Necessity Of Mechanical Ventilation Research Articles

Determinants of mortality in hypertensive patients admitted with COVID-19: a single-centre retrospective study at a tertiary hospital in South Africa

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic has significantly impacted global health, with successive outbreaks leading to substantial morbidity and mortality. Hypertension, a leading cause of cardiovascular disease globally, has been identified as a critical comorbidity in patients with severe COVID-19, exacerbating the risk of adverse outcomes. This study aimed to elucidate the impact of hypertension on COVID-19 outcomes within the South African context.MethodsA retrospective analysis was conducted at King Edward VIII Hospital, KwaZulu-Natal, South Africa, encompassing patients aged 13 years and above admitted with laboratory-confirmed SARS-CoV-2 infection between June 2020 and December 2021. The study investigated the association between hypertension and COVID-19 outcomes, analysing demographic, clinical, and laboratory data. Statistical analysis involved univariate and multivariate logistic regression to identify predictors of mortality among the hypertensive cohort.ResultsThe study included 420 participants—encompassing 205 with hypertension. Hypertensive patients demonstrated significantly greater requirements for oxygen and steroid therapy (p < 0.001), as well as higher mortality rates (44.88%, p < 0.001)) compared to their non-hypertensive counterparts. Key findings demonstrated that a lower oxygen saturation (adjusted odds ratio (aOR) 0.934, p = 0.006), higher pulse pressure (aOR 1.046, p = 0.021), elevated CRP (aOR 1.007, p = 0.004) and the necessity for mechanical ventilation (aOR 5.165, p = 0.004) were independent risk factors for mortality in hypertensive COVID-19 patients. Notably, the study highlighted the pronounced impact of hypertension-mediated organ damage (HMOD) on patient outcomes, with ischemic heart disease being significantly associated with increased mortality (aOR 8.712, p = 0.033).ConclusionHypertension significantly exacerbates the severity and mortality risk of COVID-19 in the South African setting, underscoring the need for early identification and targeted management of hypertensive patients. This study contributes to the understanding of the interplay between hypertension and COVID-19 outcomes, emphasising the importance of considering comorbidities in the management and treatment strategies for COVID-19. Enhanced pandemic preparedness and healthcare resource allocation are crucial to mitigate the compounded risk presented by these concurrent health crises.

The role of procalcitonin as a risk stratification tool of severity, prognosis, and need for surgery in patients with acute left-sided colonic diverticulitis

BackgroundImaging-based classifications do not always reflect the clinical severity and prognosis of acute left-sided colonic diverticulitis. This study aims to investigate the role of an early procalcitonin assessment in the emergency department as a risk stratification tool for severity, prognosis, and need for surgery in patients with acute left-sided colonic diverticulitis. MethodsIn this retrospective cohort study, all adult patients consecutively admitted from January 2015 to September 2020 for acute left-sided colonic diverticulitis and having a procalcitonin determination at admission were enrolled. The following data were collected: age, sex, comorbidities, laboratory parameters, level of urgency, clinical presentation, type of treatment, complications, and post-management outcomes. The association between the procalcitonin value at admission and the following endpoints was analyzed: type of treatment, classification of acute left-sided colonic diverticulitis, mortality, and type of surgery. ResultsA total of 503 consecutive patients were enrolled. Procalcitonin >0.5 ng/mL emerged as an independent risk factor for complicated acute left-sided colonic diverticulitis (P = .007). Procalcitonin >0.5 ng/mL (P = .033), together with a history of complicated acute left-sided colonic diverticulitis (P < .001), abdominal pain (P = .04), bowel perforation (P < .001), and peritonitis (P < .001), was a significant risk factor for surgery. Procalcitonin >0.5 ng/mL (P = .007) and peritonitis (P = .03) emerged as independent risk factors for sigmoidectomy without colorectal anastomosis. Procalcitonin >0.5 ng/mL (P = .004), a higher level of urgency at admission (P = .005), Hartmann’s procedure (P = .002), and the necessity of mechanical ventilation (P = .004) emerged as independent risk factors for mortality. ConclusionProcalcitonin >0.05 ng/mL at emergency department admission is a useful risk stratification tool for severity, prognosis, and need for surgical treatment in patients with acute left-sided colonic diverticulitis.

