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Lorente-González M, Terán-Tinedo JR, Zevallos-Villegas A, Laorden D, Mariscal-Aguilar P, Suárez-Ortiz M, Cano-Sanz E, Ortega-Fraile MÁ, Hernández-Núñez J, Falcone A, Saiz-Lou EM, Plaza-Moreno MC, García-Fadul C, Valle-Falcones M, Sánchez-Azofra A, Funes-Moreno C, De-La-Calle-Gil I, Navarro-Casado R, Carballo-López D, Gholamian-Ovejero S, Gallego-Rodríguez B, Villén-Villegas T, Landete P. Severe SARS-CoV-2 Pneumonia and Pneumomediastinum/Pneumothorax: A Prospective Observational Study in an Intermediate Respiratory Care Unit. J Intensive Care Med 2023; 38:1023-1041. [PMID: 37306158 PMCID: PMC10261956 DOI: 10.1177/08850666231180165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated. METHODS This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied. RESULTS A total of 1306 patients were included. 4.3% (56/1306) developed PM/PTX, 3.8% (50/1306) PM, 1.6% (21/1306) PTX, and 1.1% (15/1306) PM + PTX. 16.1% (9/56) of patients with PM/PTX had HFNC alone, while 83.9% (47/56) had HFNC + CPAP/BiPAP. In comparison, 41.7% (521/1250) of patients without PM and PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55; p < .001), while 58.3% (729/1250) had HFNC + CPAP/BiPAP (OR 3.73; 95% CI 1.81-7.68; p < .001). The probability of needing IMV among patients with PM/PTX was 67.9% (36/53) (OR 7.46; 95% CI 4.12-13.50; p < .001), while it was 22.1% (262/1185) among patients without PM and PTX. Mortality among patients with PM/PTX was 33.9% (19/56) (OR 4.39; 95% CI 2.45-7.85; p < .001), while it was 10.5% (131/1250) among patients without PM and PTX. CONCLUSIONS In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM/PTX, PM, PTX, and PM + PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM/PTX had HFNC + CPAP/BiPAP as the NIRS device, much more frequently than patients without PM and PTX. The probabilities of IMV and death among patients with PM/PTX were 64.3% and 33.9%, respectively, higher than those observed in patients without PM and PTX, which were 21.0% and 10.5%, respectively.
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Affiliation(s)
- Miguel Lorente-González
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - José Rafael Terán-Tinedo
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Annette Zevallos-Villegas
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Daniel Laorden
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Pablo Mariscal-Aguilar
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Miguel Suárez-Ortiz
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Eduardo Cano-Sanz
- Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - María Ángeles Ortega-Fraile
- Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Joaquín Hernández-Núñez
- Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Adalgisa Falcone
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Elena María Saiz-Lou
- Department of Internal Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - María Cristina Plaza-Moreno
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Christian García-Fadul
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Manuel Valle-Falcones
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Ana Sánchez-Azofra
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Clotilde Funes-Moreno
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Isabel De-La-Calle-Gil
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Rosalía Navarro-Casado
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Daniel Carballo-López
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Soraya Gholamian-Ovejero
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Berta Gallego-Rodríguez
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Tomás Villén-Villegas
- Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Pedro Landete
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid [Autónoma University of Madrid], Madrid, Madrid, Spain
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Gasa M, Ruiz-Albert Y, Cordoba-Izquierdo A, Sarasate M, Cuevas E, Suarez-Cuartin G, Méndez L, Alfaro-Álvarez JC, Sabater-Riera J, Pérez-Fernández XL, Molina-Molina M, Santos S. Outcomes of COVID-19 Patients Admitted to the Intermediate Respiratory Care Unit: Non-Invasive Respiratory Therapy in a Sequential Protocol. Int J Environ Res Public Health 2022; 19:10772. [PMID: 36078488 PMCID: PMC9518070 DOI: 10.3390/ijerph191710772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
The intermediate respiratory care units (IRCUs) have a pivotal role managing escalation and de-escalation between the general wards and the intensive care units (ICUs). Since the COVID-19 pandemic began, the early detection of patients that could improve on non-invasive respiratory therapies (NRTs) in IRCUs without invasive approaches is crucial to ensure proper medical management and optimize limiting ICU resources. The aim of this study was to assess factors associated with survival, ICU admission and intubation likelihood in COVID-19 patients admitted to IRCUs. Observational retrospective study in consecutive patients admitted to the IRCU of a tertiary hospital from March 2020 to April 2021. Inclusion criteria: hypoxemic respiratory failure (SpO2 ≤ 94% and/or respiratory rate ≥ 25 rpm with FiO2 > 50% supplementary oxygen) due to acute COVID-19 infection. Demographic, comorbidities, clinical and analytical data, and medical and NRT data were collected at IRCU admission. Multivariate logistic regression models assessed factors associated with survival, ICU admission, and intubation. From 679 patients, 79 patients (12%) had an order to not do intubation. From the remaining 600 (88%), 81% survived, 41% needed ICU admission and 37% required intubation. In the IRCU, 51% required non-invasive ventilation (NIV group) and 49% did not (non-NIV group). Older age and lack of corticosteroid treatment were associated with higher mortality and intubation risk in the scheme, which could be more beneficial in severe forms. Initial NIV does not always mean worse outcomes.
