Need For Mechanical Ventilation Research Articles

Increasing plasma calprotectin (S100A8/A9) is associated with 12-month mortality and unfavourable functional outcome in critically ill COVID-19 patients

BackgroundCalprotectin (S100A8/A9) is a pro-inflammatory mediator primarily released from neutrophils. Previous studies have revealed associations between plasma calprotectin, disease severity and in-hospital mortality in unselected COVID-19 patients.ObjectiveWe aimed to assess whether plasma calprotectin dynamics during the first week of intensive care are associated with mortality and functional outcome in critically ill COVID-19 patients.MethodsThis prospective study included 498 COVID-19 patients admitted to six intensive care units (ICUs) in Sweden between May 2020 and May 2021. Blood samples were collected on ICU admission and on day 7. The primary outcome was 12-month mortality. Secondary outcomes were functional outcome of survivors at 3 and 12 months, and the need for invasive mechanical ventilation (IMV) or continuous renal replacement therapy (CRRT) during the ICU stay. Functional outcome was assessed by the Glasgow Outcome Scale Extended (GOSE, range 1–8, with < 5 representing an unfavourable outcome). Associations between plasma calprotectin and outcomes were examined in binary logistic regression analyses adjusted for age, sex, BMI, hypertension, smoking, and creatinine.ResultsHigh plasma calprotectin on admission and day 7 was independently associated with increased 12-month mortality. Increasing calprotectin from admission to day 7 was independently associated with higher mortality at 12 months [OR 2.10 (95% CI 1.18–3.74), p = 0.012], unfavourable functional outcome at 3 months [OR 2.53 (95% CI 1.07–6.10), p = 0.036], and the use of IMV [OR 2.23 (95% CI 1.10–4.53), p = 0.027)] and CRRT [OR 2.07 (95% CI 1.07–4.00), p = 0.031)]. A receiver operator characteristic (ROC) model including day 7 calprotectin and age was a good predictor of 12-month mortality [AUC 0.79 (95% CI 0.74–0.84), p < 0.001]. Day 7 calprotectin alone predicted an unfavourable functional outcome at 3 months [AUC 0.67 (95% CI 0.58–0.76), p < 0.001].ConclusionIn critically ill COVID-19 patients, increasing calprotectin levels after admission to the ICU are associated with 12-month mortality and unfavourable functional outcome in survivors. Monitoring plasma calprotectin dynamics in the ICU may be considered to evaluate prognosis in critical COVID-19.Study registration: ClinicalTrials.gov Identifier: NCT04974775, registered April 28, 2020.

Effectiveness of Treatment Approaches in COVID-19 Pneumonia: A Comparative Evaluation between a Specialized Center and Conventional Hospitals.

The early stages of the COVID-19 pandemic overwhelmed general hospitals in Spain. In response, a dedicated hospital for COVID-19 care, the Hospital de Emergencias Enfermera Isabel Zendal (HEEIZ), was established. This study aimed to compare clinical outcomes of COVID-19 patients treated at the specialized HEEIZ with those at conventional general hospitals (CGHs) in Madrid, Spain. The study was a prospective, observational cohort study including COVID-19 patients admitted to the HEEIZ and 14 CGHs (December 2020 to August 2021). Patients were assigned based on hospital preference. Clinical data were collected and analyzed using multivariate regression to assess primary and secondary outcomes, including hospital mortality, need of invasive mechanical ventilation (IMV), and pharmacological treatments. The HEEIZ cohort (n = 2997) was younger and had lower Charlson comorbidity scores than the CGH cohort (n = 1526). Adjusted HEEIZ hospital mortality was not significantly higher compared with CGHs (OR: 1.274; 95% CI: 0.781-2.079; p = 0.332). During the study period, patients admitted to the HEEIZ showed no significant differences in clinical outcomes, compared with patients admitted at CGHs. These results might support the use of specialized centers in managing pandemic surges, allowing CGHs to handle other needs.

Comparison between Standard Dose Methyl-Prednisolone and Mega Dose Methyl-prednisolone As Regards Outcome in SARS.COV.2 Patients in Intensive Care Unit: A Retrospective Study

Abstract Background Deadly pandemics and disease emergences are not new phenomena: they have been challenging human existence throughout recorded history. Some have killed sizeable percentages of humanity, but humans have always searched for, and often found, ways of mitigating their deadly effects. Objective to compare between standard dose methyl prednisolone (1-2 mg/kg) and mega dose methyl prednisolone (0.5 g to 1g) as regards outcome reflected by mortality rate, percentage of mechanically ventilated patients and ICU length of stay of COVID 19 patients admitted in ICU. Patients and Methods After obtaining approval from the Research Ethical Committee of Ain Shams University (FMASU MS 41/2022) this study was obtained from Ain Shams University Isolation Hospitals records. Group A: Patients admitted in ICU, COVID PCR positive and requiring oxygen therapy who received methyl prednisolone standard dose (1-2 mg/kg). Group B: Patients admitted in ICU, COVID PCR positive and requiring oxygen therapy who received methyl prednisolone mega dose (0.5-1 g per day). Results This study showed that there is no significant statistical difference between receiving standard dose and mega dose methyl prednisolone as regards mortality rate or need for mechanical ventilation. Conclusion This study showed that there is no significant statistical difference between receiving standard dose and mega dose methyl prednisolone as regards mortality rate or need for mechanical ventilation. But showed significant statistical difference as regards ICU length of stay denoting that patients received mega dose methyl prednisolone showed increased ICU stay.

