Invasive Positive Pressure Ventilation Research Articles

Optimizing ventilatory support in ARDS: A comprehensive guide for ICU nurses on patient care

The emergence of COVID-19 as a global pandemic has placed an unprecedented strain on healthcare systems worldwide, highlighting a critical shortage of trained healthcare professionals equipped to manage such a crisis. This deficit poses a significant challenge to the delivery of healthcare services, particularly in the context of intensive care units (ICUs) where the use of advanced medical technologies, such as ventilators, is paramount. For nurses with limited experience in ICU settings, navigating the complexities of invasive positive pressure ventilation (IPPV), a principal method of mechanical ventilation for critically ill patients can be daunting. This article aims to serve as a comprehensive guide for nurses less familiar with the intricacies of managing patients on IPPV, offering insights and strategies to enhance their competence and confidence in this critical aspect of patient care.

Assessing the agreement of chronic lung disease of prematurity diagnosis between radiologists and clinical criteria

BackgroundChronic lung disease of prematurity (CLD) is the most prevalent complication of preterm birth and indicates an increased likelihood of long-term pulmonary complications. The accurate diagnosis of this condition is critical for long-term health management. Numerous definitions define CLD with different clinical parameters and radiology findings, making diagnosis of the disease ambiguous and potentially inaccurate.Methods95 patients were identified for this study, as determined by the diagnosis or confirmation of CLD in the impression of the radiologist’s report on chest x-ray. Pulmonary function and complications were recorded at multiple benchmark timeframes within each patient’s first few months of life and used for determining eligibility under each definition.ResultsEach clinical definition of CLD had a high sensitivity for patients identified to have CLD by radiologists, correctly fitting over 90% of patients. Most patients included required invasive mechanical ventilation or positive pressure ventilation at 36 weeks postmenstrual age, indicating patients with radiographically confirmed CLD tended to have more severe disease. Radiologists tended to diagnose CLD before 36 weeks postmenstrual age, a timepoint used by multiple standard clinical definitions, with cases called earlier fitting under a larger percentage of definitions than those called later.ConclusionsRadiologists tend to diagnose CLD in young patients with severe respiratory compromise, and can accurately diagnose the condition before developmental milestones for clinical definitions are met.

Operator gender differences in major mechanical complications after central line insertions: a subgroup analysis of a prospective multicentre cohort study.

A previous study on mechanical complications after central venous catheterisation demonstrated differences in complication rates between male and female operators. The objective of this subgroup analysis was to further investigate these differences. The hypothesis was that differences in distribution of predefined variables between operator genders could be identified. This was a subgroup analysis of a prospective, multicentre, observational cohort study conducted between March 2019 and December 2020 including 8586 patients ≥ 16years receiving central venous catheters at four emergency care hospitals. The main outcome measure was major mechanical complications defined as major bleeding, severe cardiac arrhythmia, pneumothorax, arterial catheterisation, and persistent nerve injury. Independent t-test and χ2 test were used to investigate differences in distribution of major mechanical complications and predefined variables between male and female operators. Multivariable logistic regression analysis was used to determine association between operator gender and major mechanical complications. Female operators had a lower rate of major mechanical complications than male operators (0.4% vs 0.8%, P = .02), were less experienced (P < .001), had more patients with invasive positive pressure ventilation (P < .001), more often chose the internal jugular vein (P < .001) and more frequently used ultrasound guidance (P < .001). Male operators more often chose the subclavian vein (P < .001) and inserted more catheters with bore size ≥ 9 Fr (P < .001). Multivariable logistic regression analysis showed that male operator gender was associated with major mechanical complication (OR 2.67 [95% CI: 1.26-5.64]) after correction for other relevant independent variables. The hypothesis was confirmed as differences in distribution of predefined variables between operator genders were found. Despite being less experienced, female operators had a lower rate of major mechanical complications. Furthermore, male operator gender was independently associated with a higher risk of major mechanical complications. Future studies are needed to further investigate differences in risk behaviour between male and female operators. Clinicaltrials.gov identifier: NCT03782324. Date of registration: 20/12/2018.

