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Yiğit Avcı Ş, Yılmaz D. The effect of different bed head angles on the hemodynamic parameters of intensive care patients lying in the supine position: A quasi-experimental study. Jpn J Nurs Sci 2024; 21:e12589. [PMID: 38351461 DOI: 10.1111/jjns.12589] [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: 09/12/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 07/03/2024]
Abstract
AIMS The aim of this study was to research the effect of different bed head angles on the hemodynamic parameters of intensive care patients lying in the supine position. METHODS This study was a non-randomized and non-controlled, quasi-experimental repeated measures study. The study was conducted with 50 intensive care patients aged 18 and over in a general surgery intensive care unit in Turkey. With each patient in the supine position, the bed head was raised to an angle of 0°, 20°, 30°, and 45° without a pillow, and the hemodynamic parameters of central venous pressure, systolic and diastolic blood pressure, heart rate, breathing rate, and peripheral oxygen saturation were recorded after 0 and 10 min. RESULTS It was found that the mean central venous pressure value measured at min 0 and 10 was higher when the intensive care patients' bed head angle was raised to 45° than when the bed head was at an angle of 0° or 20° (p < .05). It was found that the patients' other hemodynamic parameters were not affected by different bed head angles. CONCLUSIONS It was concluded as a result of this research that in intensive care patients in the supine position, only central venous pressure was affected by bed head angle, and that central venous pressure measurement can be reliably made at a bed head angle of 30°.
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Affiliation(s)
- Şenay Yiğit Avcı
- Vocational School, First and Emergency Aid Program, Mudanya University, Bursa, Turkey
| | - Dilek Yılmaz
- Department of Nursing, Faculty of Health Sciences, Bursa Uludağ University, Bursa, Turkey
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2
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Ma Y, Zhu C, Ma X, Zhou B, Dong M. Risk factors of acute respiratory distress syndrome in sepsis caused by intra-abdominal infections: A retrospective study. Surgery 2024; 175:1432-1438. [PMID: 38383244 DOI: 10.1016/j.surg.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Intra-abdominal infections are frequently associated with acute respiratory distress syndrome, which significantly affects patient prognosis. However, little is known about the specific risk factors of acute respiratory distress syndrome in sepsis caused by intra-abdominal infections. METHODS This retrospective study included adult patients with intra-abdominal sepsis admitted to the intensive care unit of a tertiary teaching hospital in China between June 2017 and June 2022. Patients were categorized based on the presence or absence of acute respiratory distress syndrome. Data, including vital signs, laboratory values, and severity scores collected within 24 hours of sepsis diagnosis, as well as outcomes within 90 days, were analyzed. Multivariable logistic regression was used to identify independent risk factors associated with acute respiratory distress syndrome. RESULTS A total of 738 patients were included, of whom 218 (29.5%) developed acute respiratory distress syndrome. Patients with acute respiratory distress syndrome were younger, had a higher body mass index and disease severity scores, and exhibited higher proportions of septic shock and hospital-acquired intra-abdominal infections. The mortalities in the intensive care unit and at 28 and 90 days were higher in the acute respiratory distress syndrome group. In the multivariate logistic regression model, age under 65 years (odds ratio [95% confidence interval]: 1.571 [1.093-2.259]), elevated body mass index (2.070 [1.382-3.101] for overweight, 6.994 [3.207-15.255]) for obesity, septic shock (2.043 [1.400-2.980]), procalcitonin (1.009 [1.004-1.015]), hospital-acquired intra-abdominal infections (2.528[1.373-4.657]), and source of intra-abdominal infections (2.170 [1.140-4.128] for biliary tract infection, 0.443 [0.217-0.904] for gastroduodenal perforation) were independently associated with acute respiratory distress syndrome. CONCLUSION In patients with intra-abdominal sepsis, age under 65 years, higher body mass index and procalcitonin, septic shock, hospital-acquired intra-abdominal infections, and biliary tract infection were risk factors for acute respiratory distress syndrome.
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Affiliation(s)
- Yuteng Ma
- Department of Gastrointestinal Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, China; Department of Critical Care Medicine, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Chengrui Zhu
- Department of Critical Care Medicine, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaochun Ma
- Department of Critical Care Medicine, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Baosen Zhou
- Department of Clinical Epidemiology, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ming Dong
- Department of Gastrointestinal Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, China.
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3
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Lou Q. Impact of obesity on outcomes of patients with acute respiratory distress syndrome: a retrospective analysis of a large clinical database. Med Klin Intensivmed Notfmed 2024; 119:220-226. [PMID: 37584723 PMCID: PMC10995076 DOI: 10.1007/s00063-023-01042-7] [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: 11/07/2022] [Revised: 05/07/2023] [Accepted: 06/16/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE To evaluate the link between obesity and mortality in patients with acute respiratory distress syndrome (ARDS). METHODS We performed a retrospective cohort study of a large clinical database. A Cox proportional hazards regression model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for the relationship between body mass index (BMI) and mortality. The primary endpoint was 30-day death rate and the secondary endpoints were 90-day and 1‑year mortality. RESULTS Overall, 418 patients with ARDS were enrolled in the study, including 185 women and 233 men (age: 70.7 ± 44.1 years; BMI: 28.7 ± 8.1 kg/m2). Compared with patients with normal weight, obese patients were younger (60.1 ± 13.7, p = 0.003) and a higher percentage of these patients were women (51.3% vs. 49.0%, p = 0.001). The HRs (95% CI) of 30-day mortality in the underweight, overweight, and obese populations were 1.82 (0.85, 3.90), 0.59 (0.29, 1.20), and 3.85 (1.73, 8.57), respectively, after adjustment for other confounding factors. A similar pattern was also seen for death after 90 days and after 1 year. A U-shaped association between BMI and 30-day mortality was discovered by curve fitting. CONCLUSION Obesity had a significant impact on the short- and long-term mortality in patients with ARDS. There was a U-shaped relationship between BMI and mortality, while a higher BMI was associated with an increased risk of death in patients with ARDS.
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Affiliation(s)
- Qiyan Lou
- Department of Respiratory Medicine, Zhuji Affiliated Hospital of Wenzhou Medical University, No. 9 Jianmin Road Taozhu Street, 311800, Zhuji, China.
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4
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Tang W, Wu S, Tang Y, Ma J, Ao Y, Liu L, Wei K. Microarray analysis identifies lncFirre as a potential regulator of obesity-related acute lung injury. Life Sci 2024; 340:122459. [PMID: 38307237 DOI: 10.1016/j.lfs.2024.122459] [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: 11/08/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
AIMS The inflammatory response in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is heightened in obesity. The aim of this study was to investigate whether lncRNAs are involved in the effects of obesity on acute lung injury and to find possible effector lncRNAs. MAIN METHODS Microarray analysis was used to assess the transcriptional profiles of lncRNAs and mRNAs in lung tissues from normal (CON), high-fat diet induced obese (DIO), and obese ALI mice (DIO-ALI). GO and KEGG analyses were employed to explore the biological functions of differentially expressed genes. A lncRNA-mRNA co-expression network was constructed to identify specific lncRNA. Lung tissues and peripheral blood samples from patients with obesity and healthy lean donors were utilized to confirm the expression characteristics of lncFirre through qRT-PCR. lncFirre was knocked down in MH-S macrophages to explore its function. ELISA and Griess reagent kit were used to detect PGE2 and NO. Flow cytometry was used to detect macrophages polarization. KEY FINDINGS There were 475 lncRNAs and 404 mRNAs differentially expressed between DIO and CON, while 1348 lncRNAs and 1349 mRNAs between DIO-ALI and DIO. Obesity increased lncFirre expression in both mice and patients, and PA elevated lncFirre in MH-S. PA exacerbated the inflammation and proinflammatory polarization of MH-S induced by LPS. LncFirre knockdown inhibited the secretion of PGE2 and NO, M1 differentiation while promoted the M2 differentiation in PA and LPS co-challenged MH-S. SIGNIFICANCE Interfering with lncFirre effectively inhibit inflammation in MH-S, lncFirre can serve as a promising target for treating obesity-related ALI.
