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Chenchula S, Vidyasagar K, Pathan S, Sharma S, Chavan MR, Bhagavathula AS, Padmavathi R, Manjula M, Chhabra M, Gupta R, Amerneni KC, Ghanta MK, Mudda S. Global prevalence and effect of comorbidities and smoking status on severity and mortality of COVID-19 in association with age and gender: a systematic review, meta-analysis and meta-regression. Sci Rep 2023; 13:6415. [PMID: 37076543 PMCID: PMC10115382 DOI: 10.1038/s41598-023-33314-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/11/2023] [Indexed: 04/21/2023] Open
Abstract
A COVID-19 patient often presents with multiple comorbidities and is associated with adverse outcomes. A comprehensive assessment of the prevalence of comorbidities in patients with COVID-19 is essential. This study aimed to assess the prevalence of comorbidities, severity and mortality with regard to geographic region, age, gender and smoking status in patients with COVID-19. A systematic review and multistage meta-analyses were reported using PRISMA guidelines. PubMed/MEDLINE, SCOPUS, Google Scholar and EMBASE were searched from January 2020 to October 2022. Cross-sectional studies, cohort studies, case series studies, and case-control studies on comorbidities reporting among the COVID-19 populations that were published in English were included. The pooled prevalence of various medical conditions in COVID-19 patients was calculated based on regional population size weights. Stratified analyses were performed to understand the variations in the medical conditions based on age, gender, and geographic region. A total of 190 studies comprising 105 million COVID-19 patients were included. Statistical analyses were performed using STATA software, version 16 MP (StataCorp, College Station, TX). Meta-analysis of proportion was performed to obtain pooled values of the prevalence of medical comorbidities: hypertension (39%, 95% CI 36-42, n = 170 studies), obesity (27%, 95% CI 25-30%, n = 169 studies), diabetes (27%, 95% CI 25-30%, n = 175), and asthma (8%, 95% CI 7-9%, n = 112). Moreover, the prevalence of hospitalization was 35% (95% CI 29-41%, n = 61), intensive care admissions 17% (95% CI 14-21, n = 106), and mortality 18% (95% CI 16-21%, n = 145). The prevalence of hypertension was highest in Europe at 44% (95% CI 39-47%, n = 68), obesity and diabetes at 30% (95% CI, 26-34, n = 79) and 27% (95%CI, 24-30, n = 80) in North America, and asthma in Europe at 9% (95% CI 8-11, n = 41). Obesity was high among the ≥ 50 years (30%, n = 112) age group, diabetes among Men (26%, n = 124) and observational studies reported higher mortality than case-control studies (19% vs. 14%). Random effects meta-regression found a significant association between age and diabetes (p < 0.001), hypertension (p < 0.001), asthma (p < 0.05), ICU admission (p < 0.05) and mortality (p < 0.001). Overall, a higher global prevalence of hypertension (39%) and a lower prevalence of asthma (8%), and 18% of mortality were found in patients with COVID-19. Hence, geographical regions with respective chronic medical comorbidities should accelerate regular booster dose vaccination, preferably to those patients with chronic comorbidities, to prevent and lower the severity and mortality of COVID-19 disease with novel SARS-CoV-2 variants of concern (VOC).
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Affiliation(s)
- Santenna Chenchula
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, 522503, India.
| | - Kota Vidyasagar
- Department of Pharmaceutical Sciences, University College of Pharmaceutical Sciences (UCPSc), Hanmakonda, Telangana, India
| | - Saman Pathan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - Sushil Sharma
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, 522503, India
| | - Madhav Rao Chavan
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, 522503, India
| | | | - R Padmavathi
- SVS Medical College and Hospital, Mahbubnagar, Telangana, India
| | - M Manjula
- Balaji College of Nursing, Tirupathi, Andhra Pradesh, India
| | - Manik Chhabra
- Department of Pharmacy Practice, Indo-Soviet Friendship College of Pharmacy, Moga, India
| | - Rupesh Gupta
- Department of Internal Medicine, GMC, Shahdol, Madhya Pradesh, India
| | | | | | - Sofia Mudda
- Department of AYUSH, All India Institute of Medical Sciences, Bhopal, India
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Barros C, Pinheiro M, Pinheiro G. Papel do Enfermeiro de Reabilitação à Pessoa em situação Crítica com COVID-19: Estudo de caso. REVISTA PORTUGUESA DE ENFERMAGEM DE REABILITAÇÃO 2022. [DOI: 10.33194/rper.2022.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introdução: A COVID-19 pode provocar doença moderada a severa com internamento prolongado em unidade de cuidados intensivos tendo repercussões a nível respiratório, motor e cognitivo. Como tal é importante perceber o contributo dos enfermeiros de reabilitação na recuperação da pessoa em situação crítica.
