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Immohr MB, Hettlich VH, Kindgen-Milles D, Brandenburger T, Feldt T, Aubin H, Tudorache I, Akhyari P, Lichtenberg A, Dalyanoglu H, Boeken U. Changes in Therapy and Outcome of Patients Requiring Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19. Thorac Cardiovasc Surg 2024; 72:311-319. [PMID: 37146634 DOI: 10.1055/s-0043-57032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation (vv-ECMO) is related with poor outcome, especially in Germany. We aimed to analyze whether changes in vv-ECMO therapy during the pandemic were observed and lead to changes in the outcome of vv-ECMO patients. METHODS All patients undergoing vv-ECMO support for COVID-19 between 2020 and 2021 in a single center (n = 75) were retrospectively analyzed. Weaning from vv-ECMO and in-hospital mortality were defined as primary and peri-interventional adverse events as secondary endpoints of the study. RESULTS During the study period, four infective waves were observed in Germany. Patients were assigned correspondingly to four study groups: ECMO implantation between March 2020 and September 2020: first wave (n = 11); October 2020 to February 2021: second wave (n = 23); March 2021 to July 2021: third wave (n = 25); and August 2021 to December 2021: fourth wave (n = 20). Preferred cannulation technique changed within the second wave from femoro-femoral to femoro-jugular access (p < 0.01) and awake ECMO was implemented. Mean ECMO run time increased by more than 300% from 10.9 ± 9.6 (first wave) to 44.9 ± 47.0 days (fourth wave). Weaning of patients was achieved in less than 20% in the first wave but increased to approximately 40% since the second one. Furthermore, we observed a continuous numerically decrease of in-hospital mortality from 81.8 to 57.9% (p = 0.61). CONCLUSION Preference for femoro-jugular cannulation and awake ECMO combined with preexisting expertise and patient selection are considered to be associated with increased duration of ECMO support and numerically improved ECMO weaning and in-hospital mortality.
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Affiliation(s)
- Moritz Benjamin Immohr
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | | | - Detlef Kindgen-Milles
- Department of Anesthesiology, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Timo Brandenburger
- Department of Anesthesiology, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Torsten Feldt
- Department of Hepatology and Infectiology, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Hannan Dalyanoglu
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
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McLarty J, Litton E, Beane A, Aryal D, Bailey M, Bendel S, Burghi G, Christensen S, Christiansen CF, Dongelmans DA, Fernandez AL, Ghose A, Hall R, Haniffa R, Hashmi M, Hashimoto S, Ichihara N, Kumar Tirupakuzhi Vijayaraghavan B, Lone NI, Arias López MDP, Mat Nor MB, Okamoto H, Priyadarshani D, Reinikainen M, Soares M, Pilcher D, Salluh J. Non-COVID-19 intensive care admissions during the pandemic: a multinational registry-based study. Thorax 2024; 79:120-127. [PMID: 37225417 DOI: 10.1136/thorax-2022-219592] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, there is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment. METHODS We conducted an international, retrospective cohort study using 2019 and 2020 data from 11 national clinical quality registries covering 15 countries. Non-COVID-19 admissions in 2020 were compared with all admissions in 2019, prepandemic. The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included in-hospital mortality and standardised mortality ratio (SMR). Analyses were stratified by the country income level(s) of each registry. FINDINGS Among 1 642 632 non-COVID-19 admissions, there was an increase in ICU mortality between 2019 (9.3%) and 2020 (10.4%), OR=1.15 (95% CI 1.14 to 1.17, p<0.001). Increased mortality was observed in middle-income countries (OR 1.25 95% CI 1.23 to 1.26), while mortality decreased in high-income countries (OR=0.96 95% CI 0.94 to 0.98). Hospital mortality and SMR trends for each registry were consistent with the observed ICU mortality findings. The burden of COVID-19 was highly variable, with COVID-19 ICU patient-days per bed ranging from 0.4 to 81.6 between registries. This alone did not explain the observed non-COVID-19 mortality changes. INTERPRETATION Increased ICU mortality occurred among non-COVID-19 patients during the pandemic, driven by increased mortality in middle-income countries, while mortality decreased in high-income countries. The causes for this inequity are likely multi-factorial, but healthcare spending, policy pandemic responses, and ICU strain may play significant roles.
