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Johnson JA, Mallari KF, Pepe VM, Treacy T, McDonough G, Khaing P, McGrath C, George BJ, Yoo EJ. Mechanically ventilated COVID-19 patients admitted to the intensive care unit in the United States with or without respiratory failure secondary to COVID-19 pneumonia: a retrospective comparison of characteristics and outcomes. Acute Crit Care 2023; 38:298-307. [PMID: 37652859 PMCID: PMC10497897 DOI: 10.4266/acc.2022.01123] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/06/2023] [Accepted: 05/07/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND There is increasing heterogeneity in the clinical phenotype of patients admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19,) and reasons for mechanical ventilation are not limited to COVID pneumonia. We aimed to compare the characteristics and outcomes of intubated patients admitted to the ICU with the primary diagnosis of acute hypoxemic respiratory failure (AHRF) from COVID-19 pneumonia to those patients admitted for an alternative diagnosis. METHODS Retrospective cohort study of adults with confirmed SARS-CoV-2 infection admitted to nine ICUs between March 18, 2020, and April 30, 2021, at an urban university institution. We compared characteristics between the two groups using appropriate statistics. We performed logistic regression to identify risk factors for death in the mechanically ventilated COVID-19 population. RESULTS After exclusions, the final sample consisted of 319 patients with respiratory failure secondary to COVID pneumonia and 150 patients intubated for alternative diagnoses. The former group had higher ICU and hospital mortality rates (57.7% vs. 36.7%, P<0.001 and 58.9% vs. 39.3%, P<0.001, respectively). Patients with AHRF secondary to COVID-19 pneumonia also had longer ICU and hospital lengths-of-stay (12 vs. 6 days, P<0.001 and 20 vs. 13.5 days, P=0.001). After risk-adjustment, these patients had 2.25 times higher odds of death (95% confidence interval, 1.42-3.56; P=0.001). CONCLUSIONS Mechanically ventilated COVID-19 patients admitted to the ICU with COVID-19-associated respiratory failure are at higher risk of hospital death and have worse ICU utilization outcomes than those whose reason for admission is unrelated to COVID pneumonia.
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Affiliation(s)
- Jesse A. Johnson
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kashka F. Mallari
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vincent M. Pepe
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Taylor Treacy
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory McDonough
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Phue Khaing
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher McGrath
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brandon J. George
- College of Population Health, Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Erika J. Yoo
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Khaing P, Summer R. Maxed Out on Glycolysis: Alveolar Macrophages Rely on Oxidative Phosphorylation for Cytokine Production. Am J Respir Cell Mol Biol 2020; 62:139-140. [PMID: 31560565 PMCID: PMC6993550 DOI: 10.1165/rcmb.2019-0329ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Phue Khaing
- Jane and Leonard Korman Respiratory InstituteSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphia, Pennsylvania
| | - Ross Summer
- Jane and Leonard Korman Respiratory InstituteSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphia, Pennsylvania
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Khaing P, Paruchuri A, Eisenbrey JR, Merli GJ, Gonsalves CF, West FM, Awsare BK. First year experience of a pulmonary embolism response team with comparisons of outcomes between catheter directed therapy versus standard anticoagulation. Hosp Pract (1995) 2020; 48:23-28. [PMID: 31847615 DOI: 10.1080/21548331.2020.1706315] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/25/2022]
Abstract
Objectives: The Pulmonary Embolism Response Team (PERT) model is now widely adopted in many institutions to provide multidisciplinary care for patients with acute pulmonary embolism (PE). However, descriptive experiences of PERT operations and studies on clinical outcomes remain limited.Methods: We performed a retrospective review of PERT activations at an academic tertiary care center, with secondary aims to study outcomes associated with performing catheter directed therapies (CDT).Results: The intermediate high-risk PE category was most frequent (n = 40, 76.9%) among the 52 total cases evaluated during the study period. There was one in-hospital mortality, associated with hospice admission for a non-PE diagnosis. Six patients (11.5%) experienced a bleeding complication of any severity. Anticoagulation (AC) alone was recommended in 30 patients (57.7%) and CDT was performed in 16 patients (30.8%). There were no significant differences in patient characteristics or disease severity between patients in the AC group versus the CDT group, except for a higher prevalence of malignancy in the AC group (p = 0.037). Patients who underwent CDT demonstrated a lower, albeit non-significant, median intensive care unit (ICU) length of stay (LOS) (3 vs. 4 days, p = 0.34) and hospital LOS (4 vs. 5 days, p = 0.25), as compared to patients receiving AC alone. Bleeding rates were similar between the two groups (6.7% vs. 6.3%, p = 1.0).Conclusions: Adoption of the PERT model at an academic tertiary care center was associated with acceptably low rates of mortality and bleeding, similar to other published studies. Performing CDT in select patients under PERT consultation may be associated with shorter ICU and hospital LOS; however, larger studies are needed to validate this finding.