Comparison of Bubble CPAP Versus Conventional Ventilation in Neonates Having Respiratory Distress

Objective: To compare the outcomes of bubble continuous positive airway pressure (B-CPAP) versus ventilator continuous positive airway pressure (V-CPAP) in neonates experiencing respiratory distress. Methodology: This randomized controlled trial was conducted at the Department of Neonatology, Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from March 1, 2021, to August 31, 2021. A total of 150 neonates of both genders who presented with respiratory distress and were delivered at &gt;32 weeks of gestation, weighing &gt;1500 grams. The neonates were then randomly allocated to two groups using a lottery method. Treatment failure was defined as a neonate's inability to maintain a SpO2 greater than 90% or an arterial partial pressure (PaO2) greater than 50 mmHg with a maximal CPAP of &gt;7 cm of water and a FiO2 greater than 0.6 or the necessity of mechanical ventilation. Results: Of these, 82 (54.7%) were male, and 68 (45.3%) were female, resulting in a male-to-female ratio of 1.2:1. The mean gestational age was 36±2.49 weeks in the B-CPAP group and 35.52±1.36 weeks in the V-CPAP group. The mean birth weight was 2381±506.4 grams in the B-CPAP group and 2187.3±427.49 grams in the V-CPAP group. Out of the 75 neonates in the B-CPAP group, 10 (13.3%) were classified as treatment failures, while 19 (25.3%) out of 75 neonates in the V-CPAP group met the criteria for treatment failure, according to our operational definition. Although the failure rate was slightly higher in patients receiving V-CPAP for the management of respiratory distress, these differences were not statistically significant (p-value= 0.052). Conclusion: In the treatment of neonatal respiratory distress, there was no significant difference in the failure rate between bubble CPAP and ventilatory CPAP. Regardless of the neonate's gender, birth weight, gestational age, or Silverman score, bubble CPAP may be considered as the primary mode of respiratory support for neonates with respiratory distress.

Clinico-Etiological Spectrum and Outcome in Patients With Septic Acute Kidney Injury and Its Comparison With Non-septic Acute Kidney Injury: A Hospital-Based Prospective Study Conducted in a Tertiary Care Hospital in North India.

Background Acute kidney injury (AKI) is a heterogenous syndrome defined by the impairment of kidney filtration and excretory function over days to weeks, resulting in the retention of nitrogenous and other waste products normally cleared by the kidneys. In addition, AKI is frequently recognized to be associated with sepsis and contributes to an unfavorable outcome in sepsis. This study was undertaken to study and compare the etiology and clinical profile of patients with septic and non-septicAKI and to study and compare the outcome in both groups. Materials and methods This is a prospective, observational, and comparative study with a total sample size of 200 patients selected randomly having sustained an acute kidney injury. Data was collected, recorded, analyzed, and compared for two groups of patients with septic and non-septic AKI. Results A total of 200 cases of AKIwere enrolled, out of which 120 (60%) were due to non-septic etiology and 80 (40%) were of septic etiology. Urosepsis (37.5%) due to various urinary tract infections including pyelonephritis and chest sepsis (18.75%) including community-acquired pneumonia (CAP) and aspiration pneumoniawere the predominant causes of sepsis. AKI secondary to nephrotoxic agents (27.5%) was the commonest cause in the non-septic group, followed by glomerulonephritis (13.3%), vitamin D intoxication-related hypercalcemia (12.5%), acute gastroenteritis (10.8%), etc. Patients of septic AKI had a significantly higher mean of maximum urea and creatinine than their non-septic AKI counterparts. In addition to having an increased duration of hospital stay, mortality was significantly higher in patients with septic AKI (27.5%) than in patients with non-septic AKI (4.1%). However, sepsis had no effect on renal functions, measured by urea and creatinine, at discharge. In patients with AKI, certain factors were found to increase the risk of mortality. These factors include being over 65 years old, needing mechanical ventilation or vasopressors, requiring renal replacement therapy (RRT), and having multiorgan dysfunction syndrome (MODS), septic shock, or acute coronary syndrome (ACS). However, pre-existing conditions such as diabetes, hypertension, malignancy, previous stroke, chronic kidney disease (CKD), and chronic liver disease (CLD) did not affect the overall mortality risk. Conclusion In the septic AKI group, urosepsis was the most frequent etiology of AKI, whilethe most frequent etiology of AKIin the non-septic group was nephrotoxin exposure. Patients with septic AKI had considerably longer hospital stays and greater in-hospital mortality rates than patients with non-septic AKI. The renal functions as determined by urea and creatinine at discharge were unaffected by sepsis. Finally, death was significantly impacted by age of >65 years, the necessity for mechanical ventilation, the use of vasopressors and RRT, and the presence of MODS, septic shock, and ACS.

Trends and risk factors of in-hospital mortality of patients with COVID-19 in Germany