Efficacy and Safety of Tocilizumab with Methylprednisolone versus Methylprednisolone Only as a Treatment for Severe Covid-19 Patients

Abstract Background SARS-CoV-2 was identified as a worldwide fatal pandemic that causes acute respiratory infections. The aim of this work was to compare the effect of Using combined therapy: (tocilizumab with Methylprednisolone) versus using (Methylprednisolone alone) as immuno-modulatory therapy on 28 days mortality mortality, need for mechanical ventilation &amp; adverse effects. Methods This retrospective observational cohort study was carried out on 60 patients diagnosed as having covid 19 infection with cytokine storm and severe acute respiratory syndrome during the period(2020-2021). Patients were divided into 2 groups: (TCZ+MP)group received 2 doses of tocilizumab within 24 hrs (5 mg/kg in each dose) in addition to a dose of methylprednisolone(2mg/kg/day)for7days and(MP)group:received only a dose of methylprednisolone (2 mg\kg\day) for 7days. All patients were subjected to routine laboratory investigations (Complete blood count, liver function tests, kidney function tests, LDH, ferritin, D-dimer, frequent ABGs (P/F ratio), CRP, IL6, procalcitonin&amp; albumin), and radiology investigation (Chest x-ray and CT chest). Results 60 patients with ARDS(both genders) were included in this study, in TCZ+MPgroup, 8(26.67%) of 30 patients died, compared to 17(56,67%) of 30patients in (MP)group, so mortality rate was significantly lower in patients on TCZ+MPgroup than those on (MP)group (P value =0.018). In TCZ+MPgroup, 12(40%) of 30 patients needed mechanical ventilation compared to 22(73.33%) of 30 patients in MP group, so Number of patients who required mechanical ventilation was significantly lower in patients on TCZ+MPgroup than MP group (P value = 0.009). Adverse effects of intervention drugs after 28 days were insignificantly different between both groups (P value = 0.018). Conclusions In patients with severe COVID-19 infection, combination therapy of tocilizumab &amp;methylprednisolone reduced mortality rate and need for mechanical ventilation as compared with the use of methylprednisolone alone.

The predictors of fungal infections after liver transplantation and the influence of fungal infections on outcomes

The primary objective of this study was to assess the incidence, timing, risk factors of fungal infections (FIs) within 3 months after liver transplantation (LT). The secondary objective was to evaluate the impact of FIs on outcomes. Four hundred and ten patients undergoing LT from January 2015 until January 2023 in a tertiary university hospital were included in the present retrospective cohort study to investigate the risk factors of FIs and to assess the impacts of FIs on the prognosis of LT recipients using logistic regression. The incidence of FIs was 12.4% (51/410), and median time from LT to the onset of FIs was 3 days. By univariate analysis, advanced recipient age, prolonged hospital stay prior to LT, high Model for End Stage Liver Disease (MELD) score, use of broad-spectrum antibiotics, and elevated white blood cell (WBC) count, increased operating time, massive blood loss and red blood cell transfusion, elevated alanine aminotransferase on day 1 and creatinine on day 3 after LT, prolonged duration of urethral catheter, prophylactic antifungal therapy, the need for mechanical ventilation and renal replacement therapy were identified as factors of increased post-LT FIs risk. Multivariate logistic regression analysis identified that recipient age ≥ 55 years[OR = 2.669, 95%CI: 1.292–5.513, P = 0.008], MELD score at LT ≥ 22[OR = 2.747, 95%CI: 1.274–5.922, P = 0.010], pre-LT WBC count ≥ 10 × 109/L[OR = 2.522, 95%CI: 1.117–5.692, P = 0.026], intraoperative blood loss ≥ 3000 ml [OR = 2.691, 95%CI: 1.262–5.738, P = 0.010], post-LT duration of urethral catheter > 4 d [OR = 3.202, 95%CI: 1.553–6.602, P = 0.002], and post-LT renal replacement therapy [OR = 5.768, 95%CI: 1.822–18.263, P = 0.003] were independently associated with the development of post-LT FIs. Post-LT prophylactic antifungal therapy ≥ 3 days was associated with a lower risk of the development of FIs [OR = 0.157, 95%CI: 0.073–0.340, P < 0.001]. As for clinical outcomes, FIs had a negative impact on intensive care unit (ICU) length of stay ≥ 7 days than those without FIs [OR = 3.027, 95% CI: 1.558–5.878, P = 0.001] but had no impact on hospital length of stay and 1-month all-cause mortality after LT. FIs are frequent complications after LT and the interval between the onset of FIs and LT was short. Risk factors for post-LT FIs included high MELD score at LT, advanced recipient age, pre-LT WBC count, massive intraoperative blood loss, prolonged post-LT duration of urethral catheter, and the need for post-LT renal replacement therapy. However, post-LT prophylactic antifungal therapy was independently associated with the reduction in the risk of FIs. FIs had a significant negative impact on ICU length of stay.

