Mechanical Ventilation Usage Research Articles

Higher Hospitalization Costs and Fewer Routine Discharges in the Medicaid Expansion Era for Lung Transplant Recipients.

In January 2014, states expanded Medicaid access under the Affordable Care Act. We studied the financial implications of this policy on lung transplantation, a costly procedure. Lung transplant (LT) hospitalizations were identified within the National Inpatient Sample (2005-2020). Recipients were categorized as "pre-expansion" (1/2005-12/2013) versus "post-expansion" (1/2014-12/2020) of Medicaid and as being in "expander" versus "non-expander" regions. We calculated difference-in-differences estimates comparing pre- and post-expansion eras in expander versus non-expander regions for inflation-adjusted hospitalization costs and for discharge disposition. We evaluated total hospitalization costs using multivariable generalized linear regression, adjusting for recipient demographics, Charlson Comorbidity Index, single versus double-lung transplant, and extracorporeal membrane oxygenation (ECMO), ex-vivo lung perfusion (EVLP), and mechanical ventilation usage. Of the 29225 LT recipients identified, 14085 were pre-expansion and 15140 were post-expansion. More recipients were insured by Medicaid in expander n=735 (9%) versus non-expander n=220, (3%) regions (p=0.01) post-expansion. Hospitalization costs increased post- versus pre-expansion by $20948 (95% CI=$8713-$33183, p<0.001) more in expander versus non-expander regions even after adjustment for risk factors associated with increased costs. Within expander regions, recipients post- versus pre-expansion were less likely to be discharged routinely (n=2625, 28%vs. n=3959, 44%) and more likely to be discharged to care facilities (n=2045, 22%vs. n=1045, 12%, p<0.001). Although Medicaid expansion resulted in greater access to care, it was associated with increased hospitalization costs and fewer routine discharges for LT recipients. Further research is warranted to identify the reasons that underpin the financial sequelae of Medicaid expansion, including changes in access to care for sicker patients.

Clinical Characteristics and Outcomes of SARS-CoV-2 Infection in Neonates with Persistent Pulmonary Hypertension of the Newborn (PPHN): A Systematic Review

PPHN is a common cause of neonatal respiratory failure and is still a serious condition that is associated with high mortality. Objectives: To analyze the clinical characteristics and outcomes of SARS-CoV-2 infection in neonates with PPHN to identify neonatal cases at risk to develop severe illness. Methods: For this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched Medline, Embase, CINAHL, and PubMed for studies on the development of COVID-19 in neonates with PPHN, published from 1 December 2019 to 29 February 2024, with an English language restriction. Results: Of the 2406 papers that were identified, 21 articles were included in the systematic review. Studies involving thirty-six neonates with PPHN and infected with SARS-CoV-2 were analyzed (twenty-nine survived, six died, and one is still hospitalized). The main causes of PPHN in neonates who had COVID-19 were neonatal respiratory distress syndrome (NRDS) (41.7%), meconium-stained amniotic fluid (MSAF) (16.7%), preterm premature rupture of membranes (PPROM) (11.1%), hypoxic ischemic encephalopathy (HIE) (5.5%), pneumonia (5.5%), and idiopathic (2.8%). Most of those neonates were male (33.3%), belonged to Indian ethnicity (50%), and were delivered via caesarean section (44.4%). COVID-19 in cases with PPHN commonly occurred in neonates born with a pregnancy range from 32 to &lt;37 weeks (moderate to late preterm) (36.1%). The maternal severity of COVID-19 was reported to be severe in three cases only (8.3%); however, SARS-CoV-2 infection in neonates with PPHN was either severe (44.4%) or critical (22.2%). Most of these neonates experienced acute respiratory distress syndrome (ARDS) (58.3%). Early and late multisystem inflammatory syndrome in neonates (MIS-N) were reported in 50% and 11.1%, respectively. A high proportion of neonates were admitted to the intensive care unit (ICU) (58.3%) or needed mechanical ventilation (MV) (47.2%). Neonates with concurrent PPHN and SARS-CoV-2 infection who died had worse severity of COVID-19 [i.e., severity of COVID-19 was critical in 10% (neonates with PPHN who survived group) vs. 83.3% (neonates with PPHN who died group); p = 0.026]. Neonates with PPHN and COVID-19 had a higher relative risk of death if they received more antibiotics (RR 4.14, 95% CI 0.64–6.88) and if their COVID-19 was defined as critical (RR 2.84, 95% CI 0.86–9.39). Male neonates with PPHN and COVID-19 (RR 2.60, 95% CI 0.30–1.17) and those requiring prolonged invasive positive pressure ventilation (RR 2.22, 95% CI 0.64–7.73) also showed an increased relative risk for death. Conclusions: COVID-19 in neonates with PPHN is challenging and may be associated with increased mortality, severity, ICU admission, ARDS, MIS-N, and MV usage. The results should be interpreted with caution owing to the small number of studies and substantial heterogeneity and indicate a need for future research in this area. Due to its benefits, testing for SARS-CoV-2 should be encouraged for newborns with symptoms consistent with COVID-19, especially in neonates with a history of SARS-CoV-2 exposure. Effective protection measures should be implemented during delivery and post-delivery care as necessary.