Abstract Background Unselected data of nationwide studies of hospitalized patients with COVID-19 is still sparse, but these data are of outstanding interest not to exceed hospital capacities and to avoid overloading of national health-care systems. Purpose Thus, we sought to analyze seasonal/regional trends, predictors of in-hospital case-fatality and mechanical ventilation (MV) in patients with COVID-19 in Germany. Methods We used the German nationwide inpatient sample to analyze all hospitalized patients with confirmed COVID-19 diagnosis in Germany between January 1st and December 31st in 2020 (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2020, own calculations). Covid-19-inpatients with MV vs. without MV and survivors vs. non-survivors were compared. Logistic regression models were calculated to investigate associations between patients' characteristics as well as adverse events and i) necessity of MV and ii) in-hospital death. Results We analyzed data of 176,137 hospitalizations of patients with confirmed COVID-19-infection. Among those, 31,607 (17.9%) died, whereby in-hospital case-fatality grew exponentially with age. Cardiovascular comorbidities were common in hospitalized patients with confirmed COVID-19-infections: Overall, almost half of the patients (46.8%; n=82,480) had arterial hypertension and 25,574 (14.4%) had a diagnosis of coronary artery disease. In 60.7% (n=106,913) of the hospitalizations, pneumonia was reported, 8.6% (n=15,061) had an acute infection of the upper or lower airways other than pneumonia, and 6.6% (n=11,594) suffered from an acute respiratory distress syndrome (ARDS) during hospitalization Age ≥70 years (OR 5.91, 95% CI 5.70–6.13, P&amp;lt;0.001), pneumonia (OR 4.58, 95% CI 4.42–4.74, P&amp;lt;0.001) and acute respiratory distress syndrome (OR 8.51, 95% CI 8.12–8.92, P&amp;lt;0.001) were strong predictors of in-hospital death. Most COVID-19-patients were treated in hospitals in urban areas (n=92,971) associated with lowest case-fatality (17.5%) as compared to hospitals in suburban (18.3%) or rural areas (18.8%). MV demand was highest in November/December 2020 (32.3%, 20.3%) in patients between 6th and 8th age-decade. In the first age-decade, 78 of 1861 children (4.2%) with COVID-19-infection were treated with MV and five of them died (0.3%). Conclusion The results of our study indicate seasonal and regional variations concerning number of COVID-19-patients, necessity of MV and case-fatality in Germany. These findings may help to ensure flexible allocation of intensive care (human) resources, which is essential for managing enormous societal challenges worldwide to avoid overloaded regional health-care systems. Funding Acknowledgement Type of funding sources: None.

Clinical characteristics and risk factors associated with severe disease and outcome of patients with COVID-19

Since the beginning of the pandemic, factors associated with mortality in patients with corona virus infection disease 2019 (COVID-19) have been investigated. Comorbidities and increased age have been frequently reported to be associated with mortality. We aimed to evaluate the factors associated with unfavorable outcome of patients with COVID-19 at an early period of the pandemic. This single center, retrospective, observational study was conducted among laboratory confirmed COVID-19 patients hospitalized between March 11 and May 5, 2020, at Umraniye Training and Research Hospital, Istanbul, Turkey. The effects of the severity of illness, comorbidities, symptoms, and laboratory findings on the clinical outcome were evaluated. Factors associated with unfavorable outcome (necessity of mechanical ventilation or death) were examined using Cox proportional hazards models. Out of a total of 728 patients, 53.8% were men and median age 54 years. The 30-day mortality rate was 4.9% among all hospitalized patients. A logistic regression model identified six predictors of unfavorable clinical outcome: age, severity of illness, the numbers of comorbidities, lymphopenia, high levels of C-reactive protein, and procalcitonin. The mortality rate was lower among the patients with COVID-19, hospitalized during the early period of the pandemic. Older age, higher severity score on admission, the numbers of comorbidities, higher levels of C-reactive protein, procalcitonin, and lymphopenia were identified to be associated with unfavorable outcome of the hospitalized patients with COVID-19.

Trends and Risk Factors of In-Hospital Mortality of Patients with COVID-19 in Germany: Results of a Large Nationwide Inpatient Sample.

Unselected data of nationwide studies of hospitalized patients with COVID-19 are still sparse, but these data are of outstanding interest to avoid exceeding hospital capacities and overloading national healthcare systems. Thus, we sought to analyze seasonal/regional trends, predictors of in-hospital case-fatality, and mechanical ventilation (MV) in patients with COVID-19 in Germany. We used the German nationwide inpatient samples to analyze all hospitalized patients with a confirmed COVID-19 diagnosis in Germany between 1 January and 31 December in 2020. We analyzed data of 176,137 hospitalizations of patients with confirmed COVID-19-infection. Among those, 31,607 (17.9%) died, whereby in-hospital case-fatality grew exponentially with age. Overall, age ≥ 70 years (OR 5.91, 95%CI 5.70–6.13, p < 0.001), pneumonia (OR 4.58, 95%CI 4.42–4.74, p < 0.001) and acute respiratory distress syndrome (OR 8.51, 95%CI 8.12–8.92, p < 0.001) were strong predictors of in-hospital death. Most COVID-19 patients were treated in hospitals in urban areas (n = 92,971) associated with the lowest case-fatality (17.5%), as compared to hospitals in suburban (18.3%) or rural areas (18.8%). MV demand was highest in November/December 2020 (32.3%, 20.3%) in patients between the 6th and 8th age decade. In the first age decade, 78 of 1861 children (4.2%) with COVID-19-infection were treated with MV, and five of them died (0.3%). The results of our study indicate seasonal and regional variations concerning the number of COVID-19 patients, necessity of MV, and case fatality in Germany. These findings may help to ensure the flexible allocation of intensive care (human) resources, which is essential for managing enormous societal challenges worldwide to avoid overloaded regional healthcare systems.