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Affiliation(s)
- Wenjing Tang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Siqi Wu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yin Tang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jingyue Ma
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yichan Ao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ling Liu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Ke Wei
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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ÖZAYAR E, ŞAHAP M, GÜLEÇ H, KURTAY A, SELVİ A, BULUŞ H, ARI Ö. Does the pleth variability index have any predictive value for intraoperative respiratory problems in bariatric surgery? Turk J Med Sci 2023; 54:115-120. [PMID: 38812625 PMCID: PMC11031177 DOI: 10.55730/1300-0144.5771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/15/2024] [Accepted: 12/14/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim We aimed to search the relationship between the preoperative PVI (pleth variability index) and intraoperative respiratory parameters to reveal whether PVI can be used as a prediction tool in bariatric surgery. Materials and methods Forty patients undergoing bariatric surgery were included. Noninvasive pleth variability index measured via finger probe before induction of general anesthesia. Following intubation each patient was ventilated in controlled mode. Intraoperative blood pressure, peak airway pressure, end-tidal CO2, SpO2, PEEP, and FiO2 were recorded every 5 min for the first 10 min and then every 10 min until extubation. Steroid and bronchodilator requirements were recorded. Results The systolic pressure-PVI, oxygen saturation-PVI relationship was statistically significant (p = 0.03, p = 0.013). A relationship was found between pleth variability index and peak airway pressure (p = 0.002). No correlation was detected between end-tidal CO2 and pleth variability index. The relationship between steroid, bronchodilator use, and PVI was significant (p = 0.05, p = 0.01). A positive correlation between PEEP and PVI was detected at varying time points. A positive correlation was found between FiO2-PVI. Conclusion A relationship was found between PVI and intraoperative peak airway pressures, oxygen saturation, PEEP, bronchodilatator, and steroid usage. This result may be inspiring to conduct larger studies addressing the issue of predicting intraoperative respiratory problems in bariatric surgeries.
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Affiliation(s)
- Esra ÖZAYAR
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences, Ankara,
Turkiye
| | - Mehmet ŞAHAP
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Yıldırım Beyazıt University, Ankara,
Turkiye
| | - Handan GÜLEÇ
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Yıldırım Beyazıt University, Ankara,
Turkiye
| | - Aysun KURTAY
- Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, Ankara,
Turkiye
| | - Adem SELVİ
- Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, Ankara,
Turkiye
| | - Hakan BULUŞ
- Department of General Surgery, Faculty of Medicine, University of Health Sciences, Ankara,
Turkiye
| | - Özlem ARI
- Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, Ankara,
Turkiye
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Cutuli SL, Grieco DL, Michi T, Cesarano M, Rosà T, Pintaudi G, Menga LS, Ruggiero E, Giammatteo V, Bello G, De Pascale G, Antonelli M. Personalized Respiratory Support in ARDS: A Physiology-to-Bedside Review. J Clin Med 2023; 12:4176. [PMID: 37445211 DOI: 10.3390/jcm12134176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a leading cause of disability and mortality worldwide, and while no specific etiologic interventions have been shown to improve outcomes, noninvasive and invasive respiratory support strategies are life-saving interventions that allow time for lung recovery. However, the inappropriate management of these strategies, which neglects the unique features of respiratory, lung, and chest wall mechanics may result in disease progression, such as patient self-inflicted lung injury during spontaneous breathing or by ventilator-induced lung injury during invasive mechanical ventilation. ARDS characteristics are highly heterogeneous; therefore, a physiology-based approach is strongly advocated to titrate the delivery and management of respiratory support strategies to match patient characteristics and needs to limit ARDS progression. Several tools have been implemented in clinical practice to aid the clinician in identifying the ARDS sub-phenotypes based on physiological peculiarities (inspiratory effort, respiratory mechanics, and recruitability), thus allowing for the appropriate application of personalized supportive care. In this narrative review, we provide an overview of noninvasive and invasive respiratory support strategies, as well as discuss how identifying ARDS sub-phenotypes in daily practice can help clinicians to deliver personalized respiratory support and potentially improve patient outcomes.
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Affiliation(s)
- Salvatore Lucio Cutuli
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Domenico Luca Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Teresa Michi
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Melania Cesarano
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Tommaso Rosà
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gabriele Pintaudi
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luca Salvatore Menga
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ersilia Ruggiero
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Valentina Giammatteo
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Bello
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gennaro De Pascale
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Massimo Antonelli
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Feeding intolerance during prolonged prone position in overweight and obese patients with severe COVID-19. NUTR HOSP 2023; 40:250-256. [PMID: 36880718 DOI: 10.20960/nh.04553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
OBJECTIVE the aim of this study was to compare the incidence rate of feeding intolerance (FI) during supine (SP) or prone positioning (PP) in critically ill COVID-19 patients. METHODS this was a retrospective cohort study of critically ill patients with overweight or obesity who received enteral nutrition (EN) in prone or supine positioning continuously during the first five days of mechanical ventilation. Nutritional risk, anthropometric measurements and body composition were assessed at the first 24 hours upon Intensive Care Unit (ICU) admission. Biochemical and clinical variables (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II], Acute Kidney Injury [AKI] or comorbidities diagnosis) were collected. Pharmacotherapy (prokinetics, sedatives or neuromuscular blocking agents) and FI incidence (gastric residual volume [GRV] ≥ 200 ml or ≥ 500 ml, vomiting or diarrhea) were daily recorded. Constipation was defined as the absence of evacuation for five consecutive days. RESULTS eighty-two patients were included. Higher rate of prophylactic prokinetic prescription was observed in PP (42.8 vs 12.5 %, p = 0.002). GRV ≥ 200 in supine position was not different when compared to PP (p = 0.47). Vomiting episodes in supine compared to PP showed no difference between groups (15 % vs 24 %, p = 0.31). No differences in diarrhea events were detected (10 % vs 4.7 %, p = 0.36). Constipation was common in both groups (95 % vs 82 %, p = 0.06). CONCLUSION FI during prone position was not different in comparison to supine position. Routinely use of prokinetics in continuous prone position may help to prevent FI incidence. Algorithm development is necessary for FI prevention and treatment so to avoid EN interruptions and adverse clinical outcomes.
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Golicnik A, Zivanovic I, Gorjup V, Berden J. Same but Different-ECMO in COVID-19 and ARDS of Other Etiologies. Comparison of Survival Outcomes and Management in Different ARDS Groups. J Intensive Care Med 2023:8850666231157286. [PMID: 36803290 PMCID: PMC9941000 DOI: 10.1177/08850666231157286] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Background: COVID-19 has led to increased numbers of patients in need of venovenous extracorporeal membrane oxygenation (ECMO) support, but knowledge on management in comparison to acute respiratory distress syndrome (ARDS) of other etiologies is still lacking. We analyzed venovenous ECMO management and survival outcomes in patients with COVID-19 in comparison to influenza ARDS and pulmonary ARDS of other origin. Results: Retrospective analysis of prospective venovenous ECMO registry-based data collection was performed. One hundred consecutive venovenous ECMO patients with severe ARDS were included (41 COVID-19, 24 influenza A, 35 ARDS of other etiologies). Patients with COVID-19 had higher BMI (body mass index), lower SOFA (Sequential Organ Failure Assessment) and APACHE II (Acute Physiology and Chronic Health Evaluation II) scores, lower C-reactive protein and procalcitonin levels and less vasoactive support at ECMO initiation. Significantly more patients were mechanically ventilated for more than 7 days prior to ECMO initiation in the COVID-19 group, however they were ventilated with lower tidal volumes and more often received additional rescue therapies prior to and on ECMO. COVID-19 patients had significantly more barotrauma and thrombotic events on ECMO. There were no differences in weaning of ECMO, however duration of ECMO runs and ICU length of stay was significantly longer in the COVID-19 group. The leading cause of death in the COVID-19 group was irreversible respiratory failure, while uncontrolled sepsis and multiorgan failure were leading causes in the other 2 groups. All patients who survived ICU treatment were discharged out of hospital, and there were no differences in survival among groups at 180 days. Conclusions: Survival outcomes of venovenous ECMO patients do not differ between COVID-19 and ARDS of other pulmonary etiologies. ARDS guidelines were in greater proportion adhered to in COVID-19 patients, with, however, longer time to ECMO initiation. COVID-19 ARDS seems specific as a more single-organ disease with longer ECMO duration and irreversible respiratory failure as a main cause of ICU mortality.
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Affiliation(s)
- Alenka Golicnik
- Department of Intensive Internal Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia,Alenka Golicnik, Department of Intensive Internal Medicine, University Medical Center Ljubljana, Zaloska cesta 7, Ljubljana, 1000, Slovenia.
| | - Ina Zivanovic
- Department of Intensive Internal Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Vojka Gorjup
- Department of Intensive Internal Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Berden
- Department of Intensive Internal Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia,Jernej Berden, Department of Intensive Internal Medicine, University Medical Center Ljubljana, Zaloska cesta 7, Ljubljana, 1000, Slovenia.
