COVID-19 Intensive Care Unit Research Articles

An evaluation of vilobelimab (anti-C5a) as a cost-effective option to treat severely ill mechanically ventilated patients with COVID-19.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. COVID-19 patients in intensive care units (ICUs) requiring invasive mechanical ventilation (IMV) have few available treatment options. PANAMO, a multicenter, double-blind, randomized, placebo-controlled phase 3 study of vilobelimab, which blocks the inflammatory process caused by complement component 5a, demonstrated a significant mortality benefit at 28 and 60 days in these patients. A cost-effectiveness analysis was conducted to assess the incremental cost per quality-adjusted life-year (QALY). A Markov model was used to estimate QALYs and the incremental cost-effectiveness ratio (ICER) of vilobelimab plus standard of care (SOC) versus SOC alone. The model simulated progression from severe COVID-19 to survival or death over a lifetime horizon. Outcomes data (COVID-19 all-cause mortality and renal replacement therapy) were incorporated from the PANAMO trial. COVID-19 mortality estimates were based on Centers for Disease Control and Prevention age-specific survival data. Utility values and hospital costs came from the literature. Vilobelimab cost was obtained from RED BOOK Online. For COVID-19 ICU patients, total costs of care were $103,414 (SOC) and $132,247 (SOC plus vilobelimab), respectively, resulting in an incremental cost of $28,833. SOC provided 6.70 QALYs versus 7.99 QALYs for vilobelimab, an additional 1.29 QALYs. The ICER for vilobelimab plus SOC versus SOC alone was $22,287/QALY. Probabilistic sensitivity analysis demonstrated the robustness of the cost-effectiveness result as vilobelimab plus SOC was favored at a willingness-to-pay threshold of $50,000 in over 81% of iterations. Vilobelimab provides a cost-effective option to treat ICU patients with severe COVID-19 receiving IMV compared to SOC, at well below the commonly accepted $50,000 US willingness-to-pay threshold.

Respiratory tract and bloodstream infections: microbiological profile in an intensive care unit for COVID-19

This is a retrospective cross-sectional study aimed at identifying the profile of lower respiratory tract (RTI) and bloodstream infections (BSI) in patients in the Intensive Care Unit (ICU) of a Reference Hospital for COVID-19 in Recife, Pernambuco. Data were collected on the age and sex of patients, material used in cultures, microorganisms detected, and resistance and sensitivity to the antimicrobials used. The most frequent species was Acinetobacter baumannii in RTI and Staphylococcus haemolyticus in BSI, being more resistant to levofloxacin and more sensitive to linezolid. Knowing the pathogens and their respective susceptibility patterns facilitates the choice of initial therapy, as well as the establishment of action protocols for health professionals and hospital infection control committees.

Neuroinflammation in Severe COVID-19: The Dynamics of Inflammatory and Brain Injury Markers During Hospitalization.

Patients with COVID-19 can develop excessive inflammation in the brain and consequent neurological complications. The aim of this study was to evaluate the inflammatory, endothelial and brain injury markers in hospitalized COVID-19 patients and compare those with or without neurological symptoms. A total of 30 intensive care unit (ICU) COVID-19 patients were allocated into COVID-19 (without neurological symptoms) or neuro-COVID-19 (with neurological symptoms) groups. Patients with respiratory infection symptoms but negative for COVID-19 were included as a control group. Peripheral blood samples were collected at hospital admission (T1) (controls and ICU patients) and during hospitalization (T2: last 72h before hospital discharge or in-hospital death) (ICU COVID-19 patients) to analyze inflammatory markers. Higher ICAM-1, CCL26 and VEGF at T1 were identified in both COVID-19 groups compared with control. Neuro-COVID-19 patients presented lower systemic BDNF levels compared with the control group and increased S100B compared with the control and COVID-19 groups. BDNF levels in survivors were lower in the neuro-COVID-19 group compared to the COVID-19 group, while S100B were higher, regardless of the outcome. In addition, all COVID-19 patients presented increased ICAM-1 and CCL26 levels over the hospitalization period (T2 > T1). Furthermore, S100B, ICAM-1, CCL26 and VEGF levels increased in relation to T1 in neuro-COVID-19 patients, with S100B and CCL26 being significantly higher in relation to the COVID-19 group. In conclusion, high levels of brain injury biomarkers were found in patients with neuro-COVID-19, indicating neuroinflammatory and consequent brain injury in the last 72h of hospitalization.

