Risk Of Acute Respiratory Failure Research Articles

Predicting the risk of acute respiratory failure among asthma patients-the A2-BEST2 risk score: a retrospective study.

Acute respiratory failure (ARF) is a common complication of bronchial asthma (BA). ARF onset increases the risk of patient death. This study aims to develop a predictive model for ARF in BA patients during hospitalization. This was a retrospective cohort study carried out at two large tertiary hospitals. Three models were developed using three different ways: (1) the statistics-driven model, (2) the clinical knowledge-driven model, and (3) the decision tree model. The simplest and most efficient model was obtained by comparing their predictive power, stability, and practicability. This study included 398 patients, with 298 constituting the modeling group and 100 constituting the validation group. Models A, B, and C yielded seven, seven, and eleven predictors, respectively. Finally, we chose the clinical knowledge-driven model, whose C-statistics and Brier scores were 0.862 (0.820-0.904) and 0.1320, respectively. The Hosmer-Lemeshow test revealed that this model had good calibration. The clinical knowledge-driven model demonstrated satisfactory C-statistics during external and internal validation, with values of 0.890 (0.815-0.965) and 0.854 (0.820-0.900), respectively. A risk score for ARF incidence was created: The A2-BEST2 Risk Score (A2 (area of pulmonary infection, albumin), BMI, Economic condition, Smoking, and T2(hormone initiation Time and long-term regular medication Treatment)). ARF incidence increased gradually from 1.37% (The A2-BEST2 Risk Score ≤ 4) to 90.32% (A2-BEST2 Risk Score ≥ 11.5). We constructed a predictive model of seven predictors to predict ARF in BA patients. This predictor's model is simple, practical, and supported by existing clinical knowledge.

Accident with a snake of the genus Micrurus corallinus in a dog: Case report

Elapid accidents are rare in Brazil due to these snakes' non-aggressive behavior and semi-subterranean habitat. The venom's action is mainly neurotoxic and, due to the risk of acute respiratory failure, is considered potentially severe. Symptoms occur within an hour after the accident and include sialorrhea, difficulty swallowing, flaccid paralysis, respiratory failure, and death. The diagnosis can be based on the presented clinical manifestations. Treatment, in most cases, is primarily supportive due to the lack of anti-venom serums for use in veterinary medicine. This work aims to report an elapid accident in a dog treated at a veterinary hospital in Florianópolis, SC (Brazil), presenting flaccid paralysis and subsequently evolving into respiratory failure and apnea. The promptness of care and the therapeutic approach used were essential for the significant improvement of the animal.

3P's (Pharmacokinetic, Pharmacodynamic, and Pharmacogenomic) of Valproate: What's New?

Valproate (VPA) has been used clinically for more than 40 years and remains one of the most commonly prescribed antiepileptic drugs. With the advances of various scientific disciplines, much new information about this drug has been uncovered. The aim of this review is to summarize new knowledge about the pharmacokinetics, pharmacodynamics, and pharmacogenomics (3Ps) of VPA for future applications and studies. The review was identified nonsystematically using Pubmed, Google Scholar, and open-access search engines, and studies on the pharmacokinetics, pharmacodynamics, and pharmacogenomics of VPA between 2012 and 2022 were included. Recent findings on pharmacokinetic information, including factors associated with serum VPA levels and its interaction with new drugs. On the other hand, VPA was found to have a neuroprotective effect that is beneficial in brain disorders as well as in patients with c stroke. With respect to the lungs, it has been found to reduce the risk of acute respiratory failure. Recent risk data linked VPA use to hepatotoxicity, vitamin D deficiency, prolonged QT interval, and insulin resistance, among others. Various gene polymorphisms such as CYP2C9 and UGT1A6 are some polymorphisms that may cause dose alteration in the population. The compilation of the 3Ps of VPA revealed new drug information indicating the need for further evaluation. These include new uses and benefits, toxicity data including acute and chronic use, and the involvement of genetic polymorphisms in the pharmacokinetics and pharmacodynamics of the drug.

