Use Of Ventilatory Support Research Articles

Characterizing airway obstruction syndrome in preterm neonates: A neonatology service study

IntroductionAirway Blockage Syndrome (ABS) comprises a group of clinically recognizable disorders caused by alveolar rupture and subsequent escape of air into tissues where it should not be present. ObjectiveTo characterize the airway blockage syndrome in preterm newborns admitted in a Neonatology Service during the years 2020 and 2021. Materials and methodsA descriptive study was conducted on newborns with a gestational age of less than 36.6 weeks who were treated for ABS. Data collected were statistically processed, represented in tables, and graphs. Results and discussionThe incidence of airway blockage was found to be low. There was a predominance of births from dystocic cesarean delivery (55.5%), late preterm births (78.8%) with birth weight between 2000 and 2499 g (44.4%). Pneumomediastinum (50%) was the most common form of presentation. Diagnosis occurred within the first 24 h of life (88.9%). The 55,6 % did not receive ventilatory therapy, while in ventilated cases, invasive modality predominated, showing optimal recovery in most preterm newborns. ConclusionsVariables most associated with this syndrome were gestational age, birth weight, the newborn's clinical condition at birth, and the use of ventilatory support.

Sociodemographic Profile and Risk Factors for the Evolution of Patients with COVID-19 in ICUs in Brazil: A Cross-Sectional Study.

This is a cross-sectional study, with secondary data from Brazilian hospitals in the state of Paraíba, between January 2021 and January 2022. The evolution of clinical cases configured the dependent variable (cure or death), while the predictive variables were sociodemographic data, risk factors, use of ventilatory support, and vaccination against COVID-19. With the help of R software, the following tests were used: chi-square, Pearson's chi-square, and Fisher's exact adherence. Simple logistic regression models were constructed, and odds ratios (95% CI) were estimated using the LR test and Wald test. 7373 cases were reported, with a mean age of 58.1. Of the reported cases, 63.8% died. The most frequent sociodemographic profile included male people, of mixed race, with less than eight years of schooling. Chronic cardiovascular disease (OR 1.28; 95% CI: 1.13-1.45), diabetes (OR 1.41; 95% CI: 1.24-1.61), lung disease (OR 1.52; 95% CI: 1.11-2.09), and the use of invasive ventilatory support (OR 14.1; 95% CI: 10.56-18.59) were all associated with increased mortality. Nonvaccination was associated with a decreased risk of death (OR 0.74; 95% CI: 0.65-0.84). Male patients, nonwhite, and those with low education were more likely to have a worse clinical outcome. The risk factors studied were related to deaths, and those who did not require ventilatory support were related to cure.

Respiratory mechanics characteristics at the time of barotrauma presentation in patients with critical COVID-19 infection.

To evaluate how ventilatory support, the duration of invasive ventilatory support use and lung mechanics are related to barotrauma development in patients who are severely infected with COVID-19 and who are admitted to the intensive care unit and develop pulmonary barotrauma. Retrospective cohort study of patients who were severely infected with COVID-19 and who developed pulmonary barotrauma secondary to mechanical ventilation. This study included 60 patients with lung barotrauma who were divided into two groups: 37 with early barotrauma and 23 with late barotrauma. The early barotrauma group included more individuals who needed noninvasive ventilation (62.2% versus 26.1%, p = 0.01). The tidal volume/kg of predicted body weight on the day of barotrauma was measured, and 24 hours later, it was significantly greater in the late barotrauma group than in the early barotrauma group. During the day, barotrauma was accompanied by plateau pressure and driving pressure accompanied by tidal volume, which significantly increased in the late barotrauma group. According to the SAPS 3, patients in the early barotrauma group had more pulmonary thromboembolism and more severe illness. However, the intensive care unit mortality rates did not significantly differ between the two groups (66.7% for early barotrauma versus 76.9% for late barotrauma). We investigated the effect of respiratory mechanics on barotrauma in patients with severe COVID-19 and found that 25% of patients were on nonprotective ventilation parameters when they developed barotrauma. However, 50% of patients were on protective ventilation parameters, suggesting that other nonventilatory factors may contribute to barotrauma.

Predictors of Readmission, for Patients with Chronic Obstructive Pulmonary Disease (COPD) - A Systematic Review.

Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death globally and is responsible for over 3 million deaths annually. One of the factors contributing to the significant healthcare burden for these patients is readmission. The aim of this review is to describe significant predictors and prediction scores for all-cause and COPD-related readmission among patients with COPD. A search was conducted in Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, from database inception to June 7, 2022. Studies were included if they reported on patients at least 40 years old with COPD, readmission data within 1 year, and predictors of readmission. Study quality was assessed. Significant predictors of readmission and the degree of significance, as noted by the p-value, were extracted for each study. This review was registered on PROSPERO (CRD42022337035). In total, 242 articles reporting on 16,471,096 patients were included. There was a low risk of bias across the literature. Of these, 153 studies were observational, reporting on predictors; 57 studies were observational studies reporting on interventions; and 32 were randomized controlled trials of interventions. Sixty-four significant predictors for all-cause readmission and 23 for COPD-related readmission were reported across the literature. Significant predictors included 1) pre-admission patient characteristics, such as male sex, prior hospitalization, poor performance status, number and type of comorbidities, and use of long-term oxygen; 2) hospitalization details, such as length of stay, use of corticosteroids, and use of ventilatory support; 3) results of investigations, including anemia, lower FEV1, and higher eosinophil count; and 4) discharge characteristics, including use of home oxygen and discharge to long-term care or a skilled nursing facility. The findings from this review may enable better predictive modeling and can be used by clinicians to better inform their clinical gestalt of readmission risk.

Duchenne muscular dystrophy respiratory profiles from real world registry data.

Understanding real-world profiles from neuromuscular databases is helpful for optimizing clinical care and planning research studies. The Canadian Neuromuscular Disease Registry (CNDR) has respiratory data from a population of boys with Duchenne Muscular Dystrophy (DMD). To describe cross-sectional respiratory profiles from a national DMD real-world dataset. To explore the relationship between forced vital capacity percent predicted (FVC%) and disease severity parameters: scoliosis, ambulation and ventilation status. Descriptive statistics summarized the respiratory profiles. The CNDR registry enrolls and collects DMD clinic data from 36 Canadian centers. There were 414 participants enrolled. The age ranged from 2 to 36 years old. Pulmonary function test data were available for 323 participants. The use of ventilatory support was seen in a significant proportion (19.5%) of subjects by age 14-16 years and was used by the majority (69.2%) by age 20-22 years. FVC% declined at a rate of 3.19% per year with every 1-year increase in age. FVC% declined annually by 2.47% in nonambulatory participants versus by 0.96% in ambulatory participants. FVC% did not significantly change over age with the presence of scoliosis or use of ventilatory technology. The data from this large cohort are valuable for understanding real-world patterns of clinical care and disease progression. There is a significant association between the loss of ambulation and the rate of FVC% decline. Further longitudinal studies are needed to better understand the impact of disease parameters on pulmonary function decline and the need for ventilatory support.

Severe acute respiratory syndrome by influenza and factors associated with death in older adults: a population study.

Influenza is characterized by an acute viral infection, which can lead to severe conditions and death, especially in vulnerable populations, such as older adults. Therefore, we sought to analyze cases of severe acute respiratory syndrome (SARS) due to influenza in older adults registered in Brazil and investigate the factors related to death due to this disease. This is a cross-sectional, population-based study that used secondary data from the Influenza Epidemiological Surveillance Information System (IESIS-Influenza). Older adults aged 60 years and above with laboratory diagnosis of influenza were included. A total of 3,547 older adults with SARS due to influenza were included, out of which 1,185 cases with death as the outcome were identified. Among older adults with death as the outcome, 87.4% were not vaccinated against influenza. The main risk factors for death were invasive ventilatory support use, intensive care unit admission, brown skin color and dyspnea (p < 0.001). This study described the profile of older adults with SARS due to influenza in Brazil. Factors associated with death in this population were identified. Moreover, the need to encourage compliance with vaccination among older adults is evident in order to prevent severe cases and unfavorable outcomes related to influenza.

Clinical Manifestation of Nebulin-Associated Nemaline Myopathy.