Correlation between diaphragmatic-rapid shallow breathing index and lung ultrasound score in elderly patients with mechanical ventilation and its predictive value for weaning results

To investigate the correlation between diaphragmatic-rapid shallow breathing index (D-RSBI) and lung ultrasound score (LUS) in elderly patients with mechanical ventilation and its predictive value for weaning results. A retrospective study was conducted. The clinical data of elderly patients (age > 60 years old) with invasive positive pressure ventilation (IPPV) admitted to the department of intensive care unit (ICU) of the First Affiliated Hospital of Jinzhou Medical University from January 2021 to June 2022 were enrolled. According to the outcome of withdrawal, the patients were divided into successful and failed groups. The differences in gender, age, acute physiology and chronic health evaluation II (APACHE II), D-RSBI and LUS before weaning and extubation were compared between the two groups. Pearson correlation was used to analyze the correlation between D-RSBI and LUS. The predictive value of D-RSBI and LUS on weaning results of elderly patients with IPPV was analyzed by receiver operator characteristic curve (ROC curve). A total of 398 elderly patients with IPPV were enrolled, including 300 successful weaning patients and 98 failed weaning patients. There were no significant differences in gender and age between the failed group and successful group [male: 55.1% (54/98) vs. 59.0% (177/300), age (years old): 67.02±5.03 vs. 66.96±4.99, both P > 0.05]. APACHE II score in the failed group was significantly higher than that in the successful group (17.09±3.30 vs. 16.06±3.81, P < 0.05), and the D-RSBI and LUS score before extubation were significantly higher than those in the successful group [D-RSBI (time×min-1×mm-1): 2.19±0.33 vs. 1.60±0.22, LUS: 17.30±3.04 vs. 11.97±3.20, both P < 0.01]. All patients showed a significant positive correlation between D-RSBI and LUS score (r = 0.406, P = 0.000). ROC curve analysis showed that the area under the curve (AUC) of D-RSBI for predicting weaning outcomes in elderly IPPV patients was 0.920, with a 95% confidence interval (95%CI) of 0.881-0.958 and P = 0.000. When the cut-off value was 1.85 times×min-1×mm-1, the sensitivity was 88.7% and the specificity was 86.7%. The AUC of LUS score for predicting weaning outcome in elderly IPPV patients was 0.875, with a 95%CI of 0.839-0.912 and P = 0.000. When the cut-off value was 14.50, the sensitivity was 75.7% and the specificity was 84.7%. There is a significant correlation between D-RSBI and LUS score in elderly mechanically ventilated patients, both of them can predict weaning outcome in elderly patients with mechanical ventilation.

Abstract 18350: COVID-19 Patients With Pulmonary Hypertension Hospitalized in the United States During the Early Pandemic: Analysis of In-Hospital Mortality, Clinical Outcomes, and Racial Disparities

Introduction: Coronavirus Disease 2019 (COVID-19) has been associated with adverseoutcomes among hospitalized patients with pulmonary hypertension (PH) based onlimited studies. The objective of our retrospective study was to utilize theNational Inpatient Sample (NIS) database to compare in-hospital mortality andother secondary clinical outcomes between COVID-19 patients with PH andCOVID-19 patients without PH. Hypothesis: We hypothesizedthat there would be a significant increase in inpatient mortality and othercomplications among hospitalized COVID-19 patients with PH. Methods: Patientsages 18 years and older admitted to a hospital in the United States betweenJanuary 1, 2020 and December 31, 2020 with COVID-19 were included in our studyand stratified into two cohorts. Results: Aftermultivariate adjustment, we found that COVID-19 patients with PH hadsignificantly higher in-hospital mortality, increased lengths of stay, andhigher costs of hospitalization when compared to COVID-19 patients without PH.We also noted that COVID-19 with PH had increased dependence on invasive andnon-invasive positive pressure ventilation suggestive of more severerespiratory failure. Furthermore, our data demonstrated that COVID-19 patientswith PH were at risk of pulmonary embolism and myocardial infarction. Also,Hispanic and Native American COVID-19 patients with PH remained at anindependently elevated risk for in-hospital mortality when compared to otherracial groups. Conclusions: To our knowledge this isthe largest study evaluating outcomes among COVID-19 patients with PH.In-hospital complications, especially pulmonary embolism, present a clinicalmechanism for the observed inpatient mortality. Given the significant mortalityand complications associated with COVID-19 infection and pulmonaryhypertension, we recommend vaccination against SARS-CoV-2 and aggressivenon-pharmacologic preventative measures.