Metodologia: Estudo de caso do tipo descritivo de acordo com as guidelines do Case Report. Trata-se de uma pessoa do sexo masculino, com 67 anos, internado na medicina interna, área dedicada a COVID-19, com o diagnóstico de pneumonia por COVID-19. Os focos de atenção foram o autocuidado, a força muscular, o equilíbrio, a marcha, a ventilação, e a deglutição. Face a estes focos foi delineado e implementado um plano de intervenção de acordo com a evolução da pessoa e posteriormente reavaliados os principais outcomes.
Resultados: Com cinco dias de intervenção a pessoa, segundo a escala de Barthel melhorou de um score 5 para 65; Borg score de 8 para 3; FiO2 35% para 21%; Tinetti 0/0 para 11/9; força muscular medical research council (MRC) score 2 para 4 e gugging swallowing screen (GUSS) score 5 para 8.
Discussão: O estudo de caso evidencia a necessidade e importância da implementação de um plano de cuidados adequados a cada pessoa, tendo por base critérios de segurança e progredindo conforme a tolerância da pessoa.
Conclusão: Com as intervenções do Enfermeiro Especialista em enfermagem de Reabilitação é possível reduzir as sequelas decorrentes do internamento em UCI.
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Novacescu AN, Buzzi B, Bedreag O, Papurica M, Rogobete AF, Sandesc D, Sorescu T, Baditoiu L, Musuroi C, Vlad D, Licker M. Bacterial and Fungal Superinfections in COVID-19 Patients Hospitalized in an Intensive Care Unit from Timișoara, Romania. Infect Drug Resist 2022; 15:7001-7014. [PMID: 36478964 PMCID: PMC9721122 DOI: 10.2147/idr.s390681] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/19/2022] [Indexed: 09/29/2023] Open
Abstract
PURPOSE Critically ill patients hospitalized in the intensive care unit (ICU) have an increased infection risk. The aim of this study was to determine the bacterial and fungal superinfections rate in Coronavirus disease 2019 (COVID-19) patients stationed in the ICU, identify risk factors associated with their development and to determine whether superinfection plays a role in patients' outcome in this population. PATIENTS AND METHODS In this retrospective, non-interventional, single centre, cohort study, medical records of 302 consecutive patients with SARS-COV-2 pneumonia admitted into the COVID-19 ICU of the largest university hospital from Western Romania between October 2020 and May 2021, were reviewed, of whom 236 patients met the inclusion criteria. RESULTS One hundred and nineteen patients developed a superinfection ≥48 h after being admitted to the hospital. Superinfection rate in the ICU was 50.42%. Coagulase-negative Staphylococci (CoNS) and Enterococcus spp. were predominantly isolated from blood cultures, while Acinetobacter baumannii, Staphylococcus aureus and Candida spp. from tracheobronchial aspirates. Significant independent risk factors regarding bacterial/fungal superinfection in COVID-19 patients were obtained for the following variables: number of days of central venous catheter (HR = 1.13 [1.07-1.20], p < 0.001) and prior administration of corticosteroids (HR = 2.80 [1.33-5.93], p = 0.007). Four independent predictive risk factors were associated with unfavorable outcome: age (HR = 1.07 [95% CI 1.03-1.12], p = 0.001); Carmeli Score (HR = 6.09 [1.18-31.50], p = 0.031); body mass index (HR = 1.11 [1.02-1.21], p = 0.011) and the presence of a central venous catheter (HR = 6.49 [1.93-21.89], p = 0.003). CONCLUSION The superinfection rate in COVID-19 patients was high in this study group. Exogenous risk factors were associated with superinfection more than endogenous factors. Only a small percentage of uninfected COVID-19 patients were not prescribed antibiotics during their hospitalization, raising serious concerns regarding the judicious prescribing of antibiotics in viral infections.