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Affiliation(s)
- Mercè Gasa
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
- Department of Medicine, Campus Bellvitge, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain
| | - Yolanda Ruiz-Albert
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
| | - Ana Cordoba-Izquierdo
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
| | - Mikel Sarasate
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
| | - Ester Cuevas
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
| | - Guillermo Suarez-Cuartin
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
| | - Lidia Méndez
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
| | | | - Joan Sabater-Riera
- Critical Care Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (J.S.-R.); (X.L.P.-F.)
| | - Xosé L. Pérez-Fernández
- Critical Care Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (J.S.-R.); (X.L.P.-F.)
| | - María Molina-Molina
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
- Department of Medicine, Campus Bellvitge, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain
| | - Salud Santos
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
- Department of Medicine, Campus Bellvitge, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain
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Trias-Sabrià P, Molina-Molina M, Aso S, Argudo MH, Diez-Ferrer M, Sabater J, Dorca J, Santos S, Suarez-Cuartin G. Lung Ultrasound Score to Predict Outcomes in COVID-19. Respir Care 2021; 66:1263-1270. [PMID: 34006594 PMCID: PMC9994360 DOI: 10.4187/respcare.08648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients with coronavirus disease 2019 (COVID-19) can develop severe bilateral pneumonia leading to respiratory failure. We aimed to study the potential role of lung ultrasound score (LUS) in subjects with COVID-19. METHODS We conducted an observational, prospective pilot study, including consecutive subjects admitted to an intermediate care unit due to COVID-19 pneumonia. LUS is a 12-zone examination method for lung parenchyma assessment. LUS was performed with a portable convex transducer, scores from 0 to 36 points. Clinical and demographic data were collected at LUS evaluation. Survival analysis was performed using a composite outcome including ICU admission or death. Subjects were followed for 30 d from LUS assessment. RESULTS Of 36 subjects included, 69.4% were male, and mean age was 60.19 ± 12.75 y. A cutoff LUS ≥ 24 points showed 100% sensitivity, 69.2% specificity, and an area under the receiver operating characteristic curve of 0.85 for predicting worse prognosis. The composite outcome was present in 10 subjects (55.6%) with LUS ≥ 24 points, but not in the group with lower LUS scores (P < .001). Subjects with LUS ≥ 24 points had a higher risk of ICU admission or death (hazard ratio 9.97 [95% CI 2.75-36.14], P < .001). Significant correlations were observed between LUS and [Formula: see text], serum D-dimer, C-reactive protein, lactate dehydrogenase, and lymphocyte count. CONCLUSIONS LUS ≥ 24 points can help identify patients with COVID-19 who are likely to require ICU admission or to die during follow-up. LUS also correlates significantly with clinical and laboratory markers of COVID-19 severity.
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Affiliation(s)
- Pere Trias-Sabrià
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Maria Molina-Molina
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Samantha Aso
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Marta Hernández Argudo
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Marta Diez-Ferrer
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Sabater
- Critical Care Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Jordi Dorca
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Salud Santos
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Guillermo Suarez-Cuartin
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
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Huang CT, Yu CJ. Conventional weaning parameters do not predict extubation outcome in intubated subjects requiring prolonged mechanical ventilation. Respir Care 2013; 58:1307-14. [PMID: 23307826 DOI: 10.4187/respcare.01773] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Approaches to respiratory care of patients needing prolonged mechanical ventilation (PMV) might be varied. In this study we assessed the predictive value of usual variables for extubation outcome in PMV patients. METHODS From 2005 to 2007, intubated patients who were admitted to the intermediate respiratory care unit, had been on mechanical ventilation for ≥ 21 days at the time of admission, and underwent extubation after successful spontaneous breathing trials were included. Comparisons between subjects with successful extubation and failed extubation in terms of weaning parameters and clinical predictors of extubation outcome were performed. Also, 1-year survival of subjects with regard to extubation outcome was analyzed. RESULTS Twenty-seven (23.7%) of 119 PMV subjects required reintubation within 7 days. Multivariate logistic regression analysis demonstrated that the only variable associated with extubation failure was ineffective cough (P < .001). Possessing 2 or more acceptable weaning parameters was not helpful in predicting extubation outcome. Subjects with failed extubation had worse 1-year survival (hazard ratio 0.49, 95% CI 0.28-0.87, P = .02) compared with those with successful extubation. CONCLUSIONS In PMV subjects who tolerated spontaneous breathing trials and were ready to extubate, ineffective cough was the best predictor of extubation failure. Furthermore, extubation failure was associated with future mortality; thus, different management strategies need to be developed for improving patient outcome.
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Affiliation(s)
- Chun-Ta Huang
- Department of Internal Medicine and Traumatology, National Taiwan University Hospital, Taipei, Taiwan
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