Predictors of Neurological Disability at Hospital Discharge for Acyclovir-treated Pediatric Herpes Simplex Virus Encephalitis.

Herpes simplex virus encephalitis (HSE) is a rare but serious neurological infection that causes neurological dysfunction. Research is lacking on the clinical predictors of neurological outcomes and the optimal duration of therapy for pediatric HSE patients. In this study of pediatric HSE patients, we identified factors predicting neurological disability at hospital discharge and examined associations of acyclovir therapy duration with neurological outcomes. This was a retrospective cohort study on 37 children diagnosed with HSE confirmed by polymerase chain reaction at age 1 month to 16 years from 2015 to 2021 in Ho Chi Minh City's Children's Hospital No. 2, Vietnam. For the acyclovir duration analysis, we examined 22 children with negative polymerase chain reaction on day 14 of treatment. Poisson regression was used to obtain the risk ratio and 95% confidence interval. The study population consisted of 73% males, with a median age of 14 months (interquartile range: 9-35). Coma at acyclovir treatment, hypotension and the need for mechanical ventilation ≥48 hours significantly predicted neurological disability in the bivariate analysis. There were no significant associations between acyclovir duration (14 vs. 21 days) and neurological outcomes, adjusting for age at diagnosis and pediatric Glasgow Coma Scale score at acyclovir initiation. We identified significant predictors of neurological disability unaffected by postacyclovir treatment factors. Among patients with negative HSE polymerase chain reaction on day 14, 14 days of acyclovir treatment may be as effective as 21 days. Additional studies on the effects of acyclovir duration are needed.

Chest Computed Tomography Severity Score to Predict Outcome of Patients with COVID 19

Abstract Background The coronavirus disease 2019 (COVID-19) is an acute infectious pneumonia caused by a severe acute respiratory syndrome-coronavirus-2. Some studies have suggested that C-reactive protein, lymphocyte count, and features from CT scoring as predictors of severity and prognosis of COVID-19. Non-contrast chest computed tomography (CT) scan was found to be a useful diagnostic instrument for screening COVID-19 pneumonia. This score uses lung opacification as a surrogate for extension of the disease in the lungs. Aim To assess the prognostic value of chest CT severity score (CSS) to predict the severity of symptoms and outcomes among patients with typical CT findings. Subject and Methods This Prospective Observational study was conducted at Radiology department, faculty of medicine, Ain Shams University on 94 patients. Results There is a significant difference between the groups regarding symptoms severity. there is no significant difference between the groups regarding CT findings. left lung severity scores and total severity score were significantly higher among poor prognosis patients compared to good prognosis patients. mortality rate was significantly higher among poor prognosis patients compared to good prognosis patients. severity score was significantly higher among severe symptoms patients compared to mild symptoms patients in good prognosis patients. Conclusion The current study showed that CT images and CT-severity scores can predict ICU admission and mortality in patients with COVID-19 pneumonia. Clinicians and radiologists can use the CT-severity score as a measure of disease severity and an indicator of poor prognosis, including the need for mechanical ventilation. Also, our findings showed the superiority of CT findings over other clinical information and co-morbidities in predicting the short-term outcome.

Metabolic Syndrome as A Prognostic Factor for Outcome of Severe SARS-COV-2 Cases

Abstract Background SARS-COV-2 (Coronavirus Disease-2019), a disease caused by the coronavirus. SARS-CoV-2 (Sever Acute Respiratory Syndrome-Coronavirus-2) has emerged as a rapidly spreading communicable disease affecting more than 100 countries across the globe at present. Aim of the Work To illuminate to what extent metabolic syndrome can be used as a prognostic factor for outcomes of patients infected with SARS-COV-2. Primary outcome measure is ICU stay and outcome. Secondary outcome measures are Patients requiring MV and mortality. Patients and Methods This was a retrospective study in order to illuminate to what extent metabolic syndrome can be used as a prognostic factor for outcomes of patients infected with SARS-COV-2, with Primary outcome measure which was ICU stay and outcome, and Secondary outcome measures were Patients requiring MV and mortality. Ninety patients admitted to ICU for Pneumonic COVID-19 with a confirmed positive RT-PCR for COVID-19 and chest computed tomography was divided into two groups in Ain-shams University hospitals. Results Components of metabolic syndrome such as hypertension, type 2 diabetes mellitus (T2DM), and obesity are highly prevalent and significantly increase the risk of hospitalization and mortality in SARS-COV-2 patients. Conclusion MetS is a better prognostic indicator for severe disease outcomes in patients with COVID-19 than its individual components. Patients with MetS had a significantly higher need for ICU admission irrespective of their age, sex, or race. The need for mechanical ventilation was also higher across all patients with MetS. The association of MetS with higher mortality was significant for females, patients younger than 65 years of age.

