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McHenry RD, Leech C, Barnard EBG, Corfield AR. Equity in the provision of helicopter emergency medical services in the United Kingdom: a geospatial analysis using indices of multiple deprivation. Scand J Trauma Resusc Emerg Med 2024; 32:73. [PMID: 39164775 PMCID: PMC11337590 DOI: 10.1186/s13049-024-01248-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/14/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Helicopter Emergency Medical Services (HEMS) in the United Kingdom (UK) are provided in a mixed funding model, with the majority of services funded by charities alongside a small number of government-funded operations. More socially-deprived communities are known to have greater need for critical care, such as that provided by HEMS in the UK. Equity of access is an important pillar of medical care, describing how resource should be allocated on the basis of need; a concept that is particularly relevant to resource-intensive services such as HEMS. However, the Inverse Care Law describes the tendency of healthcare provision to vary inversely with population need, where healthcare resource does not meet the expected needs in areas of higher deprivation. It is not known to what extent the Inverse Care Law applies to HEMS in the UK. METHODS Modelled service areas were created with each small unit geography locus in the UK assigned to its closest HEMS operational base. The total population, median decile on index of multiple deprivation, and geographic area for each modelled service area was determined from the most recently available national statistics. Linear regression was used to determine the association between social deprivation, geographic area, and total population served for each modelled service area. RESULTS The provision of HEMS in the UK varied inversely to expected population need; with HEMS operations in more affluent areas serving smaller populations. The model estimated that population decreases by 18% (95% confidence interval 1-32%) for each more affluent point in median decile of index of multiple deprivation. There was no significant association between geographic area and total population served. CONCLUSION The provision of HEMS in the UK is consistent with the Inverse Care Law. HEMS operations in more deprived areas serve larger populations, thus providing a healthcare resource inversely proportional with the expected needs of these communities. Funding structures may explain this variation as charities are more highly concentrated in more affluent areas.
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Affiliation(s)
- Ryan D McHenry
- ScotSTAR, Scottish Ambulance Service, Hangar B, 180 Abbotsinch Road, Paisley, PA3 2RY, UK.
| | - Caroline Leech
- Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Walsgrave, Coventry, CV2 2DX, UK
- The Air Ambulance Service, Blue Skies House, Butlers Leap, Rugby, CV21 3RQ, UK
| | - Ed B G Barnard
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Clinical Innovation), Birmingham, UK
- Department of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Norwich, UK
| | - Alasdair R Corfield
- ScotSTAR, Scottish Ambulance Service, Hangar B, 180 Abbotsinch Road, Paisley, PA3 2RY, UK
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Leggett N, Emery K, Rollinson TC, Deane AM, French C, Manski-Nankervis JA, Eastwood G, Miles B, Witherspoon S, Stewart J, Merolli M, Ali Abdelhamid Y, Haines KJ. Clinician- and Patient-Identified Solutions to Reduce the Fragmentation of Post-ICU Care in Australia. Chest 2024; 166:95-106. [PMID: 38382876 DOI: 10.1016/j.chest.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Critical care survivors experience multiple care transitions, with no formal follow-up care pathway. RESEARCH QUESTION What are the potential solutions to improve the communication between treating teams and integration of care following an ICU admission, from the perspective of patients, their caregivers, intensivists, and general practitioners (GPs) from diverse socioeconomic areas? STUDY DESIGN AND METHODS This study included a qualitative design using semi-structured interviews with intensivists, GPs, and patients and caregivers. Framework analysis was used to analyze data and to identify solutions to improve the integration of care following hospital discharge. Patients were previously mechanically ventilated for > 24 h in the ICU and had access to a video-enabled device. Clinicians were recruited from hospital networks and a state-wide GP network. RESULTS Forty-six interviews with clinicians, patients, and caregivers were completed (15 intensivists, eight GPs, 15 patients, and eight caregivers). Three higher level feedback loops were identified that comprised 10 themes. Feedback loop 1 was an ICU and primary care collaboration. It included the following: (1) developing collaborative relationships between the ICU and primary care; (2) providing interprofessional education and resources to support primary care; and (3) improving role clarity for patient follow-up care. Feedback loop 2 was developing mechanisms for improved communication across the care continuum. It included: (4) timely, concise information-sharing with primary care on post-ICU recovery; (5) survivorship-focused information-sharing across the continuum of care; (6) empowering patients and caregivers in self-management; and (7) creation of a care coordinator role for survivors. Feedback loop 3 was learning from post-ICU outcomes to improve future care. It included: (8) developing comprehensive post-ICU care pathways; (9) enhancing support for patients following a hospital stay; and (10) integration of post-ICU outcomes within the ICU to improve clinician morale and understanding. INTERPRETATION Practical solutions to enhance the quality of survivorship for critical care survivors and their caregivers were identified. These themes are mapped to a novel conceptual model that includes key feedback loops for health system improvements and foci for future interventional trials to improve ICU survivorship outcomes.