Function and activity capacity at 1 year after the admission to intensive care unit for COVID-19

Objective To describe hand grip strength, walking speed, functional mobility, and postural control at one year following intensive care unit admission for COVID-19, and to find any predictors that are associated with impaired hand grip strength, walking speed, functional mobility, or postural control at the 1-year follow-up. Design Retrospective cross-sectional and longitudinal observational study. Setting Intensive care unit and outpatient research clinic at Sahlgrenska University Hospital. Participants Of the 105 individuals in “The Gothenburg Recovery and Rehabilitation after COVID-19 and Intensive Care Unit” cohort, 78 participated in this study. Main measures Descriptive statistics for hand grip strength, walking speed, functional mobility, and postural control were presented and binary logistic regressions were performed to find their significant predictors. Results At 1-year following intensive care unit admission for COVID-19, impaired hand grip strength was found in 24.4% for the right hand and 23.1% for the left hand. Walking speed, functional mobility, and postural control were found to be impaired in 29.5%, 21.8%, and 5.1%, respectively. For impaired walking speed, longer length of stay at intensive care unit and presence of diabetes mellitus were risk factors. Diabetes mellitus was found to be the risk factor for impaired functional mobility. Conclusion In this study, 45% of the participants showed impairment in function, activity capacity or both. These results suggest that individuals who recovered after intensive care unit admission for COVID-19 would benefit from receiving long-term follow-up to enable identification of those with need of physical health assistance and rehabilitation.

Increased Activation Markers of Adaptive Immunity in Patients with Severe COVID-19.

Introduction: COVID-19 is a pandemic disease and is widespread over the world. This disease shows a 5.1% mortality. The understanding of the disease has expanded rapidly in many areas, including virological, epidemiological, clinical, and management dimensions. To better understand the inflammatory and immune profiles that impact the pathogenesis and development of severe COVID-19 symptoms, further studies are essential. This research aims to explore the inflammatory and adaptive immune responses associated with COVID-19, considering factors such as genetic diversity and environmental exposure among Saudi patients. The goal is to determine if patients with severe COVID-19 exhibit different disease phenotypes. Materials and Methods: This case-control study includes 115 participants (healthy and with COVID-19 infection), 55 of which had confirmed cases of COVID-19 in intensive care units (ICUs) at different hospitals in Makkah City, Saudi Arabia. Whole blood samples were collected from June to September 2021 for cellular analyses, and inflammation marker data were collected from hospital records. The expression of activation markers on B (CD27 and CD38) and T cells (CD27 and HLA-DR) was obtained using the flow cytometry technique. Also, serum was collected for cytokine measurements, including IL-6, INF-γ, and TNF- α. Results: The results indicated that lymphopenia and excessive T cell activation were more prevalent in severe cases than in healthy individuals. Furthermore, the results revealed that severe COVID-19 patients had an increased frequency of CD19+ B cells, with changes in B cell subsets. The current study implies impairment and changes in the phenotype of adaptive cells (including T and B cells), with an increase in HLA-DR molecules and inflammation markers with pro-inflammatory cytokines in severe COVID-19 cases. Conclusions: The current study implies impairment and changes in the phenotype of adaptive cells (including T and B cells), with an increase in HLA-DR molecules and inflammation markers in severe COVID-19 cases, which could be targeted for therapeutic interventions. This might be a valuable approach for the diagnosis and treatment of severe COVID-19 cases.

