Mechanical Ventilation Rate Research Articles

Impact of oral or enteral nutritional support on clinical outcomes of patients subjected to cardiac surgery: A systematic review.

Cardiovascular diseases represent the leading cause of death worldwide, in addition to having a direct negative impact on quality of life, functional capacity and nutritional status. Studies show high prevalence of malnutrition in patients undergoing cardiac surgery. It is known that cardiac surgery can also lead to changes in nutritional status, through surgical trauma, systemic inflammation and, often, delay in the initiation of nutritional support. On the other hand, the role of nutritional support as a driver of clinical outcomes in different surgical populations is well described in the literature. To review the literature in order to assess the effect of perioperative oral or enteral nutritional support on clinical outcomes of cardiac patients undergoing cardiac surgery. The search was conducted in February 2021 in the following databases: EMBASE, PubMed/MEDLINE, Scopus and Web of Science. Randomized clinical trials (RCT) and retrospective studies were selected, carried out with patients with heart disease, undergoing cardiac surgery and aged 18 years or over. The Outcomes of interest were: length of hospital stay, length of stay in the ICU, time on ventilatory support, mortality rate, clinical complications and use of vasoactive drugs in the postoperative period. Ten studies were included in this systematic review, of which 7 were RCTs and 3 were cohorts. The most prevalent surgery was myocardial revascularization. Six studies evaluated oral nutritional support, two enteral nutritional support and two analyzed both. Two studies found a significant reduction in the length of hospital and ICU staying associated with preoperative intake of carbohydrate-based beverages. Only one study observed a significant reduction in the requirement for ventilatory support after cardiac surgery, after preoperative carbohydrate-based drinks and early postoperative enteral nutrition. There was no influence of nutritional support on mechanical ventilation length and mortality. Most studies showed that nutritional support did not reduce hospital and ICU staying. Nutritional support benefits were demonstrated in studies that offered preoperative oral carbohydrate drinks. No association was observed between nutritional support and duration of mechanical ventilation or mortality rate. Most studies did not find any influence of nutritional support on the need and/or dosage of vasoactive drugs in the postoperative period of cardiac surgery.

COVID-19 outcomes in patients with cancer and HIV: An analysis of the COVID-19 and Cancer Consortium (CCC19).

e18790 Background: Patients with SARS-CoV-2 with a diagnosis of cancer have increased risk of severe COVID-19 outcomes compared to patients without cancer. However, little is known regarding outcomes of patients with COVID-19 and cancer in the setting of human immunodeficiency virus (HIV). Given the unique risks of this population, we sought to understand COVID-19 outcomes using registry data. Methods: This is a descriptive research study utilizing the CCC19 registry, an international multi-institutional registry with healthcare provider-reported cases of patients with cancer and COVID-19. Between March 2020-December 2021, 116 persons with HIV (PWH) and 10,642 persons without HIV (PWOH) with laboratory-confirmed SARS-CoV-2 infection were identified as eligible for the analysis. Results: Median follow-up time for both groups was 90 days, with interquartile range (IQR) 30-180 days. Most PWH were actively receiving antiretroviral therapy (ART) at the time of COVID-19 diagnosis, with 71% (n = 82) having named drug information available; bictegravir/emtricitabine/tenofovir was the most common ART (n = 25). PWH were of younger age (median 57.5 yrs [IQR 46.5-63.25] vs 65 yrs [IQR 55-74]), male (81% vs 47%), and either non-Hispanic Black or Hispanic (71% vs 34%) compared to PWOH. 12% of PWH (n = 14) were current smokers compared to 6% of PWOH (n = 638), and more than half in each group were never smokers (51% of PWH and 53% of PWOH). The following comorbidities were identified in PWH vs PWOH: cardiovascular (16% vs 20%), pulmonary (16% vs 20%), renal (15% vs 14%), and diabetes mellitus (18% vs 27%). A higher proportion of PWH had hematologic malignancy compared to PWOH (33% vs 19%). More PWH had active cancer which was progressing at the time of SARS-CoV-2 infection compared to PWOH (24% vs 14%). 44% of PWH (n = 51) had received active systemic anticancer therapy within the 3 months preceding SARS-CoV-2 infection (including cytotoxic, targeted, endocrine therapies, and immunotherapy) compared to 51% of PWOH (n = 5,420). PWH had an increased rate of hospitalization (58% vs 55%) compared to PWOH. Although a lower proportion of PWH required supplemental oxygen during hospitalization compared to PWOH (34% vs 38%) and ICU admission rates were identical between the two groups (16% vs 16%), PWH had an increased rate of mechanical ventilation (14% vs 10%) and death (24% vs 18%) compared to PWOH. Conclusions: This is the first known study describing outcomes of patients with cancer and COVID-19 in the PWH population from a large multinational dataset. PWH have characteristics associated with adverse outcomes in prior analyses (male sex, non-Hispanic Black or Hispanic, hematologic malignancy, progressing cancer) but are notably younger and have fewer comorbidities. HIV infection may portend increased risk of severe COVID-19 and death; however, additional analyses, including multivariable regression, are warranted.