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Affiliation(s)
- Nina Leggett
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia; Department of Critical Care, the University of Melbourne, Melbourne, VIC, Australia.
| | - Kate Emery
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Thomas C Rollinson
- Department of Physiotherapy, the University of Melbourne, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Adam M Deane
- Department of Intensive Care, Melbourne Health, Melbourne, VIC, Australia; Department of Critical Care, School of Medicine, the University of Melbourne, Melbourne, VIC, Australia
| | - Craig French
- Department of Intensive Care, Western Health, Melbourne, VIC, Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice and Primary Care, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Glenn Eastwood
- Department of Critical Care, Austin Health, Melbourne, VIC, Australia
| | - Briannah Miles
- Department of Intensive Care, Melbourne Health, Melbourne, VIC, Australia
| | | | - Jonathan Stewart
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Mark Merolli
- Centre for Digital Transformation of Health, the University of Melbourne, Melbourne, VIC, Australia; Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, the University of Melbourne, Melbourne, VIC, Australia
| | - Yasmine Ali Abdelhamid
- Department of Critical Care, School of Medicine, the University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia; Department of Critical Care, School of Medicine, the University of Melbourne, Melbourne, VIC, Australia
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Benaïs M, Duprey M, Federici L, Arnaout M, Mora P, Amouretti M, Bourgeon-Ghittori I, Gaudry S, Garçon P, Reuter D, Geri G, Megarbane B, Lebut J, Mekontso-Dessap A, Ricard JD, da Silva D, de Montmollin E. Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study. Ann Intensive Care 2024; 14:54. [PMID: 38592412 PMCID: PMC11004098 DOI: 10.1186/s13613-024-01279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The influence of socioeconomic deprivation on health inequalities is established, but its effect on critically ill patients remains unclear, due to inconsistent definitions in previous studies. METHODS Prospective multicenter cohort study conducted from March to June 2018 in eight ICUs in the Greater Paris area. All admitted patients aged ≥ 18 years were enrolled. Socioeconomic phenotypes were identified using hierarchical clustering, based on education, health insurance, income, and housing. Association of phenotypes with 180-day mortality was assessed using Cox proportional hazards models. RESULTS A total of 1,748 patients were included. Median age was 62.9 [47.4-74.5] years, 654 (37.4%) patients were female, and median SOFA score was 3 [1-6]. Study population was clustered in five phenotypes with increasing socioeconomic deprivation. Patients from phenotype A (n = 958/1,748, 54.8%) were without socioeconomic deprivation, patients from phenotype B (n = 273/1,748, 15.6%) had only lower education levels, phenotype C patients (n = 117/1,748, 6.7%) had a cumulative burden of 1[1-2] deprivations and all had housing deprivation, phenotype D patients had 2 [1-2] deprivations, all of them with income deprivation, and phenotype E patients (n = 93/1,748, 5.3%) included patients with 3 [2-4] deprivations and included all patients with health insurance deprivation. Patients from phenotypes D and E were younger, had fewer comorbidities, more alcohol and opiate use, and were more frequently admitted due to self-harm diagnoses. Patients from phenotype C (predominant housing deprivation), were more frequently admitted with diagnoses related to chronic respiratory diseases and received more non-invasive positive pressure ventilation. Following adjustment for age, sex, alcohol and opiate use, socioeconomic phenotypes were not associated with increased 180-day mortality: phenotype A (reference); phenotype B (hazard ratio [HR], 0.85; 95% confidence interval CI 0.65-1.12); phenotype C (HR, 0.56; 95% CI 0.34-0.93); phenotype D (HR, 1.09; 95% CI 0.78-1.51); phenotype E (HR, 1.20; 95% CI 0.73-1.96). CONCLUSIONS In a universal health care system, the most deprived socioeconomic phenotypes were not associated with increased 180-day mortality. The most disadvantaged populations exhibit distinct characteristics and medical conditions that may be addressed through targeted public health interventions.
