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Luján M, Sayas J. When hope meets reality: the challenges of awake proning in unmonitored settings. J Thorac Dis 2024; 16:810-815. [PMID: 38410573 PMCID: PMC10894434 DOI: 10.21037/jtd-23-1588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/24/2023] [Indexed: 02/28/2024]
Affiliation(s)
- Manel Luján
- Servei de Pneumologia, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigacion Biomédica en Red (CIBERES), Madrid, Spain
| | - Javier Sayas
- Pulmonology Service, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
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Meier N, Perner A, Plovsing R, Christensen S, Poulsen LM, Brøchner AC, Rasmussen BS, Helleberg M, Jensen JUS, Andersen LPK, Siegel H, Ibsen M, Jørgensen VL, Winding R, Iversen S, Pedersen HP, Sølling C, Garcia RS, Michelsen J, Mohr T, Michagin G, Espelund US, Bundgaard H, Kirkegaard L, Smitt M, Sigurdsson S, Buck DL, Ribergaard NE, Pedersen HS, Toft MH, Jonassen TB, Mølgaard Nielsen F, Madsen EK, Haberlandt TN, Bredahl LS, Haase N. Long-term outcomes in COVID-19 patients admitted to intensive care in Denmark: A nationwide observational study. Acta Anaesthesiol Scand 2023; 67:1239-1248. [PMID: 37288935 DOI: 10.1111/aas.14290] [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: 03/25/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Among ICU patients with COVID-19, it is largely unknown how the overall outcome and resource use have changed with time, different genetic variants, and vaccination status. METHODS For all Danish ICU patients with COVID-19 from March 10, 2020 to March 31, 2022, we manually retrieved data on demographics, comorbidities, vaccination status, use of life support, length of stay, and vital status from medical records. We compared patients based on the period of admittance and vaccination status and described changes in epidemiology related to the Omicron variant. RESULTS Among all 2167 ICU patients with COVID-19, 327 were admitted during the first (March 10-19, 2020), 1053 during the second (May 20, 2020 to June 30, 2021) and 787 during the third wave (July 1, 2021 to March 31, 2022). We observed changes over the three waves in age (median 72 vs. 68 vs. 65 years), use of invasive mechanical ventilation (81% vs. 58% vs. 51%), renal replacement therapy (26% vs. 13% vs. 12%), extracorporeal membrane oxygenation (7% vs. 3% vs. 2%), duration of invasive mechanical ventilation (median 13 vs. 13 vs. 9 days) and ICU length of stay (median 13 vs. 10 vs. 7 days). Despite these changes, 90-day mortality remained constant (36% vs. 35% vs. 33%). Vaccination rates among ICU patients were 42% as compared to 80% in society. Unvaccinated versus vaccinated patients were younger (median 57 vs. 73 years), had less comorbidity (50% vs. 78%), and had lower 90-day mortality (29% vs. 51%). Patient characteristics changed significantly after the Omicron variant became dominant including a decrease in the use of COVID-specific pharmacological agents from 95% to 69%. CONCLUSIONS In Danish ICUs, the use of life support declined, while mortality seemed unchanged throughout the three waves of COVID-19. Vaccination rates were lower among ICU patients than in society, but the selected group of vaccinated patients admitted to the ICU still had very severe disease courses. When the Omicron variant became dominant a lower fraction of SARS-CoV-2 positive patients received COVID treatment indicating other causes for ICU admission.