Abstract #1407376: Hospital Outcomes of Atrial Fibrillation Admissions in Patients with Thyrotoxicosis: Nationwide Analysis

Studies have shown that thyrotoxicosis can trigger or cause Atrial Fibrillation (AF). Literature is lacking studies that describe the impact of thyrotoxicosis on AF admissions in terms of in-hospital mortality and other hospital outcomes. Patients admitted with a primary diagnosis of AF with or without a subsequent diagnosis of thyrotoxicosis were found in the National Inpatient Sample (NIS) Database from 2016 to 2019. Patients were separated into two groups: those with thyrotoxicosis and those without. Univariate and multivariate logistic regression analyses were used to control for frequent confounders and compare the risk of mortality and in-hospital outcomes between the two groups. A total of 1,329,950 patients were admitted with AF as a primary diagnosis during this period. Thyrotoxicosis was diagnosed in 24,754 patients (1.8%). The average age of the aggregate cohort was 70 years old, 52% were female, and 81% were a white race. The average length of stay (LOS) was 3.2 days and the average total hospital charges were 40,048 $. The total number of patients who died during the hospitalization was 11,574 patients. The previous history of thyrotoxicosis was not associated with an increased risk of in-hospital mortality (OR 0.91, 95% CI 0.63 –1.3, p=0.613) in AF hospitalizations. Thyrotoxicosis was not linked to an increased risk of cardiac outcomes like acute coronary syndrome (OR 0.88, 95% CI 0.73-1.06, p=0.2), cardiac arrest (OR 0.97, 95% CI 0.6-1.5, p=0.91), ventricular tachycardia (OR 0.91, 95% CI 0.76-1.09, p=0.327), ventricular fibrillation (OR 0.9, 95% CI 0.44-1.8, P=0.791) or hypertensive emergency (OR 0.66, 95% CI 0.34-1.27, P=0.22). The risk of acute respiratory failure (OR 1.14, 95% CI 0.97-1.35, p=0.103) or pulmonary edema (OR 1.11, 95% CI 0.82-1.5, p=0.492) was not statistically different between the two groups. This study strongly implies that thyrotoxicosis doesn’t impact patients admitted with atrial fibrillation in terms of in-hospital mortality and other hospital outcomes including acute coronary syndrome, cardiac arrest, ventricular tachycardia, ventricular fibrillation, or hypertensive emergency.

Abstract #1403761: The Impact of COVID-19 Infection on Diabetic Ketoacidosis Acidosis Hospitalization: A Nationwide Analysis

One of the potentially fatal consequences for diabetic patients is diabetic ketoacidosis acidosis (DKA), which is also linked to poor hospital outcomes. There is no much information in literature about COVID-19 and how it relates to other hospitalizations. The impact of COVID-19 on in-hospital mortality and other clinically relevant outcomes for DKA patients is being investigated for the first time in this study. Patients admitted with a primary diagnosis of DKA with or without a subsequent diagnosis of COVID-19 Infection were found in the National Inpatient Sample (NIS) Database 2020. Patients were divided into two groups: those who have COVID-19 and those who don't. Univariate and multivariate logistic regression models were utilized to account for frequent confounders and assess the risk of mortality and in-hospital outcomes between the two groups. The total of 110,130 DKA admissions were identified between Jan and Dec 2020. COVID-19 Infection was diagnosed in 2,504 patients (2.2%). The average age of the cohort sample was 35 years old, 51% were male, and 60% were white. The average length of stay (LOS) was 3 days, and the average total hospital charges were 33,132 US dollars. The total number of patients who died was 225 patients. When the two groups were compared, COVID-19 Infection was associated with an increased risk of in-hospital mortality among DKA patients (OR 5.3, 95% CI 1.7–15.9, p=0.003). COVID-19 patients had a higher risk of acute respiratory failure (OR 2.9, 95% CI 1.7–3.9, p< 0.001) and septic shock (OR 3.9, 95% CI 1.5–9.8, p=0.003). There was no significant difference between the COVID-19 and non-COVID-19 groups in the risk of acute coronary syndrome (OR 1.2, 95% CI 0.49–3, p=0.66), cardiac arrest (OR 2, 95% CI 0.5–7.9, p=0.31), hypokalemia (OR 1.14, 95% CI 0.92–1.4, p=0.214), deep vein thrombosis (OR 0.59, 95% CI 0.14–2.4, p=0.47), or pulmonary embolism (OR 3.6, 95% CI 0.84 – 15.4, p=0.083). COVID-19 patients had a longer mean LOS (4.2 vs 2.9 days, p< 0.001) and higher mean total hospital charges (41,216 vs 32,973 $, p=0.004). Patients admitted with DKA and concomitant COVID-19 infection found to have a higher risk of in-hospital mortality and worse hospital outcomes, particularly acute respiratory failure and septic shock. In comparison to non-COVID patients, COVID-19 patients have a longer mean LOS and a higher mean of total hospital charges.