Doxapram for the prevention and treatment of apnea in preterm infants.

Doxapram for the prevention and treatment of apnea in preterm infants.

Tracheostomy in Severe Bronchopulmonary Dysplasia-How to Decide in the Absence of Evidence.

Infants with the most severe forms of bronchopulmonary dysplasia (BPD) may require long-term invasive positive pressure ventilation for survival, therefore necessitating tracheostomy. Although life-saving, tracheostomy has also been associated with high mortality, postoperative complications, high readmission rates, neurodevelopmental impairment, and significant caregiver burden, making it a highly complex and challenging decision. However, for some infants tracheostomy may be necessary for survival and the only way to facilitate a timely and safe transition home. The specific indications for tracheostomy and the timing of the procedure in infants with severe BPD are currently unknown. Hence, centers and clinicians display broad variations in practice with regard to tracheostomy, which presents barriers to designing evidence-generating studies and establishing a consensus approach. As the incidence of severe BPD continues to rise, the question remains, how do we decide on tracheostomy to provide optimal outcomes for these patients?

Early clinical application and prediction of ROX index in patients with high-flow nasal canula oxygen therapy

To investigate the application value of ROX index in evaluating the effect of high-flow nasal cannula oxygen therapy (HFNC) on patients diagnosed with respiratory failure, and to find a simpler and more effective method to observe the efficacy of HFNC. A retrospective cohort study was conducted. Patients who were admitted to department of critical care medicine of the Tianjin Third Central Hospital from April 2020 to August 2022, diagnosed with type I respiratory failure, and treated with HFNC after failure of conventional oxygen therapy were enrolled. Oxygenation index (PaO2/FiO2), fraction of inspired oxygen (FiO2), gas flow rate at the initial time of admission, and pulse oxygen saturation (SpO2), FiO2 and respiratory rate (RR) at 2, 4, 6, 8, 10 and 12 hours of HFNC were collected, and ROX index was calculated. The patients with symptoms and PaO2/FiO2 improved after HFNC treatment and without higher respiratory support lately were defined as HFNC success, while other patients with symptoms worsening and needing follow-up non-invasive positive pressure ventilation (NIPPV) or invasive positive pressure ventilation (IPPV) were defined as HFNC failure. The tendency of changes in the ROX index at each time point was observed. Receiver operator characteristic curve (ROC curve) was plotted to obtain the optimum cut-off value of ROX index for predicting HFNC outcome and the optimal monitoring time point for HFNC. A total of 142 patients were eventually enrolled, among whom 96 patients (67.61%) were in treated with HFNC successfully, while 46 patients (32.39%) were recorded as HFNC failure (39 patients and 7 patients received NIPPV or IPPV, respectively), with an overall intubation rate of 4.93% (7/142). Compared with the HFNC success group, the HFNC failure group had lower PaO2/FiO2 [mmHg (1 mmHg ≈ 0.133 kPa): 208.8±37.3 vs. 235.7±48.3, P < 0.01] and higher initial gas flow rate (L/min: 46.4±3.9 vs. 42.3±4.9, P < 0.01). However, there was no significant difference in gender, age, primary diagnosis, severity of disease, hemoglobin (Hb), C-reactive protein (CRP), and brain natriuretic peptide (BNP) between the two groups. In the HFNC failure group, there were 12 patients (26.09%) received progressive oxygen therapy within 12 hours of HFNC, of which 3 patients (6.52%) occurred within 6 hours, while the other 9 patients (19.57%) occurred after 6 hours. The initial ROX index was not statistically significant between the two groups. Both groups showed a continuous increasing ROX index with longer treatment duration of HFNC, and the ROX index at all of the time points of the HFNC failure group was significantly lower than that of the HFNC success group with statistically significant difference (2 hours: 9.39±2.85 vs. 10.91±3.51, 4 hours: 8.62±2.29 vs. 11.40±3.18, 6 hours: 7.62±1.65 vs. 11.85±3.45, 8 hours: 7.79±1.59 vs. 11.62±3.10, 10 hours: 7.97±1.62 vs. 12.44±2.75, 12 hours: 8.84±2.51 vs. 12.45±3.03, all P < 0.05). The ROC curve analysis showed that the areas under the ROC curve (AUC) of ROX index assessing the effect of HFNC at the time of treating 6, 8 and 10 hours were better than 2, 4 and 12 hours (0.890, 0.903, 0.930 vs. 0.585, 0.738 and 0.829), indicating that the ROX index could determine the efficacy at the early stage of HFNC (within 6 hours). When the optimum cut-off value of ROX index was 8.78, the sensitivity was 90.6%, and the specificity was 76.5%. The ROX index at 6 hours of HFNC has a certain predictive value for the efficacy of HFNC with an optimum cut-off value of 8.78, which can provide clinical health care personnel a method for observing the efficacy of HFNC, and guide the correct selection of oxygen therapy modality at an early stage and timely adjustment of oxygen therapy strategy.