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Affiliation(s)
- Morgan Benaïs
- Service de Médecine Intensive - Réanimation, Hôpital Delafontaine, Saint-Denis, France
| | - Matthieu Duprey
- Service de Réanimation, Grand Hôpital de l'Est Francilien-Site de Marne-la-Vallée, Jossigny, France
| | - Laura Federici
- Service de Réanimation Polyvalente, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Michel Arnaout
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Ambroise Paré, Boulogne, France
| | - Pierre Mora
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Lariboisière, Paris, France
| | - Marc Amouretti
- Service de Réanimation Polyvalente, Groupe Hospitalier Nord-Essonne, Longjumeau, France
| | - Irma Bourgeon-Ghittori
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Stéphane Gaudry
- DMU ESPRIT, Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Pierre Garçon
- Service de Réanimation, Grand Hôpital de l'Est Francilien-Site de Marne-la-Vallée, Jossigny, France
| | - Danielle Reuter
- Service de Réanimation Polyvalente, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Guillaume Geri
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Ambroise Paré, Boulogne, France
| | - Bruno Megarbane
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Lariboisière, Paris, France
| | - Jordane Lebut
- Service de Réanimation Polyvalente, Groupe Hospitalier Nord-Essonne, Longjumeau, France
| | - Armand Mekontso-Dessap
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Jean-Damien Ricard
- DMU ESPRIT, Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Louis Mourier, Colombes, France
- IAME, Université Paris Cité and Université Sorbonne Paris Nord, Inserm, 75018, Paris, France
| | - Daniel da Silva
- Service de Médecine Intensive - Réanimation, Hôpital Delafontaine, Saint-Denis, France
| | - Etienne de Montmollin
- Service de Médecine Intensive - Réanimation, Hôpital Delafontaine, Saint-Denis, France.
- IAME, Université Paris Cité and Université Sorbonne Paris Nord, Inserm, 75018, Paris, France.
- Service de Médecine Intensive - Réanimation Infectieuse, AP-HP, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France.
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Orwelius L, Kristenson M, Fredrikson M, Sjöberg F, Walther S. Effects of education, income and employment on ICU and post-ICU survival - A nationwide Swedish cohort study of individual-level data with 1-year follow up. J Crit Care 2024; 80:154497. [PMID: 38086226 DOI: 10.1016/j.jcrc.2023.154497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE The aim of this study was to examine relationships between education, income, and employment (socioeconomic status, SES) and intensive care unit (ICU) survival and survival 1 year after discharge from ICU (Post-ICU survival). METHODS Individual data from ICU patients were linked to register data of education level, disposable income, employment status, civil status, foreign background, comorbidities, and vital status. Associations between SES, ICU survival and 1-year post-ICU survival was analysed using Cox's regression. RESULTS We included 58,279 adults (59% men, median length of stay in ICU 4.0 days, median SAPS3 score 61). Survival rates at discharge from ICU and one year after discharge were 88% and 63%, respectively. Risk of ICU death (Hazard ratios, HR) was significantly higher in unemployed and retired compared to patients who worked prior to admission (1.20; 95% CI: 1.10-1.30 and 1.15; (1.07-1.24), respectively. There was no consistent association between education, income and ICU death. Risk of post-ICU death decreased with greater income and was roughly 16% lower in the highest compared to lowest income quintile (HR 0.84; 0.79-0.88). Higher education levels appeared to be associated with reduced risk of death during the first year after ICU discharge. CONCLUSIONS Significant relationships between low SES in the critically ill and increased risk of death indicate that it is important to identify and support patients with low SES to improve survival after intensive care. Studies of survival after critical illness need to account for participants SES.
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Affiliation(s)
- Lotti Orwelius
- Department of Anaesthesia and Intensive Care, Linköping University Hospital, 581 85 Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden.
| | - Margareta Kristenson
- Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, 581 83 Linköping, Sweden.