Outcomes of Patients Hospitalized for Acute Diverticulitis With Comorbid Generalized Anxiety Disorder.

Introduction Diverticular disease and anxiety disorders are common in the general population. Prior research on diverticular disease showed that these patients have an increased frequency of anxiety and depression. The objective of this study was to explore the impact of generalized anxiety disorder (GAD) on the outcomes of adult patients admitted with acute diverticulitis. Methods Using the National Inpatient Sample database from the year 2014 and International Classification of Diseases, Ninth Edition Revision, Clinical Modification (ICD-9 CM) codes, acute diverticulitis patients were selected. The outcomes of diverticulitis patients with and without GAD were explored. The outcomes of interest included inpatient mortality, hypotension/shock, acute respiratory failure, acute hepatic failure, sepsis, intestinal abscess, intestinal obstruction, myocardial infarction, acute renal failure, and colectomy. A multivariate logistic regression analysis was performed to determine if GAD is an independent predictor for the outcomes. Results Among 77,520 diverticulitis patients in the study, 8,484 had comorbid GAD. GAD was identified as a risk factor for intestinal obstruction (adjusted odds ratio (aOR) 1.22, 95% CI: 1.05-1.43, p<0.05), and intestinal abscess (aOR 1.19, 95% CI: 1.10-1.29, p<0.05). GAD was found to be a protective factor for hypotension/shock (aOR 0.83, 95% CI: 0.76-0.91, p<0.05) and acute respiratory failure (aOR 0.76, 95% CI: 0.62-0.93, p<0.05). The aORs of sepsis, inpatient mortality, myocardial infarction, acute renal failure, and colectomy were not statistically significant. Conclusions Patients with acute diverticulitis who are also diagnosed with GAD are at increased risk for intestinal obstruction and intestinal abscess, which may be due to the influence GAD has on the gut microbiota as well as the impact of GAD pharmacotherapy on gut motility. There was also a decreased risk for acute respiratory failure and hypotension/shock appreciated in the GAD cohort which may be attributable to the elevated healthcare resource utilization seen generally in GAD patients, which may allow for presentation to the emergency department, hospitalization, and treatment earlier in the diverticulitis disease course.

Direct Extubation to High-Flow Nasal Cannula versus Noninvasive Ventilation in Obese Subjects.

Patients who are obese have a higher risk of acute respiratory failure after extubation in the ICU. This study aimed to compare the extubation of subjects who were critically ill and obese to high-flow nasal cannula (HFNC) versus noninvasive ventilation (NIV) to determine whether HFNC can aid in reducing postextubation respiratory failure and the re-intubation rate. In this randomized controlled trial, subjects who were obese, defined as individuals with a body mass index ≥ 30 kg/m2, were randomly assigned to receive HFNC (n = 60) versus 60 subjects treated with NIV applied immediately after extubation. The primary outcome was the incidence of postextubation respiratory failure and re-intubation rate within 72 h. Secondary outcomes included oxygenation, breathing frequency, subjective dyspnea, ICU and hospital length of stay, and ICU mortality at day 28. Compared with NIV, HFNC reduced the risk of respiratory failure by 8.4%, 95% CI 6.2-12.8%. Even though the rate of re-intubation was lower in the HFNC group versus in the NIV group, no statistical significance was observed (11.6% vs 16.6%; difference 5%, 95% CI 2.5%-8.2%). In 48-h periods and 72 h after extubation, the mean PaO2 /FIO2 significantly increased in the HFNC group compared with the NIV group. Both groups had low dyspnea levels 72 h after extubation. No difference was detected between the groups in breathing frequency. In addition, the 2 groups had no significant difference in ICU and hospital length of stay. The HFNC and NIV groups had comparable hospital mortality rates. The multivariable logistic regression analysis revealed the presence of severe obesity, comorbidities, a higher severity score, and hypercapnia remained as factors associated with an increased risk of re-intubation. Postextubation application of HFNC may prevent respiratory failure in patients who are obese. (ClinicalTrials.gov registration NCT04035351.).

Association of surfactant protein A2 with acute respiratory failure in children.