Alarm Management in Provisional COVID-19 Intensive Care Units: Retrospective Analysis and Recommendations for Future Pandemics.

In response to the high patient admission rates during the COVID-19 pandemic, provisional intensive care units (ICUs) were set up, equipped with temporary monitoring and alarm systems. We sought to find out whether the provisional ICU setting led to a higher alarm burden and more staff with alarm fatigue. We aimed to compare alarm situations between provisional COVID-19 ICUs and non-COVID-19 ICUs during the second COVID-19 wave in Berlin, Germany. The study focused on measuring alarms per bed per day, identifying medical devices with higher alarm frequencies in COVID-19 settings, evaluating the median duration of alarms in both types of ICUs, and assessing the level of alarm fatigue experienced by health care staff. Our approach involved a comparative analysis of alarm data from 2 provisional COVID-19 ICUs and 2 standard non-COVID-19 ICUs. Through interviews with medical experts, we formulated hypotheses about potential differences in alarm load, alarm duration, alarm types, and staff alarm fatigue between the 2 ICU types. We analyzed alarm log data from the patient monitoring systems of all 4 ICUs to inferentially assess the differences. In addition, we assessed staff alarm fatigue with a questionnaire, aiming to comprehensively understand the impact of the alarm situation on health care personnel. COVID-19 ICUs had significantly more alarms per bed per day than non-COVID-19 ICUs (P<.001), and the majority of the staff lacked experience with the alarm system. The overall median alarm duration was similar in both ICU types. We found no COVID-19-specific alarm patterns. The alarm fatigue questionnaire results suggest that staff in both types of ICUs experienced alarm fatigue. However, physicians and nurses who were working in COVID-19 ICUs reported a significantly higher level of alarm fatigue (P=.04). Staff in COVID-19 ICUs were exposed to a higher alarm load, and the majority lacked experience with alarm management and the alarm system. We recommend training and educating ICU staff in alarm management, emphasizing the importance of alarm management training as part of the preparations for future pandemics. However, the limitations of our study design and the specific pandemic conditions warrant further studies to confirm these findings and to explore effective alarm management strategies in different ICU settings.

The usage of immunosuppressant agents and secondary infections in patients with COVID-19 in the intensive care unit: a retrospective study

Although COVID-19 infection is an immunosuppressant disease, many immunosuppressant agents, such as pulse methylprednisolone (PMP), dexamethasone (DXM), and tocilizumab (TCZ), were used during the pandemic. Secondary infections in patients with COVID-19 have been reported recently. This study investigated these agents’ effects on secondary infections and outcomes in patients with COVID-19 in intensive care units (ICUs). This study was designed retrospectively, and all data were collected from the tertiary intensive care units of six hospitals between March 2020 and October 2021. All patients were divided into three groups: Group I [GI, PMP (−), DXM (−) and TCZ (−)], Group II [GII, PMP (+), DXM (+)], and Group III [GIII, PMP (+), DXM (+), TCZ (+)]. Demographic data, PaO/FiO2 ratio, laboratory parameters, culture results, and outcomes were recorded. To compare GI-GII and GI-GIII, propensity score matching (PSM) was used by matching 14 parameters. Four hundred twelve patients with COVID-19 in the ICU were included in the study. The number of patients with microorganisms ≥ 2 was 279 (67.7%). After PSM, in GII and GIII, the number of (+) tracheal cultures and (+) bloodstream cultures detected different microorganisms ≥ 2 during the ICU period, neuropathy, tracheotomized patients, duration of IMV, and length of ICU stay were significantly higher than GI. The mortality rate was similar in GI and GII, whereas it was significantly higher in GIII than in GI. The use of immunosuppressant agents in COVID-19 patients may lead to an increase in secondary infections. In addition, increased secondary infections may lead to prolonged ICU stay, prolonged IMV duration, and increased mortality.

Candidaemia and Central Line-Associated Candidaemia in a Network of Indian ICUs: Impact of COVID-19 Pandemic.