Preterm Infants off Positive Pressure Respiratory Support Have a Higher Incidence of Occult Cerebral Hypoxia

To use cerebral near-infrared spectroscopy (NIRS) to quantify occult cerebral hypoxia across respiratory support modes in preterm infants. In this prospective, longitudinal, observational study, infants ≤32weeks gestation underwent serial pulse oximetry (oxygen saturation [SpO2]) and cerebral NIRS monitoring (4-6hours per session) following a standardized recording schedule (daily for 2 weeks, every other day for 2 weeks, then weekly until 35weeks corrected gestational age). Four calculations were made: median cerebral saturation, median cerebral hypoxia burden (proportion of NIRS samples below the hypoxia threshold [<67%]), median systemic saturation, and median systemic hypoxia burden (proportion of SpO2 samples below the desaturation threshold [<85%]). During each recording session, respiratory support mode was noted (room air, low-flow nasal cannula, high-flow nasal cannula, noninvasive positive pressure ventilation, continuous positive airway pressure, and invasive ventilation). There were 1013 recording sessions made from 174 infants with a median length of 6.9hours. Although the systemic (SpO2) hypoxia burden was significantly greater for infants on the highest respiratory support (invasive and noninvasive positive pressure ventilation), the cerebral hypoxia burden was significantly greater during recording sessions made on the lowest respiratory support (8% for room air; 29% for low-flow nasal cannula). Premature infants on the highest levels of respiratory support have less cerebral hypoxia than those on lower respiratory support. These results raise concern about unrecognized cerebral hypoxia during lower acuity periods of neonatal intensive care unit hospitalization and adverse outcomes.

COVID-19 in Patients with Pre-Existing Interstitial Lung Disease: Potential Value of a Steroid-Based Treatment Strategy.

The prognosis of patients with coronavirus disease 2019 (COVID-19) and pre-existing interstitial lung disease (preILD) is poor, and no effective treatment strategy has been determined. The aim of this study was to assess the effectiveness of a steroid-based treatment strategy for patients with COVID-19 and preILD. We retrospectively reviewed the medical records of 610 consecutive patients with COVID-19 treated at our institution between 1 March 2020 and 30 October 2021 and identified 7 patients with preILD, all of whom were treated with corticosteroids and remdesivir. All the patients were men with a median age of 63 years. Three of four patients with severe disease required invasive positive-pressure ventilation (n = 2) or nasal high-flow therapy (n = 1). All three patients could be weaned from respiratory support; however, one died in hospital. The remaining patient with severe COVID-19 had a do-not-resuscitate order in place and died while hospitalized. All three patients with moderate COVID-19 were discharged. The 30-day mortality was 0%, and the mortality rate during the entire observation period was 28.5%. The prognosis of our patients with COVID-19 and preILD has been better than in previous reports. Our management strategy using corticosteroids may have improved these patients' prognosis.

Chest X-Ray Severity Index as a Predictor of Requiring Invasive Positive Pressure Ventilation in COVID-19 Positive Patients.