Interactions among single nucleotide polymorphisms (SNPs) of surfactant protein (SP) are associated with acute respiratory failure (ARF) and its short-term outcome, pulmonary dysfunction at discharge (PDAD) in children. However, genetic association studies using individual SNPs have not been conducted before. We hypothesize that SP genetic variants are associated with pediatric ARF and its short-term complications by themselves. We used available genotype and clinical data in the Floros biobank consisting of 248 children aged ≤24 months with ARF; 86 developed PDAD. A logistic regression analysis was performed for each of the 14 selected SNPs, SP-A1 and SP-A2 genotypes. A p-value less than the Bonferroni correction threshold was considered significant. A likelihood ratio test was done to compare two models (one with demographic data and another with genetic variants). Before Bonferroni correction, female sex is associated with a decreased risk of ARF. Black race and the rs721917 of the SFTPD are associated with increased risk of ARF. After Bonferroni correction, the 1A0 1A1 genotype of SFTPA2 was associated with decreased risk of ARF. The likelihood ratio test showed that the model of the genotype information with demographic data was a better fit to predict ARF risk. None of the SP SNPs and SP-A1, SP-A2 genotypes were associated with PDAD. Our results indicate that SNPs and genotypes of SPs involved in innate immunity and host defense play an important role in ARF and, in the future, may be used as biomarkers.

ANTIPSYCHOTIC USE AND RISK OF ACUTE RESPIRATORY FAILURE IN PATIENTS WITH COPD

ANTIPSYCHOTIC USE AND RISK OF ACUTE RESPIRATORY FAILURE IN PATIENTS WITH COPD

A Novel Radiographic and Clinical Assessment Scoring Tool for Seizure Risk Stratification in the Acute Phase of Cerebral Venous Sinus Thrombosis: A Systematic Review and Meta-Analysis

Background: Nearly 40% of cerebral venous sinus thrombosis (CVST) cases experience a seizure. A plethora of problems may arise from seizures. Many of these are well recognized in literature as well as in clinical practice. These include the risk for acute respiratory failure, acute renal injury, demand ischemia of myocardium, aspiration pneumonia, and a variety of musculoskeletal injury. Given the lack of a validated tool to predict seizure in the acute phase of CVST, the use of prophylactic anti-epileptic drugs (AEDs) is controversial. A systematic review and meta-analysis of observational studies was conducted to identify risk factors to construct a clinical prediction tool for seizure in acute CVST. Methods: Systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Observational studies that investigated the risk factors for seizure in acute CVST were retrieved from MEDLINE, EBSCO, Web of Science, and Pro-Quest. The summary odds ratios (ORs) were calculated from the pool of data under the random effects model. A point value of 1, 2, or 3 was assigned to each risk factor based on their β-coefficient in the predictive model. Discriminative ability of this model was evaluated on the receiver operating characteristic curve. Results: Initial literature search revealed 1,046 articles discussing seizure as a complication of acute CVST. Through a robust systematic review process with two independent reviewers, 14 studies fully meeting the inclusion criteria were selected. Data elements extracted from the studies were analyzed and re-synthesized. Anatomical involvement of frontal lobe (OR: 4.85; 95% confidence interval (CI): 3.52 - 6.68), parietal lobe (OR: 2.52, 95% CI: 1.41 - 4.52), cortical vein thrombosis (OR: 3.16, 95% CI: 2.18 - 4.58), hemorrhagic venous ischemia (OR: 3.85; 95% CI: 3.20 - 4.64), and clinical presentation of motor deficit (OR: 3.07; 95% CI: 2.66 - 3.55) or confusion (OR: 2.15; 95% CI: 1.57 - 2.94) showed a strong association with increased risk for seizure in the setting of acute CVST. We developed a novel Radiographic and Clinical Assessment (RC) scoring system, consisting of the significant six risk factors. RC score yielded a calculated area under the curve of 0.89, with probabilities for seizure ranging from 40% with a score of 0 to 92% for score of 6. Conclusions: RC scoring tool can be used to stratify the seizure risk based on radiographic findings and the clinical presentation in the acute phase of CVST. This predictive tool may be helpful in identifying patients whose seizure risk is high and can potentially further be used as a clinical decision support tool for prophylactic AED treatment. J Neurol Res. 2022;12(3):114-120 doi: https://doi.org/10.14740/jnr731

Evaluation of the Causes of Acute Respiratory Failure in Pregnant Women Admitted to Shahid Sayyad Shirazi Hospital before COVID-19 Pandemic

