupp J, Suttorp N, Witzenrath M, Zoller T, Mittermaier M, Steinbeis F. Comparison of clinical outcomes in hospitalized patients with COVID-19 or non-COVID-19 community-acquired pneumonia in a prospective observational cohort study. Infection 2024:10.1007/s15010-024-02292-z. [PMID: 38761325 DOI: 10.1007/s15010-024-02292-z] [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: 02/28/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE Coronavirus disease 2019 (COVID-19) and non-COVID-19 community-acquired pneumonia (NC-CAP) often result in hospitalization with considerable risks of mortality, ICU treatment, and long-term morbidity. A comparative analysis of clinical outcomes in COVID-19 CAP (C-CAP) and NC-CAP may improve clinical management. METHODS Using prospectively collected CAPNETZ study data (January 2017 to June 2021, 35 study centers), we conducted a comprehensive analysis of clinical outcomes including in-hospital death, ICU treatment, length of hospital stay (LOHS), 180-day survival, and post-discharge re-hospitalization rate. Logistic regression models were used to examine group differences between C-CAP and NC-CAP patients and associations with patient demography, recruitment period, comorbidity, and treatment. RESULTS Among 1368 patients (C-CAP: n = 344; NC-CAP: n = 1024), C-CAP showed elevated adjusted probabilities for in-hospital death (aOR 4.48 [95% CI 2.38-8.53]) and ICU treatment (aOR 8.08 [95% CI 5.31-12.52]) compared to NC-CAP. C-CAP patients were at increased risk of LOHS over seven days (aOR 1.88 [95% CI 1.47-2.42]). Although ICU patients had similar in-hospital mortality risk, C-CAP was associated with length of ICU stay over seven days (aOR 3.59 [95% CI 1.65-8.38]). Recruitment period influenced outcomes in C-CAP but not in NC-CAP. During follow-up, C-CAP was linked to a reduced risk of re-hospitalization and mortality post-discharge (aOR 0.43 [95% CI 0.27-0.70]). CONCLUSION Distinct clinical trajectories of C-CAP and NC-CAP underscore the need for adapted management to avoid acute and long-term morbidity and mortality amid the evolving landscape of CAP pathogens.
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Affiliation(s)
- Hans-Jakob Meyer
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Pneumology, Helios Klinikum Emil Von Behring, Lungenklinik Heckeshorn, Berlin, Germany
| | - Lukas Mödl
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | | | - Weiwei Xiang
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Berger
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Moritz Müller-Plathe
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Gernot Rohde
- CAPNETZ STIFTUNG, Hannover, Germany
- Department of Respiratory Medicine, Goethe University, University Hospital, Medical Clinic I, Frankfurt/Main, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Mathias W Pletz
- CAPNETZ STIFTUNG, Hannover, Germany
- Institute of Infectious Diseases and Infection Control, Jena University Hospital /Friedrich Schiller University, Jena, Germany
| | - Jan Rupp
- CAPNETZ STIFTUNG, Hannover, Germany
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
- German Center for Lung Research (DZL), Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
- German Center for Lung Research (DZL), Berlin, Germany
| | - Thomas Zoller
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Mirja Mittermaier
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Fridolin Steinbeis
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Patel MA, Daley M, Van Nynatten LR, Slessarev M, Cepinskas G, Fraser DD. A reduced proteomic signature in critically ill Covid-19 patients determined with plasma antibody micro-array and machine learning. Clin Proteomics 2024; 21:33. [PMID: 38760690 PMCID: PMC11100131 DOI: 10.1186/s12014-024-09488-3] [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: 11/09/2023] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND COVID-19 is a complex, multi-system disease with varying severity and symptoms. Identifying changes in critically ill COVID-19 patients' proteomes enables a better understanding of markers associated with susceptibility, symptoms, and treatment. We performed plasma antibody microarray and machine learning analyses to identify novel proteins of COVID-19. METHODS A case-control study comparing the concentration of 2000 plasma proteins in age- and sex-matched COVID-19 inpatients, non-COVID-19 sepsis controls, and healthy control subjects. Machine learning was used to identify a unique proteome signature in COVID-19 patients. Protein expression was correlated with clinically relevant variables and analyzed for temporal changes over hospitalization days 1, 3, 7, and 10. Expert-curated protein expression information was analyzed with Natural language processing (NLP) to determine organ- and cell-specific expression. RESULTS Machine learning identified a 28-protein model that accurately differentiated COVID-19 patients from ICU non-COVID-19 patients (accuracy = 0.89, AUC = 1.00, F1 = 0.89) and healthy controls (accuracy = 0.89, AUC = 1.00, F1 = 0.88). An optimal nine-protein model (PF4V1, NUCB1, CrkL, SerpinD1, Fen1, GATA-4, ProSAAS, PARK7, and NET1) maintained high classification ability. Specific proteins correlated with hemoglobin, coagulation factors, hypertension, and high-flow nasal cannula intervention (P < 0.01). Time-course analysis of the 28 leading proteins demonstrated no significant temporal changes within the COVID-19 cohort. NLP analysis identified multi-system expression of the key proteins, with the digestive and nervous systems being the leading systems. CONCLUSIONS The plasma proteome of critically ill COVID-19 patients was distinguishable from that of non-COVID-19 sepsis controls and healthy control subjects. The leading 28 proteins and their subset of 9 proteins yielded accurate classification models and are expressed in multiple organ systems. The identified COVID-19 proteomic signature helps elucidate COVID-19 pathophysiology and may guide future COVID-19 treatment development.