Development and Validation of a Novel Nomogram for Predicting Mechanical Ventilation After Cervical Spinal Cord Injury

ObjectiveTo investigate the risk factors relating to the need for mechanical ventilation (MV) in isolated patients with cervical spinal cord injury (cSCI) and to construct a nomogram prediction model. DesignRetrospective analysis study. SettingNational Spinal Cord Injury Model System Database (NSCID) observation data were initially collected during rehabilitation hospitalization. ParticipantsA total of 5784 patients (N=5784) who had a cSCI were admitted to the NSCID between 2006 and 2021. InterventionsNot applicable. Main Outcome Measure(s)A univariate and multivariate logistic regression analysis was used to identify the independent factors affecting the use of MV in patients with cSCI, and these independent influencing factors were used to develop a nomogram prediction model. The area under the receiver operating characteristic curve (AUROC), calibration curve, and decision curve analysis (DCA) were used to evaluate the efficiency and the clinical application value of the model, respectively. ResultsIn a series of 5784 included patients, 926 cases (16.0%) were admitted to spinal cord model system inpatient rehabilitation with the need for MV. Logistic regression analysis demonstrated that associated injury, American Spinal Cord Injury Association Impairment Scale (AIS), the sum of unilateral optimal motor scores for each muscle segment of upper extremities (sUEM), and neurologic level of injury (NLI) were independent predictors for the use of MV (P<.05). The prediction nomogram of MV usage in patients with cSCI was established based on the above independent predictors. The AUROC of the training set, internal verification set, and external verification set were 0.871 (0.857-0.886), 0.867 (0.843-0.891), and 0.850 (0.824-0.875), respectively. The calibration curve and DCA results showed that the model had good calibration and clinical practicability. ConclusionsThe nomograph prediction model based on sUEM, NLI, associated injury, and AIS can accurately and effectively predict the risk of MV in patients with cSCI, to help clinicians screen high-risk patients and formulate targeted intervention measures.

Impact of Dementia in Colorectal Cancer Patients: United States Population-Based Cohort Study.

Various socioeconomic and racial disparities are well-documented for colon cancer. However, the association of dementia, which is a growing cause of mortality in the elderly, remains unexplored. We aim to understand the association between these two conditions, in the elderly population group. We utilized the 2020 National Inpatient Sample to investigate records admitted for colorectal cancer identified through ICD-10 CM codes. We divided records by the presence of dementia. Adjusted odds ratios (aORs) for predefined outcomes were determined using multivariable logistic and linear regression models, adjusting for comorbidities. The primary outcome assessed was inpatient mortality, while secondary outcomes include other inpatient complications. We identified 33,335 hospitalizations with ages more than 60. The mean age was 75.2 and males constituted 50.4%. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, utilizing propensity score matching, the presence of dementia is associated with lower inpatient mortality (aOR 0.49, 95% confidence interval [CI] [0.26, 0.92], p=0.03), lower hospitalization costs (beta coefficient -2,823, 95% CI [-5,266, -440], p=0.02), lower odds of acute respiratory failure (aOR 0.54, p=0.01), lower mechanical ventilation usage (aOR 0.26, p<0.01) but higher odds of mental status change (aOR 1.97, 95% CI [1.37, 2.84], p<0.01). The presence of dementia is associated with a lower risk of inpatient mortality, and other clinical outcomes, in colorectal cancer cases admitted for hospitalization. Etiologies behind this relationship should be explored to understand this inverse relationship.