Introduction: Acute respiratory failure (ARF) is rare in pregnancy and occurs in less than 0.1% of pregnancies, it is one of the most common admissions of pregnant women to the intensive care unit and one of the leading causes of maternal mortality. The aim of this study was evaluation of the causes of ARF in pregnant women admitted to Shahid Sayyad Shirazi Hospital from 2014 to 2019.&#x0D; Material and Methods: This was a retrospective cross-sectional descriptive-analytical in pregnant women with respiratory disorders chief complaints. All cases of pregnant women admitted (1226 cases) were reviewed. Data were analyzed using SPSS version 26.&#x0D; Results: In total, 75 patients were enrolled in the study and their records were reviewed. The mean age of patients was 28.47 ± 5.06 years. Fifteen patients (25%) had ARF. The results showed that 13.3% of pregnant women with ARF needed to use mechanical ventilation (P=0.038). Also, women with history of chronic lung disease (CLD) are at higher risk for ARF (46.7% vs. 33.3%, P&lt;0.001). Only 1.7% of mothers without symptoms of ARF were infected, but 46.7% of mothers with symptoms of ARF were infected (P&lt;0.001).&#x0D; Conclusion: The results of the study showed that infectious causes (influenza) and underlying CLD including asthma were major causes of ARF in pregnant women. Thus, more careful attention is needed to control the underlying disease, and planning for easier access to the influenza vaccine can play an effective role in reducing the incidence of pulmonary infections.

Admission Frailty Score Are Associated With Increased Risk of Acute Respiratory Failure and Mortality in Burn Patients 50 and Older.

Herein, we assessed the utility of the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) to predict burn-specific outcomes. We hypothesized that frail patients are at greater risk for burn-related complications and require increased healthcare support at discharge. Patients 50 years and older admitted to our institution for burn injuries between July 2009 and June 2019 were included. Demographics, comorbidities, pre-injury functional status, injury and hospitalization information, complications (graft loss, acute respiratory failure, and acute kidney disease [AKI]), mortality, and discharge disposition were collected. Multivariate analyses were performed to assess the association between admission frailty scored using the CSHA-CFS and outcomes. P < .05 was considered significant. Eight-hundred fifty-one patients were included, 697 were not frail and 154 were frail. Controlling for Baux scores, sex, race, mechanism of injury, 2nd and 3rd degree burn surface, and inhalation injury, frailty was associated with acute respiratory failure (OR = 2.599 [1.460-4.628], P = .001) and with mortality (OR = 6.080 [2.316-15.958]; P < .001). Frailty was also associated with discharge to skilled nursing facility, rehabilitation, or long-term acute care facilities (OR = 3.135 [1.784-5.508], P < .001), and to hospice (OR = 8.694 [1.646-45.938], P = .011) when compared to home without healthcare services. Frailty is associated with increased risk of acute respiratory failure, mortality, and requiring increased healthcare support post-discharge. Our data suggest that frailty can be used as a tool to predict morbidity and mortality and for goals of care discussions for the burn patient.

Serum concentration of extracellular cold-inducible RNA-binding protein is associated with respiratory failure in COVID-19.

Uncontrolled release of damage-associated molecular patterns (DAMPs) is suggested to be a major trigger for the dysregulated host immune response that leads to severe COVID-19. Cold-inducible RNA-binding protein (CIRP), is a newly identified DAMP that aggravates inflammation and tissue injury, and induces respiratory failure in sepsis. Whether CIRP contributes to the pathogenesis of respiratory failure in COVID-19 has not yet been explored.AimTo investigate if the concentration of extracellular CIRP (eCIRP) in serum associates with respiratory failure and lung involvement by chest computed tomography (CT) in COVID-19.MethodsHerein we report a prospective observational study of patients with COVID-19 included at two University Hospitals in Sweden between April 2020 and May 2021. Serum from hospitalized patients in Örebro (N=97) were used to assess the association between eCIRP and the level of respiratory support and its correlation with pulmonary involvement on chest CT and inflammatory biomarkers. A cohort of hospitalized and non-hospitalized patients from Umeå (N=78) was used as an external validation cohort. The severity of disease was defined according to the highest degree of respiratory support; mild disease (no oxygen), non-severe hypoxemia (conventional oxygen or high-flow nasal oxygen, HFNO <50% FiO2), and severe hypoxemia (HFNO ≥50% FiO2, mechanical ventilation). Unadjusted and adjusted linear regression was used to evaluate peak eCIRP day 0-4 in respect to severity, age, sex, Charlson comorbidity score, symptom duration, and BMI.ResultsPeak eCIRP concentrations were higher in patients with severe hypoxemia and were independently associated with the degree of respiratory support in both cohorts (Örebro; p=0.01, Umeå; p<0.01). The degree of pulmonary involvement measured by CT correlated with eCIRP, rs=0.30, p<0.01 (n=97).ConclusionHigh serum levels of eCIRP are associated with acute respiratory failure in COVID-19. Experimental studies are needed to determine if treatments targeting eCIRP reduces the risk of acute respiratory failure in COVID-19.