Candidaemia is a potentially life-threatening emergency in the intensive care units (ICUs). Surveillance using common protocols in a large network of hospitals would give meaningful estimates of the burden of candidaemia and central line associated candidaemia in low resource settings. We undertook this study to understand the burden and epidemiology of candidaemia in multiple ICUs of India, leveraging the previously established healthcare-associated infections (HAI) surveillance network. Our aim was also to assess the impact that the pandemic of COVID-19 had on the rates and associated mortality of candidaemia. This study included adult patients from 67 Indian ICUs in the AIIMS-HAI surveillance network that conducted BSI surveillance in COVID-19 and non-COVID-19 ICUs during and before the COVID-19 pandemic periods. Hospitals identified healthcare-associated candidaemia and central line associated candidaemia and reported clinical and microbiological data to the network as per established and previously published protocols. A total of 401,601 patient days and 126,051 central line days were reported during the study period. A total of 377 events of candidaemia were recorded. The overall rate of candidaemia in our network was 0.93/1000 patient days. The rate of candidaemia in COVID-19 ICUs (2.52/1000 patient days) was significantly higher than in non-COVID-19 ICUs (1.05/patient days) during the pandemic period. The rate of central line associated candidaemia in COVID-19 ICUs (4.53/1000 central line days) was also significantly higher than in non-COVID-19 ICUs (1.73/1000 central line days) during the pandemic period. Mortality in COVID-19 ICUs associated with candidaemia (61%) was higher than that in non-COVID-19 ICUs (41%). A total of 435 Candida spp. were isolated. C. tropicalis (26.7%) was the most common species. C. auris accounted for 17.5% of all isolates and had a high mortality. Patients in ICUs with COVID-19 infections have a much higher risk of candidaemia, CLAC and its associated mortality. Network level data helps in understanding the true burden of candidaemia and will help in framing infection control policies for the country.

Effect of amubarvimab-romlusevimab for treatment of severe COVID-19 in intensive care units: A retrospective cohort study

Amubarvimab-romlusevimab is a commonly recommended antiviral treatment in China for adult patients with mild or moderate SARS-CoV-2 infections, especially for patients with a high risk factor for progression to severe COVID-19. However, its exact efficacy in patients with severe Covid-19 is not yet known.This is a single-center retrospective cohort study, in which we collected the general data, laboratory tests, radiological characteristics, viral conversion status, and prognosis of the disease from patients with COVID-19 hospitalized, from December 2022 to March 2023 in the Department of Critical Care Medicine. The amubarvimab-romlusevimab therapy can reduce the 28-day mortality (29.79 % vs 51.35 %, p = 0.02), and ICU mortality (29.79 % vs 55.41 %, p = 0.006) of severe COVID-19.A 1:1 PSM (Propensity Score Matching) was performed to reduce bias, in order to ensure the two groups were balanced and comparable. In the matched population (n = 47), there were no statistically significant differences between the mAbs (monoclonal antibody)group and the Non-antiviral group in 28-day, and thromboembolic events in COVID-19 patients. The 40-day survival analysis shows that mAbs therapy can improve patient prognosis (HR = 0.45, 95%CI = 0.26–0.76, p = 0.008). However, no significant intergroup difference in the 40-day cumulative viral conversion rate. In a univariate Cox regression analysis, The Amubarvimab - romlusevimab therapy(HR:0.464; CI:[0.252–0.853]; p:0.013) is a protective factor and CRP, PCT, PLT, Lactate, PT, PT-INR, and pt% level at admission were risk factors for clinical prognosis. After including the above covariates, Multifactorial COX regression shows that the Amubarvimab - romlusevimab therapy(HR:0.392; CI:[0.211–0.729]; p:0.003), CRP, Lactate and PT-INR at admission are independent factors for mortality of severe COVID-19. Based on the current data, we conclude that amubarvimab-romlusevimab therapy is beneficial for patients with severe COVID-19.