D-Dimer as a Predictor of Disease Outcome in Intensive Care SARS-COV-2 Patients: A Retrospective Study

Abstract Background The novel coronavirus, designated SARS-COV-2, has caused a pandemic of respiratory illness termed coronavirus disease 2019 (COVID-19). One of the key issues has been the very high number of patients presenting to hospitals that clearly overwhelms the capacities available, especially the need for critical care support. Therefore, early and effective predictors of clinical outcomes has been urgently needed for risk stratification of COVID-19 patients. Objective To evaluate the value of D-dimer blood levels on intensive care unit (ICU) admission as a predictor of disease severity and mortality in COVID-19 ICU admitted patients. Patients and Methods The current study included the records of 465 patients who were admitted to Ain Shams University isolation hospitals ICU during the time period between 1/1/2021 and 1/6/2021. Results There are many studies that have tried to correlate between D dimer levels and COVID-19 outcome. by comparing these studies we find that the value of D-dimer levels as a predictor of disease outcome is quite obvious. Trying to find opposing literature to the previous findings is a difficult process as the great majority of the literature that tried to link D-dimer levels to COVID -19 outcomes have eventually come to the same conclusion which is proving that there is a significant relationship between D-dimer levels and disease outcome and that morbidity and mortality risk increases with elevated D-dimer levels. Conclusion In COVID-19 patients, D-dimer levels on admission to ICU and 48 hours afterwards can be a reliable indicator of the disease prognosis as high D-dimer levels are associated with increased need for mechanical ventilation and mortality with cutoff values 1.39 for initial D-dimer and 1.02 for D-dimer level after 48 hours.

Safety and Efficacy of N-Acetylcysteine as an Adjuvant Therapy in Critically Ill COVID-19 Patients

Abstract Background COVID-19 may cause pneumonia, acute respiratory distress syndrome, cardiovascular alterations, and multiple organ failure, which have been ascribed to a cytokinestorm, a systemic inflammatory response, and an attack by the immune system. Moreover, an oxidative stress imbalance has been demonstrated to occur in COVID- 19 patients. N- Acetyl-L-cysteine (NAC) is a precursor of reduced glutathione (GSH). Aim of the Work we retrospectively will investigate safety and efficacy of NAC dose given in paracetamol toxicity as an adjuvant therapy in critically ill COVID-19 patients with acute respiratory distress and determine whether NAC in high doses can avoid respiratory failure in patients with COVID-19. Patients and Methods This was a retrospective observational study in which all cases were collected from ICU of Ain shams university hospitals during COVID-19 outbreak. All data were extracted from clinical records. All patients initially admitted to ICU with SPO2 less than 94 % were included between December 2020 to February 2022. Exclusion Criteria included Need for immediate mechanical ventilation on admission, known allergy or hypersensitivity to NAC, end stage renal and liver diseases, heart failure and pregnancy. All patients with severe COVID-19 (confirmed or suspected received standard care, according to the institutional protocol. Results Patients were randomized into two equal groups (number (n)=40 each) as the N1(NAC) group who was given intravenously, initially 150 mg/kg in 200 mL of 0.9% NaCL for 60 minutes (first bag), followed by 50 mg/kg in 500 mL of 0.9% NaCL for 4 hours (second bag), and then 100 mg/kg in 1000 mL of 0.9%NaCL for 16 hours (third bag) and N2(Non NAC) group who received intravenously N-acetylcysteine (NAC) 600mg /12hr and The primary endpoint was the need for mechanical ventilation. Secondary endpoints were time of mechanical ventilation, admission to the intensive care unit (ICU), time in ICU, and mortality. There were no statistically significant differences between the two groups (p &amp;gt; 0.05) The effect of NAC on mechanical ventilations, mortality, ICU stays, and hospital stays is a matter of controverse in ARDS patients. We found that intravenous high dose of NAC did not improve oxygenation, mortality rate and did not reduce the requirement for mechanical ventilation when administered for COVID 19 patients with ARDS. Also, the duration of ICU and hospital stays were relatively prolonged in the NAC-treated patients. These might be due to prolonged survival time with NAC-treated patients, but not to be detected with the small single centered trial.. Conclusion Use of high doses of NAC administration can not affect the need of mechanical ventilation, rate of mortality, the need, duration of ICU admission and hospital stays for patients with severe COVID-19.