Clinical characteristics, risk factors, and rate of severity of a nationwide COVID-19 Saudi cohort

ObjectiveTo evaluate COVID19 patients’ clinical characteristics, risk factors, and COVID-19 severity at baseline and over one month following hospitalization. Design, setting, and participantsThis prospective cohort study of 598 Saudi COVID19 patients recruited from 4 major medical institutions nationwide between June 01, 2020, and February 28, 2021. Patients were stratified into different demographic characteristics and COVID-19 severity scale. ResultsOf the 598 hospitalized adult COVID19 patients (mean [range] age, 57 [46 to 65] years; 59% male), 300 (50.16%) had severe clinical COVID-19. Comorbidity was high among hospitalized patients (73.5 %), with diabetes mellitus (n=; 46%) and hypertension (n=; 41%) being the most common prevalent. In a multivariate logistic regression model, patient demographics and clinical factors such as age (odds ratio [OR], 1.014 per year; 95% CI, 1.003–1.025), male sex (OR, 1.63; 95% CI, 1.02–2.62), diabetes mellitus (OR, 1.63; 95% CI, 1.06–2.49), obesity (OR, 1.93; 95% CI, 1.26–2.94), oxygen saturation<92% (OR, 4.83; 95% CI, 2.96–7.86), and high neutrophil to lymphocyte ratio (OR, 3.74 per unit; 95% CI, 1.96–7.14) were independently associated with higher COVID-19 severity. Moreover, more than 60% of male patients and middle-aged patients (40–60 years) were associated with the use of COVID-19 medications, including favipiravir and dexamethasone, during their hospital stay. Additionally, the rate of invasive mechanical ventilation was the highest in female patients (61.5%) and in middle-aged patients (46.2%). However, the death rate was slightly higher in males (56%) than in female patients and in elderly patients (52%). In Cox proportional analysis, age associated with increased risk of 60-days mortality (Hazard ratio; HR, 1.05 per year; 95% CI, 1.018–1.098). Additionally, the Riyadh region associated with more COVID-19 cases required invasive respiratory support (57.7%) and Jeddah was associated with more deceased COVID-19 cases (44%). ConclusionsThe data shows that comorbidity is associated with hospitalization among COVID-19 patients, which indicates the level of severity. Infection during the winter season (November), male gender, elderly, and those with pre-existing diabetes mellitus or obesity were associated with higher COVID-19 clinical severity.

High flow nasal cannula outside the ICU provides optimal care and maximizes hospital resources for patients with multiple rib fractures