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Affiliation(s)
- Maitray A Patel
- Epidemiology and Biostatistics, Western University, London, ON, N6A 3K7, Canada
| | - Mark Daley
- Epidemiology and Biostatistics, Western University, London, ON, N6A 3K7, Canada
- Computer Science, Western University, London, ON, N6A 3K7, Canada
| | | | - Marat Slessarev
- Medicine, Western University, London, ON, N6A 3K7, Canada
- Lawson Health Research Institute, London, ON, N6C 2R5, Canada
| | - Gediminas Cepinskas
- Lawson Health Research Institute, London, ON, N6C 2R5, Canada
- Medical Biophysics, Western University, London, ON, N6A 3K7, Canada
| | - Douglas D Fraser
- Lawson Health Research Institute, London, ON, N6C 2R5, Canada.
- Children's Health Research Institute, London, ON, N6C 4V3, Canada.
- Pediatrics, Western University, London, ON, N6A 3K7, Canada.
- Clinical Neurological Sciences, Western University, London, ON, N6A 3K7, Canada.
- Physiology & Pharmacology, Western University, London, ON, N6A 3K7, Canada.
- London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
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Carvalho EV, Reboredo MM, Gomes EP, Martins PN, Mota GPS, Costa GB, Colugnati FAB, Pinheiro BV. Driving pressure, as opposed to tidal volume based on predicted body weight, is associated with mortality: results from a prospective cohort of COVID-19 acute respiratory distress syndrome patients. CRITICAL CARE SCIENCE 2024; 36:e20240208en. [PMID: 38747818 PMCID: PMC11098065 DOI: 10.62675/2965-2774.20240208-en] [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: 08/14/2023] [Accepted: 01/06/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To evaluate the association between driving pressure and tidal volume based on predicted body weight and mortality in a cohort of patients with acute respiratory distress syndrome caused by COVID-19. METHODS This was a prospective, observational study that included patients with acute respiratory distress syndrome due to COVID-19 admitted to two intensive care units. We performed multivariable analyses to determine whether driving pressure and tidal volume/kg predicted body weight on the first day of mechanical ventilation, as independent variables, are associated with hospital mortality. RESULTS We included 231 patients. The mean age was 64 (53 - 74) years, and the mean Simplified Acute and Physiology Score 3 score was 45 (39 - 54). The hospital mortality rate was 51.9%. Driving pressure was independently associated with hospital mortality (odds ratio 1.21, 95%CI 1.04 - 1.41 for each cm H2O increase in driving pressure, p = 0.01). Based on a double stratification analysis, we found that for the same level of tidal volume/kg predicted body weight, the risk of hospital death increased with increasing driving pressure. However, changes in tidal volume/kg predicted body weight were not associated with mortality when they did not lead to an increase in driving pressure. CONCLUSION In patients with acute respiratory distress syndrome caused by COVID-19, exposure to higher driving pressure, as opposed to higher tidal volume/kg predicted body weight, is associated with greater mortality. These results suggest that driving pressure might be a primary target for lung-protective mechanical ventilation in these patients.