Factors influencing window opening behavior and mechanical ventilation usage during summertime: A case study in UK dwellings

The study presents findings of a data collection campaign conducted in 61 residential buildings in England during the summer of 2022, aiming to investigate the factors influencing 1) window usage, and 2) activation and deactivation of mechanical ventilation systems, and 3) the correlation between the residential soundscape, landscape, individual noise sensitivity, and the significance attributed to the external acoustic environment in determining window usage. The survey, covering 55 dwellings reliant on windows for ventilation, highlights that window opening is predominantly driven by perceived indoor air quality (PIAQ) and thermal comfort concerns. Conversely, the acoustic factor ranks first in prompting window closure, alongside considerations related to perceived cold, safety concerns, excessive drafts, and insect intrusion. Within the 6 dwellings utilizing manually controlled mechanical ventilation, ventilation needs emerges as the predominant factor triggering system activation, followed by considerations related to thermal comfort and PIAQ. Reasons for system deactivation primarily involve a preference for window opening, excessive drafts, and, secondarily, excessive noise or thermal discomfort, with participant-voiced concerns about operational costs. The significance attributed to the external acoustic environment in determining window usage is mainly independent of perceived sound sources, measured loudness, or soundscape content. However, higher acoustic comfort scores correlate with a greater willingness to open windows for an acoustic contact. Interestingly, noise sensitivity modulates the importance attached to the external acoustic context when interacting with the window (odds ratio: 1.04). The study underscores the need of incorporating noise sensitivity as a relevant individual factor in models simulating window closing behaviour.

An externally validated prognostic model for critically ill patients with traumatic brain injury.

Patients with traumatic brain injury (TBI) who are admitted to the intensive care unit often exhibit critical conditions; thus, early prediction of in-hospital mortality is crucial. In this study, we aimed to develop a reliable and easily promotable model for predicting the in-hospital mortality of critically ill patients with TBI using easily accessible indicators and validate the model using external data. Patient data from the Medical Information Mart for Intensive Care-IV 2.2 database were used as training and internal validation sets to establish and internally validate the prognostic model. Data from the Affiliated Dongyang Hospital of Wenzhou Medical University were used for external validation. The Boruta algorithm was used for the initial feature selection, followed by univariate and multivariate logistic regression analyses to identify the final independent predictors. The predictive performance was evaluated using a receiver operating characteristic curve, calibration curve, clinical practicality decision curve analysis, and clinical impact curve. This study included 3225 patients (training set: 2042; internal validation set: 874; and external validation set: 309). Ten variables were selected for inclusion in the nomogram model: age, mechanical ventilation usage, vasoactive agent usage, intracerebral hemorrhage, temperature, respiration rate, white blood cell count, platelet count, red blood cell distribution width, and glucose. The nomogram demonstrated good predictive performance in both the internal and external validation sets. We developed an externally validated nomogram that exhibited good discrimination, calibration, and clinical utility for predicting in-hospital mortality in critically ill patients with TBI.

Epidemiological and clinical characteristics of respiratory syncytial virus infection among people aged 60 and above in Beijing City

Objective: To investigate the epidemiological and clinical characteristics of RSV among patients aged ≥60 years in Beijing from 2015 to 2023. Methods: Based on the respiratory pathogen surveillance system, samples of upper respiratory tract infections (URTI), non-severe community-acquired pneumonia (nsCAP) and severe community-acquired pneumonia (sCAP) among people aged ≥60 years were collected from 28 sentinel hospitals in 16 districts of Beijing from January 2015 to December 2023. Swab samples were collected from URTI within one week, and lower respiratory tract samples from nsCAP and sCAP were collected. Demographic and epidemiological data were also collected. Various respiratory pathogens including RSV were detected. Results: From January 2015 to December 2023, a total of 20 349 cases of acute respiratory infections aged ≥60 years were included, with the RSV-positive rate of 1.54% (313/20 349, 95%CI: 1.39%-1.68%). Among them, the total RSV-positive rates of older people during the pre-pandemic, pandemic, and post-pandemic periods of COVID-19 were 1.59% (207/13 006, 95%CI: 1.38%-1.81%), 0.82% (38/4 650, 95%CI: 0.56%-1.08%) and 2.53% (68/2 693, 95%CI: 1.93%-3.12%), respectively. The difference in RSV-positive rate was statistically significant (P<0.001). Based on the sampling time of cases, the RSV epidemic season for older people in Beijing was from October to March of the following year, with a peak period in December or January of the following year. In the post COVID-19 pandemic, there were very few RSV-positive cases detected in the elderly from April to June 2023, with only one positive case detected in May and one in June. The RSV-positive rate of older people increased significantly from October to December, reaching 11.75% (51/383) in December. Among 263 RSV-positive cases in the elderly, RSV-A, RSV-B and unclassified type accounted for 43.35% (114/263), 29.28% (77/263) and 27.38% (72/263), respectively. Since 2020, there has been a subtype conversion, with RSV-B being the main focus. Among 197 elderly cases that have complete clinical data, the main symptoms were cough (86.8%, 171/197), sputum (80.2%, 158/197) and fever (73.60%, 145/197). About 24.87% (49/197) of elderly cases experienced complications. The hospitalization mortality rate was 4.57% (9/197), and the hospitalization rate was 78.68% (155/197). The ICU occupancy rate was 1.99% (36/197). The mechanical ventilation usage rate was 13.32% (33/197), and the length of hospital stay [M (Q1, Q3)] was 12 (9, 16) days. Conclusion: In Beijing, the RSV infection rate is relatively low during the COVID-19 pandemic, and the prevalence of COVID-19 is relatively high. In 2023, there was no out-of-season outbreak of RSV infection among the elderly. Elderly RSV infection cases have multiple complications, severe diseases, and poor prognosis.