The aim of this study is to see the role of the chest X-ray severity index (Brixia score) as a predictor of requiring invasive positive pressure ventilation in COVID-19-positive patients. This descriptive cross-sectional prospective study were carried out in the Department of Pulmonology and Radiology, Mayo Hospital, Lahore. The data were collected from 1st May to 30th July 2020 from 60 consecutive COVID-19 positive patients. Analysis was conducted using each patient's age, gender, clinical presentation, and the report of CXR containing the most elevated score. The mean age of the study participants was 59.43±11.27, and 81.7% of patients had positive Brixia scores (≥8). Brixia score had high sensitivity (93.886) and specificity (90.91%) to predict the need for IPPV using chest X-rays. It showed excellent predictive power, having a high numerical AUC (0.870) and a statistically significant p-value (<0.0001). High Brixia score conferred a high risk of the need for invasive positive pressure ventilation due to COVID-19. Key Words: Chest X-ray, Brixia score, COVID-19, Invasive positive pressure ventilation.

Chest X-Ray Severity Index as a Predictor of Requiring Invasive Positive Pressure Ventilation in COVID-19 Positive Patients

Chest X-Ray Severity Index as a Predictor of Requiring Invasive Positive Pressure Ventilation in COVID-19 Positive Patients

Brief Overview of the Use of Extracorporeal Membrane Oxygenation (ECMO) in COVID-19 Patients with Severe Acute Respiratory Distress Syndrome (ARDS)

Background A serious complication of coronavirus disease 2019 (COVID-19) is acute respiratory distress syndrome (ARDS). Hypoxemia refractory to traditional management, including invasive positive pressure ventilation, is not uncommon with COVID-19. It can lead to circulatory failure necessitating the use of mechanical circulatory support devices, specifically extracorporeal membrane oxygenation (ECMO). Aim This paper provides a brief update on the use and indications of ECMO for adult patients with COVID-19 around the world. Methods We conducted a rapid umbrella review on the use of ECMO in treating COVID-19-related ARDS (CARDS), as well as current indications and contraindications for the initiation of ECMO. We reviewed the use of venovenous (V-V) ECMO and veno-arterial (V-A) ECMO in CARDS. Findings V-V ECMO is the primary ECMO mode employed in the majority of the patients who required ECMO support for CARDS. Although the duration of V-V ECMO in COVID-19 was longer than the V-V ECMO in non-COVID-19 patients with ARDS, the mortality rate appears similar. Meta-analyses reviewed reported an in-hospital mortality rate ranging from 37% to 49% for COVID-19 patients who required V-V ECMO. Conclusion The survival benefit of ECMO in COVID-19 patients with severe cardiopulmonary failure is not clearly established, but V-V ECMO may be considered in adults with COVID-19 and severe cardiopulmonary compromise when resources are available. V-A ECMO may be considered in COVID-19 patients with severe cardiac failure, but limited data are available on survival benefits.

Clinical review of high-flow nasal oxygen therapy in human and veterinary patients.

Oxygen therapy is the first-line treatment for hypoxemic acute respiratory failure. In veterinary medicine this has traditionally been provided via mask, low-flow nasal oxygen cannulas, oxygen cages and invasive positive pressure ventilation. Traditional non-invasive modalities are limited by the maximum flow rate and fraction of inspired oxygen (FiO2) that can be delivered, variability in oxygen delivery and patient compliance. The invasive techniques are able to provide higher FiO2 in a more predictable manner but are limited by sedation/anesthesia requirements, potential complications and cost. High-flow nasal oxygen therapy (HFNOT) represents an alternative to conventional oxygen therapy. This modality delivers heated and humidified medical gas at adjustable flow rates, up to 60 L/min, and FiO2, up to 100%, via nasal cannulas. It has been proposed that HFNOT improves pulmonary mechanics and reduces respiratory fatigue via reduction of anatomical dead space, provision of low-level positive end-expiratory pressure (PEEP), provision of constant FiO2 at rates corresponding to patient requirements and through improved patient tolerance. Investigations into the use of HFNOT in veterinary patients have increased in frequency since its clinical use was first reported in dogs with acute respiratory failure in 2016. Current indications in dogs include acute respiratory failure associated with pulmonary parenchymal disease, upper airway obstruction and carbon monoxide intoxication. The use of HFNOT has also been advocated in certain conditions in cats and foals. HFNOT is also being used with increasing frequency in the treatment of a widening range of conditions in humans. Although there remains conflict regarding its use and efficacy in some patient groups, overall these reports indicate that HFNOT decreases breathing frequency and work of breathing and reduces the need for escalation of respiratory support. In addition, they provide insight into potential future veterinary applications. Complications of HFNOT have been rarely reported in humans and animals. These are usually self-limiting and typically result in lower morbidity and mortality than those associated with invasive ventilation techniques.