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9
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Kunadu AQ, Nalamalapu SR, Hafiz M, Sahebazamani M. Recommended Reading from the East Carolina University Pulmonary, Critical Care and Sleep Medicine Fellows. Am J Respir Crit Care Med 2022; 206:105-107. [PMID: 35537123 DOI: 10.1164/rccm.202102-0376rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Afua Q Kunadu
- East Carolina University, 3627, Internal Medicine, Division of Pulmonary and Critical Care, Greenville, North Carolina, United States;
| | - Swaroopa R Nalamalapu
- East Carolina University, 3627, Pulmonary, Critical Care and Sleep Medicine, Greenville, North Carolina, United States
| | - Maida Hafiz
- East Carolina University, 3627, Pulmonary Critical Care and Sleep Medicine, Greenville, North Carolina, United States
| | - Mitra Sahebazamani
- East Carolina University, 3627, Pulmonary, Critical Care and Sleep Medicine, Greenville, North Carolina, United States
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10
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Ashra F, Chen R, Kang XL, Chiang KJ, Pien LC, Jen HJ, Liu D, Hsiao STS, Chou KR. Effectiveness of prone position in acute respiratory distress syndrome and moderating factors of obesity class and treatment durations for COVID-19 patients: A Meta-Analysis. Intensive Crit Care Nurs 2022; 72:103257. [PMID: 35672215 PMCID: PMC8995327 DOI: 10.1016/j.iccn.2022.103257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 12/20/2022]
Abstract
Objectives To examine the effectiveness of prone positioning on COVID-19 patients with acute respiratory distress syndrome with moderating factors in both traditional prone positioning (invasive mechanical ventilation) and awake self-prone positioning patients (non-invasive ventilation). Research methodology A comprehensive search was conducted in CINAHL, Cochrane library, Embase, Medline-OVID, NCBI SARS-CoV-2 Resources, ProQuest, Scopus, and Web of Science without language restrictions. All studies with prospective and experimental designs evaluating the effect of prone position patients with COVID-19 related to acute respiratory distress syndrome were included. Pooled standardised mean differences were calculated after prone position for primary (PaO2/FiO2) and secondary outcomes (SpO2 and PaO2) Results A total of 15 articles were eligible and included in the final analysis. Prone position had a statistically significant effect in improving PaO2/FiO2 with standardised mean difference of 1.10 (95%CI 0.60–1.59), SpO2 with standardised mean difference of 3.39 (95% CI 1.30–5.48), and PaO2 with standardised mean difference of 0.77 (95% CI 0.19–1.35). Patients with higher body mass index and longer duration/day are associated with larger standardised mean difference effect sizes for prone positioning. Conclusions Our findings demonstrate that prone position significantly improved oxygen saturation in COVID-19 patients with acute respiratory distress syndrome in both traditional prone positioning and awake self-prone positioning patients. Prone position should be recommended for patients with higher body mass index and longer durations to obtain the maximum effect.
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Affiliation(s)
- Fauzi Ashra
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Institut Kesehatan Prima Nusantara Bukittinggi, Bukittinggi, Indonesia
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, University of Pennsylvania, USA
| | - Kai-Jo Chiang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, National Defense Medical Center, Taipei, Taiwan; Department of Nursing, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shu-Tai Shen Hsiao
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Superintendent Office, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan.
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Javidfar J, Zaaqoq AM, Yamashita MH, Eschun G, Jacobs JP, Heinsar S, Hayanga JW, Peek GJ, Arora RC. Venovenous extracorporeal membrane oxygenation in obese patients. JTCVS Tech 2021; 10:335-348. [PMID: 34806050 PMCID: PMC8592387 DOI: 10.1016/j.xjtc.2021.08.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/18/2021] [Indexed: 01/14/2023] Open
Affiliation(s)
- Jeffrey Javidfar
- Division of Cardiothoracic Surgery, Department of Surgery, Emory School of Medicine, Atlanta, Ga
| | - Akram M. Zaaqoq
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Michael H. Yamashita
- Section of Cardiac Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Greg Eschun
- Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeffrey P. Jacobs
- Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Fla
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Jeremiah W. Hayanga
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Giles J. Peek
- Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Fla
| | - Rakesh C. Arora
- Section of Cardiac Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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12
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The Use of Extracorporeal Membrane Oxygenation in COVID-19 Patients with Severe Cardiorespiratory Failure: The Influence of Obesity on Outcomes. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2021; 53:293-298. [PMID: 34992320 DOI: 10.1182/ject-2100034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with COVID-19 has been reported in more than 5,827 cases worldwide according to the Extracorporeal Life Support Organization (ELSO). Several pre-existing conditions have been linked to an increase in COVID-19 mortality risk including obesity. The purpose of this research is to review the clinical experience from a cohort of 342 COVID-19 patients treated with ECMO in which 61.7% (211/342) are confirmed obese. Following institutional review board approval, we reviewed all 342 COVID-19 patients supported with ECMO between March 17, 2020 and March 18, 2021, at 40 American institutions from a multi-institutional database. Descriptive statistics comparing survivors to non-survivors were calculated using chi-square, Welch's ANOVA, and Kruskal-Wallis rank sum test as appropriate. Multivariable logistic regression was used to estimate the effect of body mass index (BMI) on the odds of survival while adjusting for age, gender, chronic renal failure, diabetes, asthma, hypertension, and pre-ECMO P/F ratio. Descriptive analysis showed that obese patients were more likely to be hypertensive (58.1% vs. 32%, p < .001), diabetic (42% vs. 30%, p < .05), and female (35% vs. 21%, p < .05), and had longer median days from intubation to cannulation (4.0 vs. 2.0, p < .05). Obese patients appeared to also have a slightly lower median age (47.9 vs. 50.5, p = .07), higher incidence of asthma (17.8% vs. 10.2%, p = .09), and a slightly lower pre-ECMO PaO2/FiO2 ratio (67.5 vs. 77.5, p = .08) though these differences were slightly less statistically reliable. Results from the logistic regression model suggest no statistically reliable association between BMI and odds of survival. Age had a moderately large and statistically reliable negative association with survival; the relative odds of survival for a 59-year-old patient were approximately half those of a 41-year-old patient (OR = .53, 95% CI: .36-.77, p < .001). Obesity does not seem to be a major risk factor for poor outcomes in COVID-19 patients supported with ECMO; however, age was moderately negatively associated with survival. The potential influence of other comorbidities on odds of survival among these patients warrant further investigation.
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Kummer RL, Shapiro RS, Marini JJ, Huelster JS, Leatherman JW. Paradoxically Improved Respiratory Compliance With Abdominal Compression in COVID-19 ARDS. Chest 2021; 160:1739-1742. [PMID: 34023319 PMCID: PMC8206456 DOI: 10.1016/j.chest.2021.05.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/08/2021] [Accepted: 05/10/2021] [Indexed: 01/04/2023] Open
Affiliation(s)
- Rebecca L. Kummer
- Division of Pulmonary and Critical Care Medicine Hennepin County Medical Center, Minneapolis, MN
| | - Robert S. Shapiro
- Division of Pulmonary and Critical Care Medicine Hennepin County Medical Center, Minneapolis, MN
| | - John J. Marini
- Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN,Regions Hospital, St. Paul, MN
| | | | - James W. Leatherman
- Division of Pulmonary and Critical Care Medicine Hennepin County Medical Center, Minneapolis, MN,CORRESPONDENCE TO: James Leatherman
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Salciute-Simene E. Manual proning of a morbidly obese COVID-19 patient: A case report. Aust Crit Care 2021; 35:102-104. [PMID: 34782246 PMCID: PMC8531411 DOI: 10.1016/j.aucc.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022] Open
Abstract
Continuously rising numbers of obese critical care patients pose many challenges to the healthcare workers, especially during the COVID-19 pandemic. Among them, proning may be one of the most labour-intensive tasks. Prone positioning is performed manually in hospitals where mechanical lifting aids are unavailable; however, the exact method of manual proning is not explicitly described in the literature. Here, we present a case of a morbidly obese patient with COVID-19 pneumonitis in the intensive care unit with a step-by-step guide of the manual proning technique. Our approach is simple and feasible, as only readily available tools, such as bed sheets and friction-reducing sheets, are used.
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Affiliation(s)
- Erika Salciute-Simene
- Critical Care Department, Acute and Critical Care Medicine Division, Queen's Hospital, Barking, Havering, And Redbridge University Hospitals NHS Trust, Rom Valley Way, Romford, RM7 0AG, UK.
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15
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Landecho MF, Marin-Oto M, Recalde-Zamacona B, Bilbao I, Frühbeck G. Obesity as an adipose tissue dysfunction disease and a risk factor for infections - Covid-19 as a case study. Eur J Intern Med 2021; 91:3-9. [PMID: 33858724 PMCID: PMC8017564 DOI: 10.1016/j.ejim.2021.03.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/20/2021] [Accepted: 03/25/2021] [Indexed: 12/13/2022]
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV2) disease (COVID-19) is a novel threat that hampers life expectancy especially in obese individuals. Though this association is clinically relevant, the underlying mechanisms are not fully elucidated. SARS CoV2 enters host cells via the Angiotensin Converting Enzyme 2 receptor, that is also expressed in adipose tissue. Moreover, adipose tissue is also a source of many proinflammatory mediators and adipokines that might enhance the characteristic COVID-19 cytokine storm due to a chronic low-grade inflammatory preconditioning. Further obesity-dependent thoracic mechanical constraints may also incise negatively into the prognosis of obese subjects with COVID-19. This review summarizes the current body of knowledge on the obesity-dependent circumstances triggering an increased risk for COVID-19 severity, and their clinical relevance.