Meta-analysis of peripheral blood eosinophils in clinical testing of chronic obstructive pulmonary disease patients.

Meta-analysis was used to investigate the relationship between peripheral blood eosinophil (EOS) levels, clinical characteristics, and prognosis in chronic obstructive pulmonary disease (COPD)patients in previous literature. To analyse the correlation between peripheral blood EOS levels and clinical characteristics and prognosis of patients with COPD using meta-analysis. In databases such as PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wan Fang Data, literature related to the clinical characteristics or prognosis of COPD patients with high-level EOS published before July 2023 was searched for meta-analysis. Through computer search and screening, 29 articles were ultimately included. The meta-analysis results showed that compared to conventional EOS levels, COPD patients with high EOS levels had a lower proportion of GOLD III-IV grade patients (OR = 00.78, 95% CI (0.68, 0.88), p < 0.001), lower CAT scores (OR = -1.01, 95% CI (-1.75, -0.28), p = 0.007), shorter hospital stay (OR = -1.33, 95% CI (-1.52, -1.14), p < 0.001), and lower mortality rate (OR = 0.53, 95% CI (0.42, 0.66), p < 0.001). The readmission rate was low (OR = 0.40, 95% CI (0.33, 0.48), p < 0.001), and there was no statistically significant difference in FEV1%pred (OR = -0.55, 95% CI (-1.33, 0.23), p = 0.17), higher FEV1/FVC values (OR = -0.45, 95% CI (-1.08, 0.18), p = 0.160), and mechanical ventilation usage rate (OR = 0.89, 95% CI (0.65, 1.21), p = 0.450) among COPD patients with different EOS levels. The levels of peripheral blood EOS in COPD patients are related to lung function, respiratory symptoms, etc.; Moreover, COPD patients with high-level EOS have shorter hospital stays, lower mortality and readmission rates. Therefore, ESO can be used as an auxiliary indicator for clinical symptom diagnosis of COPD patients and as an auxiliary indicator for predicting prognosis.

Economic burden and secondary complications of influenza-related hospitalization among adults in the US: a retrospective cohort study

Objective This study aims to describe the healthcare resource utilization (HCRU) and direct medical cost of influenza-related hospitalizations to illustrate the persistent economic burden of influenza among adults in the US. Methods A retrospective cohort study was conducted using the PINC AI Healthcare Database. Adults hospitalized with a diagnosis of influenza between August 1–May 31 from 2016–2023 were identified and stratified by age (18–49, 50–64 and ≥65 years). The index hospitalization was defined as the individual’s first influenza-related hospitalization during each season. Patient demographics, comorbidities, and hospitalization characteristics were assessed during the index hospitalization. Index hospitalization length of stay (LOS), in-hospital mortality, intensive care unit (ICU) admissions, mechanical ventilation (MV) usage, and costs were evaluated overall and by MV usage, ICU admission, and secondary complication status. Pre-index influenza-related outpatient and emergency department (ED) visits (7 days prior) were also evaluated. Results Primarily initiated in the ED, the median LOS for influenza-related hospitalizations was 3–4 days. Inpatient mortality increased with age (2.2–4.4%). Combined mean hospitalization and initial ED visit costs were $12,556–$14,494 (2017/18; high severity season) and $11,384–$12,896 (2022/23; most recent season). Compared to other age groups, adults ≥65 years had higher proportions of hospitalization with no MV or ICU usage. Adults 18–49 years had the highest proportion of ICU admission only, whereas adults 50–64 years had the highest MV usage only and both MV and ICU admission. MV and/or ICU usage was associated with higher hospitalization costs. Increasing proportionally with age, the majority of influenza-related hospitalizations had a secondary complication diagnosis, which were associated with elevated costs. Limitations Analysis of this hospital-based administrative database relied on coding accuracy. Only hospital system-associated outpatient/ED visits were captured; the full scope of HCRU was under-ascertained. Conclusions The economic burden of influenza-related hospitalizations remains substantial, driven by underlying conditions, MV/ICU usage and secondary complications.