BackgroundHigh flow nasal cannula (HFNC) use reduces work of breathing and improves oxygenation for patients with hypoxemic respiratory failure. Limited prior work has explored protocolized use of HFNC for trauma patients outside the Intensive Care Unit (ICU). The purpose of this study is to describe and evaluate use of HFNC for patients with rib fractures when therapy was standard of care on all floors of the hospital. MethodsIn 2018, the study hospital expanded use of HFNC (AIRVO; Fisher Paykel, Auckland, NZ) to all floors of the hospital, making it available in the ICU, Emergency Department (ED), and on general inpatient floors. The study group included adult patients with three or more rib fractures who received HFNC at any location in the hospital (Phase 2: January 2018-December 2019). The study group was compared to a historical control group when HFNC was available only in the ICU (Phase 1: March 2013-July 2015). Patients were excluded from the study if they received invasive mechanical ventilation prior to HFNC. Primary outcomes were mechanical ventilation rates, ICU days, length of hospitalization, and mortality. ResultsDuring the study period, 63 patients received HFNC, with 35% of patients (n = 22) receiving the duration of therapy outside the ICU. When compared to the control group (N = 63), there were no significant differences in total hospital days (9 vs. 9, p=.64), mechanical ventilation (19% vs. 13%, p=.47), or mortality (3% vs. 5%, p = 1.00). Twenty-seven percent of patients (n = 17) in the study group avoided the ICU during hospitalization. ConclusionsFindings suggest that HFNC therapy can be safely initiated and managed on all hospital floors for patients with multiple rib fractures. Making the therapy available outside the ICU may reduce healthcare resource use without adversely affecting patient outcomes.

Accuracy of Risk Estimation for Surgeons Versus Risk Calculators in Emergency General Surgery

IntroductionSurgical risk calculators have expanded in both number and sophistication of their predictive approach. These calculators are gaining popularity as validated tools to help surgeons estimate mortality and complications following emergency general surgery (EGS). However, the accuracy of risk estimates generated by these calculators compared to risk estimation by practicing surgeons has not been explored. MethodsAcute care surgeons at a quaternary care center prospectively estimated 30-d mortality and complications for adult EGS patients (2019-2021). Surgeon predictions were compared to Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) and NSQIP estimates. Observed-to-expected (O:E) ratios of median aggregate estimates were calculated. C-statistics for surgeon and calculator estimations were utilized to quantify predictive accuracy. ResultsAmong 150 patients (median 61 y, 45% male), 30-d mortality was 15% (n = 23). Observed rates of prolonged mechanical ventilation and acute renal failures were 30% and 10%, respectively. Overall, surgeon predictions were similar to risk calculator estimates for mortality (c-statistics 0.843 [surgeon] versus 0.848 [POTTER] and 0.815 [NSQIP]) and need for prolonged ventilation (c-statistics 0.801 versus 0.722 and 0.689, respectively). Surgeons tended to overestimate complication risks. Surgeon experience was not significantly associated with mortality prediction in an adjusted model. ConclusionsAcute care surgeons at a quaternary care center predicted postoperative mortality and complications with similar discrimination when compared to surgical risk calculators. Surgeon expertise should be utilized in conjunction with risk calculators when counseling EGS patients regarding anticipated postoperative outcomes. Surgeons should be cognizant of patterns in overestimation or underestimation of complications.

Timing of surgical ligation of patent ductus arteriosus in very low birth weight infants

To study the effect of timing of surgical ligation of patent ductus arteriosus (PDA) on the prognosis of very low birth weight infants (VLBWI). The medical data of VLBWI who underwent transthoracic ligation for PDA from June 2018 to May 2021 were reviewed retrospectively. The infants were divided into early ligation group (≤21 days of age) and late ligation group (>21 days of age) based on the age of ligation. The two groups were compared in terms of perioperative clinical features, complications, and mortality. The risk factors for early surgical ligation were analyzed. A total of 72 VLBWI were enrolled, with 19 infants (26%) in the early ligation group and 53 infants (74%) in the late ligation group. There were significant differences in birth weight, gestational age, weight at operation, days of age at operation, rates of preoperative invasive and noninvasive mechanical ventilation, incidence rate of pulmonary hemorrhage, incidence rate of hypotension, preoperative PDA internal diameter (mm/kg), intraoperative PDA external diameter (mm/kg), incidence rate of post-ligation cardiac syndrome, and duration of postoperative invasive mechanical ventilation between the two groups (P<0.05). A binary logistic regression analysis showed that pulmonary hemorrhage was an indication of early surgical ligation of PDA (P<0.05). There were no significant differences in the incidence rates of post-operative complications and the mortality rate between the early ligation and late ligation groups. Early surgical ligation may be performed for VLBWI who are experiencing pulmonary hemorrhage and hemodynamically significant PDA confirmed by cardiac ultrasound after birth. However, post-ligation cardiac syndrome should attract enough attention. In addition, early surgical ligation of PDA does not increase the risk of surgery-related and long-term complications or death, indicating that it is a safe and feasible treatment option.