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden.
| | - Folke Sjöberg
- Department of Anaesthesia and Intensive Care, Linköping University Hospital, 581 85 Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden; Burns, Hand, and Plastic Surgery, Linköping University Hospital, 581 85 Linköping, Sweden.
| | - Sten Walther
- Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, 581 83 Linköping, Sweden; Department of Cardiothoracic Anaesthesia and Intensive Care, Linköping University Hospital, 581 85 Linköping, Sweden.
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5
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McCrory MC, Akande M, Slain KN, Kennedy CE, Winter MC, Stottlemyre MG, Wakeham MK, Barnack KA, Huang JX, Sharma M, Zurca AD, Pinto NP, Dziorny AC, Maddux AB, Garg A, Woodruff AG, Hartman ME, Timmons OD, Heidersbach RS, Cisco MJ, Sochet AA, Wells BJ, Halvorson EE, Saha AK. Child Opportunity Index and Pediatric Intensive Care Outcomes: A Multicenter Retrospective Study in the United States. Pediatr Crit Care Med 2024; 25:323-334. [PMID: 38088770 DOI: 10.1097/pcc.0000000000003427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To evaluate for associations between a child's neighborhood, as categorized by Child Opportunity Index (COI 2.0), and 1) PICU mortality, 2) severity of illness at PICU admission, and 3) PICU length of stay (LOS). DESIGN Retrospective cohort study. SETTING Fifteen PICUs in the United States. PATIENTS Children younger than 18 years admitted from 2019 to 2020, excluding those after cardiac procedures. Nationally-normed COI category (very low, low, moderate, high, very high) was determined for each admission by census tract, and clinical features were obtained from the Virtual Pediatric Systems LLC (Los Angeles, CA) data from each site. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 33,901 index PICU admissions during the time period, median patient age was 4.9 years and PICU mortality was 2.1%. There was a higher percentage of admissions from the very low COI category (27.3%) than other COI categories (17.2-19.5%, p < 0.0001). Patient admissions from the high and very high COI categories had a lower median Pediatric Index of Mortality 3 risk of mortality (0.70) than those from the very low, low, and moderate COI groups (0.71) ( p < 0.001). PICU mortality was lowest in the very high (1.7%) and high (1.9%) COI groups and highest in the moderate group (2.5%), followed by very low (2.3%) and low (2.2%) ( p = 0.001 across categories). Median PICU LOS was between 1.37 and 1.50 days in all COI categories. Multivariable regression revealed adjusted odds of PICU mortality of 1.30 (95% CI, 0.94-1.79; p = 0.11) for children from a very low versus very high COI neighborhood, with an odds ratio [OR] of 0.996 (95% CI, 0.993-1.00; p = 0.05) for mortality for COI as an ordinal value from 0 to 100. Children without insurance coverage had an OR for mortality of 3.58 (95% CI, 2.46-5.20; p < 0.0001) as compared with those with commercial insurance. CONCLUSIONS Children admitted to a cohort of U.S. PICUs were often from very low COI neighborhoods. Children from very high COI neighborhoods had the lowest risk of mortality and observed mortality; however, odds of mortality were not statistically different by COI category in a multivariable model. Children without insurance coverage had significantly higher odds of PICU mortality regardless of neighborhood.
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Affiliation(s)
- Michael C McCrory
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Manzilat Akande
- Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, OK
| | - Katherine N Slain
- Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
| | | | - Meredith C Winter
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Kyle A Barnack
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Jia Xin Huang
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA
| | - Meesha Sharma
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA
| | - Adrian D Zurca
- Pediatrics, Northwestern University Feinberg School of Medicine and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Neethi P Pinto
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Adam C Dziorny
- Pediatrics, University of Rochester School of Medicine, Rochester, NY
| | - Aline B Maddux
- Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Anjali Garg
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Charlotte Bloomberg Children's Center, Baltimore, MD
| | - Alan G Woodruff
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Mary E Hartman
- Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Otwell D Timmons
- Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, NC
| | - R Scott Heidersbach
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Michael J Cisco
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA
| | - Anthony A Sochet
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Brian J Wells
- Department of Biostatistics and Data Science; Wake Forest University School of Medicine, Winston-Salem, NC
| | - Elizabeth E Halvorson
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Amit K Saha
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC
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6
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Kotfis K, Olusanya S, Modra L. Equity in patient care in the intensive care unit. Intensive Care Med 2024; 50:291-293. [PMID: 38236291 PMCID: PMC10907426 DOI: 10.1007/s00134-023-07310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Katarzyna Kotfis
- Department of Anesthesiology, Intensive Care and Pain Management, Pomeranian Medical University, al. Powstańców Wlkp. 72, 70-111, Szczecin, Poland.