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Affiliation(s)
- Erich Vidal Carvalho
- Universidade Federal de Juiz de ForaHospital UniversitárioPulmonary and Critical Care DivisionJuiz de ForaMGBrazilPulmonary and Critical Care Division, Hospital Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brazil.
| | - Maycon Moura Reboredo
- Universidade Federal de Juiz de ForaHospital UniversitárioPulmonary and Critical Care DivisionJuiz de ForaMGBrazilPulmonary and Critical Care Division, Hospital Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brazil.
| | - Edimar Pedrosa Gomes
- Universidade Federal de Juiz de ForaHospital UniversitárioPulmonary and Critical Care DivisionJuiz de ForaMGBrazilPulmonary and Critical Care Division, Hospital Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brazil.
| | - Pedro Nascimento Martins
- Universidade Federal de Juiz de ForaHospital UniversitárioPulmonary and Critical Care DivisionJuiz de ForaMGBrazilPulmonary and Critical Care Division, Hospital Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brazil.
| | - Gabriel Paz Souza Mota
- Universidade Federal de Juiz de ForaHospital UniversitárioPulmonary and Critical Care DivisionJuiz de ForaMGBrazilPulmonary and Critical Care Division, Hospital Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brazil.
| | - Giovani Bernardo Costa
- Universidade Federal de Juiz de ForaHospital UniversitárioPulmonary and Critical Care DivisionJuiz de ForaMGBrazilPulmonary and Critical Care Division, Hospital Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brazil.
| | - Fernando Antonio Basile Colugnati
- Universidade Federal de Juiz de ForaHospital UniversitárioPulmonary and Critical Care DivisionJuiz de ForaMGBrazilPulmonary and Critical Care Division, Hospital Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brazil.
| | - Bruno Valle Pinheiro
- Universidade Federal de Juiz de ForaHospital UniversitárioPulmonary and Critical Care DivisionJuiz de ForaMGBrazilPulmonary and Critical Care Division, Hospital Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brazil.
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Riou M, Coste F, Meyer A, Enache I, Talha S, Charloux A, Reboul C, Geny B. Mechanisms of Pulmonary Vasculopathy in Acute and Long-Term COVID-19: A Review. Int J Mol Sci 2024; 25:4941. [PMID: 38732160 PMCID: PMC11084496 DOI: 10.3390/ijms25094941] [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: 03/27/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Despite the end of the pandemic, coronavirus disease 2019 (COVID-19) remains a major public health concern. The first waves of the virus led to a better understanding of its pathogenesis, highlighting the fact that there is a specific pulmonary vascular disorder. Indeed, COVID-19 may predispose patients to thrombotic disease in both venous and arterial circulation, and many cases of severe acute pulmonary embolism have been reported. The demonstrated presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within the endothelial cells suggests that direct viral effects, in addition to indirect effects of perivascular inflammation and coagulopathy, may contribute to pulmonary vasculopathy in COVID-19. In this review, we discuss the pathological mechanisms leading to pulmonary vascular damage during acute infection, which appear to be mainly related to thromboembolic events, an impaired coagulation cascade, micro- and macrovascular thrombosis, endotheliitis and hypoxic pulmonary vasoconstriction. As many patients develop post-COVID symptoms, including dyspnea, we also discuss the hypothesis of pulmonary vascular damage and pulmonary hypertension as a sequela of the infection, which may be involved in the pathophysiology of long COVID.
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Affiliation(s)
- Marianne Riou
- Translational Medicine Federation of Strasbourg (FMTS), University of Strasbourg, CRBS, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 1 rue Eugène Boeckel, CS 60026, 67084 Strasbourg, France; (M.R.); (A.M.); (I.E.); (S.T.); (A.C.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’hôpital, 67091 Strasbourg, France
| | - Florence Coste
- EA4278, Laboratoire de Pharm-Ecologie Cardiovasculaire, UFR Sciences Technologies Santé, Pôle Sport et Recherche, 74 rue Louis Pasteur, 84000 Avignon, France; (F.C.); (C.R.)