Association between bronchopulmonary dysplasia and early respiratory morbidity in children with respiratory distress syndrome: a case–control study using nationwide data

Bronchopulmonary dysplasia (BPD) can cause respiratory morbidity beyond the neonatal period. We aimed to analyze the association of BPD on childhood lower respiratory illness (LRI) and asthma among patients diagnosed with respiratory distress syndrome (RDS). This case–control study analyzed data between 2002 and 2015 from a nationwide database. We included 55,066 children with RDS. Two-year LRI and asthma at ages 3 and 5 were assessed. Readmission for LRIs within 2 years of birth occurred in 53.9% and 37.9% of the BPD (n = 9470) and non-BPD (n = 45,596) cases, respectively. In the BPD group, the median number of hospitalizations, mechanical ventilation and oxygen use rates were significantly higher, while the hospitalization duration was significantly longer (P < 0.001 for all). The relative risk of BPD was 1.42 (1.39–1.45) on total readmission and 6.53 (5.96–7.15) on intensive care unit readmission. Asthma prevalence was significantly higher in BPD group (57.6% vs. 48.9% at age 3 and 44.3% vs. 38.2% at age 5, P < 0.001). In children with RDS, BPD could affect repetitive and worse LRI as an independent risk factor for respiratory morbidity during the first 2 years of life. BPD may also be a crucial risk factor for asthma in preschoolers.

Outcomes of Diabetic Ketoacidosis in Adults With End-Stage Kidney Disease: Retrospective Study Based on a National Database

Introduction: The prevalence of diabetes mellitus (DM) in the United States has steadily increased over the past few decades. End-stage kidney disease (ESKD) and diabetic ketoacidosis (DKA) are among the most common chronic and acute complications of DM. Guidance on the management of DKA in ESKD is limited by lack of evidence. We investigated the in-hospital outcomes of patients hospitalized for DKA with underlying ESKD. Methods: We carried out a retrospective cohort study and utilized the National Inpatient Sample (NIS) database from 2016 to 2018. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) codes were used to identify adults (>18 yrs) diagnosed with DM and ESKD. We compared patients with DKA and ESKD to patients who had DKA with preserved renal function. The primary outcomes were rates of in-hospital mortality and mechanical ventilation. Results:Out of 538,135 patients, 18,685 (3.74%) represented DKA patients with ESKD, and 519,450 (96.53%) represented DKA patients with preserved renal function. DKA with concomitant ESKD was more prevalent in a relatively older population (age>30 yrs) with female predominance (52.4%) (p<0.001). The mean age of males and females in the ESKD group was 46.2 (SD 12.7) and 43.7 (SD 13.6) years respectively. African American race and low socioeconomic status had a higher burden of ESKD. In-hospital mortality rate (adjusted OR= 1.12, p=0.56) and need for mechanical ventilation (adjusted OR= 1.11, p=0.25) did not differ significantly in the two groups but adjusted mean total hospitalization charge ($14,882) and mean length of stay (0.87) at the hospital were significantly higher in patients with DKA and ESRD than in those with preserved renal function.Conclusion: DKA is associated with short-term morbidity, increased length of stay, and cost of hospitalization. There is a dearth of evidence-based guidance regarding DKA management in CKD and ESRD. Further studies looking into measures in the management of DKA in ESRD will help develop guidelines in management, decreasing morbidity, and cost of hospitalization.

Fluvoxamine in Nonhospitalized Patients With Acute COVID-19 Infection and the Lack of Efficacy in Reducing Rates of Hospitalization, Mechanical Ventilation, and Mortality in Placebo-Controlled Trials: A Systematic Review and Meta-Analysis.