Outcome predictors and patient progress following delivery in pregnant and postpartum patients with severe COVID-19 pneumonitis in intensive care units in Israel (OB-COVICU): a nationwide cohort study

A key unresolved controversy in severe COVID-19 pneumonitis in pregnancy is the optimum timing of delivery and whether delivery improves or worsens maternal outcomes. We aimed to assess clinical data on every intensive care unit (ICU) day for pregnant and postpartum women admitted to the ICU with COVID-19, with a particular focus on the days preceding and following delivery. In this multicentre, nationwide, prospective and retrospective cohort study, we evaluated all pregnant women who were admitted to an ICU in Israel with severe COVID-19 pneumonitis from the 13th week of gestation to the 1st week postpartum. We excluded pregnant patients in which the ICU admission was unrelated to severe COVID-19 pneumonitis. We assessed maternal and neonatal outcomes and longitudinal clinical and laboratory ICU data. The primary overall outcome was maternal outcome (worst of the following: no invasive positive pressure ventilation [IPPV], use of IPPV, use of extracorporeal membrane oxygenation [ECMO], or death). The primary longitudinal outcome was Sequential Organ Failure Assessment (SOFA) score, and the secondary longitudinal outcome was the novel PORCH (positive end-expiratory pressure [PEEP], oxygenation, respiratory support, chest x-ray, haemodynamic support) score. Patients were classified into four groups: no-delivery (pregnant at admission and no delivery during the ICU stay), postpartum (ICU admission ≥1 day after delivery), delivery-critical (pregnant at admission and receiving or at high risk of requiring IPPV at the time of delivery), or delivery-non-critical (pregnant at admission and not critically ill at the time of delivery). From Feb 1, 2020, to Jan 31, 2022, 84 patients were analysed: 34 patients in the no-delivery group, four in postpartum, 32 in delivery-critical, and 14 in delivery-non-critical. The delivery-critical and postpartum groups had worse outcomes than the other groups: 26 (81%) of 32 patients in the delivery-critical group and four (100%) of four patients in the postpartum group required IPPV; 12 (38%) and three (75%) patients required ECMO, and one (3%) and two (50%) patients died, respectively. The delivery-non-critical and no-delivery groups had far better outcomes than other groups: six (18%) of 34 patients and two (14%) of 14 patients required IPPV, respectively; no patients required ECMO or died. Oxygen saturation (SpO2), SpO2 to fraction of inspired oxygen (FiO2) ratio (S/F ratio), partial pressure of arterial oxygen to FiO2 ratio (P/F ratio), ROX index (S/F ratio divided by respiratory rate), and SOFA and PORCH scores were all highly predictive for adverse maternal outcome (p<0·0001). The delivery-critical group deteriorated on the day of delivery, continued to deteriorate throughout the ICU stay, and took longer to recover (ICU duration, Mantel-Cox p<0·0001), whereas the delivery-non-critical group improved rapidly following delivery. The day of delivery was a significant covariate for PORCH (p<0·0001) but not SOFA (p=0·09) scores. In patients who underwent delivery during their ICU stay, maternal outcome deteriorated following delivery among those defined as critical compared with non-critical patients, who improved following delivery. Interventional delivery should be considered for maternal indications before patients deteriorate and require mechanical ventilation. None.

Comparing critically ill ARDS patients with COVID-19 vs. without COVID-19: A prospective, bivariate and multi-variable analysis of 690 patients