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Affiliation(s)
- M F Landecho
- Internal Medicine Department, General Health Check-up Unit, Clínica Universidad de Navarra. Avenida Pío XII, 36, 31008 Pamplona, Navarra, Spain; COVID-19 department, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008 Pamplona, Navarra, Spain;.
| | - M Marin-Oto
- COVID-19 department, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008 Pamplona, Navarra, Spain;; Pulmonary Medicine Department, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008 Pamplona, Navarra, Spain
| | - B Recalde-Zamacona
- COVID-19 department, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008 Pamplona, Navarra, Spain;; Pulmonary Medicine Department, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008 Pamplona, Navarra, Spain
| | - I Bilbao
- Internal Medicine Department, General Health Check-up Unit, Clínica Universidad de Navarra. Avenida Pío XII, 36, 31008 Pamplona, Navarra, Spain; COVID-19 department, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008 Pamplona, Navarra, Spain
| | - Gema Frühbeck
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Navarra, Spain; Metabolic Research Laboratory, Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, 31008 Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Pamplona, Spain.
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16
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Cai Z, Yang Y, Zhang J. Obesity is associated with severe disease and mortality in patients with coronavirus disease 2019 (COVID-19): a meta-analysis. BMC Public Health 2021; 21:1505. [PMID: 34348687 PMCID: PMC8334342 DOI: 10.1186/s12889-021-11546-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 07/23/2021] [Indexed: 02/08/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has led to global research to predict those who are at greatest risk of developing severe disease and mortality. The aim of this meta-analysis was to determine the associations between obesity and the severity of and mortality due to COVID-19. Methods We searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies evaluating the associations of obesity with COVID-19. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random- or fixed-effects models. Meta-regression analyses were conducted to estimate regression coefficients. Results Forty-six studies involving 625,153 patients were included. Compared with nonobese patients, obese patients had a significantly increased risk of infection. (OR 2.73, 95% CI 1.53–4.87; I2 = 96.8%), hospitalization (OR 1.72, 95% CI 1.55–1.92; I2 = 47.4%), clinically severe disease (OR 3.81, 95% CI 1.97–7.35; I2 = 57.4%), mechanical ventilation (OR 1.66, 95% CI 1.42–1.94; I2 = 41.3%), intensive care unit (ICU) admission (OR 2.25, 95% CI 1.55–3.27; I2 = 71.5%), and mortality (OR 1.61, 95% CI 1.29–2.01; I2 = 83.1%). Conclusion Patients with obesity may have a greater risk of infection, hospitalization, clinically severe disease, mechanical ventilation, ICU admission, and mortality due to COVID-19. Therefore, it is important to increase awareness of these associations with obesity in COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11546-6.
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Affiliation(s)
- Zixin Cai
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yan Yang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Battaglini D, Sottano M, Ball L, Robba C, Rocco PR, Pelosi P. Ten golden rules for individualized mechanical ventilation in acute respiratory distress syndrome. JOURNAL OF INTENSIVE MEDICINE 2021; 1:42-51. [PMID: 36943812 PMCID: PMC7919509 DOI: 10.1016/j.jointm.2021.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 12/22/2022]
Abstract
Considerable progress has been made over the last decades in the management of acute respiratory distress syndrome (ARDS). Mechanical ventilation(MV) remains the cornerstone of supportive therapy for ARDS. Lung-protective MV minimizes the risk of ventilator-induced lung injury (VILI) and improves survival. Several parameters contribute to the risk of VILI and require careful setting including tidal volume (VT), plateau pressure (Pplat), driving pressure (ΔP), positive end-expiratory pressure (PEEP), and respiratory rate. Measurement of energy and mechanical power allows quantification of the relative contributions of various parameters (VT, Pplat, ΔP, PEEP, respiratory rate, and airflow) for the individualization of MV settings. The use of neuromuscular blocking agents mainly in cases of severe ARDS can improve oxygenation and reduce asynchrony, although they are not known to confer a survival benefit. Rescue respiratory therapies such as prone positioning, inhaled nitric oxide, and extracorporeal support techniques may be adopted in specific situations. Furthermore, respiratory weaning protocols should also be considered. Based on a review of recent clinical trials, we present 10 golden rules for individualized MV in ARDS management.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa 16132, Italy
- Department of Medicine, University of Barcelona, Barcelona 08007, Spain
| | - Marco Sottano
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa 16132, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa 16126, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa 16132, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa 16126, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa 16132, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa 16126, Italy
| | - Patricia R.M. Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa 16132, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa 16126, Italy
- Corresponding author: Paolo Pelosi, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa 16132, Italy.
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18
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Liu QY, Chen Y, He Y, Zhu RL. Impact of obesity on outcomes in patients with acute respiratory syndrome. J Int Med Res 2021; 49:3000605211024860. [PMID: 34182816 PMCID: PMC8246501 DOI: 10.1177/03000605211024860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives We assessed the relationship between obesity and all-cause mortality in patients with acute respiratory distress syndrome (ARDS). Methods In this retrospective cohort study, patient data were extracted from the eICU Collaborative Research Database and the Medical Information Mart for Intensive Care Database III. Body mass index (BMI) was grouped according to World Health Organization classifications: underweight, normal weight, overweight, obese. Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality related to obesity. Results Participants included 185 women and 233 men, mean age 70.7 ± 44.1 years and mean BMI 28.7 ± 8.1 kg/m2. Compared with normal weight patients, obese patients tended to be younger (60.1 ± 13.7 years) and included more women (51.3% vs. 49.0%). In the unadjusted model, HRs (95% CIs) of 30-day mortality for underweight, overweight, and obesity were 1.57 (0.76, 3.27), 0.64 (0.39, 1.08), and 4.83 (2.25, 10.35), respectively, compared with those for normal weight. After adjustment, HRs (95% CIs) of 30-day mortality for underweight, overweight, and obesity were 1.82 (0.85, 3.90), 0.59 (0.29, 1.20), and 3.85 (1.73, 8.57), respectively, compared with the reference group; 90-day and 1-year all-cause mortalities showed similar trends. Conclusions Obesity was associated with increased all-cause mortality in patients with ARDS.
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Affiliation(s)
- Qiao-Yan Liu
- Department of Anesthesiology, Zhejiang Provincial People?s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yue Chen
- Department of Anesthesiology, Zhejiang Provincial People?s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Ying He
- Department of Anesthesiology, Zhejiang Provincial People?s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Ren-Lai Zhu
- Department of Anesthesiology, Zhejiang Provincial People?s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
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19
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20
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Huang B, Liang D, Zou R, Yu X, Dan G, Huang H, Liu H, Liu Y. Mortality prediction for patients with acute respiratory distress syndrome based on machine learning: a population-based study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:794. [PMID: 34268407 PMCID: PMC8246239 DOI: 10.21037/atm-20-6624] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/10/2021] [Indexed: 11/06/2022]
Abstract
Background Traditional scoring systems for patients' outcome prediction in intensive care units such as Oxygenation Saturation Index (OSI) and Oxygenation Index (OI) may not reliably predict the clinical prognosis of patients with acute respiratory distress syndrome (ARDS). Thus, none of them have been widely accepted for mortality prediction in ARDS. This study aimed to develop and validate a mortality prediction method for patients with ARDS based on machine learning using the Medical Information Mart for Intensive Care (MIMIC-III) and Telehealth Intensive Care Unit (eICU) Collaborative Research Database (eICU-CRD) databases. Methods Patients with ARDS were selected based on the Berlin definition in MIMIC-III and eICU-CRD databases. The APPS score (using age, PaO2/FiO2, and plateau pressure), Simplified Acute Physiology Score II (SAPS-II), Sepsis-related Organ Failure Assessment (SOFA), OSI, and OI were calculated. With MIMIC-III data, a mortality prediction model was built based on the random forest (RF) algorithm, and the performance was compared to those of existing scoring systems based on logistic regression. The performance of the proposed RF method was also validated with the combined MIMIC-III and eICU-CRD data. The performance of mortality prediction was evaluated by using the area under the receiver operating characteristics curve (AUROC) and performing calibration using the Hosmer-Lemeshow test. Results With the MIMIC-III dataset (308 patients, for comparisons with the existing scoring systems), the RF model predicted the in-hospital mortality, 30-day mortality, and 1-year mortality with an AUROC of 0.891, 0.883, and 0.892, respectively, which were significantly higher than those of the SAPS-II, APPS, OSI, and OI (all P<0.001). In the multi-source validation (the combined dataset of 2,235 patients in MIMIC-III and 331 patients in eICU-CRD), the RF model achieved an AUROC of 0.905 and 0.736 for predicting in-hospital mortality for the MIMIC-III and eICU-CRD datasets, respectively. The calibration plots suggested good fits for our RF model and these scoring systems for predicting mortality. The platelet count and lactate level were the strongest predictive variables for predicting in-hospital mortality. Conclusions Compared to the existing scoring systems, machine learning significantly improved performance for predicting ARDS mortality. Validation with multi-source datasets showed a relatively robust generalisation ability of our prediction model.