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Affiliation(s)
- Joshua McLarty
- Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Edward Litton
- St John of God Hospital Subiaco, Perth, Western Australia, Australia
- The University of Western Australia School of Medicine and Pharmacology, Perth, Western Australia, Australia
| | - Abigail Beane
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Department of Clinical Medicine, University of Oxford Nuffield, Oxford, UK
| | - Diptesh Aryal
- Nepal Intensive Care Research Foundation (NICRF), Kathmandu, Nepal
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Stepani Bendel
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- Department of Anaesthesiology and Intensive Care, University of Eastern Finland, Joensuu, Finland
| | | | - Steffen Christensen
- Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Skejby, Denmark
| | | | - Dave A Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands
| | - Ariel L Fernandez
- SATI-Q program, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
| | - Aniruddha Ghose
- Department of Internal Medicine, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh
| | - Ros Hall
- Public Health Scotland, Edinburgh, UK
| | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Department of Clinical Medicine, University of Oxford Nuffield, Oxford, UK
| | | | - Satoru Hashimoto
- Division of Intensive Care, Department of Anesthesiology & Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Japanese Intensive Care PAtient Database (JIPAD), Tokyo, Japan
| | | | | | - Nazir I Lone
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Maria Del Pilar Arias López
- Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
- PICU, Hospital de Ninos R Gutierres, Buenos Aires, Argentina
| | - Mohamed Basri Mat Nor
- Department of Anaesthesiology and Intensive Care, Kulliyyah (School) of Medicine, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- Department of Anaesthesiology and Intensive Care, University of Eastern Finland, Joensuu, Finland
| | - Marcio Soares
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - David Pilcher
- Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Jorge Salluh
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Taxbro K, Hammarskjöld F, Nilsson M, Persson M, Chew MS, Sunnergren O. Factors related to COVID-19 mortality among three Swedish intensive care units-A retrospective study. Acta Anaesthesiol Scand 2023; 67:788-796. [PMID: 36915957 DOI: 10.1111/aas.14232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 02/15/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Mortality due to acute hypoxemic respiratory failure (AHRF) in patients with coronavirus disease-19 (COVID-19) differs across units, regions, and countries. These variations may be attributed to several factors, including comorbidities, acute physiological derangement, disease severity, treatment, ethnicity, healthcare system strain, and socioeconomic status. This study aimed to explore the features of patient characteristics, clinical management, and staffing that may be related to mortality among three intensive care units (ICUs) within the same hospital system in South Sweden. METHODS We retrospectively analyzed ICU patients with COVID-19 and AHRF in Region Jönköping County, Sweden. The primary outcome was the 90-day mortality rate. We used univariate and multivariable logistic regression analyses to investigate the relationship of predictors with outcomes. RESULTS Between March 15, 2020, and May 31, 2021, 331 patients with AHRF and COVID-19 were admitted to the three ICUs. There were differences in disease severity, treatments, process-related factors, and socioeconomic factors between the units. These factors were related to 90-day mortality. After multivariable adjustment, age, severity of acute respiratory distress syndrome, and the number of nurses per ICU-bed independently predicted 90-day mortality. CONCLUSION Age, disease severity, and nurse staffing, but not treatment or socioeconomic status, were independently associated with 90-day mortality among critically ill patients with AHRF due to COVID-19. We also identified variations in care related processes, which may be a modifiable risk factor and warrants future investigation.
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Affiliation(s)
- Knut Taxbro
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mats Nilsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Futurum, Academy of Health and Care, Region Jönköping County, Jönköping, Sweden
| | - Magnus Persson
- Department of Anaesthesia and Intensive Care Medicine, Värnamo Hospital, Värnamo, Sweden
| | - Michelle S Chew
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Anaesthesia and Intensive Care Medicine, Linköping University Hospital, Linköping, Sweden
| | - Ola Sunnergren
- Department of Otorhinolaryngology, Region Jönköping County, Jönköping, Sweden
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Dörr S, Joachim R, Chatzitomaris A, Lobmann R. [Risk factors for outcome and mortality in hospitalized geriatric patients with SARS-CoV-2 infection : Data from a hospital of maximum care during in the period of the second corona wave 2020/2021 in Germany]. Z Gerontol Geriatr 2023; 56:118-124. [PMID: 36749443 PMCID: PMC9903262 DOI: 10.1007/s00391-023-02161-8] [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: 02/26/2022] [Accepted: 07/07/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND From autumn 2020 until spring 2021 Germany experienced the second wave of SARS-CoV‑2 infections. As in the previous wave, the older population in nursing homes was hard hit by this infection because of the lack of available vaccines. Due to the multimorbidity in this susceptible group the mortality was high. METHODS Retrospectively collected patient data of geriatric patients treated from 1 October 2020 to 31 March 2021 due to proven SARS-CoV‑2 infection were evaluated concerning the duration of symptoms, hospital stay, and laboratory results. The results are presented descriptively and significance tests were performed with t‑test and log-rank test to reveal some risk factors for a worse outcome. RESULTS A total of 168 patients aged from 65 to 97 years were included, with a mean mortality rate of 28% and was highest in the age group over 90 years old. Most patients died within the first 10 days of hospitalization. Intensive care treatment prolonged the hospital stay by 6 days, but the average survival time became equal at the end. Risk factors for worse outcome and the need of intensive care treatment were neutrophilia, lymphopenia, high levels of ferritin and high D‑dimer levels on the day of admission. Age, short duration of symptoms and pre-existing dementia, administration of neuroleptic drugs and antidepressants increased the risk of death.
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Affiliation(s)
- Stefan Dörr
- Krankenhaus Bad Cannstatt, Klinik für Endokrinologie, Diabetologie und Geriatrie, Klinikum der Landeshauptstadt Stuttgart gKAöR, Prießnitzweg 24, 70374, Stuttgart, Deutschland.
| | - Regina Joachim
- Krankenhaus Bad Cannstatt, Klinik für Endokrinologie, Diabetologie und Geriatrie, Klinikum der Landeshauptstadt Stuttgart gKAöR, Prießnitzweg 24, 70374, Stuttgart, Deutschland
| | - Apostolos Chatzitomaris
- Krankenhaus Bad Cannstatt, Klinik für Endokrinologie, Diabetologie und Geriatrie, Klinikum der Landeshauptstadt Stuttgart gKAöR, Prießnitzweg 24, 70374, Stuttgart, Deutschland
| | - Ralf Lobmann
- Krankenhaus Bad Cannstatt, Klinik für Endokrinologie, Diabetologie und Geriatrie, Klinikum der Landeshauptstadt Stuttgart gKAöR, Prießnitzweg 24, 70374, Stuttgart, Deutschland
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Characteristics and risk factors for mortality in critically ill patients with COVID-19 receiving invasive mechanical ventilation: the experience of a private network in Sao Paulo, Brazil. J Crit Care Med (Targu Mures) 2022; 8:165-175. [PMID: 36062038 PMCID: PMC9396953 DOI: 10.2478/jccm-2022-0015] [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: 12/12/2021] [Accepted: 06/12/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Introduction
The use of invasive mechanical ventilation (IMV) in COVID-19 represents in an incremental burden to healthcare systems.
Aim of the study
We aimed to characterize patients hospitalized for COVID-19 who received IMV and identify risk factors for mortality in this population.
Material and Methods
A retrospective cohort study including consecutive adult patients admitted to a private network in Brazil who received IMV from March to October, 2020. A bidirectional stepwise logistic regression analysis was used to determine the risk factors for mortality.