Abstract 17668: Association of Female Sex With Outcomes in Older Patients With STEMI

Introduction: Acute coronary syndrome is increasingly affecting the aging population. Despite this, we have observed that older patients presenting with acute coronary syndromes often experience poorer outcomes in the setting of age-related comorbidities and undergo decreased rates of reperfusion therapy. In this analysis, we aimed to uncover any sex differences in outcomes amongst older female patients admitted with ST-Elevation Myocardial Infarction (STEMI). Methods: We utilized the National Inpatient Sample data from 2020 to isolate cases where patients were primarily admitted for STEMI. From this pool, we then identified two subsets: individuals who were aged 65 and over and females. We implemented both logistic and linear regression analyses and accounted for any potential confounding factors. We considered our findings to be statistically significant if the 2-tailed p-value was &lt;0.05. Results: During 2020, there were a total of 159,890 hospitalizations for STEMI. Among these cases, 46.3% or 74,013 involved patients over 65 years old. After adjusting for various factors such as race, hospital characteristics (including bed size, location, and teaching status), insurance coverage, income level, and Elixhauser comorbidities, we noted a number of significant findings for women over the age of 65 admitted due to STEMI. These included a heightened in-hospital mortality rate (aOR 1.36, 95% CI 1.23- 1.52), reduced usage of mechanical ventilation (aOR 0.86, 95% CI 0.78 - 0.96), less likelihood to receive mechanical circulatory support (aOR 0.64, 95% CI 0.53 - 0.78), and a decreased probability to undergo PCI (aOR 0.87, 95% CI 0.81 - 0.94). Conclusion: In hospital admissions for STEMI, we observed that older female patients experienced increased complications during hospitalization and were less likely to undergo invasive reperfusion therapy. Additional research would be required to identify if these sex differences can be attributed to variations in initial presentation before STEMI or if changes in clinical management by sex are contributing to adverse outcomes.

Patient Admission and Mechanical Ventilator Allocation Decision-Making Processes by Frontline Medical Professionals in a Japanese ICU During the COVID-19 Pandemic: A Qualitative Study.

During the COVID-19 pandemic, the need to triage COVID-19 patients in ICUs emerged globally. Triage guidelines were established in many countries; however, the actual triage decision-making processes and decisions themselves made by frontline medical providers may not have exactly reflected those guidelines. Despite the need to understand decisions and processes in practice regarding patient ICU admission and mechanical ventilator usage to identify areas of improvement for medical care provision, such research is limited. This qualitative study was conducted to identify the decision-making processes regarding COVID-19 patient ICU admissions and mechanical ventilator allocation by frontline medical providers and issues associated with those processes in an ICU during the COVID-19 pandemic. Semi-structured, in-depth interviews were conducted with ICU physicians and nurses working at an urban tertiary referral hospital in Japan between February and April 2022. Patient characteristics that influenced triage decisions made by physicians and the interaction between physicians, nurses, and senior management staff upon making such decisions are discussed in this article. An implicated issue was the lack of legal support for Japanese physicians to practice withdrawal of life-sustaining treatments even during emergencies. Another issue was the impact of non-clinical forces-likely specific to health emergencies-on physicians' decisions regarding mechanical ventilator allocation, where such forces imposed a significant mental burden on the medical providers. We consider public policy and legal implications for future pandemics.

SAT289 Prevalence And Treatment Outcomes of Critical Illness-related Corticosteroid Insufficiency (CIRCI) In Septic Shock Patients In Medical Wards And Emergency Room In Thammasat University Hospital