Recent clinical trials have investigated the use of fluvoxamine in preventing clinical deterioration in nonhospitalized patients with acute COVID-19 infection via stimulation of sigma-1 receptors, which regulates cytokine production and functional inhibition of acid sphingomyelinase activity, which may prevent infection of epithelial cells with SARS-CoV-2. However, the role of fluvoxamine is currently unclear because of a paucity of studies, particularly because the drug is being repurposed as an immunomodulatory and antiviral agent. Aim of our meta-analysis was to investigate the efficacy of fluvoxamine in nonhospitalized patients with acute COVID-19 infection. Comprehensive literature search of PubMed, Embase, Cochrane Library databases, and Web of Science was performed from inception to February 10, 2022, for studies comparing fluvoxamine versus placebo for outpatient management of COVID-19. The primary outcome of interest was rate of hospitalization. The secondary outcomes were rates of patients requiring mechanical ventilation and mortality. The random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CI). A P value <0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index. Three studies (2 randomized controlled trials and one prospective cohort trial) involving 1762 patients were included in the meta-analysis. In patients who received fluvoxamine compared with placebo, there was no significant difference in rates of hospitalization (RR 0.26, 95% CI, 0.04-1.73, P = 0.16, I2 = 62%), mechanical ventilation (RR 0.73, 95% CI, 0.45-1.19, P = 0.21, I2 = 0%), and mortality (RR 0.67, 95% CI, 0.37-1.22, P = 0.19, I2 = 0%). Current evidence does not indicate a significant effect of fluvoxamine on the rates of hospitalization, mechanical ventilation, and mortality of patients with COVID-19 infection.

Clinical effect of fluid resuscitation guided by intra-abdominal pressure and oxygenation index for severe acute pancreatitis patients

To investigate the effect of the liquid resuscitation therapy strategy using intra-abdominal pressure (IAP) and oxygenation index (PaO2/FiO2) as the end point in patients with severe acute pancreatitis (SAP). A retrospective study was performed, including 84 patients with SAP in emergency intensive care unit of Qingzhou Hospital Affiliated to Shandong First Medical University from January 2018 to August 2021. According to the status of fluid balance at admission, all patients were divided into the positive fluid balance group (43 cases) and the negative fluid balance group (41 cases). The clinical data including gender, age, etiology, underlying disease, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) of all patients were collected. Fluid balance, PaO2/FiO2, IAP, compliance rate, new mechanical ventilation rate and overall hospital stay of 1 week after admission were recorded and compared between the two groups. After 72 hours of treatment, the cumulative fluid balance was (5 219.5±1 038.4) mL in the positive fluid balance group; IAP was higher than that before treatment [mmHg (1 mmHg ≈ 0.133 kPa): 11.9±2.0 vs. 11.7±2.1], but no significant difference was found (P > 0.05); PaO2/FiO2 was significantly higher than that before treatment (mmHg: 299.8±51.4 vs. 220.5±50.4, P < 0.05). After 72 hours of treatment, the cumulative fluid balance in negative fluid balance group was (-3 542.4±1 310.6) mL; IAP was significantly lower than before treatment (mmHg: 11.4±1.8 vs. 15.2±1.9, P < 0.05); PaO2/FiO2 was significantly higher than that before treatment (mmHg: 309.9±50.9 vs. 215.4±49.7, P < 0.05). In the fluid resuscitation goals, after 72 hours of treatment, the compliance rate in the negative fluid balance group was significantly higher than that in the positive fluid balance group [82.93% (34/41) vs. 62.79% (27/43), P < 0.05]; 1 week after admission, the new mechanical ventilation rate in the negative fluid balance group was significantly lower than that in the positive fluid balance group [21.95% (9/41) vs. 41.86% (18/43), P < 0.05]; however, there was no significant difference in overall hospital stay between the two groups (days: 41.2±10.9 vs. 39.1±11.5, P > 0.05). After treatment, 70 patients survived and 14 patients died (including 9 cases in the positive fluid balance group and 5 cases in the negative fluid balance group). Using IAP and PaO2/FiO2 to guide liquid therapy could result in effective fluid resuscitation in SAP. The treatment strategy effectively improved prognosis of patients with SAP.

Analysis of hypervirulent Klebsiella pneumoniae and classic Klebsiella pneumoniae infections in a Chinese hospital.