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Affiliation(s)
- Nick Meier
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Ronni Plovsing
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Copenhagen, Denmark
| | - Steffen Christensen
- Department of Anaesthesiology and Intensive Care, Århus University Hospital, Århus, Denmark
| | - Lone M Poulsen
- Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Anne C Brøchner
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Denmark
| | - Bodil S Rasmussen
- Department of Anaesthesiology and Intensive Care, Ålborg University Hospital, Ålborg, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Jens U S Jensen
- Department of Respiratory Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Lars P K Andersen
- Department of Anaesthesiology and Intensive Care, Bispebjerg Hospital, Copenhagen, Denmark
| | - Hanna Siegel
- Department of Anaesthesiology and Intensive Care, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Michael Ibsen
- Department of Anaesthesiology and Intensive Care, North Zealand Hospital, Hillerød, Denmark
| | - Vibeke L Jørgensen
- Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - Robert Winding
- Department of Anaesthesiology and Intensive Care, Herning Hospital, Herning, Denmark
| | - Susanne Iversen
- Department of Anaesthesiology and Intensive Care, Slagelse Hospital, Slagelse, Denmark
| | - Henrik P Pedersen
- Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Christoffer Sølling
- Department of Anaesthesiology and Intensive Care, Viborg Hospital, Viborg, Denmark
| | - Ricardo S Garcia
- Department of Anaesthesiology and Intensive Care, Esbjerg Hospital, Esbjerg, Denmark
| | - Jens Michelsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Thomas Mohr
- Department of Anaesthesiology and Intensive Care, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - George Michagin
- Department of Anaesthesiology and Intensive Care, Svendborg Hospital, Svendborg, Denmark
| | - Ulrick S Espelund
- Department of Anaesthesiology and Intensive Care, Horsens Hospital, Horsens, Denmark
| | - Helle Bundgaard
- Department of Anaesthesiology and Intensive Care, Randers Hospital, Randers, Denmark
| | - Lynge Kirkegaard
- Department of Anaesthesiology and Intensive Care, Åbenrå Hospital, Åbenrå, Denmark
| | - Margit Smitt
- Department of Anaesthesiology and Intensive Care, Glostrup Hospital, Copenhagen, Denmark
| | | | - David L Buck
- Department of Anaesthesiology and Intensive Care, Holbaek Hospital, Holbaek, Denmark
| | - Niels-Erik Ribergaard
- Department of Anaesthesiology and Intensive Care, Hjørring Hospital, Hjørring, Denmark
| | - Helle S Pedersen
- Department of Anaesthesiology and Intensive Care, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Mette Helene Toft
- Department of Anaesthesiology and Intensive Care, Bornholms Hospital, Rønne, Denmark
| | - Trine B Jonassen
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Copenhagen, Denmark
| | | | - Emilie K Madsen
- Department of Anaesthesiology and Intensive Care, Århus University Hospital, Århus, Denmark
| | - Trine N Haberlandt
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Denmark
| | - Louise Sophie Bredahl
- Department of Anaesthesiology and Intensive Care, Hjørring Hospital, Hjørring, Denmark
| | - Nicolai Haase
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
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Crimi C, Murphy P, Patout M, Sayas J, Winck JC. Lessons from COVID-19 in the management of acute respiratory failure. Breathe (Sheff) 2023; 19:230035. [PMID: 37378059 PMCID: PMC10292773 DOI: 10.1183/20734735.0035-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 06/29/2023] Open
Abstract
Accumulated evidence supports the efficacy of noninvasive respiratory support therapies in coronavirus disease 2019 (COVID-19)-related acute hypoxaemic respiratory failure, alleviating admissions to intensive care units. Noninvasive respiratory support strategies, including high-flow oxygen therapy, continuous positive airway pressure via mask or helmet and noninvasive ventilation, can be alternatives that may avoid the need for invasive ventilation. Alternating different noninvasive respiratory support therapies and introducing complementary interventions, like self-proning, may improve outcomes. Proper monitoring is warranted to ensure the efficacy of the techniques and to avoid complications while supporting transfer to the intensive care unit. This article reviews the latest evidence on noninvasive respiratory support therapies in COVID-19-related acute hypoxaemic respiratory failure.