Ambulation capacity, age, immunosuppression, and mechanical ventilation are risk factors of in-hospital death in severe COVID-19: a cohort study

Despite ambulation capacity being associated with a decreased level of physical activity and survival may be influenced by the functional capacity, studies have not addressed the association between ambulation capacity and death in patients hospitalized by COVID-19. To verify the functional, clinical, and sociodemographic risk factors associated with in-hospital death in individuals with severe COVID-19. It is a cohort retrospective study performed at a large tertiary hospital. Patients18years of age or more, of both sexes, hospitalized due to severe COVID-19 were included. Cases with dubious medical records and/or missing essential data were excluded. Patients were classified according to their ambulation capacity before the COVID-19 infection. Information regarding sociodemographic characteristics, in-hospital death, total hospital stays, Intensive Care Unit (ICU) stays, and the necessity of Mechanical Ventilation (MV) were collected from medical records and registered in a RedCap database. Multiple logistic regression analysis was used to identify possible factors associated with the in-hospital death rate. Data from1110participants were included in the statistical analysis. The median age of the patients was57(46‒66)years, 58.42% (n=590) were male, and 61.73% (n=602) were brown or black. The case fatality rate during hospitalization was36.0%(n=363). In-hospital death was associated with ambulation capacity; dependent ambulators (OR=2.3; CI 95%=1.2-4.4) and non-functional ambulation (OR=1.9; CI 95%= 1.1-3.3), age [older adults (OR=3.0; CI 95%=1.9‒4.), ICU stays (OR=1.4; CI 95%=1.2‒1.4), immunosuppression (OR=5.5 CI 95%=2.3‒13.5) and mechanical ventilation (OR=27.5; CI95%=12.0-62.9). Decreased ambulation capacity, age, length of ICU stay, immunosuppression, and mechanical ventilation was associated with a high risk of in-hospital death due to COVID-19.

Assessment of The Effect of Tocilizumab in Adult Hospitalized COVID-19 Pneumonia Patients: A Clinical Trial

ackground: Coronavirus disease 2019 (COVID-19) is a life-threatening infectious disease causing potentially severe acute respiratory infection which may lead to multi-organ dysfunction or failure due to severe acute respiratory syndrome coronavirus (SARS-CoV-2) also known as novel coronavirus (nCoV). Tocilizumab is anti-interleukin-6 receptor antibody may have potential role in minimizing mortality and mechanical ventilation requirements among hospitalized COVID-19 patients. Objective: To analyze the effect of tocilizumab in adult hospitalized COVID-19 pneumonia patients. Methods: This non-randomized, controlled, open-label trial was carried out at a tertiary care hospital, Sylhet, Bangladesh. Hospitalized COVID-19 pneumonia patients with hypoxia ( oxygen saturation &lt; 92% on air or required oxygen) and proof of systemic inflammation(C-reactive protein ≥50mg/L) were assigned (in 1:1 ratio) to receive a standard care plus single dose of tocilizumab (8mg/kg up to a maximum of 800mg) or only standard care, who were not provided mechanical ventilation. Primary outcomes were 28-day mortality and necessity of mechanical ventilation. Results: The mean age was 59.08±12.39 years in tocilizumab group and mean age was 55.41±12.82 years in control group. Maximum patients were &gt;60 years. The most common symptoms were fever (44.4%) then cough (38.9%), and others including diarrhoea, fatigue (33.3%). Majority risk factors were DM (47.7%) followed by HTN (30.5%). Mortality was more in control group than tocilizumab group which was 83.3% and 44.4% respectively. It is also observed that tocilizumab group patients needed mechanical ventilation significantly lower than the control group which was 19.4% and 44.4% respectively. The difference was statistically remarkable between the two groups (P&lt;0.05). Conclusion: This study shows that hospitalized COVID-19 patients who were not receiving mechanical ventilation,tocilizumab increased survival rate and reduced the need of mechanical ventilation.

Antibiotic Use and Associated Risk Factors for Antibiotic Prescribing in COVID-19 Hospitalized Patients

Background: Literature suggests that antibiotic prescribing in COVID-19 patients is high. Currently, there are insufficient data on what drives antibiotic prescribing practices throughout the COVID-19 pandemic. Objective: This study sought to determine antibiotic use rates and identify risk factors for antibiotic prescribing in hospitalized patients. It was the first study to assess risk factors for receiving more than 1 course of antibiotics. Methods: This was a retrospective, multi-center, observational study. Patients admitted from March 1, 2020, to May 31, 2020, and treated for COVID-19 were included. The primary endpoint was the rate of antibiotic use during hospitalization. Secondary endpoints included risk factors associated with antibiotic use, risk factors associated with receiving more than 1 antibiotic course, and rate of microbiologically confirmed infections. Results: A total of 208 encounters (198 patients) were included in the final analysis. Eighty-three percent of patients received at least 1 course of antibiotics, despite low rates of microbiologically confirmed infection (12%). Almost one-third of patients (30%) received more than 1 course of antibiotics. Risk factors identified for both antibiotic prescribing and receiving more than 1 course of antibiotics included increased hospital length of stay (median 12 days), intensive care unit admission, and the necessity for mechanical ventilation. Conclusion and Relevance: There were high rates of antibiotic prescribing with low rates of microbiologically confirmed bacterial co-infection. Many patients received more than 1 course of antibiotics during hospitalization. This study highlights the importance and demand for appropriate antibiotic stewardship practices in COVID-19 patients.