Background &amp; objective: Few studies have directly and prospectively compared ICU patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 vs. other causes. Almost all previously-published studies were retrospective and employed historical non-COVID cases. We aimed to identify and compare patient characteristics and predictors of mortality associated with COVID-related vs. non-CIVID-related ARDS.&#x0D; Methodology: We performed a prospective cohort study. Consecutive ARDS patients with or without confirmed COVID-19 admitted to an ICU of a major tertiary-care hospital from March-December 2020 were included. A total of 160 patients with ARDS and positive for COVID-19 and 530 ARDS patients without COVID-19 were enrolled. Data were collected and both bivariate and multivariable analyses performed on COVID-19 status, demographics, morphometrics, comorbidities, presenting symptoms, general health status (APACHE-II) on admission, respiratory parameters and laboratory tests at admission, within 24 h of admission, and pre-intubation. The treatment administered and outcomes were also recorded. Data capture was almost 100%.&#x0D; Results: Numerous clinical differences were detected between 160 patients with COVID-19 vs. 530 patients without COVID-19. Most notably, COVID-19 patients were generally older and heavier, much more frequently presented with fevers/chills, dyspnea, cough, anosmia/ageusia, and sore throat — and had worse outcomes. including over a two-fold rate of mortality and five-fold rate of survivors requiring prolonged supplemental oxygen. The presenting symptom dyad of fevers and/or chills and dyspnea was 93.0% sensitive and 63.4% specific for COVID-related ARDS. A baseline APACHE-II Score ≥ 17 and requiring mechanical ventilation was 94.4% sensitive and 70.5% specific for mortality. All 37 COVID patients with an APACHE-II score &gt; 30 died, vs. survival among non-COVID patients with APACHE-II scores up to 40.&#x0D; Conclusion: In one of the first large studies to directly compare contemporary populations of COVID-19 and non-COVID ICU patients with ARDS, employing multi-variable analysis, numerous differences in patient characteristics, presentation, and outcomes were detected.&#x0D; Abbreviations: APACHE-II - Acute Physiologic Assessment and Chronic Health Evaluation 2nd edition; PaO2 - Partial Pressure of Oxygen; SaO2 - Arterial Oxygen Saturation; BUN - Blood Urea Nitrogen; ALT - Alanine Aminotransferase; AST - Aspartate Aminotransferase; LDH - Lactate Dehydrogenase; NIPPV - Non- Invasive Intermittent Positive Pressure Ventilation; HFNC - High-Flow Nasal Cannula; ECMO - Extra-Corporeal Membrane Oxygenation&#x0D; Key words: COVID-19; ARDS; Clinical Characteristics; Treatment; Outcomes; Predictors&#x0D; Citation: Algethamy HM, Aboudeif MM, Alhandi MO, Majrashi FY, Hakami SH, Jan MA, Kabli HA, Alhomrani MH, White KP. Comparing critically ill ARDS patients with COVID-19 vs. without COVID-19: A prospective, bivariate and multi-variable analysis of 690 patients. Anaesth. pain intensive care 2023;27(6):652−664; DOI: 10.35975/apic.v27i6.2355&#x0D; Received: March 04, 2023; Revised: October 09, 2023; Accepted: October 25, 2023

A Hospital-based Study to Assess Various Laboratory Parameters for Prediction of Severity of COVID-19 Disease at the Time of Admission at a Teaching Tertiary Hospital

Abstract Background: The main aim of this study was to determine the association between various laboratory parameter values at the time of admission with the severity classification of COVID-19 infection. Secondarily, this study also determined the cutoff value of associated laboratory parameters with the severity of infection at the time of admission. This study evaluated the association of laboratory parameters and other factors with the severity of COVID-19 infection (mild, moderate, and severe). Methodology: This study analyzed 170 adult patients with symptomatic COVID-19 infection hospitalized between July 2020 and December 2020 at a teaching tertiary care center in South Gujarat. All the patients selected in the study had a positive polymerase chain reaction test result of SARS-CoV-2. Laboratory parameters and clinical details of patients were recorded. Results: A total of 170 COVID-19-infected hospitalized patients were analyzed. The serum ferritin levels were 1.12 times higher in severe patients compared to mild category patients and 1.006 times higher in severe patients compared to moderate category patients, as determined using multinomial logistic regression. The requirement of invasive positive pressure ventilation (IPPV), BIPAP, and nonrebreathing mask at admission was substantially linked with patients in the severe and moderate categories (P &lt; 0.0001). Compared to the mild category, the need for IPPV was 534.9 (95% confidence interval [CI]: [21.93–13022.20]) times greater in the severe category, and 50.41 (95% CI: [3.034–837.55]) times higher in the severe individuals. In addition, this study also evaluated the cutoff value for serum ferritin was identified at ≤276.35 ng/mL for mild, 276.35–473.5 ng/mL for moderate, and ≥473.5 as severe COVID-19 infection at the time of admission. Conclusion: Early ferritin estimation could be used to assess the severity and categorization of COVID-19 infection at the time of admission itself and can be of immense benefit in the treatment of the disease.