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Affiliation(s)
- Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
| | - Patrick Murphy
- Lane Fox Respiratory Service, Guy's and St Thomas’ Hospitals NHS Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Maxime Patout
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
| | - Javier Sayas
- Pulmonology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
| | - Joao Carlos Winck
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Centro De Reabilitação Do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova De Gaia, Portugal
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Teran-Tinedo JR, Gonzalez-Rubio J, Najera A, Lorente-Gonzalez M, Cano-Sanz E, De La Calle-Gil I, Ortega-Fraile MÁ, Carballo-López D, Hernández-Nuñez J, Churruca-Arróspide M, Zevallos-Villegas A, López-Padilla D, Puente-Maestú L, Navarro-Lopez JD, Jimenez-Diaz L, Landete P. Effect of the Early Combination of Continuous Positive Airway Pressure and High-Flow Nasal Cannula on Mortality and Intubation Rates in Patients With COVID-19 and Acute Respiratory Distress Syndrome. The DUOCOVID Study. Arch Bronconeumol 2023; 59:288-294. [PMID: 36797139 PMCID: PMC9892311 DOI: 10.1016/j.arbres.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Non invasive respiratory support (NIRS) is useful for treating acute respiratory distress syndrome (ARDS) secondary to COVID-19, mainly in mild-moderate stages. Although continuous positive airway pressure (CPAP) seems superior to other NIRS, prolonged periods of use and poor adaptation may contribute to its failure. The combination of CPAP sessions and high-flow nasal cannula (HFNC) breaks could improve comfort and keep respiratory mechanics stable without reducing the benefits of positive airway pressure (PAP). Our study aimed to determine if HFNC+CPAP initiates early lower mortality and endotracheal intubation (ETI) rates. METHODS Subjects were admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital between January and September 2021. They were divided according to Early HFNC+CPAP (first 24h, EHC group) and Delayed HFNC+CPAP (after 24h, DHC group). Laboratory data, NIRS parameters, and the ETI and 30-day mortality rates were collected. A multivariate analysis was performed to identify the risk factors associated with these variables. RESULTS The median age of the 760 included patients was 57 (IQR 47-66), who were mostly male (66.1%). The median Charlson Comorbidity Index was 2 (IQR 1-3) and 46.8% were obese. The median PaO2/FiO2 upon IRCU admission was 95 (IQR 76-126). The ETI rate in the EHC group was 34.5%, with 41.8% for the DHC group (p=0.045), while 30-day mortality was 8.2% and 15.5%, respectively (p=0.002). CONCLUSIONS Particularly in the first 24h after IRCU admission, the HFNC+CPAP combination was associated with a reduction in the 30-day mortality and ETI rates in patients with ARDS secondary to COVID-19.
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Affiliation(s)
- Jose Rafael Teran-Tinedo
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, National Hospital for Paraplegics, Toledo, Spain; Complutense University of Madrid, Spain
| | - Jesus Gonzalez-Rubio
- Department of Medical Sciences, Faculty of Medicine of Albacete, University of Castilla-La Mancha, Albacete, Spain; Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, Albacete, Spain.
| | - Alberto Najera
- Department of Medical Sciences, Faculty of Medicine of Albacete, University of Castilla-La Mancha, Albacete, Spain; Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, Albacete, Spain.
| | - Miguel Lorente-Gonzalez
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, Infanta Leonor University Hospital, Madrid, Spain
| | - Eduardo Cano-Sanz
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Emergency Department, Fundación Alcorcon University Hospital, Madrid, Spain
| | - Isabel De La Calle-Gil
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Anesthesia Department, Octubre University Hospital, Madrid, Spain
| | - Maria Ángeles Ortega-Fraile
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Emergency Department, Fundación Alcorcon University Hospital, Madrid, Spain
| | - Daniel Carballo-López
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Anesthesia Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Joaquín Hernández-Nuñez
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, San Carlos University Hospital, Madrid, Spain
| | - Maria Churruca-Arróspide
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, San Carlos University Hospital, Madrid, Spain
| | - Annette Zevallos-Villegas
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, San Carlos University Hospital, Madrid, Spain
| | - Daniel López-Padilla
- Complutense University of Madrid, Spain; Pneumology Department, Gregorio Marañon University Hospital, Madrid, Spain
| | - Luis Puente-Maestú
- Complutense University of Madrid, Spain; Pneumology Department, Gregorio Marañon University Hospital, Madrid, Spain
| | - Juan D Navarro-Lopez
- Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, Albacete, Spain; Department of Medical Sciences, Faculty of Medicine of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain.