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Affiliation(s)
- Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.,Clinical Research Center for Neurological Diseases, Shenzhen University General Hospital, Shenzhen, China
| | - Dong Liang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Rushi Zou
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Xiaxia Yu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Guo Dan
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Haofan Huang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Heng Liu
- Medical Imaging Center of Guizhou Province, Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yong Liu
- Department of Intensive Care Unit, Shenzhen Hospital, Southern Medical University, Shenzhen, China
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21
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Nikniaz Z, Somi MH, Dinevari MF, Taghizadieh A, Mokhtari L. Diabesity Associates with Poor COVID-19 Outcomes among Hospitalized Patients. J Obes Metab Syndr 2021; 30:149-154. [PMID: 33927066 PMCID: PMC8277582 DOI: 10.7570/jomes20121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/10/2020] [Accepted: 02/07/2021] [Indexed: 12/20/2022] Open
Abstract
Background Although numerous studies have investigated obesity's negative effect on coronavirus disease 2019 (COVID-19) outcomes, only a limited number focused on this association in diabetic patients. In this study, we analyzed the association between obesity and COVID-19 outcome (death, intensive care unit [ICU] admission, mechanical ventilation needs, quick Sequential Organ Failure Assessment [qSOFA] score, and confusion, urea, respiratory rate, blood pressure [CURB-65] scores) for hospitalized diabetic patients. Methods In this prospective hospital-based registry of patients with COVID-19 in East Azerbaijan, Iran, 368 consecutive diabetic patients with COVID-19 were followed from admission until discharge or death. Self-reported weight and height were used to calculate body mass index (kg/m2) upon admission. Our primary endpoint was analyzing obesity and COVID-19 mortality association. Assessing the associations among obesity and disease severity, ICU admission, and mechanical ventilation was our secondary endpoint. Results We analyzed data from 317 patients and found no significant difference between obese and non-obese patients regarding frequency of death, invasive mechanical ventilation, ICU admission, CURB-65, or qSOFA scores (P>0.05). After adjusting for confounding factors, obese diabetic COVID-19 patients were 2.72 times more likely to die than non-obese patients. Moreover, ventilator dependence (adjusted odds ratio [aOR], 1.87; 95% confidence interval [CI], 1.03-4.76) and ICU admission (aOR, 2.41; 95% CI, 1.11-5.68) odds were significantly higher for obese patients than non-obese patients. Conclusion The results of the present study indicated that obesity worsens health outcomes for diabetic COVID-19 patients.
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Affiliation(s)
- Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Tabriz, Iran
| | | | - Masood Faghih Dinevari
- Liver and Gastrointestinal Diseases Research Center, Tabriz, Iran.,Imam Reza Hospital, Tabriz, Iran
| | - Ali Taghizadieh
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Schavemaker R, Schultz MJ, Lagrand WK, van Slobbe-Bijlsma ER, Serpa Neto A, Paulus F. Associations of Body Mass Index with Ventilation Management and Clinical Outcomes in Invasively Ventilated Patients with ARDS Related to COVID-19-Insights from the PRoVENT-COVID Study. J Clin Med 2021; 10:jcm10061176. [PMID: 33799735 PMCID: PMC8000207 DOI: 10.3390/jcm10061176] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 12/16/2022] Open
Abstract
We describe the practice of ventilation and mortality rates in invasively ventilated normal-weight (18.5 ≤ BMI ≤ 24.9 kg/m2), overweight (25.0 ≤ BMI ≤ 29.9 kg/m2), and obese (BMI > 30 kg/m2) COVID-19 ARDS patients in a national, multicenter observational study, performed at 22 intensive care units in the Netherlands. The primary outcome was a combination of ventilation variables and parameters over the first four calendar days of ventilation, including tidal volume, positive end–expiratory pressure (PEEP), respiratory system compliance, and driving pressure in normal–weight, overweight, and obese patients. Secondary outcomes included the use of adjunctive treatments for refractory hypoxaemia and mortality rates. Between 1 March 2020 and 1 June 2020, 1122 patients were included in the study: 244 (21.3%) normal-weight patients, 531 (47.3%) overweight patients, and 324 (28.8%) obese patients. Most patients received a tidal volume < 8 mL/kg PBW; only on the first day was the tidal volume higher in obese patients. PEEP and driving pressure were higher, and compliance of the respiratory system was lower in obese patients on all four days. Adjunctive therapies for refractory hypoxemia were used equally in the three BMI groups. Adjusted mortality rates were not different between BMI categories. The findings of this study suggest that lung-protective ventilation with a lower tidal volume and prone positioning is similarly feasible in normal-weight, overweight, and obese patients with ARDS related to COVID-19. A patient’s BMI should not be used in decisions to forgo or proceed with invasive ventilation.
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Affiliation(s)
- Renée Schavemaker
- Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands; (R.S.); (M.J.S.); (W.K.L.); (A.S.N.)
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands; (R.S.); (M.J.S.); (W.K.L.); (A.S.N.)
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Wim K. Lagrand
- Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands; (R.S.); (M.J.S.); (W.K.L.); (A.S.N.)
| | | | - Ary Serpa Neto
- Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands; (R.S.); (M.J.S.); (W.K.L.); (A.S.N.)
- Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, VIC 3004, Australia
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands; (R.S.); (M.J.S.); (W.K.L.); (A.S.N.)
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, 1105 AZ Amsterdam, The Netherlands
- Correspondence:
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Hassan EA, Baraka AAE. The effect of reverse Trendelenburg position versus semi-recumbent position on respiratory parameters of obese critically ill patients: A randomised controlled trial. J Clin Nurs 2021; 30:995-1002. [PMID: 33432600 DOI: 10.1111/jocn.15645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/12/2020] [Accepted: 12/31/2020] [Indexed: 01/21/2023]
Abstract
AIMS AND OBJECTIVES To investigate the effect of reverse Trendelenburg position versus semi-recumbent position on respiratory parameters of obese critically ill patients. BACKGROUND Reverse Trendelenburg position is recommended for obese patients; however, the effect among critically ill patients, especially those on mechanical ventilation, has limited study. DESIGN Randomised, controlled pretest, repeated post-test trial with two parallel groups. METHODS The study started from 13 January 2020-12 March 2020. Adult critically ill patients with a body mass index ≥30 were randomly assigned by computer-generated randomisation to either reverse Trendelenburg position group (intervention) or semi-recumbent position group (active comparator control). Outcome measures were ventilation parameters (dynamic compliance, partial pressure of arterial carbon dioxide and minute volume) and oxygenation parameters (hypoxaemic index and partial pressure of arterial oxygen). Measures were assessed immediately before positioning and after positioning in 10 minutes, 20 minutes and 30 minutes. CONSORT checklist was used to report the current study. SETTINGS Four general intensive care units. RESULTS One hundred and ten patients (55 patients in each group) completed the study. The reverse Trendelenburg position group had a higher improvement than the semi-recumbent position group as estimated by mean differences in their dynamic compliance, minute volume, partial pressure of carbon dioxide, partial pressure of oxygen and hypoxaemic index. CONCLUSION Reverse Trendelenburg position improves obese patients' respiratory parameters more than semi-recumbent position. RELEVANCE TO CLINICAL PRACTICE This study directs nurses to use the reverse Trendelenburg position, which is an important position for enhancing the parameters of ventilation and oxygenation of obese mechanically ventilated patients.
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Affiliation(s)
- Eman Arafa Hassan
- Lecturer of Critical Care and Emergency Nursing, Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Azza Abd Elrazek Baraka
- Lecturer of Critical Care and Emergency Nursing, Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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Association between obesity and hospital mortality in critical COVID-19: a retrospective cohort study. Int J Obes (Lond) 2021; 45:2617-2622. [PMID: 34433907 PMCID: PMC8385700 DOI: 10.1038/s41366-021-00938-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/28/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The impact of obesity on outcomes in acute respiratory distress syndrome (ARDS) is not well understood and remains controversial. Recent studies suggest that obesity might be associated with higher morbidity and mortality in respiratory disease caused by SARS-CoV-2 (COVID-19 disease). Our objective was to evaluate the association between obesity and hospital mortality in critical COVID-19 patients. METHODS We conducted a retrospective cohort study in a tertiary academic center located in Montréal between March and August 2020. We included all consecutive adult patients admitted to the ICU for COVID-19-confirmed respiratory disease. Our main outcome was hospital mortality. We estimated the association between obesity, using the body mass index as a continuous variable, and hospital survival by fitting a multivariable Cox proportional hazards model. RESULTS We included 94 patients. Median [q1, q3] body mass index (BMI) was 29 [26-32] kg/m2 and 37% of patients were obese (defined as BMI > 30 kg/m2). Hospital mortality for the entire cohort was 33%. BMI was significantly associated with hospital mortality (hazard ratio [HR] = 2.49 per 10 units BMI; 95% CI, from 1.69 to 3.70; p < 0.001) even after adjustment for sex, age and obesity-related comorbidities (adjusted HR = 3.50; 95% CI from 2.03 to 6.02; p < 0.001). CONCLUSIONS Obesity was prevalent in hospitalized patients with critical illness secondary to COVID-19 disease and a higher BMI was associated with higher hospital mortality. Further studies are needed to validate this association and to better understand its underlying mechanisms.