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Affiliation(s)
- Alexandru Noris Novacescu
- Doctoral School, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- Compartment of Anesthesia and Intensive Care, ‘Dr. Victor Babes’ Infectious Diseases and Pulmonology Clinical Hospital, Timisoara, Romania
| | - Bettina Buzzi
- Clinic of Anesthesia and Intensive Care, ‘Pius Brînzeu’ Emergency Clinical County Hospital, Timisoara, Romania
| | - Ovidiu Bedreag
- Clinic of Anesthesia and Intensive Care, ‘Pius Brînzeu’ Emergency Clinical County Hospital, Timisoara, Romania
- Department of Anaesthesia and Intensive Care, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
| | - Marius Papurica
- Clinic of Anesthesia and Intensive Care, ‘Pius Brînzeu’ Emergency Clinical County Hospital, Timisoara, Romania
- Department of Anaesthesia and Intensive Care, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
| | - Alexandru Florin Rogobete
- Clinic of Anesthesia and Intensive Care, ‘Pius Brînzeu’ Emergency Clinical County Hospital, Timisoara, Romania
- Department of Anaesthesia and Intensive Care, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
| | - Dorel Sandesc
- Clinic of Anesthesia and Intensive Care, ‘Pius Brînzeu’ Emergency Clinical County Hospital, Timisoara, Romania
- Department of Anaesthesia and Intensive Care, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
| | - Teodora Sorescu
- Department of Diabetes, Nutrition and Metabolic Diseases, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- Clinic of Diabetes, Nutrition and Metabolic Diseases, ‘Pius Brînzeu’ Emergency Clinical County Hospital, Timisoara, Romania
| | - Luminita Baditoiu
- Department of Epidemiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Multidisciplinary Research Center on Antimicrobial Resistance, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
| | - Corina Musuroi
- Department of Microbiology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- Clinical Laboratory, ‘Pius Brînzeu’ Emergency Clinical County Hospital, Timisoara, Romania
| | - Daliborca Vlad
- Clinical Laboratory, ‘Pius Brînzeu’ Emergency Clinical County Hospital, Timisoara, Romania
- Department of Pharmacology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
| | - Monica Licker
- Multidisciplinary Research Center on Antimicrobial Resistance, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- Department of Microbiology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- Clinical Laboratory, ‘Pius Brînzeu’ Emergency Clinical County Hospital, Timisoara, Romania
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Gomez-Paz S, Lam E, Gonzalez-Mosquera L, Berookhim B, Mustacchia P, Fogel J, Rubinstein S. MELD-Na score, Acute Physiologic and Chronic Health Evaluation II score, and SOFA score and their association with mortality in critically ill COVID-19 patients with liver injury: A retrospective single-center study. Int J Crit Illn Inj Sci 2022; 12:222-228. [PMID: 36779216 PMCID: PMC9910115 DOI: 10.4103/ijciis.ijciis_29_22] [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: 04/16/2022] [Revised: 07/03/2022] [Accepted: 07/12/2022] [Indexed: 12/24/2022] Open
Abstract
Background The Acute Physiologic and Chronic Health Evaluation II (APACHE-II), Sequential Organ Failure Assessment (SOFA), and Model for End-Stage Liver Disease modified for Sodium concentration (MELD-Na) scores are validated to predict disease mortality. We studied the prognostic utility of these scoring systems in critically ill coronavirus disease 2019 (COVID-19) patients with liver injury. Methods This was a retrospective study of 291 confirmed COVID-19 and liver injury patients requiring intensive care unit level of care. These patients required supplemental oxygen requirement with fraction of inspired oxygen >55% and/or the use of vasopressor. MELD-Na, SOFA, and APACHE-II scores were adjusted. Outcomes were mortality and length of stay (LOS). Results SOFA (odds ratio: 0.78, 95% confidence interval: 0.63-0.98, P < 0.05) was associated with decreased odds for mortality. APACHE-II and MELD-Na were not associated with mortality or LOS. Conclusions We suggest that the novel nature of COVID-19 necessitates new scoring systems to predict outcomes in critically ill COVID-19 patients with liver injury.