Abstract Disclosure: K. Sanpawithayakul: None. K. Meepornbucha: None. P. Pirompanich: None. P. Vibhatavata: None. Background: The reported prevalence of critical illness-related corticosteroid insufficiency (CIRCI) varies widely, depending on the patient population studied and the diagnostic criteria used. Although hydrocortisone (HC) is widely used in patients with septic shock who respond poorly to adequate fluid resuscitation and vasopressors, clinical outcomes remain controversial. Objectives: To investigate the prevalence of CIRCI and to evaluate characteristics of septic shock patients treated with HC due to suspicion of CIRCI as compared to septic shock patients without CIRCI. Material and Method: Retrospective analysis of septic shock patients admitted in medical wards in Thammasat University Hospital, from January 2020 to June 2021, was performed. Prevalence of CIRCI in septic shock patients was explored by using different serum cortisol cutoff at 10 μg/dL (C-10) and 18 μg/dL (C-18), respectively. 28-day mortality, duration of hospital and intensive care unit (ICU) admission, mechanical ventilator usage, need for vasopressor support, and complications of HC use were also analyzed. Results: Of the 252 septic shock patients, 68 patients were met our inclusion criteria. Eight (11.8%) and 20 (29.4%) patients was diagnosed with CIRCI by serum cortisol cutoff 10 and 18 µg/dL, respectively. There were no significant differences in baseline characteristics (i.e., age, sex and preexisting diseases) between groups. Of the septic shock patients without CIRCI diagnosed by C-18 cutoff, initial SOFA and APACHE II, serum creatinine and lactate were significantly higher. Moreover, 28-day mortality rate was statistically higher in patients without CIRCI by C-18 cutoff (70.8% vs 40.0%, p=0.03). Multivariate analysis recognized the the amount of vasopressor use as significant predictor of 28-day mortality, with OR 19.04 (95%CI 1.23-293.80, p=0.04) and 19.34 (95% CI 1.27-293.50, p=0.03) in C-10 and C-18, respectively. However, in-patient mortality was not statistically different between groups regardless of the cortisol cutoff. Conclusion: Using a 18-C cutoff, there was a higher mortality rate in patients without CIRCI. Keyword: Septic shock, CIRCI, critical illness-related corticosteroid insufficiency Presentation: Saturday, June 17, 2023

Mechanical Ventilation Management for Aneurysmal Subarachnoid Hemorrhage in ICU Settings: A Literature Review

Aneurysmal Subarachnoid Hemorrhage (aSAH) is one of the challenging neurologic emergencies with a high mortality rate along with various permanent disabilities. In order to provide the patient with the most appropriate and accurate treatment, as well as to prevent further complications, a multidiscipline approach is required. This study aimed to review the various mechanisms, indications, management, and sedation of mechanical ventilation in aSAH, along with a review of prone positioning and acute respiratory distress management in aSAH. Although the main injured organ is the brain, aSAH also affects the respiratory system through various mechanisms. The usage of mechanical ventilation plays an important part in brain oxygenation and perfusion and helps prevent related complications. Levels of oxygen and carbon dioxide in the blood might play some roles in aSAH patients. No significant difference was found in using various sedative regimens. Prone positioning is indeed beneficial for the oxygenation of aSAH patients, provided that continuous monitoring is done. Blood glucose and calcium levels might be able to help predict the outcome of aSAH patients. Mechanical ventilation plays an important part in aSAH management. Clinicians must be aware of the impact of mechanical ventilation on neurological organs and the cardiopulmonary system. Balancing between oxygenation, ventilation, and sedation must be in line with aSAH condition. Several prognostic factors and tools can help predict aSAH mortality that might be able to help the clinician tailor aSAH management to their patient's needs.&#x0D;

The prevalence and outcomes of hyponatremia in children with COVID-19 and multisystem inflammatory syndrome in children (MIS-C).

To assess the prevalence of hyponatremia among pediatric patients with coronavirus disease 2019 (COVID-19) and Multisystem Inflammatory Syndrome in Children (MIS-C) and determine if pediatric hyponatremia was associated with an increased length of stay, higher rates of mechanical ventilation, and/or elevated inflammatory markers on admission as compared to eunatremic patients. Electronic health records were retrospectively analyzed for 168 children less than 18 years old with COVID-19 or MIS-C who were admitted to pediatric units within the Northwell Health system. The primary exposure was hyponatremic status (serum sodium <135 mEq/L) and the primary outcomes were length of stay, mechanical ventilation usage and increased inflammatory markers. Of the 168 children in the study cohort, 95 (56%) were admitted for COVID-19 and 73 (43.5%) for MIS-C. Overall, 60 (35.7%) patients presented with hyponatremia on admission. Patients with hyponatremia had higher rates of intensive care unit admission when compared to eunatremic patients (32/60 [53.3%] vs. 39/108 [36.1%], p = 0.030). In regression models, hyponatremia was not significantly associated with increased length of stay or mechanical ventilation rates. After adjustment for relevant confounders, hyponatremia remained associated with an increased square root CRP (β = 1.79: 95% CI: 0.22-3.36) and lower albumin levels (β = -0.22: 95% CI: -0.42--0.01). Hyponatremia is common in pediatric COVID-19 and MIS-C. Hyponatremia was associated with a lower albumin and higher square root CRP levels. This may suggest an association of inflammation with lower serum sodium levels.