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Dana R, Bannay A, Bourst P, Ziegler C, Losser MR, Gibot S, Levy B, Audibert G, Ziegler O. Obesity and mortality in critically ill COVID-19 patients with respiratory failure. Int J Obes (Lond) 2021; 45:2028-2037. [PMID: 34112941 PMCID: PMC8190754 DOI: 10.1038/s41366-021-00872-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 05/05/2021] [Accepted: 05/24/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with obesity are at increased risk of severe COVID-19, requiring mechanical ventilation due to acute respiratory failure. However, conflicting data are obtained for intensive care unit (ICU) mortality. OBJECTIVE To analyze the relationship between obesity and in-hospital mortality of ICU patients with COVID-19. SUBJECTS/METHODS Patients admitted to the ICU for COVID-19 acute respiratory distress syndrome (ARDS) were included retrospectively. The following data were collected: comorbidities, body mass index (BMI), the severity of ARDS assessed with PaO2/FiO2 (P/F) ratios, disease severity measured by the Simplified Acute Physiology Score II (SAPS II), management and outcomes. RESULTS For a total of 222 patients, there were 34 patients (15.3%) with normal BMI, 92 patients (41.4%) who were overweight, 80 patients (36%) with moderate obesity (BMI:30-39.9 kg/m2), and 16 patients (7.2%) with severe obesity (BMI ≥ 40 kg/m2). Overall in-hospital mortality was 20.3%. Patients with moderate obesity had a lower mortality rate (13.8%) than patients with normal weight, overweight or severe obesity (17.6%, 21.7%, and 50%, respectively; P = 0.011. Logistic regression showed that patients with a BMI ≤ 29 kg/m2 (odds ratio [OR] 3.64, 95% CI 1.38-9.60) and those with a BMI > 39 kg/m2 (OR 10.04, 95% CI 2.45-41.09) had a higher risk of mortality than those with a BMI from 29 to 39 kg/m2. The number of comorbidities (≥2), SAPS II score, and P/F < 100 mmHg were also independent predictors for in-hospital mortality. CONCLUSIONS COVID-19 patients admitted to the ICU with moderate obesity had a lower risk of death than the other patients, suggesting a possible obesity paradox.
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Affiliation(s)
- Richard Dana
- grid.29172.3f0000 0001 2194 6418Department of Anesthesiology and Intensive Care Medicine, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Aurélie Bannay
- grid.29172.3f0000 0001 2194 6418Medical Information Department, CHRU-Nancy, CNRS, Inria, LORIA, Université de Lorraine, Nancy, France
| | - Pauline Bourst
- grid.29172.3f0000 0001 2194 6418Department of Anesthesiology and Intensive Care Medicine, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Caroline Ziegler
- grid.410527.50000 0004 1765 1301Department of Hematology, CHRU-Nancy, Brabois Hospital, Nancy, France
| | - Marie-Reine Losser
- grid.29172.3f0000 0001 2194 6418Department of Anesthesiology and Intensive Care Medicine, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Sébastien Gibot
- grid.29172.3f0000 0001 2194 6418Medical Intensive Care Unit, CHRU-Nancy, Central Hospital, Université de Lorraine, Nancy, France
| | - Bruno Levy
- grid.29172.3f0000 0001 2194 6418Medical Intensive Care Unit, CHRU-Nancy, Brabois Hospital, Université de Lorraine, Nancy, France
| | - Gérard Audibert
- grid.29172.3f0000 0001 2194 6418Department of Anesthesiology and Intensive Care Medicine, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Olivier Ziegler
- grid.29172.3f0000 0001 2194 6418Specialized Obesity Center and Department of Endocrinology, Diabetology, Nutrition, CHRU-Nancy, Brabois Hospital, Université de Lorraine, Nancy, France
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Kwok S, Adam S, Ho JH, Iqbal Z, Turkington P, Razvi S, Le Roux CW, Soran H, Syed AA. Obesity: A critical risk factor in the COVID-19 pandemic. Clin Obes 2020; 10:e12403. [PMID: 32857454 PMCID: PMC7460880 DOI: 10.1111/cob.12403] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022]
Abstract
Obesity is an emerging independent risk factor for susceptibility to and severity of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Previous viral pandemics have shown that obesity, particularly severe obesity (BMI > 40 kg/m2 ), is associated with increased risk of hospitalization, critical care admission and fatalities. In this narrative review, we examine emerging evidence of the influence of obesity on COVID-19, the challenges to clinical management from pulmonary, endocrine and immune dysfunctions in individuals with obesity and identify potential areas for further research. We recommend that people with severe obesity be deemed a vulnerable group for COVID-19; clinical trials of pharmacotherapeutics, immunotherapies and vaccination should prioritize inclusion of people with obesity.
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Affiliation(s)
- See Kwok
- Cardiovascular Trials UnitManchester University NHS Foundation TrustManchesterUK
- Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
| | - Safwaan Adam
- Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
- Department of EndocrinologyChristie NHS Foundation TrustManchesterUK
| | - Jan Hoong Ho
- Cardiovascular Trials UnitManchester University NHS Foundation TrustManchesterUK
- Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
| | - Zohaib Iqbal
- Cardiovascular Trials UnitManchester University NHS Foundation TrustManchesterUK
- Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
| | - Peter Turkington
- Department of Respiratory MedicineSalford Royal NHS Foundation TrustSalfordUK
| | - Salman Razvi
- Cardiovascular Research CentreInstitute of Genetic Medicine, Newcastle UniversityNewcastle upon TyneUK
| | - Carel W. Le Roux
- Diabetes Complications Research CentreUniversity College DublinDublinIreland
| | - Handrean Soran
- Cardiovascular Trials UnitManchester University NHS Foundation TrustManchesterUK
- Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
| | - Akheel A. Syed
- Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
- Department of DiabetesEndocrinology and Obesity Medicine, Salford Royal NHS Foundation TrustSalfordUK
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Czernichow S, Beeker N, Rives‐Lange C, Guerot E, Diehl J, Katsahian S, Hulot J, Poghosyan T, Carette C, Jannot A. Obesity Doubles Mortality in Patients Hospitalized for Severe Acute Respiratory Syndrome Coronavirus 2 in Paris Hospitals, France: A Cohort Study on 5,795 Patients. Obesity (Silver Spring) 2020; 28:2282-2289. [PMID: 32815621 PMCID: PMC7461006 DOI: 10.1002/oby.23014] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Preliminary data from different cohorts of small sample size or with short follow-up indicate poorer prognosis in people with obesity compared with other patients. This study aims to precisely describe the strength of association between obesity in patients hospitalized with coronavirus disease 2019 (COVID-19) and mortality and to clarify the risk according to usual cardiometabolic risk factors in a large cohort. METHODS This is a prospective cohort study including 5,795 patients aged 18 to 79 years hospitalized from February 1 to April 30, 2020, in the Paris area, with confirmed infection by severe acute respiratory syndrome coronavirus 2. Adjusted regression models were used to estimate the odds ratios (ORs) and 95% CIs for the mortality rate at 30 days across BMI classes, without and with imputation for missing BMI values. RESULTS Eight hundred ninety-one deaths had occurred at 30 days. Mortality was significantly raised in people with obesity, with the following ORs for BMI of 30 to 35 kg/m2 , 35 to 40 kg/m2 , and >40 kg/m2 : 1.89 (95% CI: 1.45-2.47), 2.79 (95% CI: 1.95-3.97), and 2.55 (95% CI: 1.62-3.95), respectively (18.5-25 kg/m2 was used as the reference class). This increase holds for all age classes. CONCLUSIONS Obesity doubles mortality in patients hospitalized with COVID-19.