Results
We included 215 patients, of which 96 died and 119 were discharged from ICU. The mean age was 62.7 ± 15.4 years and the most important comorbidities were hypertension (62.8%), obesity (50.7%) and diabetes (40%). Non-survivors had lower body mass index (BMI) (28.3 [25.5; 31.6] vs. 31.2 [28.3; 35], p<0.001, and a shorter duration from symptom onset to intubation (8.5 [6.0; 12] days vs. 10 [8.0; 12.5] days, p = 0.005). Multivariable regression analysis showed that the risk factors for mortality were age (OR: 1.07, 95% CI: 1.03 to 1.1, p < 0.001), creatinine level at the intubation date (OR: 3.28, 95% CI: 1.47 to 7.33, p = 0.004), BMI (OR: 0.91, 95% CI: 0.84 to 0.99, p = 0.033), lowest PF ratio within 48 hours post-intubation (OR: 0.988, 95% CI: 0.979 to 0.997, p = 0.011), barotrauma (OR: 5.18, 95% CI: 1.14 to 23.65, p = 0.034) and duration from symptom onset to intubation (OR: 0.76, 95% CI: 0.76 to 0.95, p = 0.006).
Conclusion
In our retrospective cohort we identified the main risk factors for mortality in COVID-19 patients receiving IMV: age, creatinine at the day of intubation, BMI, lowest PF ratio 48-hours post-intubation, barotrauma and duration from symptom onset to intubation.
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Hartmann B, Verket M, Balfanz P, Hartmann NU, Jacobsen M, Brandts J, Dreher M, Kossack N, Häckl D, Marx N, Müller-Wieland D. Glycaemic variability is associated with all-cause mortality in COVID-19 patients with ARDS, a retrospective subcohort study. Sci Rep 2022; 12:9862. [PMID: 35701574 PMCID: PMC9194894 DOI: 10.1038/s41598-022-13816-8] [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: 11/24/2021] [Accepted: 05/27/2022] [Indexed: 01/08/2023] Open
Abstract
There is high mortality among intensive care unit (ICU) patients with acute respiratory distress syndrome (ARDS) caused by coronavirus disease (COVID-19). Important factors for COVID-19 mortality are diabetes status and elevated fasting plasma glucose (FPG). However, the effect of glycaemic variability on survival has not been explored in patients with COVID-19 and ARDS. This single-centre cohort study compared several metrics of glycaemic variability for goodness-of-fit in patients requiring mechanical ventilation due to COVID-19 ARDS in the ICU at University Hospital Aachen, Germany. 106 patients had moderate to severe ARDS (P/F ratio median [IQR]: 112 [87–148] mmHg). Continuous HRs showed a proportional increase in mortality risk with daily glycaemic variability (DGV). Multivariable unadjusted and adjusted Cox-models showed a statistically significant difference in mortality for DGV (HR: 1.02, (P) < 0.001, LR(P) < 0.001; HR: 1.016, (P) = 0.001, LR(P) < 0.001, respectively). Kaplan–Meier estimators yielded a shorter median survival (25 vs. 87 days) and a higher likelihood of death (75% vs. 31%) in patients with DGV ≥ 25.5 mg/dl (P < 0.0001). High glycaemic variability during ICU admission is associated with significant increase in all-cause mortality for patients admitted with COVID-19 ARDS to the ICU. This effect persisted even after adjustment for clinically predetermined confounders, including diabetes, median procalcitonin and FPG.
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Affiliation(s)
- Bojan Hartmann
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Marlo Verket
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Paul Balfanz
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Niels-Ulrik Hartmann
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Malte Jacobsen
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Julia Brandts
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Nils Kossack
- WIG2 - Scientific Institute for Health Economics and Health System Research, Leipzig, Germany
| | - Dennis Häckl
- Faculty of Economics and Management Science, University Leipzig, Leipzig, Germany
| | - Nikolaus Marx
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Dirk Müller-Wieland
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany. .,Department of Cardiology, Angiology and Intensive Care Medicine, Medical Clinic I, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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7
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Durie ML, Neto AS, Burrell AJ, Cooper DJ, Udy AA. ISARIC-4C Mortality Score overestimates risk of death due to COVID-19 in Australian ICU patients: a validation cohort study. CRIT CARE RESUSC 2021; 23:403-413. [PMID: 38046684 PMCID: PMC10692605 DOI: 10.51893/2021.4.oa5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To assess the performance of the UK International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) Coronavirus Clinical Characterisation Consortium (4C) Mortality Score for predicting mortality in Australian patients with coronavirus disease 2019 (COVID-19) requiring intensive care unit (ICU) admission. Design: Multicentre, prospective, observational cohort study. Setting: 78 Australian ICUs participating in the SPRINT-SARI (Short Period Incidence Study of Severe Acute Respiratory Infection) Australia study of COVID-19. Participants: Patients aged 16 years or older admitted to participating Australian ICUs with polymerase chain reaction (PCR)-confirmed COVID-19 between 27 February and 10 October 2020. Main outcome measures: ISARIC-4C Mortality Score, calculated at the time of ICU admission. The primary outcome was observed versus predicted in-hospital mortality (by 4C Mortality and APACHE II). Results: 461 patients admitted to a participating ICU were included. 149 (32%) had complete data to calculate a 4C Mortality Score without imputation. Overall, 61/461 patients (13.2%) died, 16.9% lower than the comparable ISARIC-4C cohort in the United Kingdom. In patients with complete data, the median (interquartile range [IQR]) 4C Mortality Score was 10.0 (IQR, 8.0-13.0) and the observed mortality was 16.1% (24/149) versus 22.9% median predicted risk of death. The 4C Mortality Score discriminatory performance measured by the area under the receiver operating characteristic curve (AUROC) was 0.79 (95% CI, 0.68-0.90), similar to its performance in the original ISARIC-4C UK cohort (0.77) and not superior to APACHE II (AUROC, 0.81; 95% CI, 0.75-0.87). Conclusions: When calculated at the time of ICU admission, the 4C Mortality Score consistently overestimated the risk of death for Australian ICU patients with COVID-19. The 4C Mortality Score may need to be individually recalibrated for use outside the UK and in different hospital settings.