The Association of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio to the Prognosis of Acute Kidney Injury Patients

Abstract Background Acute kidney injury (AKI) is an increasingly common problem facing clinicians, especially nephrologists, intensive care physicians, general physicians and surgeons. Acute kidney injury is a heterogeneous group of conditions characterized by a sudden decrease in glomerular filtration rate, manifested by an increase in serum creatinine concentration or oliguria, and classified by stage and cause. Aim of the Work The aim of the study was to evaluate the prognostic ability of the Neutrophil to Lymphocyte ratio, Platelet to Lymphocyte ratio and neutrophil to lymphocyte and platelet ratio in adult patients with acute kidney injury with various etiologies and to evaluate their role in the prediction of both morbidity and mortality over period of three months. Patients and Methods To achieve this goal, we conducted this study on 102 patients who developed acute kidney injury during hospital admission in Ain Shams University hospitals. Results he study found no significant differences between PLR and NLP ratios among different AKI stages. NLP ratio showed an inverse correlation with serum creatinine and a positive correlation with estimated Glomerular Filtration Rate (eGFR), while PLR did not show significant correlation. NLP ratio had the ability to predict the outcome of AKI with significant differences between mortality and recovery cases, while PLR did not have significant ability to predict outcome. NLP ratio showed high sensitivity and specificity in predicting the need for vasopressors, mechanical ventilation, or hemodialysis, while PLR had moderate sensitivity and high specificity in predicting recovery. The study had some limitations, including not enrolling non-AKI control group and not evaluating the effect of certain treatments on the studied markers. Conclusion The study had the advantages of being conducted on relatively large sample size and included patients of variable causes of admission. The included patients had also variable causes of AKI and of different AKI stages. The study had some limitations as we did not enroll non- AKI control group. We did not evaluate the effect of certain treatment modalities as some antibiotics or interventions on the studied markers.

A Complex Interplay: Navigating the Crossroads of Tobacco Use, Cardiovascular Disease, and the COVID-19 Pandemic: A WHF Policy Brief.

The Coronavirus Disease 2019, commonly referred to as COVID-19, is responsible for one of the deadliest pandemics in human history. The direct, indirect and lasting repercussions of the COVID-19 pandemic on individuals and public health, as well as health systems can still be observed, even today. In the midst of the initial chaos, the role of tobacco as a prognostic factor for unfavourable COVID-19 outcomes was largely neglected. As of 2023, numerous studies have confirmed that use of tobacco, a leading risk factor for cardiovascular and other diseases, is strongly associated with increased risks of severe COVID-19 complications (e.g., hospitalisation, ICU admission, need for mechanical ventilation, long COVID, etc.) and deaths from COVID-19. In addition, evidence suggests that COVID-19 directly affects multiple organs beyond the respiratory system, disproportionately impacting individuals with comorbidities. Notably, people living with cardiovascular disease are more prone to experiencing worse outcomes, as COVID-19 often inherently manifests as thrombotic cardiovascular complications. As such, the triad of tobacco, COVID-19 and cardiovascular disease constitutes a dangerous cocktail. The lockdowns and social distancing measures imposed by governments have also had adverse effects on our lifestyles (e.g., shifts in diets, physical activity, tobacco consumption patterns, etc.) and mental well-being, all of which affect cardiovascular health. In particular, vulnerable populations are especially susceptible to tobacco use, cardiovascular disease and the psychological fallout from the pandemic. Therefore, national pandemic responses need to consider health equity as well as the social determinants of health. The pandemic has also had catastrophic impacts on many health systems, bringing some to the brink of collapse. As a result, many health services, such as services for cardiovascular disease or tobacco cessation, were severely disrupted due to fears of transmission and redirection of resources for COVID-19 care. Unfortunately, the return to pre-pandemic levels of cardiovascular disease care activity has stagnated. Nevertheless, digital solutions, such as telemedicine and apps, have flourished, and may help reduce the gaps. Advancing tobacco control was especially challenging due to interference from the tobacco industry. The industry exploited lingering uncertainties to propagate misleading information on tobacco and COVID-19 in order to promote its products. Regrettably, the links between tobacco use and risk of SARS-CoV-2 infection remain inconclusive. However, a robust body of evidence has, since then, demonstrated that tobacco use is associated with more severe COVID-19 illness and complications. Additionally, the tobacco industry also repeatedly attempted to forge partnerships with governments under the guise of corporate social responsibility. The implementation of the WHO Framework Convention on Tobacco Control could address many of the aforementioned challenges and alleviate the burden of tobacco, COVID-19, and cardiovascular disease. In particular, the implementation of Article 5.3 could protect public health policies from the vested interests of the industry. The world can learn from the COVID-19 pandemic to better prepare for future health emergencies of international concern. In light of the impact of tobacco on the COVID-19 pandemic, it is imperative that tobacco control remains a central component in pandemic preparedness and response plans.

L-carnitine: A novel approach in management of acute cholinesterase inhibitor insecticide poisoning.