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Affiliation(s)
- Sébastien Czernichow
- Université de ParisParisFrance
- Department of NutritionSpecialized Obesity CenterHôpital Européen Georges PompidouAssistance Publique–Hôpitaux de ParisParisFrance
- Epidemiology and Biostatistics Sorbonne Paris City CenterUMR1153Institut National de la Santé et de la Recherche MédicaleParisFrance
| | - Nathanael Beeker
- Université de ParisParisFrance
- Clinical Research UnitHôpital CochinAssistance Publique–Hôpitaux de ParisParisFrance
| | - Claire Rives‐Lange
- Université de ParisParisFrance
- Department of NutritionSpecialized Obesity CenterHôpital Européen Georges PompidouAssistance Publique–Hôpitaux de ParisParisFrance
- Epidemiology and Biostatistics Sorbonne Paris City CenterUMR1153Institut National de la Santé et de la Recherche MédicaleParisFrance
| | - Emmanuel Guerot
- Université de ParisParisFrance
- Department of Intensive Care MedicineHôpital Européen Georges PompidouAssistance Publique–Hôpitaux de ParisParisFrance
| | - Jean‐Luc Diehl
- Université de ParisParisFrance
- Department of Intensive Care MedicineHôpital Européen Georges PompidouAssistance Publique–Hôpitaux de ParisParisFrance
| | - Sandrine Katsahian
- Université de ParisParisFrance
- Department of Medical Informatics, Biostatistics, and Public HealthHôpital Européen Georges PompidouAssistance Publique–Hôpitaux de ParisParisFrance
- Department of Information Sciences to Support Personalized MedicineCentre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de ParisParisFrance
| | - Jean‐Sébastien Hulot
- Université de ParisParisFrance
- Clinical Investigation Center 1418Hôpital Européen Georges PompidouAssistance Publique–Hôpitaux de ParisParisFrance
- Cardiovascular, Renal, Transplants, and Neurovascular Medical University DepartmentHôpital Européen Georges PompidouAssistance Publique–Hôpitaux de ParisParisFrance
| | - Tigran Poghosyan
- Université de ParisParisFrance
- Department of Digestive, Oncological, and Bariatric SurgeryHôpital Européen Georges PompidouAssistance Publique–Hôpitaux de ParisParisFrance
| | - Claire Carette
- Université de ParisParisFrance
- Department of NutritionSpecialized Obesity CenterHôpital Européen Georges PompidouAssistance Publique–Hôpitaux de ParisParisFrance
- Clinical Investigation Center 1418Hôpital Européen Georges PompidouAssistance Publique–Hôpitaux de ParisParisFrance
| | - Anne‐Sophie Jannot
- Université de ParisParisFrance
- Department of Medical Informatics, Biostatistics, and Public HealthHôpital Européen Georges PompidouAssistance Publique–Hôpitaux de ParisParisFrance
- Department of Information Sciences to Support Personalized MedicineCentre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de ParisParisFrance
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Edriss H, Yang S, Juarez E, Crane J, Lear M, Sanchez A, Nugent K. The Association Between the Mechanical Ventilator Pressures and Outcomes in a Cohort of Patients with Acute Respiratory Failure. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2020; 14:1179548420966246. [PMID: 33117037 PMCID: PMC7573745 DOI: 10.1177/1179548420966246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022]
Abstract
Background Pressures measured during mechanical ventilation provide important information about the respiratory system mechanics and can help predict outcomes. Methods The electronic medical records of patients hospitalized between 2010 and 2016 with sepsis who required mechanical ventilation were reviewed to collect demographic information, clinical information, management requirements, and outcomes, such as mortality, ICU length of stay, and hospital length of stay. Mechanical ventilation pressures were recorded on the second full day of hospitalization. Results This study included 312 adult patients. The mean age is 59.1 ± 16.3 years; 57.4% were men. The mean BMI was 29.3 ± 10.7. Some patients had pulmonary infections (46.2%), and some patients had extrapulmonary infections (34.9%). The overall mortality was 42.6%. In a multi-variable model that included age, gender, number of comorbidities, APACHE 2 score, and PaO2/FiO2 ratio, peak pressure, plateau pressure, driving pressure, and PEEP all predicted mortality when entered into the model separately. There was an increase in peak pressure, plateau pressure, and driving pressure across BMI categories ranging from underweight to obese. Conclusions This study demonstrates that ventilator pressure measurements made early during the management of patients with acute respiratory failure requiring mechanical ventilation provide prognostic information regarding outcomes, including mortality. Patients with high mechanical ventilator pressures during the early course of their acute respiratory failure require more attention to identify reversible disease processes when possible. In addition, increased BMIs are associated with increased ventilator pressures, and this increases the complexity of the clinical evaluation in the management of obese patients.
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Affiliation(s)
- Hawa Edriss
- CHI Saint Joseph Health, Lexington, Kentucky, USA
| | - Shengping Yang
- Department of Biostatistics, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Edna Juarez
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Joshua Crane
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Michelle Lear
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Asley Sanchez
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Jaber S, Rolle A, Jung B, Chanques G, Bertet H, Galeazzi D, Chauveton C, Molinari N, De Jong A. Effect of endotracheal tube plus stylet versus endotracheal tube alone on successful first-attempt tracheal intubation among critically ill patients: the multicentre randomised STYLETO study protocol. BMJ Open 2020; 10:e036718. [PMID: 33033014 PMCID: PMC7542923 DOI: 10.1136/bmjopen-2019-036718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Tracheal intubation is one of the most daily practiced procedures performed in intensive care unit (ICU). It is associated with severe life-threatening complications, which can lead to intubation-related cardiac arrest. Using a preshaped endotracheal tube plus stylet may have potential advantages over endotracheal tube without stylet. The stylet is a rigid but malleable introducer which fits inside the endotracheal tube and allows for manipulation of the tube shape; to facilitate passage of the tube through the laryngeal inlet. However, some complications from stylets have been reported including mucosal bleeding, perforation of the trachea or oesophagus and sore throat. The use of a stylet for first-attempt intubation has never been assessed in ICU and benefit remains to be established. METHODS AND ANALYSIS The endotracheal tube plus stylet to increase first-attempt success during orotracheal intubation compared with endotracheal tube alone in ICU patients (STYLETO) trial is an investigator-initiated, multicentre, stratified, parallel-group unblinded trial with an electronic system-based randomisation. Patients will be randomly assigned to undergo the initial intubation attempt with endotracheal tube alone (ie,without stylet, control group) or endotracheal tube + stylet (experimental group). The primary outcome is the proportion of patients with successful first-attempt orotracheal intubation. The single, prespecified, secondary outcome is the incidence of complications related to intubation, in the hour following intubation. Other outcomes analysed will include safety, exploratory procedural and clinical outcomes. ETHICS AND DISSEMINATION The study project has been approved by the appropriate ethics committee 'Comité-de-Protection-des-Personnes Nord-Ouest3-19.04.26.65808 Cat2 RECHMPL19_0216/STYLETO2019-A01180-57'". Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. If combined use of endotracheal tube plus stylet facilitates tracheal intubation of ICU patients compared with endotracheal tube alone, its use will become standard practice, thereby decreasing first-attempt intubation failure rates and, potentially, the frequency of intubation-related complications. TRIAL REGISTRATION DETAILS ClinicalTrials.gov Identifier: NCT04079387; Pre-results.
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Affiliation(s)
- Samir Jaber
- Department of Anaesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, University Teaching Hospital of Montpellier, 80 avenue Augustin Fliche, 34295 Montpellier, France, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
- PhyMed Exp, Université de Montpellier, INSERM U1046 Montpellier, France, Inserm U1046, Montpellier, Languedoc-Roussillon, France
| | - Amélie Rolle
- Intensive Care & Anesthesiology Department, University of Pointe à Pitre Hospital. Guadeloupe, France, Université des Antilles Bibliothèque Hospitalo-universitaire de Guadeloupe, Pointe-a-Pitre, Guadeloupe
| | - Boris Jung
- PhyMed Exp, Université de Montpellier, INSERM U1046 Montpellier, France, Inserm U1046, Montpellier, Languedoc-Roussillon, France
- Departement of Medical Intensive Care, Lapeyronie Teaching Hospital, Montpellier University, 191, Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, Université de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Gerald Chanques
- Department of Anaesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, University Teaching Hospital of Montpellier, 80 avenue Augustin Fliche, 34295 Montpellier, France, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
- PhyMed Exp, Université de Montpellier, INSERM U1046 Montpellier, France, Inserm U1046, Montpellier, Languedoc-Roussillon, France
| | - Helena Bertet
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - David Galeazzi
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Claire Chauveton
- Clinical research department of Montpellier university hospital, Montpellier, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Nicolas Molinari
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Audrey De Jong
- Department of Anaesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, University Teaching Hospital of Montpellier, 80 avenue Augustin Fliche, 34295 Montpellier, France, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
- PhyMed Exp, Université de Montpellier, INSERM U1046 Montpellier, France, Inserm U1046, Montpellier, Languedoc-Roussillon, France
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Pettit NN, MacKenzie EL, Ridgway JP, Pursell K, Ash D, Patel B, Pho MT. Obesity is Associated with Increased Risk for Mortality Among Hospitalized Patients with COVID-19. Obesity (Silver Spring) 2020; 28:1806-1810. [PMID: 32589784 PMCID: PMC7362135 DOI: 10.1002/oby.22941] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Obesity has been identified as a risk factor for severe coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 virus. This study sought to determine whether obesity is a risk factor for mortality among patients with COVID-19. METHODS The study was a retrospective cohort that included patients with COVID-19 between March 1 and April 18, 2020. RESULTS A total of 238 patients were included; 218 patients (91.6%) were African American, 113 (47.5%) were male, and the mean age was 58.5 years. Of the included patients, 146 (61.3%) had obesity (BMI > 30 kg/m2 ), of which 63 (26.5%), 29 (12.2%), and 54 (22.7%) had class 1, 2, and 3 obesity, respectively. Obesity was identified as a predictor for mortality (odds ratio [OR] 1.7 [1.1-2.8], P = 0.016), as was male gender (OR 5.2 [1.6-16.5], P = 0.01) and older age (OR 3.6 [2.0-6.3], P < 0.0005). Obesity (OR 1.7 [1.3-2.1], P < 0.0005) and older age (OR 1.3 [1.0-1.6], P = 0.03) were also risk factors for hypoxemia. CONCLUSIONS Obesity was found to be a significant predictor for mortality among inpatients with COVID-19 after adjusting for age, gender, and other comorbidities. Patients with obesity were also more likely to present with hypoxemia.