| | - Alain Meyer
- Translational Medicine Federation of Strasbourg (FMTS), University of Strasbourg, CRBS, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 1 rue Eugène Boeckel, CS 60026, 67084 Strasbourg, France; (M.R.); (A.M.); (I.E.); (S.T.); (A.C.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’hôpital, 67091 Strasbourg, France
| | - Irina Enache
- Translational Medicine Federation of Strasbourg (FMTS), University of Strasbourg, CRBS, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 1 rue Eugène Boeckel, CS 60026, 67084 Strasbourg, France; (M.R.); (A.M.); (I.E.); (S.T.); (A.C.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’hôpital, 67091 Strasbourg, France
| | - Samy Talha
- Translational Medicine Federation of Strasbourg (FMTS), University of Strasbourg, CRBS, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 1 rue Eugène Boeckel, CS 60026, 67084 Strasbourg, France; (M.R.); (A.M.); (I.E.); (S.T.); (A.C.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’hôpital, 67091 Strasbourg, France
| | - Anne Charloux
- Translational Medicine Federation of Strasbourg (FMTS), University of Strasbourg, CRBS, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 1 rue Eugène Boeckel, CS 60026, 67084 Strasbourg, France; (M.R.); (A.M.); (I.E.); (S.T.); (A.C.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’hôpital, 67091 Strasbourg, France
| | - Cyril Reboul
- EA4278, Laboratoire de Pharm-Ecologie Cardiovasculaire, UFR Sciences Technologies Santé, Pôle Sport et Recherche, 74 rue Louis Pasteur, 84000 Avignon, France; (F.C.); (C.R.)
| | - Bernard Geny
- Translational Medicine Federation of Strasbourg (FMTS), University of Strasbourg, CRBS, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 1 rue Eugène Boeckel, CS 60026, 67084 Strasbourg, France; (M.R.); (A.M.); (I.E.); (S.T.); (A.C.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’hôpital, 67091 Strasbourg, France
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Collado-Lledó E, Moyon Q, Chommeloux J, Pineton de Chambrun M, Hékimian G, Saura O, Lévy D, Schmidt M, Combes A, Luyt CE, Le Fevre L. Recurrent ventilator-associated pneumonia in severe Covid-19 ARDS patients requiring ECMO support. Ann Intensive Care 2024; 14:67. [PMID: 38662274 PMCID: PMC11045714 DOI: 10.1186/s13613-024-01295-1] [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: 01/08/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE To describe ventilator-associated pneumonia (VAP) recurrence in COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO) support, and to evaluate the impact of antimicrobial treatment duration of the first VAP episode on VAP recurrence. METHODS Adult patients with COVID-19 severe pneumonia on ECMO admitted between March 2020 and January 2022 were retrospectively included. Primary outcome was incidence of VAP recurrence, and secondary outcome was the impact of duration of antimicrobial treatment on VAP recurrence. RESULTS Among the 252 included patients, 226 (90%) developed a first VAP. Sixteen had lung abscess and were excluded, leaving 210 patients. VAP recurrence occurred in 172 patients (82%), with a median (IQR) time from first VAP to recurrence of 10 (7-13) days. Pseudomonas aeruginosa and Enterobacteriaceae were respectively responsible for 28% and 52% of first VAP, and 51% and 62% of first recurrence episodes. Among the 210 patients with a first VAP, 158 (75%) received a short course of antibiotics [< 8 days, median (IQR) duration 6 (5-7) days] and 52 (25%) received a prolonged course of antibiotics [≥ 8 days, median (IQR) duration 9 (8-10) days]. Estimated cumulative incidence of VAP recurrence, taking into account death and extubation as competing risks, was not different in patients with short- and prolonged-antimicrobial treatment. CONCLUSIONS In patients with severe Covid-19-ARDS requiring ECMO support, VAP recurrence occurs frequently, with Enterobacteriaceae and Pseudomonas aeruginosa as predominant causative microorganisms. An antimicrobial treatment of ≥ 8 days for the treatment of first VAP episode did not reduce the risk of VAP recurrence, as compared to shorter duration.
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Affiliation(s)
- Elena Collado-Lledó
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris, France
| | - Quentin Moyon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris, France
| | - Juliette Chommeloux
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris, France
| | - Marc Pineton de Chambrun
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris, France
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Guillaume Hékimian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris, France
| | - Ouriel Saura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris, France
| | - David Lévy
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris, France
| | - Matthieu Schmidt
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris, France
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Alain Combes
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris, France
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Charles-Edouard Luyt
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris, France.
- INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France.
| | - Lucie Le Fevre
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris, France
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Razazi K, Luyt CE, Voiriot G, Rouzé A, Garnier M, Ferré A, Camous L, Heming N, Lapidus N, Charles-Nelson A, Mekontso-Dessap A. Ventilator-associated pneumonia related to extended-spectrum beta-lactamase producing Enterobacterales during severe acute respiratory syndrome coronavirus 2 infection: risk factors and prognosis. Crit Care 2024; 28:131. [PMID: 38641851 PMCID: PMC11031867 DOI: 10.1186/s13054-024-04906-2] [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: 10/16/2023] [Accepted: 04/08/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring mechanical ventilation suffer from a high incidence of ventilator associated pneumonia (VAP), mainly related to Enterobacterales. Data regarding extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) VAP are scarce. We aimed to investigate risk factors and outcomes of ESBL-E related VAP among critically ill coronavirus infectious disease-19 (COVID-19) patients who developed Enterobacterales related VAP. PATIENTS AND METHODS We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU) that included 4929 COVID-19 critically ill patients. For the present analysis, only patients with complete data regarding resistance status of the first episode of Enterobacterales related VAP (ESBL-E and/or carbapenem-resistant Enterobacterales, CRE) and outcome were included. RESULTS We included 591 patients with Enterobacterales related VAP. The main causative species were Enterobacter sp (n = 224), E. coli (n = 111) and K. pneumoniae (n = 104). One hundred and fifteen patients (19%), developed a first ESBL-E related VAP, mostly related to Enterobacter sp (n = 40), K. pneumoniae (n = 36), and E. coli (n = 31). Eight patients (1%) developed CRE related VAP. In a multivariable analysis, African origin (North Africa or Sub-Saharan Africa) (OR 1.7 [1.07-2.71], p = 0.02), time between intubation and VAP (OR 1.06 [1.02-1.09], p = 0.002), PaO2/FiO2 ratio on the day of VAP (OR 0.997 [0.994-0.999], p = 0.04) and trimethoprim-sulfamethoxazole exposure (OR 3.77 [1.15-12.4], p = 0.03) were associated with ESBL-E related VAP. Weaning from mechanical ventilation and mortality did not significantly differ between ESBL-E and non ESBL-E VAP. CONCLUSION ESBL-related VAP in COVID-19 critically-ill patients was not infrequent. Several risk factors were identified, among which some are modifiable and deserve further investigation. There was no impact of resistance of the first Enterobacterales related episode of VAP on outcome.
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Affiliation(s)
- Keyvan Razazi
- Hôpitaux Universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010, Créteil, France.
- IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil (UPEC), 94010, Créteil, France.
- Service de Medicine Intensive Réanimation, CHU Henri Mondor, 51, Av de Lattre de Tassigny, 94000, Créteil Cedex, France.
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, Sorbonne-Université, Hôpital Pitié-Salpêtrière, and Sorbonne Université, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), 47-83, Boulevard de L'Hôpital, 75651, Paris, France
| | - Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Anahita Rouzé
- Inserm U1285, CHU Lille, Service de Médecine Intensive - Réanimation, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Univ. Lille, 59000, Lille, France
| | - Marc Garnier
- GRC29, DMU DREAM, Anesthesiology and Critical Care Medicine Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, Paris, France
| | - Alexis Ferré
- Intensive Care Unit, Versailles Hospital, Le Chesnay, France
| | - Laurent Camous
- Medical and Surgical Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles-Guyane University, Les Abymes, France
| | - Nicholas Heming
- Department of Intensive Care, Hôpital Raymond Poincaré, APHP University Versailles Saint Quentin - University Paris Saclay, Paris, France
- Laboratory of Infection and Inflammation - U1173, School of Medicine Simone Veil, INSERM, University Versailles Saint Quentin - University Paris Saclay, Garches, France
- FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), Garches, France
| | - Nathanaël Lapidus
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Saint-Antoine Hospital, Public Health Department, Sorbonne University, 75012, Paris, France
| | - Anais Charles-Nelson
- Hôpital Européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, INSERM, Centre d'Investigation Clinique1418, Module Épidémiologie Clinique, AP-HP (Assistance Publique Hôpitaux de Paris), Paris, France
| | - Armand Mekontso-Dessap
- Hôpitaux Universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010, Créteil, France
- IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil (UPEC), 94010, Créteil, France
- INSERM, Unité U955, Université Paris Est, 94010, Créteil, France