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Affiliation(s)
- Sandra Gomez-Paz
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Nassau University Medical Center, New York, USA
| | - Eric Lam
- Department of Internal Medicine, Nassau University Medical Center, New York, USA
| | | | - Brian Berookhim
- Department of Internal Medicine, Nassau University Medical Center, New York, USA
| | - Paul Mustacchia
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Nassau University Medical Center, New York, USA
| | - Joshua Fogel
- Department of Business Management, Brooklyn College, New York, USA
| | - Sofia Rubinstein
- Department of Internal Medicine, Division of Nephrology and Hypertension, Nassau University Medical Center, New York, USA
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Nogueira GM, Silva NLOR, Moura AF, Duarte Silveira MA, Moura-Neto JA. Acute kidney injury and electrolyte disorders in COVID-19. World J Virol 2022; 11:283-292. [PMID: 36188735 PMCID: PMC9523327 DOI: 10.5501/wjv.v11.i5.283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/30/2022] [Accepted: 08/22/2022] [Indexed: 02/05/2023] Open
Abstract
Acute kidney injury (AKI) and electrolyte disorders are important complications of hospitalized coronavirus disease 2019 (COVID-19) patients. AKI is thought to occur due to multiple pathophysiological mechanisms, such as multiple organ dysfunction (mainly cardiac and respiratory), direct viral entry in the renal tubules, and cytokine release syndrome. AKI is present in approximately one in every ten hospitalized COVID-19 patients. The incidence rates of AKI increase in patients who are admitted to the intensive care unit (ICU), with levels higher than 50%. Additionally, renal replacement therapy (RRT) is used in 7% of all AKI cases, but in nearly 20% of patients admitted to an ICU. COVID-19 patients with AKI are considered moderate-to-severe cases and are managed with multiple interdisciplinary conducts. AKI acts as a risk factor for mortality in severe acute respiratory syndrome coronavirus 2 infection, especially when RRT is needed. Electrolyte disorders are also common manifestations in hospitalized COVID-19 patients, mainly hyponatremia, hypokalemia, and hypocalcemia. Hyponatremia occurs due to a combination of syndrome of inappropriate secretion of antidiuretic hormone and gastrointestinal fluid loss from vomiting and diarrhea. When it comes to hypokalemia, its mechanism is not fully understood but may derive from hyperaldosteronism due to renin angiotensin aldosterone system overstimulation and gastrointestinal fluid loss as well. The clinical features of hypokalemia in COVID-19 are similar to those in other conditions. Hypocalcemia is the most common electrolyte disorder in COVID-19 and seems to occur because of vitamin D deficiency and parathyroid imbalance. It is also highly associated with longer hospital and ICU stay.
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Affiliation(s)
- Gabriel Martins Nogueira
- Department of Medicine, Bahiana School of Medicine and Public Health, Salvador 40290-000, Bahia, Brazil
| | | | - Ana Flávia Moura
- Department of Medicine, Bahiana School of Medicine and Public Health, Salvador 40290-000, Bahia, Brazil
| | | | - José A Moura-Neto
- Department of Medicine, Bahiana School of Medicine and Public Health, Salvador 40290-000, Bahia, Brazil
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Calderón-Moreno J, Juárez-Vela R, Delgado-Rodríguez MJ, Quintana-Díaz M, Magallón-Botaya R, Olivan-Blázquez B, Cobos-Rincón A, Santolalla-Arnedo I, Ramírez-Torres CA, Gea-Caballero V, Andrés-Esteban EM. Approximation to the Consumption of Healthcare Resources and the Economic Cost of SARS-CoV-2 Patient Management: A Retrospective Study. Front Public Health 2022; 10:843751. [PMID: 35433597 PMCID: PMC9008573 DOI: 10.3389/fpubh.2022.843751] [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: 12/26/2021] [Accepted: 02/02/2022] [Indexed: 12/05/2022] Open
Abstract
Spain has become one of the countries most affected by coronavirus disease 2019 (COVID-19), with the highest testing rates, and one of the worst-performing countries in the fight against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. There are no studies related to the consumption of health resources and the economic cost of the SARS-CoV-2 virus. We present a retrospective analysis of 9,811 (Primary Care and Hospital) patients which aimed to estimate public health expenditure by the consumption of health resources due to COVID-19. According to the results, the gender distribution of patients has a similar rate in both groups, with slightly higher rates in women. Similarly, age is the same in both groups, with a median of 62 years in the case of hospitalizations and 61 years in the case of primary care; using a weighted average of these rates and costs, we can estimate that the average cost of care per patient infected with the SARS-CoV-2 virus, regardless of the course is €2373.24. We conclude that a patient with COVID-19 without hospitalization costs €729.79, while the expenses of a hospitalized patient are between €4294.36 and €14440.68, if there is ICU admission.