| | - Segun Olusanya
- Department of Perioperative Medicine, Barts Heart Centre, London, UK
| | - Lucy Modra
- Department of Critical Care, University of Melbourne, Melbourne, Australia
- Intensive Care Unit, Austin Hospital, Melbourne, Australia
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7
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Declercq PL, Fournel I, Demeyere M, Berraies A, Ksiazek E, Nyunga M, Daubin C, Ampere A, Sauneuf B, Badie J, Delbove A, Nseir S, Artaud-Macari E, Bironneau V, Ramakers M, Maizel J, Miailhe AF, Lacombe B, Delberghe N, Oulehri W, Georges H, Tchenio X, Clarot C, Redureau E, Bourdin G, Federici L, Adda M, Schnell D, Bousta M, Salmon-Gandonnière C, Vanderlinden T, Plantefeve G, Delacour D, Delpierre C, Le Bouar G, Sedillot N, Beduneau G, Rivière A, Meunier-Beillard N, Gélinotte S, Rigaud JP, Labruyère M, Georges M, Binquet C, Quenot JP. Influence of socio-economic status on functional recovery after ARDS caused by SARS-CoV-2: the multicentre, observational RECOVIDS study. Intensive Care Med 2023; 49:1168-1180. [PMID: 37620561 PMCID: PMC10556111 DOI: 10.1007/s00134-023-07180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Survivors after acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) are at high risk of developing respiratory sequelae and functional impairment. The healthcare crisis caused by the pandemic hit socially disadvantaged populations. We aimed to evaluate the influence of socio-economic status on respiratory sequelae after COVID-19 ARDS. METHODS We carried out a prospective multicenter study in 30 French intensive care units (ICUs), where ARDS survivors were pre-enrolled if they fulfilled the Berlin ARDS criteria. For patients receiving high flow oxygen therapy, a flow ≥ 50 l/min and an FiO2 ≥ 50% were required for enrollment. Socio-economic deprivation was defined by an EPICES (Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé - Evaluation of Deprivation and Inequalities in Health Examination Centres) score ≥ 30.17 and patients were included if they performed the 6-month evaluation. The primary outcome was respiratory sequelae 6 months after ICU discharge, defined by at least one of the following criteria: forced vital capacity < 80% of theoretical value, diffusing capacity of the lung for carbon monoxide < 80% of theoretical value, oxygen desaturation during a 6-min walk test and fibrotic-like findings on chest computed tomography. RESULTS Among 401 analyzable patients, 160 (40%) were socio-economically deprived and 241 (60%) non-deprived; 319 (80%) patients had respiratory sequelae 6 months after ICU discharge (81% vs 78%, deprived vs non-deprived, respectively). No significant effect of socio-economic status was identified on lung sequelae (odds ratio (OR), 1.19 [95% confidence interval (CI), 0.72-1.97]), even after adjustment for age, sex, most invasive respiratory support, obesity, most severe P/F ratio (adjusted OR, 1.02 [95% CI 0.57-1.83]). CONCLUSIONS In COVID-19 ARDS survivors, socio-economic status had no significant influence on respiratory sequelae 6 months after ICU discharge.