AimsTo evaluate the clinical and genetic virulence characteristics of critically ill patients with hypervirulent Klebsiella pneumoniae (hvKP) and classic KP (cKP) infection.Methods and ResultsThe patients included in this retrospective study (n = 225) were grouped according to their hvKP (n = 114) or cKP (n = 111) status, and their clinical characteristics were analysed and compared. Cox multivariate analysis was conducted to determine the risk factors for hvKP infection. Length of hospital stay, length of intensive care unit stay, duration of mechanical ventilation and 28‐day survival rate were similar between the groups. However, the incidence of septic shock was higher in the hvKP group (16.7%) than in the cKP group (8.1%).ConclusionsThere was a high rate of hvKP infection in this population. Compared to patients with cKP infection, those with hvKP infection showed a higher probability of having septic shock; nevertheless, survival and length of hospital stay were similar between the groups. Risk factors for hvKP infection included hospital‐acquired infection and renal insufficiency.Significance and Impact of the StudyThis study presents relevant information on the characteristics of hvKP infection in a Chinese population, and this promotes early diagnosis and supports the view that the prevalence of hvKP is high in China.

Efficacy of oseltamivir in the treatment of patients infected with Covid-19

ObjectiveThe recent unprecedented pandemic caused by Sars-Cov-2 (the new coronavirus 2019), is threatening public health around the world. Although several studies have been performed, there is no identified treatment for Covid-19 patients. Here we assessed the efficacy of oseltamivir in combination therapy, by comparing two different therapeutic regimens in hospitalized patients, in improving outcomes and find better treatment for Covid-19 patients. MethodsThis is a single-center retrospective cohort study of 285 confirmed Covid-19 in patients at (XXX). Depending on the date of admission, the patients were divided into two groups; group 1 (oseltamivir group) from February 20, 2020 to March 15, 2020 received Oseltamivir with routine regimen and group 2 (control group) from March 20, 2020 to April 20, 2020 received routine regimen alone that included Azithromycin 500 mg/day and Hydroxychloroquine 200 mg/12 h.Endpoints including duration of hospitalization, requirement to admission to intensive care unit (ICU) and mechanical ventilation, outcome and mortality rate. ResultsA total of 285 patients were enrolled in the two months, 120 patients for group 1 and 165 for group 2. The median time from admission to discharge was significantly shorter in the oseltamivir group compared to the control group (4.9 vs 6.6 days, p < 0.001). Additionally, the mortality rate was found to be lower in the oseltamivir group than in the control group (1.7% vs 6,7%, p = 0.06) which was statistically significant by multivariate analysis (p = 0.03). The incidence of admission to the ICU (6.7% vs 11.5%, p = 0.1) and mechanical ventilation (2.5% vs 4.8%, p = 0.3) were also decreased in the oseltamivir group, but was not statistically significant. ConclusionsThis study showed that administration of oseltamivir was associated with shorter length of hospital stay and earlier recovery and discharge of hospital, and a lower mortality rate.

Long term outcomes following rib fracture fixation in patients with major chest trauma

Severe chest injuries are associated with significant morbidity and mortality. Surgical rib fixation has become a more commonplace procedure to improve chest wall mechanics, pain, and function. The aim of this study was to characterise the epidemiology and long-term functional outcomes of chest trauma patients who underwent rib fixation in a major trauma centre (MTC). This was a retrospective review (2014-19) of all adult patients with significant chest injury who had rib fixation surgery following blunt trauma to the chest. The primary outcome was functional recovery after hospital discharge, and secondary outcomes included length of intensive care unit (ICU) and hospital stay, maximum organ support, tracheostomy insertion, ventilator days. 60 patients underwent rib fixation. Patients were mainly male (82%) with median age 52 (range 24-83) years, injury severity score (ISS) of 29 (21-38), 10 (4-19) broken ribs, and flail segment in 90% of patients. Forty-six patients (77%) had a good outcome (GOSE grade 6-8). Patients in the poor outcome group (23%; GOSE 1-5) tended to be older [55 (39-83) years vs. 51 (24-78); p=0.05] and had longer length of hospital stay [42 (19-82) days vs. 24 (7-90); p<0.01]. Injury severity, rate of mechanical ventilation or organ dysfunction did not affect long term outcome. Nineteen patients (32%) were not mechanically ventilated. Rib fixation was associated with good long-term outcomes in severely injured patients. Age was the only predictor of long-term outcome. The results suggest that rib fixation be considered in patients with severe chest injuries and may also benefit those who are not mechanically ventilated but are at risk of deterioration.