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Affiliation(s)
- Jesús Calderón-Moreno
- Business Economics Department, University of Rey Juan Carlos, Madrid, Spain
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
| | - Raúl Juárez-Vela
- Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain
| | | | - Manuel Quintana-Díaz
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
- Intensive Care Unit, Research Group Blood Patient Management, IDI-Paz Research Institute, University Hospital “La Paz, ” Madrid, Spain
| | - Rosa Magallón-Botaya
- Primary Care Prevention and Health Promotion Network, Research Unit in Primary Care, IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Olivan-Blázquez
- Department of Psychology and Sociology, Institute for Health Research Aragón (IISA), University of Zaragoza, Zaragoza, Spain
| | - Ana Cobos-Rincón
- Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain
- *Correspondence: Ana Cobos-Rincón
| | | | | | - Vicente Gea-Caballero
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
- Faculty of Health Sciences, Valencia International University, Valencia, Spain
| | - Eva María Andrés-Esteban
- Business Economics Department, University of Rey Juan Carlos, Madrid, Spain
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
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Zattera L, Veliziotis I, Benitez-Cano A, Ramos I, Larrañaga L, Nuñez M, Román L, Adalid I, Ferrando C, Muñoz G, Arruti E, Minini A, Bassas E, Hernández M, Taccone FS, Peluso L, Adalia R. Early procalcitonin to predict mortality in critically ill COVID-19 patients: a multicentric cohort study. Minerva Anestesiol 2022; 88:259-271. [PMID: 35072432 DOI: 10.23736/s0375-9393.22.15942-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND High levels of procalcitonin (PCT) have been associated with a higher risk of mortality in COVID-19 patients. We explored the prognostic role of early PCT assessment in critically ill COVID-19 patients and whether PCT predictive performance would be influenced by immunosuppression. METHODS Retrospective multicentric analysis of prospective collected data in COVID-19 patients consecutively admitted to 36 intensive care units (ICUs) in Spain and Andorra from March to June 2020. Adult (>18 years) patients with confirmed COVID-19 and available PCT values (<72 hours from ICU admission) were included. Patients were considered as "No Immunosuppression" (NI), "Chronic Immunosuppression" (CI) and "Acute Immunosuppression" (AIT if only tocilizumab; AIS if only steroids, AITS if both). The primary outcome was the ability of PCT to predict ICU mortality. RESULTS Of the 1079 eligible patients, 777 patients were included in the analysis. Mortality occurred in 227 (28%) patients. In the NI group 144 (19%) patients were included, 67 (9%) in the CI group, 66 (8%) in the AIT group, 262 (34%) in the AIS group and 238 (31%) in the AITS group; PCT was significantly higher in non-survivors when compared with survivors (0.64 [0.17-1.44] vs. 0.23 [0.11-0.60] ng/mL; p<0.01); however, in the multivariable analysis, PCT values was not independently associated with ICU mortality. PCT values and ICU mortality were significantly higher in patients in the NI and CI groups. CONCLUSIONS PCT values are not independent predictors of ICU mortality in COVID-19 patients. Acute immunosuppression significantly reduced PCT values, although not influencing its predictive value.