| | - Lydia Jimenez-Diaz
- Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, Albacete, Spain; Department of Medical Sciences, Faculty of Medicine of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain.
| | - Pedro Landete
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Department of Pneumology, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Pneumology department. Hospital Universitario La Princesa, Madrid, Spain.
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Negroni D, Carriero S, Passarella I, Siani A, Biondetti P, Pizzolante A, Saba L, Guzzardi G. Preliminary Analysis of the Effects of Ad26.COV2.S Vaccination on CT Findings and High Intensive Care Admission Rates of COVID-19 Patients. Tomography 2022; 8:2403-2410. [PMID: 36287798 PMCID: PMC9611738 DOI: 10.3390/tomography8050199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
On 27 February 2021, the Food and Drug Administration(FDA) authorized the administration of the adenovirus-based Ad26.COV2-S vaccine (J&J-Janssen) for the prevention of COVID-19, a viral pandemic that, to date, has killed more than 5.5 million people. Performed during the early phase of the COVID-19 4th wave, this retrospective observational study aims to report the computerized tomography (CT) findings and intensive care unit admission rates of Ad26.COV2-S-vaccinated vs. unvaccinated COVID-19 patients. From the 1st to the 23rd of December 2021, all confirmed COVID-19 patients that had been subjected to chest non-contrast CT scan analysis were enrolled in the study. These were divided into Ad26.COV2.S-vaccinated (group 1) and unvaccinated patients (group 2). The RSNA severity score was calculated for each patient and correlated to CT findings and type of admission to a healthcare setting after CT—i.e., home care, ordinary hospitalization, sub-intensive care, and intensive care. Descriptive and inference statistical analyses were performed by comparing the data from the two groups. Data from a total of 71 patients were collected: 10 patients in group 1 (4M, 6F, mean age 63.5 years, SD ± 4.2) and 61 patients in group 2 (32M, 29F, mean age 64.7 years, SD ± 3.7). Statistical analysis showed lower values of RSNA severity in group 1 compared to group 2 (mean value 14.1 vs. 15.7, p = 0.009, respectively). Furthermore, vaccinated patients were less frequently admitted to both sub-intensive and high-intensive care units than group 2, with an odds ratio of 0.45 [95%CI (0.01; 3.92)]. Ad26.COV2.S vaccination protects from severe COVID-19 based on CT severity scores. As a result, Ad26.COV2.S-vaccinated COVID-19 patients are more frequently admitted to home in comparison with unvaccinated patients.
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Affiliation(s)
- Davide Negroni
- Department of Radiology, University of Piemonte Orientale, Piedmont, 28100 Novara, Italy
- Correspondence: ; Tel.: +39-3348163299
| | - Serena Carriero
- Department of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Ilaria Passarella
- Departement of Internal Medicine, ASST Ovest Milanese Ospedale Fornaroli, 20013 Magenta, Italy
| | - Agnese Siani
- Department of Radiology, University of Piemonte Orientale, Piedmont, 28100 Novara, Italy
| | - Pierpaolo Biondetti
- Department of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Antonio Pizzolante
- Department of Radiology, University of Piemonte Orientale, Piedmont, 28100 Novara, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria Cagliari, 09124 Polo di Monserrato, Italy
| | - Giuseppe Guzzardi
- Department of Radiology, University of Piemonte Orientale, Piedmont, 28100 Novara, Italy
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