What would have made work in the COVID-19 ICU less demanding? A qualitative study from 13 Swedish COVID-19 ICUs.

The COVID-19 pandemic stretched Swedish intensive care unit (ICU) resources to an extent never experienced before, but even before the pandemic staffing was difficult and the number of staffed ICU beds was low. Studies have revealed high levels of COVID-19 ICU staff burn-out and fatigue, and as similar situations with high demands are likely to occur in the future a better understanding of resources that improve staff resilience is important. Using the job-demand resource theory as a framework, we explored ICU professionals' views on demands and resources when working in COVID-19 ICUs with the aim to highlight factors that increased the job resources. Data were collected via a web survey distributed to COVID-19 ICU professionals, including both regular and temporary roles, working in 13 COVID-19 ICU wards in Stockholm and Sörmland counties during the spring 2021. A total of 251 written responses to the question "What would have made work in the COVID-19 ICU less demanding?" were analyzed using thematic analysis. One year later a member-checking focus group interview was conducted to validate and further explore staff experiences. The main themes were work strategy, fairness and support, continuity, accessible leadership, introduction/information, and crisis preparedness. The analysis of the focus group conducted confirmed the main results and the extreme demands on ICU staff during the initial stages of the pandemic. To increase staff health and performance in a long-term crisis our results suggest; maintaining workplace leadership, scheduling work in advance and, when possible, schedule for recovery.

Optic nerve sheath diameter measurement using ultrasonography: associations with in-hospital mortality in COVID-19 intensive care unit admissions.

Optic nerve sheath diameter measurement using ultrasonography: associations with in-hospital mortality in COVID-19 intensive care unit admissions.

Prediction of Mortality Using the Sequential Organ Failure Assessment Score in Critically Ill COVID-19 Patients.

To determine the accuracy and reliability of the sequential organ failure assessment (SOFA) score in predicting the risk of mortality in ICU-admitted COVID-19 patients. Cross-sectional study. Place and Duration of the Study: COVID Intensive Care Unit (ICU), The Aga Khan University Hospital, Karachi,from January to June 2022. A total of 62 patients with a positive RT-PCR for COVID-19, admitted into the intensive care unit (ICU), were included in this descriptive cross-sectional study. Written informed consent was obtained after explaining the risks and benefits of the study to the patients / next of kin. SOFA score at the time of admission and 48 hours after admission was calculated. The outcome variable, i.e., mortality, was assessed in association with the SOFA score. Results: The study had a predominantly male population of 54.8% (n = 34). The SOFA score >7 at admission and 48 hours after admission was observed in 46.8% (n = 29) patients. Among 62 COVID-19 patients, the majority were found to have a severe nature of the disease, i.e., 69.4% (n = 43), followed by moderate / mild cases 30.6% (n = 19). Depending on the requirement of the patient, 74.2% (n = 46) were invasively ventilated while 77.4% (n = 48) were on non-invasive ventilation. Overall the mortality rate of the present study was 43.5% (n = 27). The scores both at the time of admission and 48 hours after admission for the survivors had a significant difference (p = 0.001) with the non-survivors. The SOFA score on admission and 48 hours after had a significant positive association with the severity of COVID-19 infection and its risk of mortality. COVID-19, Mortality prediction, SOFA score.

Informed consent for national registration of COVID-19 vaccination caused information bias of vaccine effectiveness estimates mostly in older adults: a bias correction study