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Affiliation(s)
- Matthew L. Durie
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Aidan J.C. Burrell
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - D. Jamie Cooper
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew A. Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
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8
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Mayerhöfer T, Klein SJ, Peer A, Perschinka F, Lehner GF, Hasslacher J, Bellmann R, Gasteiger L, Mittermayr M, Eschertzhuber S, Mathis S, Fiala A, Fries D, Kalenka A, Foidl E, Hasibeder W, Helbok R, Kirchmair L, Stögermüller B, Krismer C, Heiner T, Ladner E, Thomé C, Preuß-Hernandez C, Mayr A, Pechlaner A, Potocnik M, Reitter B, Brunner J, Zagitzer-Hofer S, Ribitsch A, Joannidis M. Changes in characteristics and outcomes of critically ill COVID-19 patients in Tyrol (Austria) over 1 year. Wien Klin Wochenschr 2021; 133:1237-1247. [PMID: 34661740 PMCID: PMC8521508 DOI: 10.1007/s00508-021-01945-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/25/2021] [Indexed: 12/15/2022]
Abstract
Background Widely varying mortality rates of critically ill Coronavirus disease 19 (COVID-19) patients in the world highlighted the need for local surveillance of baseline characteristics, treatment strategies and outcome. We compared two periods of the COVID-19 pandemic to identify important differences in characteristics and therapeutic measures and their influence on the outcome of critically ill COVID-19 patients. Methods This multicenter prospective register study included all patients with a SARS-CoV‑2 infection confirmed by polymerase chain reaction, who were treated in 1 of the 12 intensive care units (ICU) from 8 hospitals in Tyrol, Austria during 2 defined periods (1 February 2020 until 17 July: first wave and 18 July 2020 until 22 February 2021: second wave) of the COVID-19 pandemic. Results Overall, 508 patients were analyzed. The majority (n = 401) presented during the second wave, where the median age was significantly higher (64 years, IQR 54–74 years vs. 72 years, IQR 62–78 years, p < 0.001). Invasive mechanical ventilation was less frequent during the second period (50.5% vs 67.3%, p = 0.003), as was the use of vasopressors (50.3% vs. 69.2%, p = 0.001) and renal replacement therapy (12.0% vs. 19.6%, p = 0.061), which resulted in shorter ICU length of stay (10 days, IQR 5–18 days vs. 18 days, IQR 5–31 days, p < 0.001). Nonetheless, ICU mortality did not change (28.9% vs. 21.5%, p = 0.159) and hospital mortality even increased (22.4% vs. 33.4%, p = 0.039) in the second period. Age, frailty and the number of comorbidities were significant predictors of hospital mortality in a multivariate logistic regression analysis of the overall cohort. Conclusion Advanced treatment strategies and learning effects over time resulted in reduced rates of mechanical ventilation and vasopressor use in the second wave associated with shorter ICU length of stay. Despite these improvements, age appears to be a dominant factor for hospital mortality in critically ill COVID-19 patients. Supplementary Information The online version of this article (10.1007/s00508-021-01945-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Timo Mayerhöfer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Sebastian J Klein
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.,Doctoral College Medical Law and Healthcare, Faculty of Law, University Innsbruck, Innsbruck, Austria
| | - Andreas Peer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Fabian Perschinka
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Georg F Lehner
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Julia Hasslacher
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Romuald Bellmann
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Lukas Gasteiger
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Mittermayr
- Department of Anesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | - Simon Mathis
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Fiala
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Dietmar Fries
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Armin Kalenka
- Department of Anesthesia and Intensive Care Medicine, Hospital Kufstein, Kufstein, Austria
| | - Eva Foidl
- Department of Anesthesia and Intensive Care Medicine, Hospital Kufstein, Kufstein, Austria
| | - Walter Hasibeder
- Department of Anesthesiology and Critical Care Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Lukas Kirchmair
- Department of Anesthesia and Critical Care Medicine, Hospital Schwaz, Schwaz, Austria
| | - Birgit Stögermüller
- Department of Anesthesia and Critical Care Medicine, Hospital Schwaz, Schwaz, Austria
| | - Christoph Krismer
- Department of Internal Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Tatjana Heiner
- Department of Anesthesia and Intensive Care Medicine, Hospital Reutte, Reutte, Austria
| | - Eugen Ladner
- Department of Anesthesia and Intensive Care Medicine, Hospital Reutte, Reutte, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | | | - Andreas Mayr
- Department of Anesthesia and Intensive Care Medicine, Hospital Lienz, Lienz, Austria
| | - Agnes Pechlaner
- Department of Internal Medicine, Hospital St. Vinzenz Zams, Zams, Austria
| | - Miriam Potocnik
- Department of Anesthesia and Intensive Care Medicine, Hospital St. Johann in Tyrol, St. Johann in Tyrol, Austria
| | - Bruno Reitter
- Department of Anesthesia and Intensive Care Medicine, Hospital St. Johann in Tyrol, St. Johann in Tyrol, Austria
| | - Jürgen Brunner
- Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
| | | | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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van de Sande D, Van Genderen ME, Huiskens J, Veen RER, Meijerink Y, Gommers D, van Bommel J. Generating insights in uncharted territories: real-time learning from data in critically ill patients-an implementer report. BMJ Health Care Inform 2021; 28:bmjhci-2021-100447. [PMID: 34535448 PMCID: PMC8450955 DOI: 10.1136/bmjhci-2021-100447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/13/2021] [Indexed: 01/30/2023] Open
Abstract
Introduction In the current situation, clinical patient data are often siloed in multiple hospital information systems. Especially in the intensive care unit (ICU), large volumes of clinical data are routinely collected through continuous patient monitoring. Although these data often contain useful information for clinical decision making, they are not frequently used to improve quality of care. During, but also after, pressing times, data-driven methods can be used to mine treatment patterns from clinical data to determine the best treatment options from a hospitals own clinical data. Methods In this implementer report, we describe how we implemented a data infrastructure that enabled us to learn in real time from consecutive COVID-19 ICU admissions. In addition, we explain our step-by-step multidisciplinary approach to establish such a data infrastructure. Conclusion By sharing our steps and approach, we aim to inspire others, in and outside ICU walls, to make more efficient use of data at hand, now and in the future.