Abstract P380: Impact Of The Smoking Paradox On Outcomes Of Hypertensive Emergencies

Introduction: The "smoking paradox" is a surprising occurrence wherein smoking appears to offer a protective benefit, leading to enhanced survival rates for particular patient populations. This research seeks to explore the presence of this paradox in patients who were admitted due to hypertensive emergencies across the United States in the initial year of the COVID-19 pandemic. Methods: We examined data from the 2020 National Inpatient Sample to identify patients who were primarily admitted due to hypertensive emergency. We used ICD-10 codes to distinguish between those with and without a smoking history. We employed logistic and linear regression analyses and accounted for potential confounders. We deemed the results as statistically significant when the 2-tailed p-value was less than 0.05 Results: In the year 2020, a total of 1,221,535 admissions were primarily due to hypertensive emergencies. Out of these, 527,559 cases, constituting 43.2%, involved patients with a history of smoking. Once we adjusted for confounding variables, we found that patients with a smoking history who were hospitalized due to hypertensive emergencies demonstrated a reduced risk of in-hospital mortality (aOR, of 0.58, 95% CI of 0.55 - 0.63). They also showed decreased usage of mechanical ventilation (aOR 0.86, 95% CI 0.82 - 0.88), vasopressor therapy (aOR 0.57, 95% CI 0.50 - 0.64), mechanical circulatory support (aOR 0.37, 95% CI 0.28 - 0.49), and hemodialysis (aOR 0.90, 95% CI 0.87 - 0.94). Conclusion: In summary, patients who have a history of smoking and who are hospitalized due to hypertensive emergencies tend to fare better than those without a smoking history. Further in-depth studies are necessary to fully understand the implications of this smoking paradox on such patients. This would help in revealing any underlying factors and consequently lead to improvements in patient care strategies.

Factors Affecting Hospitalization Length and in-Hospital Death Due to COVID-19 Infection in Saudi Arabia: A Single-Center Retrospective Analysis.

The emerging COVID-19 coronavirus disease has widely spread, causing a serious worldwide pandemic. Disease severity and mortality risk can be predicted using an analysis of COVID-19 clinical characteristics. Finding out what influences patients' hospitalization length and in-hospital mortality is crucial for decision-making and planning for emergencies. The goal of this study is to identify the factors that influence hospital stay length and in-hospital death due to COVID-19 infection. This cross-sectional study was conducted from August to October 2020 and included 630 patients with a confirmed diagnosis of COVID-19 infection. Using odds ratios (OR) and 95% confidence intervals (CI), a multivariable logistic regression model was used to assess the variables that are linked to longer hospital stays and in-hospital deaths. Most patients were male (64.3%), and most were older than 40 years (81.4%). The mean length of hospital stay (LoHS) was 10.4±11.6 days. The overall death rate among these COVID-19 cases was 14.3%. Non-survivors were older, had more comorbidities, had prolonged LoHS with increased ICU admission rates and mechanical ventilation usage, and had a more severe condition than survivors. ICU admission, low serum albumin, and elevated LDH levels were associated with longer LoHS, while ICU admission, DM, and respiratory diseases as comorbidities, total leukocytic count, and serum albumin were predictors of mortality. Longer LoHS due to COVID-19 infection was linked to ICU admission, low serum albumin, and elevated LDH levels, while the independent predictors of in-hospital death were ICU admission, DM, and respiratory diseases as comorbidities, total leukocytic count, and serum albumin.

A Research Study on Prompt Results and Physical Assessment of Mechanically Ventilated Children

Objective: There is alarming information on the usage of MV in PICUs from Asian nations. The goals of this research were to identify the patients' clinical profiles, traits, frequent causes of breathing problems, complications connected to ventilation problems, and ultimate outcomes. For admittance to the pediatric critical care unit, the criterion for mechanical ventilation (MV) is rigorous (ICU). It may be difficult to manage children in impoverished nations with minimal resources that need invasive ventilation. Methods: The information gathered included epidemiological trends, ventilation indications, problems, duration of use of the ventilator, and results. From January 2022 to December 2022, a retrospective analysis of kids who needed ventilator support in the Liaqaut National Hospital, Karachi was conducted. Results: The most frequent indications for ventilation in this research were impending respiratory arrest (34.6%) and a low Glasgow coma rating (17.8%). Of the 1172 patients who were brought to the PICU, 101 (8.6%) needed mechanical ventilation. 75% of the patients on mechanical ventilation were male, and 42% were newborns. We discuss the epidemiological patterns, prevalence, causes, and results of pediatric intensive care unit ventilator support cases. Planning better treatment plans in the future may assist improve outcomes, which can be achieved by analysis of this data. The average MV lasted 2.1 days. These kids had a 38.6% death rate. Conclusions: In summary, there is little MV activity in our PICU. The most frequent justification for mechanical ventilation was respiratory failure. Keywords: Respiratory Failure, Mechanically Ventilated, Pediatrics Intensive Care Unit.