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Adda M, Dupuis C, Gouby G, Dubray C, Reignier J, Souweine B, Dualé C. Job description and perception of clinical research personnel working in a network of French intensive care units. Crit Care 2024; 28:119. [PMID: 38605352 PMCID: PMC11010361 DOI: 10.1186/s13054-024-04900-8] [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: 02/02/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND There is a lack of information about the organisation and management of clinical research personnel in Europe and of their professional activity in intensive care. We therefore conducted a cross-sectional survey among personnel currently working in a French intensive care research network that involves 41 centres nationwide. The aim of the survey was to describe the personnel's personal and institutional organisation and management, their job perception in terms of satisfaction and stress, and suggestions for improvement. METHODS Over 3 months in 2023, the research personnel received an electronic questionnaire on their personal and professional profile, past and present training, workplace and functions currently performed, personal knowledge about job skills required, job satisfaction and stress by as measured on a rating scale, and suggested ways of improvement. RESULTS Ninety seven people replied to the questionnaire (a response rate of 71.3%), of whom 78 (57.3%) were sufficiently involved in intensive care to provide complete answers. This core sample had profiles in line with French recruitment policies and comprised mainly Bachelor/Master graduates, with nurses accounting for only 21.8%. The female to male ratio was 77:23%. Many responders declared to have a shared activity of technician (for investigation) and assistant (for quality control). More than 70% of the responders considered that most of the tasks required of each worker were major. Figures were much lower for project managers, who were few to take part in the survey. On a scale of 10, the median of job satisfaction was 7 for personal work organisation, 6 for training and for institutional organisation, and only 5 for personal career management. The median of job stress was 5 and was inversely correlated with satisfaction with career management. Respect of autonomy, work-sharing activity between investigation and quality control, a better career progression, financial reward for demanding tasks, and participation in unit staff meetings were the main suggestions to improve employee satisfaction. CONCLUSION This nationwide survey provides a new insight into the activity of French clinical research personnel and points to ways to improve the quality and efficiency of this workforce.
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Affiliation(s)
- Mireille Adda
- CHU Clermont-Ferrand, Médecine Intensive et Réanimation, Clermont-Ferrand, France
- Direction de la Recherche Clinique et des Innovations, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Claire Dupuis
- CHU Clermont-Ferrand, Médecine Intensive et Réanimation, Clermont-Ferrand, France
- Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Gérald Gouby
- Direction de la Recherche Clinique et des Innovations, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Claude Dubray
- Direction de la Recherche Clinique et des Innovations, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean Reignier
- CHU Nantes, Médecine Intensive et Réanimation, Nantes, France
| | - Bertrand Souweine
- CHU Clermont-Ferrand, Médecine Intensive et Réanimation, Clermont-Ferrand, France
- Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Christian Dualé
- CHU Clermont-Ferrand, Centre d'Investigation Clinique (INSERM CIC1405), 58 Rue Montalembert, 63000, Clermont-Ferrand, France.
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Lee JE, Kang DH, Kim SY, Kim DK, Lee SI. Clinical Manifestations and Outcomes of Older Patients with COVID-19: A Comprehensive Review. Tuberc Respir Dis (Seoul) 2024; 87:145-154. [PMID: 38368903 PMCID: PMC10990616 DOI: 10.4046/trd.2023.0157] [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: 10/03/2023] [Revised: 11/17/2023] [Accepted: 01/13/2024] [Indexed: 02/20/2024] Open
Abstract
The consequences of coronavirus disease 2019 (COVID-19) are particularly severe in older adults with a disproportionate number of severe and fatal outcomes. Therefore, this integrative review aimed to provide a comprehensive overview of the clinical characteristics, management approaches, and prognosis of older patients diagnosed with COVID-19. Common clinical presentations in older patients include fever, cough, and dyspnea. Additionally, preexisting comorbidities, especially diabetes and pulmonary and cardiovascular diseases, were frequently observed and associated with adverse outcomes. Management strategies varied, however, early diagnosis, vigilant monitoring, and multidisciplinary care were identified as key factors for enhancing patient outcomes. Nonetheless, the prognosis remains guarded for older patients, with increased rates of hospitalization, mechanical ventilation, and mortality. However, timely therapeutic interventions, especially antiviral and supportive treatments, have demonstrated some efficacy in mitigating the severe consequences in this age group. In conclusion, while older adults remain highly susceptible to severe outcomes from COVID-19, early intervention, rigorous monitoring, and comprehensive care can play a pivotal role in improving their clinical outcomes.