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Affiliation(s)
- Natasha N. Pettit
- Department of PharmacyUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Erica L. MacKenzie
- Department of MedicineSection of Pulmonary and Critical CareUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Jessica P. Ridgway
- Department of MedicineSection of Infectious Diseases and Global HealthUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Kenneth Pursell
- Department of MedicineSection of Infectious Diseases and Global HealthUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Daniel Ash
- Department of MedicineSection of Hospital MedicineUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Bhakti Patel
- Department of MedicineSection of Pulmonary and Critical CareUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Mai T. Pho
- Department of MedicineSection of Infectious Diseases and Global HealthUniversity of Chicago MedicineChicagoIllinoisUSA
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Achanta A, Hayden D, Thompson BT. Fluid Management in Patients with Acute Respiratory Distress Syndrome and Diabetes Mellitus: A propensity score matched analysis of the fluid and catheter treatment trial. Medicine (Baltimore) 2020; 99:e22311. [PMID: 32957394 PMCID: PMC7505338 DOI: 10.1097/md.0000000000022311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Diabetes mellitus results in an attenuated inflammatory response, reduces pulmonary microvascular permeability, and may decrease the risk of developing acute respiratory distress syndrome (ARDS). Studies have shown that patients with ARDS are better managed by a conservative as compared to liberal fluid management strategy. However, it is not known if the same fluid management principles hold true for patients with comorbid diabetes mellitus and ARDS.As diabetes mellitus results in reduced pulmonary microvascular permeability and an attenuated inflammatory response, we hypothesize that in the setting of ARDS, diabetic patients will be able to tolerate a positive fluid balance better than patients without diabetes.The Fluid and Catheter Treatment Trial (FACTT) randomized patients with ARDS to conservative versus liberal fluid management strategies. In a secondary analysis of this trial, we calculated the interaction of diabetic status and differing fluid strategies on outcomes. Propensity score subclassification matching was used to control for the differing baseline characteristics between patients with and without diabetes.Nine hundred fifty-six patients were analyzed. In a propensity score matched analysis, the difference in the effect of a conservative as compared to liberal fluid management strategy on ventilator free days was 2.23 days (95% CI: -0.97 to 5.43 days) in diabetic patients, and 2.37 days (95% CI: -0.21 to 4.95 days) in non-diabetic patients. The difference in the effect of a conservative as compared to liberal fluid management on 60 day mortality was 2% (95% CI: -11.8% to 15.8%) in diabetic patients, and -7.9% (95% CI: -21.7% to 5.9%) in non-diabetic patients.When comparing a conservative fluid management strategy to a liberal fluid management strategy, diabetic patients with ARDS did not have a statistically significant difference in outcomes than non-diabetic patients.
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Affiliation(s)
- Aditya Achanta
- Biostatistics Center, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
| | - Douglas Hayden
- Biostatistics Center, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
| | - Boyd Taylor Thompson
- Biostatistics Center, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
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Manning S. The Crashing Obese Patient. Emerg Med Clin North Am 2020; 38:857-869. [PMID: 32981622 DOI: 10.1016/j.emc.2020.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The obesity pandemic now affects hundreds of millions of people worldwide. As obesity rates continue to increase, emergency physicians are called on with increasing frequency to resuscitate obese patients. This article discusses important anatomic, physiologic, and practical challenges imposed by obesity on resuscitative care. Impacts on hemodynamic monitoring, airway and ventilator management, and pharmacologic therapy are discussed. Finally, several important clinical scenarios (trauma, cardiac arrest, and sepsis), in which alterations to standard treatments may benefit obese patients, are highlighted.
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Affiliation(s)
- Sara Manning
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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Alberca RW, Oliveira LDM, Branco ACCC, Pereira NZ, Sato MN. Obesity as a risk factor for COVID-19: an overview. Crit Rev Food Sci Nutr 2020; 61:2262-2276. [PMID: 32539446 DOI: 10.1080/10408398.2020.1775546] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The current coronavirus disease-2019 (COVID-19) pandemic presents a huge challenge for health-care systems worldwide. Many different risk factors are associated with disease severity, such as older age, diabetes, hypertension, and most recently obesity. The incidence of obesity has been on the rise for the past 25 years, reaching over 2 billion people throughout the world, and obesity itself could be considered a pandemic. In this review, we summarize aspects involved with obesity, such as changes in the immune response, nutritional factors, physiological factors, and the gut-lung axis, that impact the viral response and the COVID-19 prognosis.
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Affiliation(s)
- Ricardo Wesley Alberca
- Laboratory of Medical Investigation-56, - Departament of Dermatology, - Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luana de Mendonça Oliveira
- Institute of Biomedical Sciences, - Departament of Immunology, - University of São Paulo, São Paulo, Brazil
| | | | - Nátalli Zanete Pereira
- Laboratory of Medical Investigation-56, - Departament of Dermatology, - Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Maria Notomi Sato
- Laboratory of Medical Investigation-56, - Departament of Dermatology, - Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Ciceri F, Castagna A, Rovere-Querini P, De Cobelli F, Ruggeri A, Galli L, Conte C, De Lorenzo R, Poli A, Ambrosio A, Signorelli C, Bossi E, Fazio M, Tresoldi C, Colombo S, Monti G, Fominskiy E, Franchini S, Spessot M, Martinenghi C, Carlucci M, Beretta L, Scandroglio AM, Clementi M, Locatelli M, Tresoldi M, Scarpellini P, Martino G, Bosi E, Dagna L, Lazzarin A, Landoni G, Zangrillo A. Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy. Clin Immunol 2020; 217:108509. [PMID: 32535188 PMCID: PMC7289745 DOI: 10.1016/j.clim.2020.108509] [Citation(s) in RCA: 197] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023]
Abstract
Background National health-system hospitals of Lombardy faced a heavy burden of admissions for acute respiratory distress syndromes associated with coronavirus disease (COVID-19). Data on patients of European origin affected by COVID-19 are limited. Methods All consecutive patients aged ≥18 years, coming from North-East of Milan's province and admitted at San Raffaele Hospital with COVID-19, between February 25th and March 24th, were reported, all patients were followed for at least one month. Clinical and radiological features at admission and predictors of clinical outcomes were evaluated. Results Of the 500 patients admitted to the Emergency Unit, 410 patients were hospitalized and analyzed: median age was 65 (IQR 56–75) years, and the majority of patients were males (72.9%). Median (IQR) days from COVID-19 symptoms onset was 8 (5–11) days. At hospital admission, fever (≥ 37.5 °C) was present in 67.5% of patients. Median oxygen saturation (SpO2) was 93% (range 60–99), with median PaO2/FiO2 ratio, 267 (IQR 184–314). Median Radiographic Assessment of Lung Edema (RALE) score was 9 (IQR 4–16). More than half of the patients (56.3%) had comorbidities, with hypertension, coronary heart disease, diabetes and chronic kidney failure being the most common. The probability of overall survival at day 28 was 66%. Multivariable analysis showed older age, coronary artery disease, cancer, low lymphocyte count and high RALE score as factors independently associated with an increased risk of mortality. Conclusion In a large cohort of COVID-19 patients of European origin, main risk factors for mortality were older age, comorbidities, low lymphocyte count and high RALE.
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Affiliation(s)
- Fabio Ciceri
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Laura Galli
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Conte
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rebecca De Lorenzo
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Poli
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Carlo Signorelli
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eleonora Bossi
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Fazio
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Giacomo Monti
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | | | - Luigi Beretta
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Massimo Clementi
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | - Gianvito Martino
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Bosi
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Adriano Lazzarin
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
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How can I manage anaesthesia in obese patients? Anaesth Crit Care Pain Med 2020; 39:229-238. [DOI: 10.1016/j.accpm.2019.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 12/01/2019] [Accepted: 12/09/2019] [Indexed: 12/17/2022]
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Barabutis N. Unfolded Protein Response supports endothelial barrier function. Biochimie 2019; 165:206-209. [PMID: 31404589 DOI: 10.1016/j.biochi.2019.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/07/2019] [Indexed: 12/17/2022]
Abstract
Ongoing efforts are oriented towards the development of novel therapeutic agents to repress lung hyperpermeability responses due to inflammation. The endothelial barrier dysfunction triggered by such events, may eventually lead to severe cardiovascular complications, such as the Acute Respiratory Distress Syndrome. Hsp90 inhibitors are anticancer compounds, associated with strong anti-inflammatory responses in the endothelium. Our latest observations in experimental models of Acute Lung Injury suggest that P53 orchestrates, at least in part, such activities. Remarkably, both Hsp90 inhibition and P53 induction are associated with the activation of the Unfolded Protein Response element. The purpose of the current manuscript, is to introduce the hypotheses that UPR induction protects the vasculature against inflammation.
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Affiliation(s)
- Nektarios Barabutis
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana Monroe, Monroe, LA, 71201, USA.
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