Cholinesterase inhibitors (ChEIs) insecticide poisoning is a serious global health concern that results in hundreds of thousands of fatalities each year. Although inhibition of the cholinesterase enzyme is the main mechanism of ChEI poisoning, oxidative stress is considered the mechanism underlying the related complications. The study aimed to assess the oxidative status of the patients with ChEI insecticide poisoning and the role of L-carnitine as adjuvant therapy in their management. Human studies on the efficacy and safety of L-carnitine in treating insecticide poisoning are limited despite its growing research interest as a safe antioxidant. This prospective study was conducted on eighty patients with acute ChEIs insecticide poisoning admitted to Alexandria Poison Center, Alexandria Main University Hospital, Egypt. Patients were allocated into two equal groups randomly. The L-carnitine (LC) group received the conventional treatment (atropine & toxogonin) and LC and the standard treatment (ST) group received the standard treatment only. Outcome measures were fatality rate, the total administered dose of atropine & toxogonin, length of hospital stay, and the requirement for ICU admission or mechanical ventilation. The study results revealed that malondialdehyde (MDA) significantly decreased in the LC group. Cholinesterase enzyme levels increased significantly after treatment in the LC group than in the ST group. The LC group needed lower dosages of atropine and toxogonin than the ST group. Also, the LC group showed no need for ICU admission or mechanical ventilation. The study concluded that LC can be considered a promising adjuvant antioxidant treatment in acute ChEIs pesticide poisoning.

Hypoxaemic respiratory failure and awake prone ventilation (HYPER-AP) - Protocol for randomized, controlled clinical trial

BackgroundAwake prone positioning is studied extensively during Covid-19 pandemic, but there is very limited evidence on its utility in acute hypoxic respiratory failure caused by bacterial infections or other causes. The aim of our research is to evaluate the impact of awake prone positioning on outcomes in non-intubated adult patients with acute non-Covid19 hypoxemic respiratory failure. MethodsThis is a multi-center randomized controlled trial (RCT) with a parallel-group design and a 1:1 allocation ratio. Adult patients, admitted to ICU and diagnosed with hypoxemic respiratory failure will be randomly allocated into intervention (awake prone position (APP)) or control group. Our hypothesis is that addition of awake prone positioning to standard oxygen, high flow oxygen therapy and non-invasive ventilation may reduce the need for mechanical ventilation in adult patients diagnosed with acute hypoxemic respiratory failure. Primary outcome is rate of endotracheal intubation; secondary outcomes include intensive care and hospital mortality, duration of mechanical ventilation, length of intensive care and hospital stay and health related quality of life post hospital discharge. Primary and secondary outcomes will be assessed at hospital discharge, 30, 90 days and 1 year following randomisation. ConclusionThe Hyper-AP study will assess the superiority of awake prone positioning versus standard treatment in spontaneously breathing ICU patients diagnosed with hypoxaemic respiratory failure.

Airway management may influence postoperative ventilation need in preterm infantsafter laser eye treatment.

Retinopathy of prematurity is treated with laser photocoagulation under general anaesthesia with intubation using endotracheal tube (ETT), which carries a risk for postoperative mechanical ventilation (MV). Laryngeal mask airway (LMA) may provide a safe alternative. We assessed the need for postoperative MV in preterm infants who received LMA versus ETT. In this single-centre, retrospective cohort study, preterm infants who underwent laser photocoagulation between 2014-2021 were enroled. For airway management, patients received either LMA (n = 224) or ETT (n = 47). The outcome was the rate of postoperative MV. Patients' age were 37 [35;39] weeks of postmenstrual age, median bodyweight of Group LMA was higher than Group ETT's (2110 [1800;2780] g versus 1350 [1230;1610] g, respectively, p < 0.0001). After laser photocoagulation, 8% of Group LMA and 74% of Group ETT left the operating theatre requiring MV. Multiple logistic regression revealed that the use of LMA and every 100 g increase in bodyweight significantly decreased the odds of mechanical ventilation (OR 0.21 [95% CI 0.07-0.60], and 0.73 [95% CI 0.63-0.84], respectively). Propensity score matching confirmed that LMA decreased the odds of postoperative MV (OR 0.30 [95% CI 0.11-0.70]). The use of LMA is associated with a reduced need for postoperative MV. Using laryngeal mask airway instead of endotracheal tube for airway management in preterm infants undergoing general anaesthesia for laser photocoagulation for treating retinopathy of prematurity could significantly decrease the postoperative need for mechanical ventilation. According to our current understanding, this has been the largest study investigating the effect of laryngeal mask airway during general anaesthesia in preterm infants. Our study suggests that the use of laryngeal mask airway is a viable alternative to intubation in the vulnerable population of preterm infants in need of laser treatment.