Glycated Hemoglobin (HbA1c) as a Predictor of Outcomes during Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Systemic inflammation may be the common denominator between COPD and type 2 diabetes and may explain the correlation in both diseases’ development and progress. The aim of this prospective observational study is to examine the prognostic value of glycated hemoglobin levels (HbA1c) and HbA1c-adjusted glycemic variables (glycemic gap, stress hyperglycemia ratio και modified stress hyperglycemia ratio) in an acute exacerbation of COPD (AECOPD) as well as in COPD disease's morbidity and mortality during the following year. We evaluated patients hospitalized only for COPD exacerbations. Levels of HbA1c and HbA1c-adjusted glycemic variables were recorded upon admission. The study outcomes included duration of hospital stay, need for mechanical ventilation and exacerbation outcome. All subjects were followed up for one year. A total of 156 patients were included in the study (74.4% men, age [mean ± SD] 72 ± 7 years). Patients (21.8%) had type 2 diabetes and 67.9% of patients were receiving ICS treatment. The median value of HbA1c was 5.9 (IQR: 5.4, 6.5). Necessity for mechanical ventilation was significantly higher for patients with lower values of HbA1c [median: 5.3 (IQR 5.02, 6.3) vs. 5.9 (IQR 5.5, 6.5), p = .038]. However, duration of hospitalization, death during hospitalization as well as the number of new exacerbation events, time to next exacerbation and mortality during the following year did not differ significantly. Moreover, none of the HbA1c-adjusted glycemic variables examined, demonstrated any statistical significance. In conclusion neither the preceding nor the present glycemic state exhibit a predictive value regarding short- or long-term outcomes of an AECOPD.

Dynamics of SARS-CoV-2 shedding in the respiratory tract depends on the severity of disease in COVID-19 patients

A fraction of COVID-19 patients progress to a severe disease manifestation with respiratory failure and the necessity of mechanical ventilation. Identifying patients at risk is critical for optimised care and early therapeutic interventions. We investigated the dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding relative to disease severity.We analysed nasopharyngeal and tracheal shedding of SARS-CoV-2 in 92 patients with diagnosed COVID-19. Upon admission, standardised nasopharyngeal swab or sputum samples were collected. If patients were mechanically ventilated, endotracheal aspirate samples were additionally obtained. Viral shedding was quantified by real-time PCR detection of SARS-CoV-2 RNA.45% (41 out of 92) of COVID-19 patients had a severe disease course with the need for mechanical ventilation (severe group). At week 1, the initial viral shedding determined from nasopharyngeal swabs showed no significant difference between nonsevere and severe cases. At week 2, a difference could be observed as the viral shedding remained elevated in severely ill patients. A time-course of C-reactive protein, interleukin-6 and procalcitonin revealed an even more protracted inflammatory response following the delayed drop of virus shedding load in severely ill patients. A significant proportion (47.8%) of patients showed evidence of prolonged viral shedding (>17 days), which was associated with severe disease courses (73.2%).We report that viral shedding does not differ significantly between severe and nonsevere COVID-19 cases upon admission to the hospital. Elevated SARS-CoV-2 shedding in the second week of hospitalisation, a systemic inflammatory reaction peaking between the second and third week, and prolonged viral shedding are associated with a more severe disease course.

Acute Kidney Injury in COVID-19 Pneumonia: A Single-Center Experience in Bahrain.

BackgroundKidney disease accompanying coronavirus disease 2019 (COVID-19) is not well understood, and information about the presentation of acute kidney injury (AKI), its risk factors, and outcomes is scarce, particularly in Bahrain and the Gulf region. In this study, we aimed to determine the rate of AKI among patients hospitalized with COVID-19 pneumonia at a tertiary hospital in Bahrain and to describe the various aspects of AKI in these patients, including its relationship with respiratory failure and in-hospital mortality.MethodsThis retrospective observational cohort study of patients admitted with COVID-19 pneumonia from April 1 to May 31, 2020, excluded those aged less than 18 years, those with end-stage renal disease, and those with renal transplants. Clinical and laboratory patient data were collected. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define AKI.ResultsThe mean age across the 73 included patients was approximately 54 years; about 60% were men, and nearly 58% were Bahraini nationals. Of the patients, 39.7% (29) developed AKI during hospitalization, out of which 11.0% reached stage 1, 15.1% reached stage 2, and 13.7% reached stage 3. Of all patients, seven (9.6%) required hemodialysis. Chronic kidney disease conferred an increased risk for AKI (P = 0.003) as did critical COVID-19 status (P < 0.001) and the necessity for mechanical ventilation or intensive care admission (P < 0.001 for both). Additionally, AKI was significantly associated with a lower PaO2/FiO2 (partial pressure of arterial oxygen/percentage of inspired oxygen) ratio (P < 0.001) and a greater number of medications for COVID-19 pneumonia (P = 0.003). Finally, in-hospital death tolls were remarkably higher in patients with AKI (P < 0.001). No association was found between AKI and each of the following therapies: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, tocilizumab, and convalescent plasma.ConclusionsThe rate of AKI in patients hospitalized with COVID-19 pneumonia at our institution is relatively high and is strongly associated with disease severity, respiratory failure, and in-hospital mortality. Awareness of kidney disease in COVID-19 patients is crucial and of vital importance.