CLINICAL FEATURES OF DIABETIC KETO ACIDOSIS INDIVIDUALS IN THE INTENSIVE CARE UNIT

Background: Diabetic ketoacidosis (DKA) is the most common acute hyperglycemic condition related to diabetes. Recent investigations suggest that DKA affects approximately 8 out of every 1,000 diabetics annually. Objective: This study aims to determine the clinical features of individuals with severe DKA admitted to ICU. Study Design: A retrospective analysis. Setting: The study was conducted at Bahria International Hospital Lahore and Services Institute of Medical Sciences Lahore, Pakistan. Duration of Study: The study period was from Oct 01, 2022, to March 30, 2023. Methods: Data from patients' health records were retrospectively analysed, including demographics, clinical manifestations (fever, nausea, vomiting, abdominal pain, breathlessness, altered sensorium, low blood pressure), and triggering factors (insulin discontinuation, septicemia). Hospital stay duration, mortality rate, and usage of mechanical ventilation were also documented. Results: A total of 30 patients were enrolled in the study, of whom 26 (86.6%) were males. The most prevalent complaint was abdominal discomfort, observed in 86.6% of the study population. Vomiting was present in 93.3% of the individuals. Only 8 (26.6%) patients were newly diagnosed with diabetes, while the remainder were known type 1 diabetics on insulin treatment. The mean HbA1c was 10.2%, ranging from 8.7% to 12.6%. Serum blood glucose, bicarbonate levels, and anion gap were independently associated with clinical indicators of severe DKA. A correlation was found between DKA indicators and the requirement for mechanical ventilation. Conclusion: The majority of individuals with severe DKA admitted to our ICU experienced gastrointestinal symptoms, with noncompliance to insulin treatment being the primary cause of DKA.

The Characteristics and Duration of Mechanical Ventilator Use on Patient with Neuromuscular Paralysis Diseases in Intensive Care Unit (ICU) Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar in December 2019 - December 2022

Background: Amyotrophic Lateral Sclerosis (ALS), Guillain-Barre Syndrome (GBS), and Myasthenia Gravis (MG) are neuromuscular diseases which involved the dysfunction of peripheral nerves or muscles. Respiratory muscle weakness often happens in neuromuscular diseases, where it leads to the requirement of mechanical ventilation or even death from respiratory failure. This study aims to determine the characteristics and duration of mechanical ventilator usage in patients with neuromuscular paralysis diseases at Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar. Results: From December 2019 to December 2022, there were 5 GBS patients (20%), 19 MG crisis patients (76%), and 1 ALS patient (4%). The mean of age was 40.8 years and the majority was female. The average duration of ventilator use in GBS patients was 25.8 days, in MG crisis was 26.2 days, and in ALS was 30 days, therefore all of them were prolonged. The outcomes were 3 GBS patients (12%) lived and 2 GBS patients (8%) died; 14 MG crisis patients (56%) lived and 5 MG crisis patients (20%) died; and 1 ALS patient (4%) died. The ICU diagnosis which complicated the patients were electrolyte disturbances, hypoalbuminemia, and community or ventilator acquired pneumonia. Conclusion: Neuromuscular disease mostly causes respiratory muscle weakness and results in increased mortality and morbidity requiring mechanical ventilation. Risk factors affecting the prolonged duration of ventilator use were electrolyte disturbances, hypoalbuminemia, and pneumonia. Keywords: length of ventilator usage, neuromuscular paralysis disease, amyotrophic lateral sclerosis, Guillain-Barre syndrome, myasthenia gravis, intensive care unit, Bali

Weighted gene co-expression network analysis revealed T cell differentiation associated with the age-related phenotypes in COVID-19 patients

The risk of severe condition caused by Corona Virus Disease 2019 (COVID-19) increases with age. However, the underlying mechanisms have not been clearly understood. The dataset GSE157103 was used to perform weighted gene co-expression network analysis on 100 COVID-19 patients in our analysis. Through weighted gene co-expression network analysis, we identified a key module which was significantly related with age. This age-related module could predict Intensive Care Unit status and mechanical-ventilation usage, and enriched with positive regulation of T cell receptor signaling pathway biological progress. Moreover, 10 hub genes were identified as crucial gene of the age-related module. Protein–protein interaction network and transcription factors-gene interactions were established. Lastly, independent data sets and RT-qPCR were used to validate the key module and hub genes. Our conclusion revealed that key genes were associated with the age-related phenotypes in COVID-19 patients, and it would be beneficial for clinical doctors to develop reasonable therapeutic strategies in elderly COVID-19 patients.