ObjectivesRegistration in the Dutch national COVID-19 vaccination register requires consent from the vaccinee. This causes misclassification of nonconsenting vaccinated persons as being unvaccinated. We quantified and corrected the resulting information bias in vaccine effectiveness (VE) estimates. Study Design and SettingNational data were used for the period dominated by the SARS-CoV-2 Delta variant (July 11 to November 15, 2021). VE ((1-relative risk)∗100%) against COVID-19 hospitalization and intensive care unit (ICU) admission was estimated for individuals 12 to 49, 50 to 69, and ≥70 years of age using negative binomial regression. Anonymous data on vaccinations administered by the Municipal Health Services were used to determine informed consent percentages and estimate corrected VEs by iteratively imputing corrected vaccination status. Absolute bias was calculated as the absolute change in VE; relative bias as uncorrected/corrected relative risk. ResultsA total of 8804 COVID-19 hospitalizations and 1692 COVID-19 ICU admissions were observed. The bias was largest in the 70+ age group where the nonconsent proportion was 7.0% and observed vaccination coverage was 87%: VE of primary vaccination against hospitalization changed from 75.5% (95% CI 73.5–77.4) before to 85.9% (95% CI 84.7–87.1) after correction (absolute bias −10.4 percentage point, relative bias 1.74). VE against ICU admission in this group was 88.7% (95% CI 86.2–90.8) before and 93.7% (95% CI 92.2–94.9) after correction (absolute bias −5.0 percentage point, relative bias 1.79). ConclusionVE estimates can be substantially biased with modest nonconsent percentages for vaccination data registration. Data on covariate-specific nonconsent percentages should be available to correct this bias.

Nursing management in the humanization of clinical care of adult patients in the COVID Intensive Care Unit: A Review of the topic

Introducción: el cuidado humanizado en el ámbito sanitario, en especial en la UCI, es esencial para preservar la integridad de la persona. A pesar de los desafíos de la pandemia, la deshumanización persiste, lo que destaca la importancia de la gestión del profesional de enfermería, actuando como nexo entre el equipo asistencial, el paciente y la familia. Objetivo: analizar la gestión de los cuidados de enfermería como eje humanizador de la atención clínica de los pacientes adultos internados por COVID en la Unidad de Cuidados Intensivos durante la pandemia. Metodología: se realizó una revisión de artículos publicados en revistas científicas desde el 2016 hasta el 2022, utilizando la metodología PRISMA en las bases de datos PubMed, ScienceDirect (Elsevier), Web of Science, LILACS, BVS y ProQuest. Resultados: Se obtuvieron 367 documentos, de los cuales, 24 artículos fueron seleccionados para la revisión. Mediante un análisis temático se definieron cuatro temas principales: humanización de la atención, la familia como elemento fundamental en la humanización de los servicios, comunicación y gestión ética de los recursos tecnológicos como eje humanizador, y la importancia de la relación profesional de enfermería - paciente como componente fundamental en la humanización sanitaria a la luz de la teoría humanista de Peplau. Conclusiones: fue posible brindar un cuidado humanizado a los pacientes internados en una UCI COVID, a la luz de las relaciones interpersonales, aprovechando las herramientas tecnológicas disponibles, entendiendo que estos recursos son un medio y sitúa al paciente como el único fin de la atención del profesional de enfermería.

One-year outcomes in COVID-19 and non-COVID-19 intensive care unit survivors

PurposeTo determine differences in one-year multi-domain health outcomes in COVID-19 and non-COVID-19 intensive care unit (ICU) survivors. Materials and methodsAdult ICU survivors treated for COVID-19 were compared to a control group consisting of survivors admitted for respiratory distress due to other causes, i.e. non-COVID-19 ARDS or pneumonia. Occurrence of physical (frailty, fatigue, physical symptoms), mental (anxiety, depression, post-traumatic stress) and cognitive symptoms, and quality of life (QoL) scores were measured, using validated questionnaires, before and one year after ICU treatment. ResultsIn total, 506 COVID-19 survivors could be compared to 228 non-COVID-19 survivors. At one-year follow-up, COVID-19 ICU survivors had less physical (76.2% vs. 86.9%, p = 0.001) and mental symptoms (32.0% vs. 47.1%, p < 0.001) than the control group. Cognitive symptoms were comparable (22.5% vs. 17.2%, p = 0.12). However, compared to pre-ICU health symptoms and scores, COVID-19 survivors experienced an increase in symptom occurrence rates in all domains and a decrease in QoL, whereas the control group only experienced an increase in mental and cognitive symptoms, with a similar QoL at one-year follow-up. ConclusionsCOVID-19 ICU survivors experience equal or less health problems but a greater decline in QoL one year after ICU admission compared to non-COVID-19 ARDS or pneumonia survivors.