Acute Kidney Injury in Critically Ill Patients in Intensive Care Unit

Foundation and destinations .Acute kidney injury (AKI) is related with unfavorable results, particularly in youngsters admitted to the pediatric emergency unit). AKI is a typical inconvenience related with longer medical clinic length of remain, increment of dismalness and mortality in kids who require concentrated consideration. Around then the RIFLE (Risk Injury Failure Loss End stage) score fills in as an appropriate characterization of AKI when defined by clinical seriousness. This investigation done to decide the frequency, etiology of AKI, pointer of casualty and transient result of AKI in fundamentally sick youngsters. Subjects and Methods:This imminent examination incorporate 200critically sick patients with at least one framework disappointment admitted to the PICU during the time of study. Consideration measures was successive patients admitted to the PICU. Avoidance rules - was Patients with known interminable kidney infection stage 5 (assessed glomerular filtration rate < 15 ml/min/1.73 m2). They were screened for AKI, characterized by the pRIFLE measures. The patients with AKI were followed-up until release/demise. Their clinical and biochemical information were recorded. All patients were exposed to: full history including the etiology of PICU confirmation and reasons for intense kidney injury. Nitty gritty fundamental assessment, including indispensable signs, cardiovascular and different frameworks. Fundamentally sick patients were characterized on the off chance that at least one of the rules which present during a 24-hr period as per organ brokenness standards . Research center Investigations were incorporated finished blood check, C-receptive protein, blood vessel blood gases, corrosive base status, blood urea, serum creatinine , electrolytes, blood glucose, serum bilirubin level, cerebrospinal liquid examination and culture for bacteriologic investigations (blood, endotracheal suction, and cerebrospinal fluid)when required. results: The occurrence of AKI among 200 patients screened was 54 (27%). The basic etiologies in AKI bunch were contaminations, 28 (51.8%), stun 18(33.3%), intense glomerulonephritis 2 (3.7%), cardiovascular disappointments 4(7.4%) and status epilepticus 2(3.7%). Among diseases, pneumonia and septicemia comprised 78.5%, meningoencephalitis represented 21.5% and 6 (11) % of patients required dialysis. In general mortality in AKI bunch was 37%. On strategic relapse examination, necessity of mechanical ventilation was a free indicator of casualty in AKI gathering.

Switch from oral anticoagulants to parenteral heparin in SARS-CoV-2 hospitalized patients.

The development of COVID-19 syndrome in anticoagulated patients, and especially their admission to intensive-care units with acute severe respiratory syndrome (SARS-CoV-2), expose them to specific problems related to their therapy, in addition to those associated with the acute viral infection. Patients on VKA hospitalized with SARS-CoV-2 show high instability of PT INR due to the variability of vitamin K metabolism, diet, fasting, co-medications, liver impairment, and heart failure. Patients on DOAC are exposed to under/over treatment caused by significant pharmacological interferences. In consideration of the pharmacological characteristics of oral anticoagulant drugs, the multiple pharmacological interactions due to the treatment of acute disease and the possible necessity of mechanical ventilation with hospitalization in intensive-care units, we suggest replacing oral anticoagulant therapies (VKA and DOAC) with parenteral heparin to avoid the risk of over/under treatment.

Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients: a cross-sectional hospital-based registry study