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Affiliation(s)
- Davy van de Sande
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Michel E Van Genderen
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Joost Huiskens
- Department of Health, SAS Institute Inc, Huizen, The Netherlands
| | - Robert E R Veen
- Information Technology; project Research Suite, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Yvonne Meijerink
- Data and Analytics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Diederik Gommers
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jasper van Bommel
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Bauer S, Contreras S, Dehning J, Linden M, Iftekhar E, Mohr SB, Olivera-Nappa A, Priesemann V. Relaxing restrictions at the pace of vaccination increases freedom and guards against further COVID-19 waves. PLoS Comput Biol 2021; 17:e1009288. [PMID: 34473693 PMCID: PMC8412259 DOI: 10.1371/journal.pcbi.1009288] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022] Open
Abstract
Mass vaccination offers a promising exit strategy for the COVID-19 pandemic. However, as vaccination progresses, demands to lift restrictions increase, despite most of the population remaining susceptible. Using our age-stratified SEIRD-ICU compartmental model and curated epidemiological and vaccination data, we quantified the rate (relative to vaccination progress) at which countries can lift non-pharmaceutical interventions without overwhelming their healthcare systems. We analyzed scenarios ranging from immediately lifting restrictions (accepting high mortality and morbidity) to reducing case numbers to a level where test-trace-and-isolate (TTI) programs efficiently compensate for local spreading events. In general, the age-dependent vaccination roll-out implies a transient decrease of more than ten years in the average age of ICU patients and deceased. The pace of vaccination determines the speed of lifting restrictions; Taking the European Union (EU) as an example case, all considered scenarios allow for steadily increasing contacts starting in May 2021 and relaxing most restrictions by autumn 2021. Throughout summer 2021, only mild contact restrictions will remain necessary. However, only high vaccine uptake can prevent further severe waves. Across EU countries, seroprevalence impacts the long-term success of vaccination campaigns more strongly than age demographics. In addition, we highlight the need for preventive measures to reduce contagion in school settings throughout the year 2021, where children might be drivers of contagion because of them remaining susceptible. Strategies that maintain low case numbers, instead of high ones, reduce infections and deaths by factors of eleven and five, respectively. In general, policies with low case numbers significantly benefit from vaccination, as the overall reduction in susceptibility will further diminish viral spread. Keeping case numbers low is the safest long-term strategy because it considerably reduces mortality and morbidity and offers better preparedness against emerging escape or more contagious virus variants while still allowing for higher contact numbers (freedom) with progressing vaccinations.
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Affiliation(s)
- Simon Bauer
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - Sebastian Contreras
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Centre for Biotechnology and Bioengineering, Universidad de Chile, Santiago, Chile
| | - Jonas Dehning
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - Matthias Linden
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Institute for Theoretical Physics, Leibniz University, Hannover, Germany
| | - Emil Iftekhar
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - Sebastian B. Mohr
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - Alvaro Olivera-Nappa
- Centre for Biotechnology and Bioengineering, Universidad de Chile, Santiago, Chile
| | - Viola Priesemann
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Institute for the Dynamics of Complex Systems, University of Göttingen, Göttingen, Germany
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11
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Bilgic A, Sudhalkar A, Gonzalez-Cortes JH, March de Ribot F, Yogi R, Kodjikian L, Mathis T. ENDOGENOUS ENDOPHTHALMITIS IN THE SETTING OF COVID-19 INFECTION: A Case Series. Retina 2021; 41:1709-1714. [PMID: 33734193 DOI: 10.1097/iae.0000000000003168] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To describe endogenous endophthalmitis in the setting of COVID-19 pneumonia. METHODS Patients recovering from COVID-19 pneumonia who presented to our department with any or all of the following complaints: pain, watering, redness, and decreased vision were identified. All relevant data were collected for analysis. RESULTS Three patients with endogenous endophthalmitis were identified. All patients had been treated for COVID-19 pneumonia and therefore had received remdesivir and systemic steroids; 2 of the 3 patients received tocilizumab. All patients received vitreous biopsy, vitrectomy, and intraocular antibiotic injection. Patient 1 demonstrated Klebsiella pneumoniae in blood culture, K. pneumoniae and Escherichia coli in urine culture, and K. pneumoniae in vitreous fluid, whereas Patients 2 and 3 demonstrated Stenotrophomonas maltophilia and methicillin-resistant Staphylococcus aureus in the blood and nasopharyngeal culture, respectively. Correspondingly, the same organism was cultured from vitreous in Patients 2 and 3. The visual acuity at the last follow-up in Patients 1 to 3 was 20/100, 20/80, and 20/40, respectively. The probable source of infection was identified in each as renal calculi, dental caries, and the pharynx, respectively. Real-time polymerase chain reaction demonstrated the presence of Severe Acute Respiratory Syndrome Coronavirus 2 in the vitreous fluid of Patient 1. CONCLUSION We report good outcomes of early intervention for endogenous endophthalmitis in the setting of COVID-19 infection. We also document the presence of SARS-CoV-2 in vitreous.