5 Admission Frailty Is Associated with Acute Respiratory Failure and Mortality in Burn Patients &amp;gt; 50

IntroductionPre-injury frailty has been shown to predict mortality of older burn patients. Herein, we assessed the utility of the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) to predict burn-specific outcomes. We hypothesize that frail patients are at greater risk for complications such as graft loss, acute respiratory failure, and acute kidney injury and will require increased healthcare support at discharge.MethodsThis is a retrospective cohort study. Patients 50 years and older admitted to our Institution for burn injuries between July 2009 and June 2019 were included. Patients with inhalation injury only, no data on total burn surface area, or for whom medical history was incomplete were excluded. Demographics; comorbidities; pre-injury functional status; admission, injury, and hospitalization information; complications (graft loss, acute respiratory failure, and acute kidney disease (AKI)); mortality, and discharge disposition were collected. Patients were scored on the CSHA-CFS based on pre-admission health and functional status. The frail and non-frail groups were compared. Multivariate analyses were performed to assess the association between admission frailty and outcomes. P < 0.05 was considered significant.ResultsWe included 851 patients, 697 were not frail and 154 were frail. Frail patients were significantly older (66.1 ± 10.8 vs. 63.5 ± 10.9, p = 0.002), more likely Caucasian (98.1% vs. 91%, p = 0.027) and to have suffered flame burn injuries (68.8% vs. 59.8%, p < 0.001). Frail patients had a lower %TBSA (4.4 ± 8.1% vs. 10.1 ± 13.1, p < 0.001) but were more likely to stay longer in hospital relative to %TBSA (3.6 ± 6.7 vs. 1.9 ± 3.1, p < 0.001). Frail patients were less likely to have had skin graft procedures (27.3% vs. 57.4, p < 0.001). On multivariate analysis, controlling for age, sex, race, mechanism of injury, %TBSA, 2nd degree and 3rd degree burn surface, inhalation injury, frailty was associated with acute respiratory failure (OR = 2.599 [1.460-4.628], p = 0.001). Frailty was also associated with mortality (OR = 6.915 [2.455-19.980]; p < 0.001) when controlling for the same variables as well as acute respiratory failure and AKI. Frailty was also associated with discharge to home with healthcare services (OR = 2.678 [1.491-4.809], p = 0.001), to SNF, rehabilitation, or long-term acute care facilities (OR = 3.572 [1.933-6.602], p < 0.001), and to hospice (OR = 5.759 [1.519-21.827], p = 0.010) when compared to home without healthcare services.ConclusionsFrailty is associated with increased risk of acute respiratory failure, mortality, and requiring increased healthcare support post-discharge. Our data suggest frailty as a tool to predict morbidity and mortality as well as for goals of care discussions for the burn patient.

Interleukin-6 Test Strip Combined With a Spectrum-Based Optical Reader for Early Recognition of COVID-19 Patients With Risk of Respiratory Failure.

The COVID-19 pandemic has had a globally devastating impact. This highly contagious virus has significantly overburdened and undermined medical systems. While most infected patients experience only mild symptoms, those who are severely affect require urgent medical interventions and some develop acute respiratory failure and require mechanical ventilation. The broad and potentially deadly impact of infection underscores the critical need for early recognition, especially for those at risk for respiratory failure. Those who are severely impacted and at high risk for respiratory failure have been found to present high levels of serum cytokines, such as interleukin-6 (IL-6). Timely diagnosis and management of those at risk for respiratory failure is crucial. Measurement of IL-6 may provide a means for distinguishing such patients. Currently, most serum IL-6 detection relies on the use of laboratory-based conventional enzyme-linked immunosorbent assays. Although some rapid assays have been developed recently, they need to be conducted by specific technicians in central laboratory settings with advanced and expensive equipment. In this study, we propose an IL-6 test strip combined with a spectrum-based optical reader for early recognition of COVID-19-infected patients at imminent risk of acute respiratory failure requiring mechanical ventilator support. For our analyses, clinical demographic data and sera samples were obtained from three medical centers, and test strip specificity and detection performance were analyzed. This would help healthcare personnel stratify the risk of respiratory failure and provide prompt, and suitable management.