BackgroundDiagnosing dysphagia in acute stroke patients is crucial, as this comorbidity determines morbidity and mortality; we therefore investigated the impact of flexible nasolaryngeal endoscopy (FEES) in acute stroke patients.MethodsThe FEES investigation as performed in acute stroke patients treated at a large university hospital, allocated as a standard procedure for all patients suspected of dysphagia. We correlated our findings with baseline data, disability status, pneumonia, duration of hospitalisation, necessity for mechanical ventilation and treatment on the intensive care unit. The study was designed as a cross-sectional hospital-based registry.ResultsWe investigated 152 patients. The median age was 73; 94 were male. Ischemic stroke was diagnosed in 125 patients (82.2%); 27 (17.8%) suffered intracerebral haemorrhage.Oropharyngeal dysphagia was diagnosed in 72.4% of the patients, and was associated with higher stroke severity on admission (median NIHSS 11 [IQR 6–17] vs. 7 [4–12], p = .013; median mRS 5 [IQR 4–5] vs. 4 [IQR 3–5], p = .012). Short-term mortality was higher among patients diagnosed with dysphagia (7.2% vs. 0%, p = .107). FEES examinations revealed that only 30.9% of the patients had an oral diet appropriate for their swallowing abilities.A change of oral diet was associated with a better outcome at discharge (mRS; p = .006), less need of mechanical ventilation (p = .028), shorter period of hospitalisation (p = .044), and lower rates of pneumonia (p = .007) and mortality (p = .011).ConclusionDue to the inability of clinical assessments to detect silent aspiration, FEES might be better suited to identify stroke patients at risk and may contribute to a better functional outcome and lower rates of pneumonia and mortality. Our findings also point to a low awareness of dysphagia, even in a specialised stroke centre.FEES in acute stroke patients helps to adjust the oral diet for the vast majority of stroke patients (69.1%) based on their swallowing abilities, potentially avoiding severe complications.

Does less surgical trauma result in better outcome in management of iatrogenic tracheobronchial laceration?

Iatrogenic tracheobronchial injury is a rare, but severe complication of endotracheal intubation. Risk factors are emergency intubation, percutaneous dilatational tracheostomy and intubation with double lumen tube. Regarding these procedures, underlying patients often suffer from severe comorbidities. The aim of this study was to evaluate the results of a standardized treatment algorithm in a referral center with focus on the surgical approach. Sixty-four patients with iatrogenic tracheal lesion were treated in our department by standardized management adopted to clinical findings between 2003 and 2019. Patients with superficial laceration were treated conservatively. In the case of transmural injury of the tracheal wall and necessity of mechanical ventilation, patients underwent surgery. We decided on a cervical surgical approach for lesions limited to the trachea. In case of involvement of a main bronchus we performed thoracotomy. Data were evaluated retrospectively. In 19 patients the tracheal lesion occurred in elective intubation and in 17 patients during emergency intubation. In 23 cases a tracheal tear occurred during percutaneous dilatational tracheostomy and in three patients at replacement of a tracheostomy tube. Two patients received laceration during bronchoscopy. Twenty-nine patients underwent surgery with cervical approach and 14 underwent thoracotomy. There was no difference in the mortality of these groups. Treatment of tracheal tear was successful in 62 individuals. Nine patients died of multi organ dysfunction syndrome (MODS), two of them during surgery. Iatrogenic tracheal laceration is a life-threatening complication and the mortality after tracheal injury is high, even in a specialized thoracic unit. Conservative management in patients with superficial tracheal lesion is a feasible procedure. In case of complete laceration of tracheal wall, surgical therapy is recommendable, whereby several approaches of surgical management seem to be equivalent.

Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment.

ObjectiveTo assess intensive care unit (ICU) complications, their management, and prognostic factors associated with outcomes in a cohort of patients with autoimmune encephalitis (AE).MethodsThis study was an observational multicenter registry of consecutively included patients diagnosed with AE requiring Neuro-ICU treatment between 2004 and 2016 from 18 tertiary hospitals. Logistic regression models explored the influence of complications, their management, and diagnostic findings on the dichotomized (0–3 vs 4–6) modified Rankin Scale score at hospital discharge.ResultsOf 120 patients with AE (median age 43 years [interquartile range 24–62]; 70 females), 101 developed disorders of consciousness, 54 autonomic disturbances, 42 status epilepticus, and 39 severe sepsis. Sixty-eight patients were mechanically ventilated, 85 patients had detectable neuronal autoantibodies, and 35 patients were seronegative. Worse neurologic outcome at hospital discharge was associated with necessity of mechanical ventilation (sex- and age-adjusted OR 6.28; 95% CI, 2.71–15.61) tracheostomy (adjusted OR 6.26; 95% CI, 2.68–15.73), tumor (adjusted OR 3.73; 95% CI, 1.35–11.57), sepsis (adjusted OR 4.54; 95% CI, 1.99–10.43), or autonomic dysfunction (adjusted OR 2.91; 95% CI, 1.24–7.3). No significant association was observed with autoantibody type, inflammatory changes in CSF, or pathologic MRI.ConclusionIn patients with AE, mechanical ventilation, sepsis, and autonomic dysregulation appear to indicate longer or incomplete convalescence. Classic ICU complications better serve as prognostic markers than the individual subtype of AE. Increased awareness and effective management of these AE-related complications are warranted, and further prospective studies are needed to confirm our findings and to develop specific strategies for outcome improvement.

Can we find accessible and relevant markers for sepsis outcome?