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Affiliation(s)
- Alper Bilgic
- Alphavision Augenarztpraxis, Bremerhaven, Germany
| | - Aditya Sudhalkar
- Alphavision Augenarztpraxis, Bremerhaven, Germany
- Sudhalkar Eye Hospital and Retina Centre, Baroda, India
| | - Jesus H Gonzalez-Cortes
- Department of Ophthalmology, Dr Jose E. Gonzalez Autonomous University of Nuevo Leon, San Nicolás de los Garza, Mexico
| | | | | | - Laurent Kodjikian
- Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon, France; and
- Laboratoire UMR-CNRS 5510 Matéis, Université Lyon 1, Villeurbane, France
| | - Thibaud Mathis
- Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon, France; and
- Laboratoire UMR-CNRS 5510 Matéis, Université Lyon 1, Villeurbane, France
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12
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Schroeder I, Scharf C, Zoller M, Wassilowsky D, Frank S, Stecher SS, Stemmler J, Kneidinger N, Peterß S, Zwißler B, Irlbeck M. [Characteristics and outcome of 70 ventilated COVID-19 patients : Summary after the first wave at a university center]. Anaesthesist 2021; 70:573-581. [PMID: 33369696 PMCID: PMC7768596 DOI: 10.1007/s00101-020-00906-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/12/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND In a pandemic situation the overall mortality rate is of considerable interest; however, these data must always be seen in relation to the given healthcare system and the availability of local level of care. A recently published German data evaluation of more than 10,000 COVID-19 patients treated in 920 hospitals showed a high mortality rate of 22% in hospitalized patients and of more than 50% in patients requiring invasive ventilation. Because of the high infection rates in Bavaria, a large number of COVID-19 patients with considerable severity of disease were treated at the intensive care units of the LMU hospital. The LMU hospital is a university hospital and a specialized referral center for the treatment of patients with acute respiratory distress syndrome (ARDS). OBJECTIVE Data of LMU intensive care unit (ICU) patients were systematically evaluated and compared with the recently published German data. METHODS Data of all COVID-19 patients with invasive and noninvasive ventilation and with completed admission at the ICU of the LMU hospital until 31 July 2020 were collected. Data were processed using descriptive statistics. RESULTS In total 70 critically ill patients were included in the data evaluation. The median SAPS II on admission to the ICU was 62 points. The median age was 66 years and 81% of the patients were male. More than 90% were diagnosed with ARDS and received invasive ventilation. Treatment with extracorporeal membrane oxygenation (ECMO) was necessary in 10% of the patients. The median duration of ventilation was 16 days, whereby 34.3% of patients required a tracheostomy. Of the patients 27.1% were transferred to the LMU hospital from external hospitals with reference to our ARDS/ECMO program. Patients from external hospitals had ARDS of higher severity than the total study population. In total, nine different substances were used for virus-specific treatment of COVID-19. The most frequently used substances were hydroxychloroquine and azithromycin. Immunomodulatory treatment, such as Cytosorb® (18.6%) and methylprednisolone (25.7%) were also frequently used. The overall in-hospital mortality rate of ICU patients requiring ventilation was 28.6%. The mortality rates of patients from external hospitals, patients with renal replacement therapy and patients with ECMO therapy were 47.4%, 56.7% and 85.7%, respectively. CONCLUSION The mortality rate in the ventilated COVID-19 intensive care patients was considerably different from the general rate in Germany. The data showed that treatment in an ARDS referral center could result in a lower mortality rate. Low-dose administration of steroids may be another factor to improve patient outcome in a preselected patient population. In the authors' opinion, critically ill COVID-19 patients should be treated in an ARDS center provided that sufficient resources are available.
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Affiliation(s)
- Ines Schroeder
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
| | - Christina Scharf
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Michael Zoller
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Dietmar Wassilowsky
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Sandra Frank
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Stephanie-Susanne Stecher
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Joachim Stemmler
- Medizinische Klinik und Poliklinik III, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Nikolaus Kneidinger
- Medizinische Klinik und Poliklinik V, Deutsches Zentrum für Lungenforschung (DZL), LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Sven Peterß
- Herzchirurgische Klinik und Poliklinik, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Bernhard Zwißler
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Michael Irlbeck
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
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13
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Ferreira JC, Ho YL, Besen BAMP, Malbouisson LMS, Taniguchi LU, Mendes PV, Costa ELV, Park M, Daltro-Oliveira R, Roepke RML, Silva-Jr JM, Carmona MJC, Carvalho CRR. Protective ventilation and outcomes of critically ill patients with COVID-19: a cohort study. Ann Intensive Care 2021; 11:92. [PMID: 34097145 PMCID: PMC8182738 DOI: 10.1186/s13613-021-00882-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background Approximately 5% of COVID-19 patients develop respiratory failure and need ventilatory support, yet little is known about the impact of mechanical ventilation strategy in COVID-19. Our objective was to describe baseline characteristics, ventilatory parameters, and outcomes of critically ill patients in the largest referral center for COVID-19 in Sao Paulo, Brazil, during the first surge of the pandemic. Methods This cohort included COVID-19 patients admitted to the intensive care units (ICUs) of an academic hospital with 94 ICU beds, a number expanded to 300 during the pandemic as part of a state preparedness plan. Data included demographics, advanced life support therapies, and ventilator parameters. The main outcome was 28-day survival. We used a multivariate Cox model to test the association between protective ventilation and survival, adjusting for PF ratio, pH, compliance, and PEEP. Results We included 1503 patients from March 30 to June 30, 2020. The mean age was 60 ± 15 years, and 59% were male. During 28-day follow-up, 1180 (79%) patients needed invasive ventilation and 666 (44%) died. For the 984 patients who were receiving mechanical ventilation in the first 24 h of ICU stay, mean tidal volume was 6.5 ± 1.3 mL/kg of ideal body weight, plateau pressure was 24 ± 5 cmH2O, respiratory system compliance was 31.9 (24.4–40.9) mL/cmH2O, and 82% of patients were ventilated with protective ventilation. Noninvasive ventilation was used in 21% of patients, and prone, in 36%. Compliance was associated with survival and did not show a bimodal pattern that would support the presence of two phenotypes. In the multivariable model, protective ventilation (aHR 0.73 [95%CI 0.57–0.94]), adjusted for PF ratio, compliance, PEEP, and arterial pH, was independently associated with survival. Conclusions During the peak of the epidemic in Sao Paulo, critically ill patients with COVID-19 often required mechanical ventilation and mortality was high. Our findings revealed an association between mechanical ventilation strategy and mortality, highlighting the importance of protective ventilation for patients with COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00882-w.