251. Clinical Features and Outcomes of Pneumothorax and Pneumomediastinum in COVID-19

Abstract Background Pneumothorax (PTX) and pneumomediastinum (PM) have been reported among hospitalized patients with COVID-19. It can occur among patients breathing spontaneously or as a result of barotrauma from invasive positive-pressure ventilation or from medical procedures. We aim to study the clinical features and outcomes of pneumothorax and pneumomediastinum within 48 hours of hospitalization among COVID-19 patients. Methods We conducted a multicenter retrospective study among the hospitalized adults with COVID-19 who had pneumothorax and pneumomediastinum within 48 hrs. of admission between November 2020 and December 2021. Cases were identified using ICD 10 codes. Electronic medical records were reviewed after Institutional Board approval. Results We identified a total of 21 patients, 12 (57%) only had PTX, 6 (28%) only had PM, and 3(14%) had both. Mean age for the cohort was 57 yrs, 13 (62%) were females, and 14 (67%) were whites. Chronic lung and end-stage renal diseases were noted among 9 (43%) patients followed by obesity in 9 (43%) and diabetes in 4 (19%). A total of 12 (57%) patients have smoked tobacco. At the time of hospitalization, 12 (57%) patients had oxygen saturation ≤94% and 9 (43%) had ≤90%. PTX and PM on admission chest x-ray were noted in 12(57%) and 4 (19%) respectively. 3 (14%) developed them after intubating and/ or after BiPAP. Patients were treated with steroids (90%), remdesivir (62%), interleukin-6 inhibitors (24%), and convalescent plasma (9%). Chest tube was placed in 7 (33%) patients and thoravent in 1 (5%) patient. Complications were septic shock (14%) and deep venous thrombosis (10%). There were 4(19%) deaths. Conclusion Spontaneous PTX can be a presenting sign for COVID-19. We noted higher complications and mortality among the COVID-19 patients with PTX and PM than reported in literature. Clinicians should be aware of this potential occurrence, requiring close monitoring and aggressive management. Larger studies can further validate the findings of our study. Disclosures All Authors: No reported disclosures.

Respiratory function after birth in infants with congenital diaphragmatic hernia

ObjectiveTo characterise the transitional pulmonary physiology of infants with congenital diaphragmatic hernia (CDH) using measures of expiratory tidal volume (TV) and end-tidal carbon dioxide (ETCO2).DesignProspective single-centre observational study.SettingQuaternary neonatal intensive...

Clinical Characteristics, Comorbidities, and Outcome of Critically Sick Patients With COVID-19 Pneumonia Admitted in the Intensive Care Unit of a Tertiary Care Hospital in Lahore, Pakistan: A Retrospective Cohort Study.

BackgroundCoronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a multisystem disease that primarily involves the respiratory tract. The first case of COVID-19 was identified in late 2019 in the province of Wuhan, China, which was followed by the rapid spread of the disease globally, becoming a present-day pandemic.ObjectivesThe aim of this study is to describe the clinical characteristics, comorbidities, and outcomes of critically sick patients with COVID-19 pneumonia admitted to the intensive care unit (ICU) of Fatima Memorial Hospital, Lahore, from March 2021 to August 2021. A total of 133 patients were chosen for this retrospective cohort study.ResultsThere was a total of 133 patients, out of which 65 (48.9%) were male and 68 (51.1%) were female. Of these 133 patients, 70 (52.6%) were discharged home after recovery and 63 (47.4%) died; 96 (72.2%) patients had diabetes mellitus and of these, 53 (55.2%) patients died and 43 (44.8%) were discharged, 94 (70.7%) patients had hypertension, out of which 53 (56.4%) died and 41 (43.6%) were discharged home, 40 (30.1%) patients had ischemic heart disease (IHD), out of which 28 (70%) died and 12 (30%) were discharged. A total of 48 (36.1%) patients needed invasive positive pressure ventilation (IPPV) and 78 (58.6%) patients required noninvasive positive pressure ventilation (NIPPV).ConclusionPatients with one or more underlying co-morbidities had poor clinical outcomes compared to those with no co-morbidities, with the most vulnerable group being patients with Ischemic heart disease, chronic kidney disease, hypertension, and diabetes mellitus in descending order.