Effect of Interleukin-6 Inhibitor (Tocilizumab) in Treatment of Severe Cases of COVID-19 in Intensive Care Unit, Prospective Clinical Trial

Abstract Background COVID-19 is a respiratory disease induced by a novel coronavirus (SARS- CoV-2), having already caused more than 2.5 million deaths over the world. Most people with COVID-19 have only mild or uncomplicated symptoms. Aim of the Work to study the effect of using Tocilizumab in treatment of severe cases of COVID-19 in ICU. Patients and Methods is a clinical trial study (Analytic, Intervention study, single arm, prospective); this study was carried out at Ain shams university hospitals. Results The mean Time to death from receiving Tocilizumab was 6.1888 ± 0.6 SD (Days), the mean Hospital length of stay 14.94 ± 1.85 SD (Days), the number of patients required Mechanical Ventilation was 29 Patients, the mean Duration of mechanical ventilation was 15.19 ± 1.094SD (Days), the number of patients who demonstrated clinical improvement was 38 (73%) and the number of patients who discharged alive was 31 (60%). Conclusion in critically ill adult patients with Covid-19 receiving organ support in ICUs, treatment with the interleukin-6 receptor antagonists, Tocilizumab improved outcomes, including survival. Many patients achieved clinical improvement and were eventually discharged from the hospital.

Treatment of acute kidney injury with continuous renal replacement therapy and cytokine adsorber (CytoSorb®) in critically ill patients with COVID-19.

This retrospective study aimed to evaluate the 30 and 60-day survival of critically ill patients with COVID-19 and AKI. Inflammatory and biochemical biomarkers, length of intensive care unit (ICU) stay and mortality at Day 30 and Day 60 after ICU admission were analyzed. A total of 44 patients treated with continuous renal replacement therapy (CRRT) with cytokine adsorber (CA group) were compared to 58 patients treated with CRRT alone (non-CA group). Patients in CA group were younger, had better preserved kidney function prior to the beginning of CRRT and had higher levels of interleukin-6. There were no statistically significant differences in their comorbidities and in other measured biomarkers between the two groups. The number of patients who died 60 days after ICU admission was statistically significantly higher in non-CA group (p = 0.029). Treatment with CRRT and cytokine adsorber may have positively influenced 60-day survival in our COVID-19 ICU patients with AKI.

COVID-19 Bed Management Using a Two-Step Process Mining and Discrete-Event Simulation Approach

The sudden admission of many patients with similar needs caused by the COVID-19 (SARS-CoV-2) pandemic forced health care centers to temporarily transform units to respond to the crisis. This process greatly impacted the daily activities of the hospitals. In this paper, we propose a two-step approach based on process mining and discrete-event simulation for sizing a recovery unit dedicated to COVID-19 patients inside a hospital. A decision aid framework is proposed to help hospital managers make crucial decisions, such as hospitalization cancellation and resource sizing, taking into account all units of the hospital. Three sources of patients are considered: (i) planned admissions, (ii) emergent admissions representing day-to-day activities, and (iii) COVID-19 admissions. Hospitalization pathways have been modeled using process mining based on synthetic medico-administrative data, and a generic model of bed transfers between units is proposed as a basis to evaluate the impact of those moves using discrete-event simulation. A practical case study in collaboration with a local hospital is presented to assess the robustness of the approach. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —In this paper we develop and test a new decision-aid tool dedicated to bed management, taking into account exceptional hospitalization pathways such as COVID-19 patients. The tool enables the creation of a dedicated COVID-19 intensive care unit with specific management rules that are fine-tuned by considering the characteristics of the pandemic. Health practitioners can automatically use medico-administrative data extracted from the information system of the hospital to feed the model. Two execution modes are proposed: (i) fine-tuning of the staffed beds assignment policies through a design of experiment and (ii) simulation of user-defined scenarios. A practical case study in collaboration with a local hospital is presented. The results show that our model was able to find the strategy to minimize the number of transfers and the number of cancellations while maximizing the number of COVID-19 patients taken into care was to transfer beds to the COVID-19 ICU in batches of 12 and to cancel appointed patients using ICU when the department hit a 90% occupation rate.