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Affiliation(s)
- Luigi Zattera
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain - .,Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium -
| | - Ioannis Veliziotis
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Adela Benitez-Cano
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Isabel Ramos
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Leire Larrañaga
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Maria Nuñez
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Lorena Román
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Irina Adalid
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Carlos Ferrando
- Department of Anesthesiology and Critical Care, Hospital Clinic, Barcelona, Spain.,Institut D'investigació August Pi i Sunyer, Barcelona, Spain
| | - Guido Muñoz
- Department of Anesthesiology and Critical Care, Hospital Clinic, Barcelona, Spain
| | | | - Andrea Minini
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Eva Bassas
- Department of Anesthesiology and Critical Care, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Maria Hernández
- Department of Anesthesiology and Critical Care, Hospital Universitario Cruces, Barakaldo, Spain
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Ramon Adalia
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
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Abkhoo A, Shaker E, Mehrabinejad MM, Azadbakht J, Sadighi N, Salahshour F. Factors Predicting Outcome in Intensive Care Unit-Admitted COVID-19 Patients: Using Clinical, Laboratory, and Radiologic Characteristics. Crit Care Res Pract 2021; 2021:9941570. [PMID: 34306751 PMCID: PMC8285200 DOI: 10.1155/2021/9941570] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/23/2021] [Accepted: 06/23/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To investigate the factors contributing to mortality in coronavirus disease 2019 (COVID-19) patients admitted in the intensive care unit (ICU) and design a model to predict the mortality rate. METHOD We retrospectively evaluated the medical records and CT images of the ICU-admitted COVID-19 patients who had an on-admission chest CT scan. We analyzed the patients' demographic, clinical, laboratory, and radiologic findings and compared them between survivors and nonsurvivors. RESULTS Among the 121 enrolled patients (mean age, 62.2 ± 14.0 years; male, 82 (67.8%)), 41 (33.9%) survived, and the rest succumbed to death. The most frequent radiologic findings were ground-glass opacity (GGO) (71.9%) with peripheral (38.8%) and bilateral (98.3%) involvement, with lower lobes (94.2%) predominancy. The most common additional findings were cardiomegaly (63.6%), parenchymal band (47.9%), and crazy-paving pattern (44.4%). Univariable analysis of radiologic findings showed that cardiomegaly (p : 0.04), pleural effusion (p : 0.02), and pericardial effusion (p : 0.03) were significantly more prevalent in nonsurvivors. However, the extension of pulmonary involvement was not significantly different between the two subgroups (11.4 ± 4.1 in survivors vs. 11.9 ± 5.1 in nonsurvivors, p : 0.59). Among nonradiologic factors, advanced age (p : 0.002), lower O2 saturation (p : 0.01), diastolic blood pressure (p : 0.02), and hypertension (p : 0.03) were more commonly found in nonsurvivors. There was no significant difference between survivors and nonsurvivors in terms of laboratory findings. Three following factors remained significant in the backward logistic regression model: O2 saturation (OR: 0.91 (95% CI: 0.84-0.97), p : 0.006), pericardial effusion (6.56 (0.17-59.3), p : 0.09), and hypertension (4.11 (1.39-12.2), p : 0.01). This model had 78.7% sensitivity, 61.1% specificity, 90.0% positive predictive value, and 75.5% accuracy in predicting in-ICU mortality. CONCLUSION A combination of underlying diseases, vital signs, and radiologic factors might have prognostic value for mortality rate prediction in ICU-admitted COVID-19 patients.
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Affiliation(s)
- Aminreza Abkhoo
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Shaker
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mehdi Mehrabinejad
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Javid Azadbakht
- Department of Radiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Nahid Sadighi
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Faeze Salahshour
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Bose P, Roy S, Ghosh P. A Comparative NLP-Based Study on the Current Trends and Future Directions in COVID-19 Research. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2021; 9:78341-78355. [PMID: 34786315 PMCID: PMC8545210 DOI: 10.1109/access.2021.3082108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/15/2021] [Indexed: 05/03/2023]
Abstract
COVID-19 is a global health crisis that has altered human life and still promises to create ripples of death and destruction in its wake. The sea of scientific literature published over a short time-span to understand and mitigate this global phenomenon necessitates concerted efforts to organize our findings and focus on the unexplored facets of the disease. In this work, we applied natural language processing (NLP) based approaches on scientific literature published on COVID-19 to infer significant keywords that have contributed to our social, economic, demographic, psychological, epidemiological, clinical, and medical understanding of this pandemic. We identify key terms appearing in COVID literature that vary in representation when compared to other virus-borne diseases such as MERS, Ebola, and Influenza. We also identify countries, topics, and research articles that demonstrate that the scientific community is still reacting to the short-term threats such as transmissibility, health risks, treatment plans, and public policies, underpinning the need for collective international efforts towards long-term immunization and drug-related challenges. Furthermore, our study highlights several long-term research directions that are urgently needed for COVID-19 such as: global collaboration to create international open-access data repositories, policymaking to curb future outbreaks, psychological repercussions of COVID-19, vaccine development for SARS-CoV-2 variants and their long-term efficacy studies, and mental health issues in both children and elderly.