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Affiliation(s)
- Juliana C Ferreira
- Divisao de Pneumologia, Instituto Do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil. .,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.
| | - Yeh-Li Ho
- Divisao de Molestias Infecciosas, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Bruno Adler Maccagnan Pinheiro Besen
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Marcelo Sa Malbouisson
- Divisao de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Leandro Utino Taniguchi
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Vitale Mendes
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Leite Vieira Costa
- Divisao de Pneumologia, Instituto Do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Marcelo Park
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renato Daltro-Oliveira
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.,Divisao de Molestias Infecciosas, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Roberta M L Roepke
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.,UTI Emergencias Cirurgicas E Trauma, Departamento de Cirurgia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Joao M Silva-Jr
- Divisao de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria Jose Carvalho Carmona
- Divisao de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carlos R R Carvalho
- Divisao de Pneumologia, Instituto Do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
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Fleuren LM, de Bruin DP, Tonutti M, Lalisang RCA, Elbers PWG. Large-scale ICU data sharing for global collaboration: the first 1633 critically ill COVID-19 patients in the Dutch Data Warehouse. Intensive Care Med 2021; 47:478-481. [PMID: 33595710 PMCID: PMC7887418 DOI: 10.1007/s00134-021-06361-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/22/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Lucas M Fleuren
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
| | | | | | | | - Paul W G Elbers
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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15
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Bauer M, Groesdonk HV, Preissing F, Dickmann P, Vogelmann T, Gerlach H. [Mortality in sepsis and septic shock in Germany. Results of a systematic review and meta-analysis]. Anaesthesist 2021; 70:673-680. [PMID: 33559687 PMCID: PMC7871311 DOI: 10.1007/s00101-021-00917-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/05/2020] [Accepted: 01/13/2021] [Indexed: 12/18/2022]
Abstract
Hintergrund Verschiedene Autoren diskutieren, ob fehlende Qualitätsinitiativen und Behandlungsstandards in Deutschland im internationalen Vergleich zu höherer Sterblichkeit bei Sepsis und septischem Schock führen könnten. Dem gegenüber steht eine international anerkannte intensivmedizinische Versorgung in Deutschland, z. B. während der COVID-19-Pandemie. Ziel der Arbeit Ziel dieser Studie war es, die Sterblichkeit bei Sepsis und septischem Schock in Deutschland zu ermitteln und mit anderen Industrienationen zu vergleichen. Material und Methoden In eine systematischen Literaturrecherche wurden alle zwischen 2009 und 2020 veröffentlichten Interventions- und Beobachtungsstudien aus den Datenbanken PubMed und Cochrane Library eingeschlossen. Die 30- und 90-Tages-Sterblichkeit bei Sepsis und septischem Schock wurde in einer Metaanalyse mittels „Random-effects“-Modells gepoolt. Ergebnisse Insgesamt wurden 134 Studien in die Meta-Analyse eingeschlossen. Die 30-Tages-Sterblichkeit bei Sepsis betrug in Deutschland 26,50 % (95 %-KI: 19,86–33,15 %), in Europa (ohne Deutschland) 23,85 % (95%-KI: 20,49–27,21 %) und in Nordamerika 19,58 % (95%-KI: 14,03–25,14 %). Die 30-Tages-Sterblichkeit bei septischem Schock betrug 30,48 % (95 %-KI: 29,30–31,67 %), 34,57 % (95 %-KI: 33,51–35,64 %) bzw. 33,69 % (95 %-KI: 31,51–35,86 %). Die 90-Tages-Sterblichkeit bei septischem Schock betrug 38,78 % (95 %-KI: 32,70–44,86 %), 41,90 % (95 %-KI: 38,88–44,91 %) beziehungsweise 34,41 % (95 %-KI: 25,66–43,16 %). Diskussion Es ergaben sich somit keine Anhaltspunkte dafür, dass die Sterblichkeit bei Sepsis/septischem Schock im internationalen Vergleich in Deutschland erhöht ist. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00101-021-00917-8) enthält zusätzliche Informationen zu den eingeschlossenen Studien. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
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Affiliation(s)
- Michael Bauer
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - Heinrich Volker Groesdonk
- Klinik für Interdisziplinäre Intensivmedizin und Intermediate Care, Helios Klinikum Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Deutschland
| | | | - Petra Dickmann
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | | | - Herwig Gerlach
- Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Vivantes Klinikum Neukölln, Rudower Straße 48, 12351, Berlin, Deutschland
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Cavayas YA, Noël A, Brunette V, Williamson D, Frenette AJ, Arsenault C, Bellemare P, Lagrenade-Verdant C, LeGuillan S, Levesque E, Lamarche Y, Giasson M, Rico P, Beaulieu Y, Marsolais P, Serri K, Bernard F, Albert M. Early experience with critically ill patients with COVID-19 in Montreal. Can J Anaesth 2021; 68:204-213. [PMID: 32935329 PMCID: PMC7491980 DOI: 10.1007/s12630-020-01816-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/21/2020] [Accepted: 08/31/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Montreal has been the epicentre of the coronavirus disease (COVID-19) pandemic in Canada. Given the regional disparities in incidence and mortality in the general population, we aimed to describe local characteristics, treatments, and outcomes of critically ill COVID-19 patients in Montreal. METHODS A single-centre retrospective cohort of consecutive adult patients admitted to the intensive care unit (ICU) of Hôpital du Sacré-Coeur de Montréal with confirmed COVID-19 were included. RESULTS Between 20 March and 13 May 2020, 75 patients were admitted, with a median [interquartile range (IQR)] age of 62 [53-72] yr and high rates of obesity (47%), hypertension (67%), and diabetes (37%). Healthcare-related infections were responsible for 35% of cases. The median [IQR] day 1 sequential organ failure assessment score was 6 [3-7]. Invasive mechanical ventilation (IMV) was used in 57% of patients for a median [IQR] of 11 [5-22] days. Patients receiving IMV were characterized by a moderately decreased median [IQR] partial pressure of oxygen:fraction of inspired oxygen (day 1 PaO2:FiO2 = 177 [138-276]; day 10 = 173 [147-227]) and compliance (day 1 = 48 [38-58] mL/cmH2O; day 10 = 34 [28-42] mL/cmH2O) and very elevated estimated dead space fraction (day 1 = 0.60 [0.53-0.67]; day 10 = 0.72 [0.69-0.79]). Overall hospital mortality was 25%, and 21% in the IMV patients. Mortality was 82% in patients ≥ 80 yr old. CONCLUSIONS Characteristics and outcomes of critically ill patients with COVID-19 in Montreal were similar to those reported in the existing literature. We found an increased physiologic dead space, supporting the hypothesis that pulmonary vascular injury may be central to COVID-19-induced lung damage.