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Affiliation(s)
- Jeong Eun Lee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Da Hyun Kang
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - So-Yun Kim
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Duk Ki Kim
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Song I Lee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
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Trieu M, Qadir N. Adjunctive Therapies in Acute Respiratory Distress Syndrome. Crit Care Clin 2024; 40:329-351. [PMID: 38432699 DOI: 10.1016/j.ccc.2023.12.004] [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: 03/05/2024]
Abstract
Despite significant advances in understanding acute respiratory distress syndrome (ARDS), mortality rates remain high. The appropriate use of adjunctive therapies can improve outcomes, particularly for patients with moderate to severe hypoxia. In this review, the authors discuss the evidence basis behind prone positioning, recruitment maneuvers, neuromuscular blocking agents, corticosteroids, pulmonary vasodilators, and extracorporeal membrane oxygenation and considerations for their use in individual patients and specific clinical scenarios. Because the heterogeneity of ARDS poses challenges in finding universally effective treatments, an individualized approach and continued research efforts are crucial for optimizing the utilization of adjunctive therapies and improving patient outcomes.
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Affiliation(s)
- Megan Trieu
- Division of Pulmonary Critical Care Sleep Medicine and Physiology, Department of Medicine, University of California San Diego, 9300 Campus Point Drive, #7381, La Jolla, CA 92037-1300, USA
| | - Nida Qadir
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Room 43-229 CHS, Los Angeles, CA 90095, USA.
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Primmaz S, Rochat Negro T, Suh N, Le Terrier C, Wozniak H, Pugin J, Bendjelid K. Pulmonary embolism impacts clinical outcomes of intubated patients with acute respiratory distress syndrome related to COVID-19. Anaesth Crit Care Pain Med 2024; 43:101348. [PMID: 38278355 DOI: 10.1016/j.accpm.2024.101348] [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: 10/19/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Pulmonary embolism (PE) in critically ill patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 is a major complication which might impact survival. We aimed to determine the prevalence of PE and assess its impact of PE on clinical outcomes in intubated patients with ARDS due to COVID-19. METHODS All intubated patients with ARDS due to COVID-19 admitted to the intensive care unit (ICU) of Geneva University Hospitals between March 9, 2020, and May 31, 2022, were included. A retrospective analysis was conducted on the occurrence of PE and its association with clinical outcomes. The primary outcome was ventilator-free days during the first 28 days after ICU admission. Linear regressions were performed to investigate the association between PE and outcomes. RESULTS Among the 370 intubated patients with ARDS related to COVID-19, 58 (15.7%) presented with PE. Patients with PE had significantly fewer ventilator-free days than patients without PE (median (IQR) of 3 (0-11) days versus 12 (0-19) days; p < 0.001). Mortality did not differ significantly between groups (12/58 [20.7%] of patients with PE versus 71/312 [22.8%] of patients without PE; p = 0.72). Duration of IMV, and ICU and hospital LOS were significantly longer among patients with PE. The need for ECMO support was similar among both groups. CONCLUSIONS The occurrence of PE in patients with ARDS due to COVID-19 had a significant impact on clinical outcomes. They had fewer ventilator-free days, longer duration of IMV, and longer ICU and hospital lengths of stay. However, pulmonary embolism was not associated with higher mortality. ETHICS APPROVAL Ethical committee of Geneva (BASEC #: 2020-00917).
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Affiliation(s)
- Steve Primmaz
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland.
| | - Tommaso Rochat Negro
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Noémie Suh
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Christophe Le Terrier
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Hannah Wozniak
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Jérôme Pugin
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Karim Bendjelid
- Division of Intensive Care, Geneva University Hospitals and the University of Geneva Faculty of Medicine, Geneva, Switzerland
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