Noninvasive ventilation in COVID-19 patients aged ≥ 70 years-a prospective multicentre cohort study

BACKGROUND

Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV.

METHODS

This is a substudy of COVIP study-an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality.

RESULTS

Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36-5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06-2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI - 2.27 to - 0.46 days) compared to primary IMV group (n = 1876).

CONCLUSIONS

Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial Registration NCT04321265 , registered 19 March 2020, https://clinicaltrials.gov .

Role of real-time shear-wave elastogarphy in differentiating hepatocellular carcinoma from other hepatic focal lesions

BACKGROUND

Hepatocellular carcinoma (HCC) has an increasing incidence worldwide, and is considered the second cause of cancer-related death.

AIM

The aim of the study is to assess the usefulness of real-time shear-wave elastography in differentiating HCC from other hepatic focal lesions.

PATIENTS AND METHODS

The current study was conducted on 110 patients in addition to 10 healthy subjects, divided into four groups as follows: liver cirrhosis, HCC, hepatic focal lesions other than HCC, and control. Demographic, laboratory and imaging data were collected and then elastographic assessment of the hepatic focal lesions and the surrounding liver parenchyma using elastograph point quantification (ElastPQ) (iU22x MATRIX, Philips) was done.

RESULTS

ElastPQ (iU22x MATRIX, Philips) has shown its ability to differentiate between HCC and cystic focal lesions, HCC and cholangiocarcinoma, and HCC and focal nodular hyperplasia (FNH). Cystic lesions demonstrated lower stiffness in comparison to HCC; however, cholangiocarcinoma and FNH demonstrated higher stiffness in comparison to HCC. ElastPQ was unable to differentiate between stiffness in both 'HCC and hemangioma' and 'HCC and metastatic focal lesions'. ElastPQ showed that HCC, cystic focal lesions, and cholangiocarcinoma had lower stiffness in comparison to their surrounding liver parenchyma, whereas FNH had higher stiffness in comparison to the surrounding liver parenchyma. ElastPQ showed that the surrounding liver parenchyma of the HCC group has the highest stiffness amongst all studied hepatic focal lesions surrounding liver parenchyma.

CONCLUSION

'Point' shear-waves elastography (ElastPQ; Philips iU22x MATRIX, Philips) is a noninvasive, quantitative and nonradiating method for evaluation of tissue elasticity, and is helpful in differentiating HCC from other hepatic focal lesions.