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Affiliation(s)
- Yiorgos Alexandros Cavayas
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada.
- ERESI (Equipe de Recherche En Soins Intensifs), Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada.
| | - Alexandre Noël
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Veronique Brunette
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - David Williamson
- ERESI (Equipe de Recherche En Soins Intensifs), Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
- Département de Pharmacie, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Faculté de Pharmacie, Université de Montréal, Montreeal, QC, Canada
| | - Anne Julie Frenette
- Département de Pharmacie, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Faculté de Pharmacie, Université de Montréal, Montreeal, QC, Canada
| | - Christine Arsenault
- Département de Biologie Médicale, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Microbiologie, Université de Montréal, Montreal, QC, Canada
| | - Patrick Bellemare
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Colin Lagrenade-Verdant
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Soazig LeGuillan
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
- Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Chirurgie, Université de Montréal, Montreal, QC, Canada
| | - Emilie Levesque
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Yoan Lamarche
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Marc Giasson
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Philippe Rico
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Yanick Beaulieu
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Pierre Marsolais
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Karim Serri
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
- ERESI (Equipe de Recherche En Soins Intensifs), Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Francis Bernard
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
- ERESI (Equipe de Recherche En Soins Intensifs), Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Martin Albert
- Service de Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de l'île de Montréal, Département de Médecine, Université de Montréal, 5400 Gouin Ouest, Montreal, QC, H4J 1C5, Canada
- ERESI (Equipe de Recherche En Soins Intensifs), Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
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Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med 2020. [PMID: 33211135 PMCID: PMC7674575 DOI: 10.1007/s00134-020-06294-x] [Citation(s) in RCA: 387] [Impact Index Per Article: 96.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose To describe acute respiratory distress syndrome (ARDS) severity, ventilation management, and the outcomes of ICU patients with laboratory-confirmed COVID-19 and to determine risk factors of 90-day mortality post-ICU admission. Methods COVID-ICU is a multi-center, prospective cohort study conducted in 138 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, adjunctive interventions, ICU length-of-stay, and survival data were collected. Results From February 25 to May 4, 2020, 4643 patients (median [IQR] age 63 [54–71] years and SAPS II 37 [28–50]) were admitted in ICU, with day-90 post-ICU admission status available for 4244. On ICU admission, standard oxygen therapy, high-flow oxygen, and non-invasive ventilation were applied to 29%, 19%, and 6% patients, respectively. 2635 (63%) patients were intubated during the first 24 h whereas overall 3376 (80%) received invasive mechanical ventilation (MV) at one point during their ICU stay. Median (IQR) positive end-expiratory and plateau pressures were 12 (10–14) cmH2O, and 24 (21–27) cmH2O, respectively. The mechanical power transmitted by the MV to the lung was 26.5 (18.6–34.9) J/min. Paralyzing agents and prone position were applied to 88% and 70% of patients intubated at Day-1, respectively. Pulmonary embolism and ventilator-associated pneumonia were diagnosed in 207 (9%) and 1209 (58%) of these patients. On day 90, 1298/4244 (31%) patients had died. Among patients who received invasive or non-invasive ventilation on the day of ICU admission, day-90 mortality increased with the severity of ARDS at ICU admission (30%, 34%, and 50% for mild, moderate, and severe ARDS, respectively) and decreased from 42 to 25% over the study period. Early independent predictors of 90-day mortality were older age, immunosuppression, severe obesity, diabetes, higher renal and cardiovascular SOFA score components, lower PaO2/FiO2 ratio and a shorter time between first symptoms and ICU admission. Conclusion Among more than 4000 critically ill patients with COVID-19 admitted to our ICUs, 90-day mortality was 31% and decreased from 42 to 25% over the study period. Mortality was higher in older, diabetic, obese and severe ARDS patients. Electronic supplementary material The online version of this article (10.1007/s00134-020-06294-x) contains supplementary material, which is available to authorized users.
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18
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Szakmany T. Noninvasive ventilatory support in COVID-19: operating in the evidence free zone. Minerva Anestesiol 2020; 86:1126-1128. [PMID: 33054025 DOI: 10.23736/s0375-9393.20.15158-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tamas Szakmany
- Division of Population Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Cardiff University, Cardiff, UK - .,Division of Scheduled Care, Department of Critical Care, Aneurin Bevan University Health Board, Newport, UK -
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