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Affiliation(s)
| | - Isabelle Fournel
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | | | | | - Eléa Ksiazek
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Martine Nyunga
- Service de Médecine Intensive Réanimation, CH de Roubaix, Roubaix, France
| | - Cédric Daubin
- Department of Medical Intensive Care, CHU de Caen Normandie, Caen, France
| | | | - Bertrand Sauneuf
- Service de Médecine Intensive Réanimation, CH Public du Cotentin, Cherbourg-en-Cotentin, France
| | - Julio Badie
- Service de Médecine Intensive Réanimation, Hopital Nord Franche-Comte, Trevenans, France
| | - Agathe Delbove
- Service de Réanimation Polyvalente, CHBA Vannes, Vannes, France
| | - Saad Nseir
- Service de Médecine Intensive Réanimation, CHRU Roger Salengro, Lille, France
- Inserm U1285, Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Elise Artaud-Macari
- University of Normandie, UNIROUEN, EA3830, CHU Rouen, Department of Pneumology, Thoracic Oncology and Respiratory Intensive Care Unit, Rouen, France
| | - Vanessa Bironneau
- Service de Pneumologie, CHU Poitiers, Poitiers, France
- INSERM CIC 1402, ALIVES Research Group, Université de Poitiers, Poitiers, France
| | - Michel Ramakers
- Service de Médecine Intensive Réanimation, Centre Hospitalier Mémorial de Saint-Lô, Saint-Lô, France
| | - Julien Maizel
- Service de Médecine Intensive Réanimation, CHU d’Amiens, Amiens, France
| | | | - Béatrice Lacombe
- Service de Réanimation Polyvalente, Groupe Hospitalier Bretagne Sud, Lorient, France
| | | | - Walid Oulehri
- Service de Réanimation Chirurgicale, CHRU Strasbourg, Strasbourg, France
| | - Hugues Georges
- Service de Médecine Intensive Réanimation, CH de Tourcoing, Tourcoing, France
| | - Xavier Tchenio
- Service de Réanimation Polyvalente, Centre Hospitalier Fleyriat, Bourg en Bresse, France
| | | | - Elise Redureau
- Service de Pneumologie, CHD Vendée, La Roche-sur-Yon, France
| | - Gaël Bourdin
- Service de Réanimation Polyvalente, CH Saint Joseph Saint Luc, Lyon, France
| | - Laura Federici
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Mélanie Adda
- Service de Médecine Intensive Réanimation, Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - David Schnell
- Service de Réanimation Polyvalente et USC, CH d’Angoulême, Angoulême, France
| | - Mehdi Bousta
- Service de Réanimation Médico-Chirugicale, Groupe Hospitalier du Havre, Le Havre, France
| | | | - Thierry Vanderlinden
- Intensive Care Unit, St Philibert hospital, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Gaëtan Plantefeve
- Service de Médecine Intensive Réanimation, CH d’Argenteuil, Argenteuil, France
| | - David Delacour
- Service de radiologie, Clinique du Cèdre, Bois-Guillaume, France
| | | | - Gurvan Le Bouar
- Service de Médecine Intensive Réanimation, CHES Evreux, Evreux, France
| | - Nicholas Sedillot
- Service de Réanimation Polyvalente, Centre Hospitalier Fleyriat, Bourg en Bresse, France
| | - Gaëtan Beduneau
- Normandie Univ, UNIROUEN, UR3830, CHU Rouen, Department of Medical Intensive Care, 76000 Rouen, France
| | - Antoine Rivière
- Service de Réanimation Polyvalente, CH d’Abbeville, Abbeville, France
| | - Nicolas Meunier-Beillard
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | | | - Jean-Philippe Rigaud
- Service de Médecine Intensive Réanimation, CH de Dieppe, Dieppe, France
- Espace de Réflexion Ethique de Normandie, CHU Caen, Caen, France
| | - Marie Labruyère
- Department of Intensive Care, Burgundy University Hospital, 14 rue Paul Gaffarel, B.P 77908, 21079 Dijon Cedex, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Marjolaine Georges
- Department of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France
| | - Christine Binquet
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, Burgundy University Hospital, 14 rue Paul Gaffarel, B.P 77908, 21079 Dijon Cedex, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
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Strandberg G, Lipcsey M. Association of socioeconomic and demographic factors with limitations of life sustaining treatment in the intensive care unit. Intensive Care Med 2023; 49:1249-1250. [PMID: 37580572 DOI: 10.1007/s00134-023-07177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/24/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Gunnar Strandberg
- Department of Surgical Sciences, Cardiothoracic Surgery and Anesthesiology, Uppsala University, Uppsala, Sweden.
| | - Miklós Lipcsey
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
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