Non-invasive ventilation versus oxygen therapy after extubation in patients with obesity in intensive care units: the multicentre randomised EXTUB-OBESE study protocol

IntroductionPatients with obesity are considered to be at high risk of acute respiratory failure (ARF) after extubation in intensive care unit (ICU). Compared with oxygen therapy, non-invasive ventilation (NIV) may...

Machine Learning Approaches for Predicting Acute Respiratory Failure, Ventilator Dependence, and Mortality in Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and contributes to high morbidity worldwide. Patients with COPD have a higher risk for acute respiratory failure, ventilator dependence, and mortality after hospitalization compared with the general population. Accurate and early risk detection will provide more information for early management and better decision making. This study aimed to build prediction models using patients’ characteristics, laboratory data, and comorbidities for early detection of acute respiratory failure, ventilator dependence, and mortality in patients with COPD after hospitalization. We retrospectively collected the electronic medical records of 5061 patients with COPD in three hospitals of the Chi Mei Medical Group, Taiwan. After data cleaning, we built three prediction models for acute respiratory failure, ventilator dependence, and mortality using seven machine learning algorithms. Based on the AUC value, the best model for mortality was built by the XGBoost algorithm (AUC = 0.817), the best model for acute respiratory failure was built by random forest algorithm (AUC = 0.804), while the best model for ventilator dependence was built by LightGBM algorithm (AUC = 0.809). A web service application was implemented with the best models and integrated into the existing hospital information system for physician’s trials and evaluations. Our machine learning models exhibit excellent predictive quality and can therefore provide physicians with a useful decision-making reference for the adverse prognosis of COPD patients.

481. SARS-CoV-2 Infection in Hospitalized Children: An Elevated Body Mass Index is a Marker of Increased Risk of Acute Respiratory Failure

BackgroundSeveral risk factors are known to increase the severity of coronavirus disease 2019 (COVID-19) illness in adults, including age and obesity. Specific comorbidities affecting COVID-19 outcomes in children are less well defined. MethodsWe performed a retrospective cohort study of overweight and obese (OW) children compared to underweight and normal weight (NW) children with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Children between 2 and 18 years of age who were admitted to Texas Children’s Hospital from April through December of 2020 with a positive SARS-CoV-2 polymerase chain reaction test were included. Asymptomatic patients undergoing surveillance testing for SARS-CoV-2 were excluded. Body mass index (BMI) was calculated using the Centers for Disease Control definition. Demographic and clinical information was obtained from the electronic medical record. Statistical analyses were performed using SAS 9.0. ResultsWe identified 145 total children who met inclusion criteria. Fifty-five (38%) children were NW and 90 (62%) children were OW. Demographics and characteristics are shown (Figure 1). Underlying asthma or chronic lung disease was present in 13 (24%) vs 31 (34%) in the NW and OW groups respectively (P=0.17). OW children were more likely to have pneumonia than NW children [relative risk1.6 (CI 1.40-2.45)]. An elevated BMI was also associated with an increased risk of requiring oxygen [relative risk 1.4 (CI 1.03-1.96)]. The median length of hospitalization was 4 days for NW versus 5 days for OW children (P=0.6). Admission to the Intensive Care Unit (ICU) was similar between the groups (P=0.7). There was no significant difference in treatments administered to children in the two groups, although there was a trend towards increased steroid (29 (53%) vs 59 (67%), P=0.13) and remdesivir (12 (22%) vs 30 (33%), P=0.14) use in the OW children. Four children in each group died. Characteristics of Hospitalized Children with SARS-CoV-2 Infection by Weight Category Abbreviations: ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit; MIS-C, multisystem inflammatory syndrome in children; MV, mechanical ventilation; NC, nasal cannula *Denotes statistically significant P-value a. Calculated using chi-square or fisher exact unless otherwise noted. a. Calculated using chi-square or fisher exact unless otherwise noted. A P-value <0.05 was considered significant. b. Calculated using Wilcoxon rank sum test. c. Includes patients with home noninvasive MV (2) or tracheostomy and home MV(4).ConclusionFor children admitted with symptomatic COVID-19, being overweight or obese was significantly associated with having pneumonia and with requiring oxygen. A difference in ICU admission, length of hospitalization, and mortality was not observed. Obesity prevention along with vaccination efforts may prevent COVID-19 related morbidity in this group. Disclosures All Authors: No reported disclosures

PREDICTING THE NEED FOR INVASIVE VENTILATION WITH APACHE IV SCORE IN PATIENTS WITH SEPSIS FROM COMMUNITY ACQUIRED PNEUMONIA