Abstract Background and Aim: Sepsis is a life-threatening disease with high mortality, therefore establishing early diagnostic and finding reliable prognostic biomarkers is vital. We aimed to investigate the prognostic role, as a single value, of serum procalcitonin, C-reactive protein, serum lactate, platelets number and serum glucose level in septic patients, all measured in the first 24 hours after hospital admittance. Materials and methods: This retrospective study included 241 adult patients with sepsis, severe sepsis or septic shock. We use data from patients observation sheets. Data that were collected include: demographic parameters, comorbidities, necessity of mechanical ventilation and laboratory variables. We performed the statistical analysis with the chi square test for nonparametric data and to analyse the accuracy of prediction we used the receiver - operator curves with the level of significance set at p &lt; 0.05. Results: From 241 patients with a median age of 68 years, 127 (52.69%) were male.113 patients had severe sepsis. 89 patients (36.9%) died and male had an increase mortality rate. Most cases were respiratory sepsis (45.20%). The highest mortality rate was in septic shock (51.2%). Procalcitonin, C-reactive protein and glucose serum level at admittance were not correlated with mortality. The serum levels of creatinine &gt;1.67 mg/dL and serum lactate &gt;1.9 mmol/L at admittance were correlated with mortality (p &lt; 0.01). The cutoff value of 121×103/uL platelets number was also correlated with mortality (p &lt; 0.01). Conclusions: Our findings suggest that serum creatinine, serum lactate and the platelets number could be used as prognostic markers in septic patients at admittance.

Comparing Rhinovirus Pneumonia, Bacterial Pneumonia and Rhinovirus and Bacterial Pneumonia Infections in Adults at Charleston Area Medical Center

SESSION TITLE: Pneumonia Diagnosis and Outcomes SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, October 26, 2016 at 02:45 PM - 04:15 PM PURPOSE: The purpose of this study was to examine the respiratory support, length of stay (LOS), age, intensive care unit (ICU) admission, respiratory failure and requirement of steroids in patients diagnosed with: Rhinovirus alone, bacterial pneumonia alone, and bacterial pneumonia in combination with Rhinovirus. METHODS: This study was a retrospective chart review of patients admitted to Charleston Area Medical Center (CAMC) with a positive diagnosis of Rhinovirus and/or community acquired pneumonia (CAP) for a single respiratory season. Inclusion Criteria:age >18 years, respiratory symptoms present on admission, and qualifying diagnosis on admission. The patients were divided into three groups: Rhinovirus alone, Rhinovirus in combination with bacterial pneumonia, and bacterial pneumonia alone. RESULTS: 168 patients were diagnosed with Rhinovirus alone, 25 patients were diagnosed with Rhinovirus and bacterial pneumonia, 58 patients had bacterial pneumonia alone. There were 123 males and 128 females. The average age was 61.34 years, (SD 17.65). Age range was 19 years of age to 95 years old. 74 patients had the diagnosis of obesity. Asthma was diagnosed in 17 patients. 122 patients had a diagnosis of chronic obstructive pulmonary disease. 40 patients had a diagnosis of chronic respiratory failure. 68.2% of the patients were admitted to the general ward, 31.8% of the patients were admitted to the ICU. The average LOS was 11.3 days, (SD 19.2 days). LOS ranged from one day to 189 days. 154 patients (61.4%) required steroids (IV or PO). 208 patients (82.9%) required some type of respiratory support. 202 (80.5%) required supplemental oxygen. 59 (23.5%) required noninvasive positive pressure ventilation. 68 (27.1%) required mechanical ventilation. 12 of the 251 patients died while in the hospital. Patients diagnosed with Rhinovirus were older (p<.05). A significant proportion of patients diagnosed with bacterial pneumonia alone went to the ICU (p<0.0001) and had longer LOS at 17.9 days.(p<.05). A significant proportion of patients diagnosed with bacterial pneumonia alone needed respiratory support (p<0.001) either in the form of supplemental oxygen (p<0.05) or the necessity for mechanical ventilation (p,0.001). A significant proportion of patients diagnosed with bacterial pneumonia + Rhinovirus had respiratory failure and required steroids (p<.05). CONCLUSIONS: Patients diagnosed with only Rhinovirus were older. A significant proportion of patients diagnosed with bacterial pneumonia only went to the ICU, had a longer LOS and needed respiratory support, either in the form of supplemental oxygen or the necessity for mechanical ventilation. A significant proportion of patients diagnosed with bacterial pneumonia + Rhinovirus had respiratory failure and required steroids. CLINICAL IMPLICATIONS: In our study, patients with Rhinovirus +bacterial pneumonia had increased respiratory failure and requirement for steroids. Additionally, Rhinovirus infection alone did not negatively affect patients as far as ICU admission, LOS, and the need for respiratory support compared to patients with bacterial pneumonia alone or Rhinovirus + bacterial pneumonia. It appears that Rhinovirus infection alone does not have a significant influence on hospitalized patients with pneumonia. DISCLOSURE: The following authors have nothing to disclose: Holly Hill, Suzanne Kemper, Kevin Maupin No Product/Research Disclosure Information