Human metapneumovirus infection is associated with a substantial morbidity and mortality burden in adult inpatients

BackgroundHuman metapneumovirus (hMPV) is one of the leading respiratory viruses. This prospective observational study aimed to describe the clinical features and the outcomes of hMPV-associated lower respiratory tract infections in adult inpatients. MethodsConsecutive adult patients admitted to one of the 31 participating centers with an acute lower respiratory tract infection and a respiratory multiplex PCR positive for hMPV were included. A primary composite end point of complicated course (hospital death and/or the need for invasive mechanical ventilation) was used. ResultsBetween March 2018 and May 2019, 208 patients were included. The median age was 74 [62–84] years. Ninety-seven (47 %) patients were men, 187 (90 %) had at least one coexisting illness, and 67 (31 %) were immunocompromised. Median time between first symptoms and hospital admission was 3 [2–7] days. The two most frequent symptoms were dyspnea (86 %) and cough (85 %). The three most frequent clinical diagnoses were pneumonia (42 %), acute bronchitis (20 %) and acute exacerbation of chronic obstructive pulmonary disease (16 %). Among the 52 (25 %) patients who had a lung CT-scan, the most frequent abnormality was ground glass opacity (41 %). While over four-fifths of patients (81 %) received empirical antibiotic therapy, a bacterial coinfection was diagnosed in 61 (29 %) patients. Mixed flora (16 %) and enterobacteria (5 %) were the predominant documentations. The composite criterion of complicated course was assessable in 202 (97 %) patients, and present in 37 (18 %) of them. In the subpopulation of pneumonia patients (42 %), we observed a more complicated course in those with a bacterial coinfection (8/24, 33 %) as compared to those without (5/60, 8 %) (p = 0.02). Sixty (29 %) patients were admitted to the intensive care unit. Among them, 23 (38 %) patients required invasive mechanical ventilation. In multivariable analysis, tachycardia and alteration of consciousness were identified as risk factors for complicated course. ConclusionhMPV-associated lower respiratory tract infections in adult inpatients mostly involved elderly people with pre-existing conditions. Bacterial coinfection was present in nearly 30 % of the patients. The need for mechanical ventilation and/or the hospital death were observed in almost 20 % of the patients.

A retrospective validation of the effective and safe treatment of patients on general care wards with high velocity nasal insufflation therapy utilizing prognostic risk scores during COVID-19

Background Non-invasive positive pressure ventilation (NIPPV) has been a traditional therapy for acute respiratory failure (ARF). However, the use of NIPPV during the COVID-19 pandemic was challenging, while the use of invasive mechanical ventilation produced poor outcomes. An alternative to NIPPV, high velocity nasal insufflation (HVNI) has shown promise in treating ARF effectively. Objective This study evaluated whether HVNI can be used to treat ARF safely on the general care ward (GCW) during COVID-19 pandemic surges. Methods After introducing HVNI therapy to the facility, an evidence-based scoring system, Modified Early Warning Score (MEWS), was used to risk stratify patients and assist in assigning care level. Initial settings, demographic data, patient outcomes, and health care worker (HCW) virus conversion were measured throughout the study. Treatment failure was defined as the need for invasive mechanical ventilation (IMV) or NIPPV after HVNI therapy. MEWS and ROX index were compared retrospectively using the Pearson product-moment correlation coefficient to identify trends. The Welch two sample t-test (desired power of 90% with alpha=0.05) was used for demographic and outcome analysis. Results Two hundred thirty-four patients were treated with HVNI. The GCW failure rate of 18.56% (n=31/167) was lower than the ICU failure rate of 37.31% (n=25/67) but not statistically significant (P 0.175). No elevated risk to patients or HCW was observed. Respiratory rate (GCW 24.85 vs. ICU 30.14; P &lt;0.001), MEWS (GCW 2.34 vs. ICU 3.09; p=0.002), and ROX index (GCW 5.49 vs. ICU 4.68; P 0.002) assessments appear to be adequate predictors of HVNI failure. The Pearson product-moment coefficient comparing MEWS and ROX index identified a moderate negative correlation (-0.434; P &lt;0.001). Discussion HVNI therapy is an effective alternative to NIPPV for treating patients with COVID-19 associated ARF. Using measures such as MEWS and/or ROX, strict patient monitoring, and HCW surveillance, HVNI can be safely utilized on the GCW. This has a direct impact when dealing with patient surges where ICU beds and resources are limited. Additional studies are needed to further delineate these concepts. Keywords: COVID-19, Non-invasive Positive Pressure Ventilation, Acute Respiratory Failure, High Flow Nasal Oxygen, High Velocity Nasal Insufflation, ICU Admission, General Care Ward, MEWS, ROX

Fibrinolysis and clinical outcomes in acute pulmonary embolism. Madras medical college pulmonary embolism (M-PER) registry from India