Heliox Prescribing Trends for Pediatric Critical Asthma.

Children with asthma exacerbations requiring pediatric ICU (PICU) admission, known as critical asthma (CA), are prescribed a variety of therapeutic interventions including heliox. Delivered invasively and noninvasively, heliox is employed to enhance deposition of aerosolized medications, improve obstructive pulmonary pathophysiology, and avoid complications associated with invasive mechanical ventilation. We used the Virtual Pediatric Systems database to update estimates of heliox prescription and explore for relationships between heliox and mechanical ventilation frequency and duration. We performed a retrospective cohort study using data from 97 PICUs among children 3-17 y of age admitted for CA from 2013-2019. The primary outcome was heliox prescribing rates and trends. Subgroup analyses assessed mechanical ventilation rates and duration by heliox exposure. Of 43,238 subjects studied, 1,070 (2.5%) were prescribed heliox. Mean heliox prescribing rates fell from 4.11% in 2013 to 2.37% in 2019. Heliox use was greater from centers in the South (2.6%) and Midwest (3.3%) as compared to the West (1.6%) and Northeast United States (1.6%, P < .001). In the subgroup assessing mechanical ventilation frequency, mechanical ventilation rates were 273/39,739 (0.7%) and greater for those provided heliox (1.9% vs 0.7%, P < .001). In the subgroup assessing mechanical ventilation duration, no differences in median mechanical ventilation duration were observed (4.94 [interquartile range [IQR] 3.04-6.36] vs 4.63 [IQR 3.11-7.30] d; P = .35) for those with and without heliox. In exploratory adjusted models, noninvasive heliox was not associated with mechanical ventilation. Mortality was rare (206/43,238 [0.47%]) and predominantly among subjects intubated prehospitalization (188/206 [91.3%]). Heliox as adjunctive therapy for children with CA is uncommon (2.5%) and not associated with mechanical ventilation or decreased mechanical ventilation duration in adjusted models. Updated estimates provided herein inform prospective controlled trial development to better define the role of heliox for CA.

Respiratory viral infections are prevalent but uncomplicated in single ventricle CHD.

Patients with single ventricle CHD have significant morbidity and healthcare utilisation throughout their lifetime, including non-cardiac hospital admissions. Respiratory viral infections are the main cause of hospitalisation in children, but few data exist for single ventricle patients. We sought to identify how respiratory viral infections impact patients with single ventricle CHD and potential differences between Glenn and Fontan circulation. We conducted a retrospective study of patients seen from 01/01/2011-12/31/2020. We identified patients with a history of single ventricle CHD and Glenn palliation, and a normoxic control group with isolated atrial septal defect requiring surgical closure. We compared viral-related clinical presentations, admissions, and admission characteristics. A total of 312 patients were included (182 single ventricle, 130 atrial septal defect). Single ventricle patients were more likely than children with isolated atrial septal defect to be admitted with a respiratory virus (odds ratio 4.15 [2.30-7.46]), but there was no difference in mechanical ventilation or hospital length of stay (p = 0.4709). Single ventricle patients with Glenn circulation were more likely than those with Fontan circulation to present and be admitted (odds ratio 3.25 [1.62-6.52]), but there was no difference in ICU admission, mechanical ventilation, or hospital length of stay (p = 0.1516). Respiratory viral infections are prevalent but uncomplicated in patients with single ventricle CHD. Viral-related presentations and admissions are more prevalent during the period of Glenn circulation compared to Fontan circulation; however, rate of mechanical ventilation and hospital length of stay are similar.

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

COVID-19 Vaccine Hesitancy during the Perinatal Period: Understanding Psychological and Cultural Factors to Improve Care and Address Racial/Ethnic Health Inequities.

COVID-19 Vaccine Hesitancy during the Perinatal Period: Understanding Psychological and Cultural Factors to Improve Care and Address Racial/Ethnic Health Inequities.