Severe COVID-19 Outcomes in Five Latin American Countries in the Postvaccination Era.

We conducted a multicountry retrospective study using data from COVID-19 national surveillance databases to analyze clinical profiles, hospitalization rates, intensive care unit (ICU) admissions, utilization of ventilatory support, and mortality rates in five Latin American countries in the context of COVID-19 vaccination implementation. We analyzed the sociodemographic characteristics, comorbidities, clinical outcomes, and vaccination status of laboratory-confirmed COVID-19 cases from January 2021 to December 2022. We calculated the yearly and quarterly hospitalization rates per 1000 confirmed COVID-19 cases and ICU admissions, use of mechanical ventilators, and mortality rates per 1000 hospitalized cases, with their corresponding 95% confidence interval (CI) of 38,852,831 confirmed COVID-19 cases. Rates of hospitalization, ICU admission, ventilatory support, and death were higher among males than among females (38.2 vs. 32.4, 148.4 vs. 117.7, 282.9 vs. 236.2, and 346.9 vs. 320.1 per 1000, respectively); higher in 2021 than in 2022 (50.7 vs. 19.9, 207.8 vs. 58.2, 441.5 vs. 114.9, and 352.5 vs. 285.2 per 1000, respectively); and in the >50 age group (range: 5.7-18.6, 20.1-71.5, 12.2-67.9, and 353.1-577.4, per 1000) than the <50 age group (range: 2.2-9.3, 5.4-33.2, 41.4-135.8, and 22-243.5 per 1000). Hypertension and diabetes mellitus were the most common comorbidities in Mexico and Colombia. Prevention and treatment strategies for these case profiles could bring benefits from a public health perspective.

Are omicron infections more frequently associated with bacterial co-infections?

Clinical observations suggest that Omicron infections may present with different radiographic findings and be more frequently associated with bacterial co-infections, but there is a paucity of published data. This study aimed to compare the clinical and radiographic findings of patients hospitalized with Omicron versus alpha-delta infections. Between January 1, 2021 and June 30, 2021 (alpha and delta period) and between January 1, 2022 and July 31, 2022 (Omicron period), respectively 149 and 163 COVID-19 PCR-positive patients who were followed up in the COVID-19 ward and intensive care unit of a tertiary care center were included in the study. Clinical (presence of fever and purulent sputum), laboratory and radiologic findings of the two groups were compared. Sputum culture results and antibiotic use were also evaluated. In the alpha/delta group, ground glass opacities were seen in 75.2% (112) of the patients, consolidation in 2.7% (4), and both findings together in 6.0% (9). In the Omicron group, ground glass was seen in 40.5% (66), consolidation in 5.5% (9), and both ground glass and consolidation together in 8.7% (13) (p< 0.001). Procalcitonin levels were 0.25 µg/L or higher in 29.6% and 43.9% of the patients in the alpha/delta and Omicron groups, respectively. Mean PCT values were 0.36 µg/L and 1.93 µg/L, respectively (p> 0.05). CRP levels were similar in both groups. Mean LDH level in the Omicron group was 278 U/L and was significantly lower than the alpha/delta group (381 U/L) (p< 0.001). The proportion of patients requiring intensive care during hospitalization was higher in the alpha/delta group (36.2% vs 26.4%) (p= 0.06). Lower LDH levels, less need for intensive care and less frequent development of ARDS indicate that Omicron causes milder disease, while a higher rate of consolidation and higher procalcitonin levels suggest a higher frequency of bacterial co-infections.