BackgroundAcute pulmonary embolism (APE) is the third most common cause of vascular death. Data on APE from India and other low-and middle-income countries is sparse. ObjectivesStudy the clinical characteristics, prognostic factors, in-hospital mortality (IMH) and 12 months mortality of patients with APE in India. MethodsWe prospectively enrolled 186 consecutive patients diagnosed with APE between November 2016 and November 2021 in Madras Medical College Pulmonary Embolism Registry (M-PER). All patients had electrocardiography and echocardiography. High risk patients and selected intermediate risk patients underwent fibrinolysis. Results75 % of our patients were below 50 years of age. 35 % were women. The mean time to presentation from symptom onset was 6.04 ± 10.01 days. 92 % had CT pulmonary angiography. Intermediate risk category (61.3 %) was the more common presentation followed by high risk (26.9 %). Electrocardiography showed S1Q3T3 pattern in 56 %. 76 % had right ventricular dysfunction and 12.4 % had right heart thrombi(RHT) by echocardiography. 50.5 % received fibrinolysis. Patients with RHT received fibrinolysis more frequently (78.3 % vs 46.6 %; p = 0.007). In-hospital mortality (IHM) was 15.6 %. Systemic arterial desaturation and need for mechanical ventilation independently predicted IHM. Ten patients (5.3 %) were lost to follow up. One year mortality was 26.7 % (47/176). One year mortality of patients discharged alive was similar among high, intermediate and low risk groups(14.8 % vs 1.9 % vs 10.5 %; p = 0.891). ConclusionsPatients with PE are often young and present late in India. The in-hospital and 12 months mortality were high. Low and intermediate risk groups had a high post discharge mortality similar to high risk patients.

Retrospective, Observational Analysis on the Impact of SARS-CoV-2 Variant Omicron in Hospitalized Immunocompromised Patients in a German Hospital Network-The VISAGE Study.

Endemic SARS-CoV-2 infections still burden the healthcare system and represent a considerable threat to vulnerable patient cohorts, in particular immunocompromised (IC) patients. This study aimed to analyze the in-hospital outcome of IC patients with severe SARS-CoV-2 infection in Germany. This retrospective, observational study, analyzed administrative data from inpatient cases (n = 146,324) in 84 German Helios hospitals between 1 January 2022 and 31 December 2022 with regard to in-hospital outcome and health care burden in IC patients during the first 12 months of Omicron dominance. As the primary objective, in-hospital outcomes of patients with COVID-19-related severe acute respiratory infection (SARI) were analyzed by comparing patients with (n = 2037) and without IC diagnoses (n = 14,772). Secondary analyses were conducted on IC patients with (n = 2037) and without COVID-19-related SARI (n = 129,515). A severe in-hospital outcome as a composite endpoint was defined per the WHO definition if one of the following criteria were met: intensive care unit (ICU) treatment, mechanical ventilation (MV), or in-hospital death. In total, 12% of COVID-related SARI cases were IC patients, accounting for 15% of ICU admissions, 15% of MV use, and 16% of deaths, resulting in a higher prevalence of severe in-hospital courses in IC patients developing COVID-19-related SARI compared to non-IC patients (Odds Ratio, OR = 1.4, p < 0.001), based on higher in-hospital mortality (OR = 1.4, p < 0.001), increased need for ICU treatment (OR = 1.3, p < 0.001) and mechanical ventilation (OR = 1.2, p < 0.001). Among IC patients, COVID-19-related SARI profoundly increased the risk for severe courses (OR = 4.0, p < 0.001). Our findings highlight the vulnerability of IC patients to severe COVID-19. The persistently high prevalence of severe outcomes in these patients in the Omicron era emphasizes the necessity for continuous in-hospital risk assessment and monitoring of IC patients.

Life expectancy and long-term survival after traumatic spinal cord injury: a systematic review.

Spinal cord injuries have a considerable impact on healthcare in terms of mortality and morbidity. To address the difficulties faced by people affected by this condition and to raise awareness among stakeholders and policymakers, it is crucial to understand factors impacting survival. The purpose of this study is to systematically review the literature on life expectancy in people with traumatic spinal cord injury (tSCI), identifying key factors influencing mortality and survival. We conducted a systematic review, searching the literature for articles published up to July 2023 in PubMed, Web of Science, Cochrane Library, Google Scholar, and PEDro. Study outcomes had to be one of survival rate, life expectancy, standardized mortality ratio, or mortality rate. Only original research articles published in English were included. The quality of evidence was evaluated with the MINORS scale. The level of evidence was categorized according to the OCEBM model. A comprehensive literature search yielded 102 articles, after the selection process 20 studies were included in our review. The main factors negatively influencing survival and life expectancy included higher neurological level of injury (NLI), completeness of the lesion, need for mechanical ventilation, increasing age, and male gender. The development of SCI-related comorbidities also negatively impacted survival as well as the lack of specialized care, especially in low-income countries. Additionally, pre-injury health status and personal income may affect survival. Current literature shows that people affected by tSCI have a shorter life expectancy compared to the general population, highlighting some factors as possible predictors. It is difficult to compare available evidence due to the methodological heterogeneity across studies, which makes it challenging to draw generalizable conclusions on life expectancy in people with tSCI. Further studies are required to address these issues and accurately estimate life expectancy accounting for gaps in the management of people affected by tSCI to improve their care.