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Affiliation(s)
- Phue Khaing
- Division of Pulmonary and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Department of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Arpana Paruchuri
- Department of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - John R Eisenbrey
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Geno J Merli
- Jefferson Vascular Center, Department of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Carin F Gonsalves
- Division of Interventional Radiology, Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Frances M West
- Division of Pulmonary and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Department of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Bharat K Awsare
- Division of Pulmonary and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Department of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Au C, Gupta E, Khaing P, DiBello J, Chengsupanimit T, Mitchell EP, West F, Baram M, Awsare BK, Kane GC. Impact of cancer in pulmonary embolism presentation and outcomes: A large academic center study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6613 Background: The risk of venous thromboembolism is increased 4- to 7-fold in patients with malignancy, emphasizing the need to identify and treat these patients early to improve outcomes. We aimed to study the clinical presentation and outcomes of pulmonary embolism (PE) in patients with and without cancer. Methods: We performed a retrospective analysis of consecutive patients diagnosed with PE via CT scan from 2014-2016 at Jefferson Hospital. We compared patient characteristics, presentation, PE characteristics and mortality of patients with and without cancer. Cox proportional regression hazards model was used for survival-time analysis. Results: Our study included 581 patients, of which 187 (32.1%) had active cancer. Cancer patients were less likely to have chest pain (18.2% vs 37.4% p < 0.01), syncope (2.7% vs 6.6% p = 0.05), bilateral PEs (50% vs 60% p = 0.025), and right heart strain (RHS) (48% vs 58% p = 0.024). Indwelling catheters (IC) were present in 41.2% (n = 77) of cancer patients. However, presence of IC was not associated finding of incidental PEs (26% vs 18.2% p = 0.201). There was no difference in hospital length of stay (8.9 vs 9.4 days p = 0.61) or intensive care unit admission (31.9% vs 33.3% p = 0.75). There were fewer massive PE (3.2% vs 7.1% p = 0.06) in patients with cancer, but this difference was not statistically significant. Cancer patients elected comfort care at higher rates (15.2% vs 5.4% p = 0.01). Cancer patients had higher 1-year mortality as compared to non-cancer (adj HR 6.9, 95% CI 3.3- 14.7, p < 0.01). Among cancer patients, 52.7% had metastasis with a higher 1-year mortality (adj HR 2.5, 95% CI 1.8- 4.9, p < 0.1) and 35.8% were on active chemotherapy with no difference in 1-year survival (adj HR 1.1, 95% CI 0.6-1.8, p = 0.79). The most represented cancers were genitourinary, lung and head and neck (35.3%, 23.0%, 13.4%, respectively). Conclusions: Cancer patients presented with less severe pulmonary emboli which may be due to increased health care contact and pre-clinical suspicion. The presence of IC did not affect the size, location of PE or incidental PEs among cancer patients. Although cancer patients have higher 1-year mortality, PE may not be as large as a contributor as previously perceived.
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Affiliation(s)
- Cherry Au
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Ena Gupta
- Division of Pulmonary and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Phue Khaing
- Division of Pulmonary and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Joseph DiBello
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | | | - Edith P. Mitchell
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Frances West
- Division of Pulmonary and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Michael Baram
- Division of Pulmonary and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Bharat K. Awsare
- Division of Pulmonary and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Gregory C. Kane
- Division of Pulmonary and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Abstract
INTRODUCTION Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. Currently, for any incidentally discovered Meckel's diverticulum, the management approach is based on weighing the statistical odds of future complications against the risks of a diverticulectomy. MATERIALS AND METHODS The temporal relationship between age at Meckel's diverticulectomy and the presence of ectopic epithelium was evaluated in our series. A meta-analysis of all reported recent literature on this condition was subsequently performed to evaluate the strength of the relationship between ectopic epithelium and symptomatic Meckel's diverticulum. RESULTS There was a paucity of ectopic epithelium in Meckel's diverticulectomy specimens in infants operated on at less than 1 year of age. Having two or more ectopic epithelia in a diverticulum does not appear to carry an additive risk for complications. The meta-analysis confirmed that ectopic epithelium was the most significant factor that influenced surgical intervention in all series of Meckel's diverticulum. CONCLUSION The relationship between ectopic epithelium and the development of symptomatic Meckel's diverticulum is complex. Further understanding of the development of ectopic rests in the diverticulum will facilitate elucidating the pathophysiology in symptomatic cases.
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Affiliation(s)
- Sathyaprasad Burjonrappa
- Department of Pediatric Surgery, Children's Hospital of New Jersey and Beth Israel Medical Center, Newark, USA
| | - Phue Khaing
- Medical Student, The University of Medicine and Dentistry of New Jersey, NJ, USA
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