Trends in the use of non-invasive respiratory support for term infants in tertiary neonatal units in Australia and New Zealand

ObjectiveTo determine whether the use of non-invasive respiratory support, such as continuous positive airway pressure and nasal high flow, to treat term infants in Australian and New Zealand tertiary neonatal...

Pregnancy and the Risk of In-Hospital Coronavirus Disease 2019 (COVID-19) Mortality.

To evaluate whether pregnancy is an independent risk factor for in-hospital mortality among patients of reproductive age hospitalized with coronavirus disease 2019 (COVID-19) viral pneumonia. We conducted a retrospective cohort study (April 2020-May 2021) of 23,574 female inpatients aged 15-45 years with an International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code for COVID-19 discharged from 749 U.S. hospitals in the Premier Healthcare Database. We used a viral pneumonia diagnosis to select for patients with symptomatic COVID-19. The associations between pregnancy and in-hospital mortality, intensive care unit (ICU) admission, and mechanical ventilation were analyzed using propensity score-matched conditional logistic regression. Models were matched for age, marital status, race and ethnicity, Elixhauser comorbidity score, payer, hospital number of beds, season of discharge, hospital region, obesity, hypertension, diabetes mellitus, chronic pulmonary disease, deficiency anemias, depression, hypothyroidism, and liver disease. In-hospital mortality occurred in 1.1% of pregnant patients and 3.5% of nonpregnant patients hospitalized with COVID-19 and viral pneumonia (propensity score-matched odds ratio [OR] 0.39, 95% CI 0.25-0.63). The frequency of ICU admission for pregnant and nonpregnant patients was 22.0% and 17.7%, respectively (OR 1.34, 95% CI 1.15-1.55). Mechanical ventilation was used in 8.7% of both pregnant and nonpregnant patients (OR 1.05, 95% CI 0.86-1.29). Among patients who were admitted to an ICU, mortality was lower for pregnant compared with nonpregnant patients (OR 0.33, 95% CI 0.20-0.57), though mechanical ventilation rates were similar (35.7% vs 38.3%, OR 0.90, 95% CI 0.70-1.16). Among patients with mechanical ventilation, pregnant patients had a reduced risk of in-hospital mortality compared with nonpregnant patients (0.26, 95% CI 0.15-0.46). Despite a higher frequency of ICU admission, in-hospital mortality was lower among pregnant patients compared with nonpregnant patients with COVID-19 viral pneumonia, and these findings persisted after propensity score matching.

Isolated Durable LVAD Bridge to Transplant: Institutional Review Following 2018 Allocation Changes

<h3>Purpose</h3> The purpose of this study was to compare our institutional experience using durable left ventricular assist devices (dLVADs) as a bridge to transplant before and after the 2018 heart allocation policy change. <h3>Methods</h3> Since the allocation change, 29 patients have been bridged to heart transplantation with an isolated dLVAD at our institution. We matched these patients with the most recent 29 consecutive patients bridged to heart transplantation with isolated dLVAD. Baseline pretransplant characteristics and comorbidities were compared between cohorts. Incidence of posttransplant complications, intensive care unit and hospital lengths of stay were compared, as well as 90-day mortality. <h3>Results</h3> Annual number of recipients bridged to transplant using a dLVAD declined after the first year following the allocation policy change (Figure A). Median age, body mass index, and distributions of primary heart failure etiology and dLVAD usage were similar between cohorts. The new policy cohort had a higher incidence of female recipients (21% vs 3%; P=0.044), but a lower incidence of patients maintained on intravenous inotropic therapy at time of transplant (3% vs 21%; P=0.044). Rates of prolonged mechanical ventilation, re-intubation, stroke and renal failure were comparable between cohorts. Intensive care unit length of stay and hospital length of stay were also similar. At 90 days, the new policy cohort experienced higher mortality (21% vs 3%; P=0.044) (Figure B). <h3>Conclusion</h3> From our institutional experience, there appears to be continual decline in patients bridged with dLVAD following the allocation policy change. While rates of many postoperative complications appear comparable to the prior era, short-term mortality appears to be higher. Changes in the heart transplant allocation system have resulted in changes in donor availability and selection for recipients with durable LVADs. These changes, along with the impact of the COVID-19 pandemic, may be responsible for these observations.