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Affiliation(s)
- Priyankar Bose
- Department of Computer ScienceVirginia Commonwealth UniversityRichmondVA23284USA
| | - Satyaki Roy
- Department of GeneticsUniversity of North Carolina at Chapel HillChapel HillNC27515USA
| | - Preetam Ghosh
- Department of Computer ScienceVirginia Commonwealth UniversityRichmondVA23284USA
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Corrao S, Pinelli K, Vacca M, Raspanti M, Argano C. Type 2 Diabetes Mellitus and COVID-19: A Narrative Review. Front Endocrinol (Lausanne) 2021; 12:609470. [PMID: 33868163 PMCID: PMC8044543 DOI: 10.3389/fendo.2021.609470] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/03/2021] [Indexed: 01/08/2023] Open
Abstract
The pandemic of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has involved more than one hundred million individuals, including more than two million deaths. Diabetes represents one of the most prevalent chronic conditions worldwide and significantly increases the risk of hospitalization and death in COVID-19 patients. In this review, we discuss the prevalence, the pathophysiological mechanisms, and the outcomes of COVID-19 infection in people with diabetes. We propose a rationale for using drugs prescribed in patients with diabetes and some pragmatic clinical recommendations to deal with COVID-19 in this kind of patient.
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Affiliation(s)
- Salvatore Corrao
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", PROMISE, University of Palermo, Palermo, Italy
| | - Karen Pinelli
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Martina Vacca
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Massimo Raspanti
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Christiano Argano
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
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11
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Zirpe KG, Tiwari AM, Gurav SK, Deshmukh AM, Suryawanshi PB, Wankhede PP, Kapse US, Bhoyar AP, Khan AZ, Malhotra RV, Kusalkar PH, Chavan KJ, Naik SA, Bhalke RB, Bhosale NN, Makhija SV, Kuchimanchi VN, Jadhav AS, Deshmukh KR, Kulkarni GS. Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome. Indian J Crit Care Med 2021; 25:493-498. [PMID: 34177166 PMCID: PMC8196392 DOI: 10.5005/jp-journals-10071-23816] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Severe acute respiratory distress syndrome associated with coronavirus disease-2019 (COVID-19) (CARDS) pneumonitis presents a clinical challenge as regards to the timing of intubation and ambiguity of outcome. There is a lack of clear consensus on when to switch patients from trials of noninvasive therapies to invasive mechanical ventilation. We investigated the effect of the timing of intubation from the time of admission on the clinical outcome of CARDS. Aim and objective The aim and objective was to analyze the effect of timing of intubation early (within 48 hours of admission to critical care unit) versus delayed (after 48 hours of admission to critical care unit) on mortality in severe CARDS patients. Materials and methods A retrospective observational study performed in a 28-bedded COVID-19 intensive care unit of a tertiary care hospital in Pune, India. All patients admitted between April 1, 2020, and October 15, 2020, with confirmed COVID-19 (RT-PCR positive) requiring mechanical ventilation were included in the study. Results The primary outcome was in-hospital mortality. Among 2,230 patients that were admitted to the hospital, 525 required critical care (23.5%), invasive mechanical ventilation was needed in 162 patients and 147 (28%) of critical care admission were included in the study cohort after exclusion. Seventy-five patients (51%) were intubated within 48 hours of critical care admission (early group) and 72 (48.9%) were intubated after 48 hours of critical care admission (delayed group). With regards to the total of 147 included patients; male patients were 74.1% with a median age of 59 years (interquartile range, 51-68 years). Diabetes (44.9%) and hypertension (43.5%) were the most common comorbidities. Higher admission acute physiology and chronic health evaluation II scores and lower absolute lymphocyte count were observed in patients intubated within 48 hours. The early intubated group had a mortality of 60% whereas the same was observed as 77.7% in delayed intubation group, and this difference was statistically significant (p = 0.02). Conclusion Current study concludes that early intubation is associated with improved survival rates in severe CARDS patients. How to cite this article Zirpe KG, Tiwari AM, Gurav SK, Deshmukh AM, Suryawanshi PB, Wankhede PP, et al. Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome. Indian J Crit Care Med 2021;25(5):493-498.