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Community-acquired pneumonia (CAP) is a leading cause of mortality worldwide. CAP mortality is driven by the development of sepsis and acute respiratory failure (ARF). Predicting the need for invasive ventilation in patients with sepsis from community-acquired pneumonia and early initiation of mechanical ventilation is a critical strategy in the management of ARF. Acute Physiology and Chronic Health Evaluation (APACHE) IV score has been evaluated in assessing the prognosis of critically ill patients. This study aims to predict the need for invasive ventilation with APACHE IV score in patients with sepsis from community-acquired pneumonia. The secondary outcomes were to predict hospital mortality, vasopressor requirements, and the duration of intensive care unit (ICU) stay. METHODS: A retrospective chart review was performed on adult ICU patients admitted with sepsis due to CAP from July 2017 until July 2020 at Metropolitan Hospital Centre. APACHE IV scores were calculated on patients on day one of admission. Based on day one APACHE IV score, patients were grouped into mild, moderate, and severe categories. Patients with APACHE IV score of 25-50 were grouped into the mild category, patients with APACHE IV score of 51-75 were grouped into the moderate category, and patients with APACHE IV score of more than 75 were grouped into the severe category. Each patient was evaluated for the outcomes of invasive ventilation, hospital mortality, vasopressor requirement, and duration of ICU stay. The outcomes were then compared between the three categories. RESULTS: In total, there were 93 patients selected. The mild category had 28 patients, the moderate category had 45 patients, and the severe category had 20 patients. The severe category had the highest need for invasive ventilation (85%), the highest hospital mortality (50%), and the highest vasopressor requirement (5.5 days). Statistical analysis was performed using ordinal regression and multinomial logistics. There was a trend towards statistical significance in the outcome of invasive ventilation requirement with a P-value of 0.06. The differences between the three categories were statistically significant in the vasopressor requirement with a P-value of 0.047. However, the outcomes of hospital mortality and duration of MICU stay were not statistically significant, with P values of 0.16 and 0.10, respectively. CONCLUSIONS: In patients with sepsis from community-acquired pneumonia, high APACHE IV scores can indicate a higher need for invasive ventilation and a higher need for vasopressor requirements. CLINICAL IMPLICATIONS: The APACHE IV scoring system can be helpful in triaging patients with sepsis from CAP and in identifying patients at higher risk of acute respiratory failure and the need for invasive ventilation. DISCLOSURES: No relevant relationships by Antony Arumairaj, source=Web Response No relevant relationships by Imnett Habtes, source=Web Response No relevant relationships by Thomas Newman, source=Web Response No relevant relationships by Hansang Park, source=Web Response No relevant relationships by Julio Valencia, source=Web Response

Association of antihypertensives during hospitalisation with acute respiratory failure in patients with viral pneumonia: A population-based case-control study.

We aimed to identify associations between the risk of acute respiratory failure (ARF) and types of antihypertensive agents in patients with viral pneumonia. In this case-control study, data extracted from the Taiwan National Health Insurance Research Database were analysed. The base population comprised patients with viral pneumonia treated from 2000 to 2013. The case group comprised patients with ARF and the control group comprised participants without ARF. Adjusted odds ratios (ORs) were calculated using a multivariable logistic regression model. In total, 4427 viral pneumonia patients with ARF and 4427 matched control participants without ARF were recruited. Patients with diabetes, alcohol-related disease, asthma, chronic kidney disease or end-stage renal disease, chronic obstructive pulmonary disease, cancer, congestive heart failure, stroke, acute pulmonary oedema and shock had increased odds of developing ARF, especially shock (adjusted OR=49.3; 95% CI=27.4, 88.7), cancer (12.6; 8.67, 18.2) and stroke (7.51; 5.32, 10.6). Increasing odds of developing ARF were noted in patients using potassium-sparing diuretics (2.95; 1.54, 5.64), loop diuretics (68.2; 48.1, 96.6), calcium channel blockers (1.64; 1.26, 2.13) and angiotensin-converting enzyme inhibitors (1.70; 1.15, 2.53). Patients with prescriptions of α-blockers (0.44; 0.26, 0.74), β-blockers (0.37; 0.26, 0.52), thiazides (0.38; 0.25, 0.59) and angiotensin receptor blockers (0.65; 0.51, 0.83) had lower odds of having ARF. Patients with viral pneumonia who received α-blockers, β-blockers, thiazides or angiotensin receptor blockers during hospitalisation had a lower risk of developing ARF.