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Affiliation(s)
- Kapil G Zirpe
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Anand M Tiwari
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Sushma K Gurav
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Abhijit M Deshmukh
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Prasad B Suryawanshi
- Department of Critical Care, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Prajkta P Wankhede
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Upendrakumar S Kapse
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Abhaya P Bhoyar
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Afroz Z Khan
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Ria V Malhotra
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Pranoti H Kusalkar
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Kaustubh J Chavan
- Department of Cardiac Anaesthesia, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Seema A Naik
- Department of Cardiac Anaesthesia, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Rahul B Bhalke
- Department of Cardiac Anaesthesia, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Ninad N Bhosale
- Department of Critical Care, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Sonika V Makhija
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Venkata N Kuchimanchi
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Amol S Jadhav
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Kedar R Deshmukh
- Department of Cardiac Anaesthesia, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Gaurav S Kulkarni
- Department of Cardiac Anesthesia and Intensive Care, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
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Singh S, Wadke R, Gupta A, Samel S, Taank P. Correlation of inflammatory markers with renal dysfunction and their outcome in symptomatic adult COVID-19 patients. JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/jmedsci.jmedsci_155_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Ferrando C, Mellado-Artigas R, Gea A, Arruti E, Aldecoa C, Adalia R, Ramasco F, Monedero P, Maseda E, Tamayo G, Hernández-Sanz ML, Mercadal J, Martín-Grande A, Kacmarek RM, Villar J, Suárez-Sipmann F. Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:597. [PMID: 33023669 PMCID: PMC7537953 DOI: 10.1186/s13054-020-03314-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022]
Abstract
Background Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone. Methods Prospective, multicenter, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory Sequential Organ Failure Assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate, and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, laboratory markers, need for invasive mechanical ventilation, days to intubation, ICU length of stay, and ICU mortality between HFNO patients with and without awake-PP. Results A total of 1076 patients with COVID-19 ARF were admitted, of which 199 patients received HFNO and were analyzed. Fifty-five (27.6%) were pronated during HFNO; 60 (41%) and 22 (40%) patients from the HFNO and HFNO + awake-PP groups were intubated. The use of awake-PP as an adjunctive therapy to HFNO did not reduce the risk of intubation [RR 0.87 (95% CI 0.53–1.43), p = 0.60]. Patients treated with HFNO + awake-PP showed a trend for delay in intubation compared to HFNO alone [median 1 (interquartile range, IQR 1.0–2.5) vs 2 IQR 1.0–3.0] days (p = 0.055), but awake-PP did not affect 28-day mortality [RR 1.04 (95% CI 0.40–2.72), p = 0.92]. Conclusion In patients with COVID-19 ARF treated with HFNO, the use of awake-PP did not reduce the need for intubation or affect mortality.
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Affiliation(s)
- Carlos Ferrando
- Department of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Villarroel 170, 08036, Barcelona, Spain. .,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Ricard Mellado-Artigas
- Department of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Villarroel 170, 08036, Barcelona, Spain
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | | | - César Aldecoa
- Department of Anesthesiology and Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Ramón Adalia
- Department of Anesthesiology and Critical Care, Hospital del Mar, Barcelona, Spain
| | - Fernando Ramasco
- Department of Anesthesiology and Critical Care, Hospital Universitario La Princesa, Madrid, Spain
| | - Pablo Monedero
- Department of Anesthesiology and Intensive Care, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Emilio Maseda
- Department of Anesthesiology and Critical Care, Hospital Universitario La Paz, Madrid, Spain
| | - Gonzalo Tamayo
- Department of Anesthesiology and Critical Care, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - María L Hernández-Sanz
- Department of Anesthesiology and Critical Care, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - Jordi Mercadal
- Department of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Villarroel 170, 08036, Barcelona, Spain
| | - Ascensión Martín-Grande
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Robert M Kacmarek
- Department of Respiratory Care, Massachusetts General Hospital, Boston, MA, USA
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Fernando Suárez-Sipmann
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Intensive Care Unit, Hospital Universitario La Princesa, Madrid, Spain
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