Nemaline myopathy (NM) is a genetically heterogeneous inherited myopathy related with at least 12 genes, whereas pathogenic variants in NEB gene are the most common genetic cause. The clinical spectrum of NM caused by NEB pathogenic variants (NM-NEB) is very broad, ranging from mild to severe presentations manifesting with generalized weakness, as well as respiratory and bulbar involvement. There is currently not enough data regarding the progression of the disease. In this study, we present a genotypic and phenotypic spectrum of 33 patients with NM caused by NEB variants (NM-NEB) classified according to age groups and the use of ventilatory support. We focused on interventional support, genotype-phenotype correlation, and association between respiratory, bulbar, and motor systems in groups of patients stratified by age and by the use of ventilatory support (VS). Clinical and genetic data from patients with NM-NEB followed up in one specialized center were collected through regular consultations. Patients were evaluated regarding motor, bulbar, and respiratory functions. Thirty-three patients with NM-NEB were evaluated consisting of 15 females and 18 males with an average age of 18 (±12) years and a median of 17 (±11) years. 32% of patients with NM-NEB used a G tube, 35% were not able to walk without support, and 55% needed VS. Scoliosis and dysphagia were more common among patients who used VS. Described for the first time, half of the patients presented tongue atrophy in a triple furrow pattern, and the presence of the atrophy was associated with dysphagia. Comparing the patients grouped by age, we found that, proportionally, older patients had more scoliosis and respiratory dysfunction than younger groups, suggesting the progression of the disease in these domains. In addition to that, we showed that VS use was associated with scoliosis and dysphagia. NM-NEB is a very debilitating disease. There is an association between scoliosis and respiratory dysfunction while patients using VS have more often scoliosis than the no-VS group. Triple furrow tongue atrophy is a novel and frequent finding, which is directly associated with dysphagia. Grouping patients by age suggested disease stability in motor and swallow function, but a progression in respiratory dysfunction and skeletal deformities. All observations are relevant in the management care of patients with NM.

Tracking excess of maternal deaths associated with COVID-19 in Brazil: a nationwide analysis

BackgroundThe COVID-19 pandemic brought a new challenge to maternal mortality in Brazil. Throughout 2020, Brazil registered 549 maternal deaths, mainly in second and third-trimester pregnant women. The objective of this study was to estimate the excess maternal deaths in Brazil caused directly and indirectly by Covid-19 in the year 2020. In addition, we sought to identify clinical, social and health care factors associated with the direct maternal deaths caused by Covid-19.MethodsWe performed nationwide analyses based on data from the Mortality Information System (SIM) for general and maternal deaths and the Influenza Epidemiological Surveillance System (SIVEP-Influenza) for estimates of female and maternal deaths due to COVID-19. Two distinct techniques were adopted. First, we describe maternal deaths directly caused by covid-19 and compare them with the historical series of deaths from covid-19 among women of childbearing age (15 to 49 years). Next, we estimated the total excess maternal mortality. Then, we calculated odds ratios for symptoms, comorbidities, social determination proxies and hospital care aspects between COVID-19 maternal deaths and deaths of women of childbearing age who were not pregnant or no maternal deaths. We chose women of childbearing age (15 to 49 years) as a reference because sex and age introduce differentials in the risk of COVID-19 death.ResultsMost maternal deaths occurred during pregnancy compared to postpartum deaths month by month in 2020 (μ = 59.8%, SD = 14.3%). The excess maternal mortality in 2020 in Brazil was 1.40 (95% CI 1.35–1.46). Even considering excess mortality due to COVID-19 for the childbearing age female population (MMR 1.14; 95% CI 1.13–1.15), maternal mortality exceeded the expected number. The odds of being a black woman, living in a rural area and being hospitalized outside the residence municipality among maternal deaths were 44, 61 and 28% higher than the control group. Odds of hospitalization (OR 4.37; 95% CI 3.39–5.37), ICU admission (OR 1.73; 95% CI 1.50–1.98) and invasive ventilatory support use (OR 1.64; CI 95% 1.42–1.86) among maternal deaths were higher than in the control group.ConclusionsThere was excess maternal mortality in 2020 in Brazil. Even with adjustment for the expected excess mortality from Covid-19 in women of childbearing age, the number of maternal deaths exceeds expectations, suggesting that there were deaths among pregnant and postpartum women indirectly caused by the pandemic, compromising access to prenatal care., adequate childbirth and puerperium.

COVID-19 mortality in metropolitan areas vs. other regions of Brazil, 2020 to 2021Mortalidad por COVID-19 en las regiones metropolitanas y en el interior de Brasil, 2020-2021

To compare hospital mortality rates (HMR) due to severe acute respiratory syndrome (SARS) associated with COVID-19 recorded in metropolitan areas and other regions (interior) of Brazil in 2020 and 2021. This ecological study used public data available on OpenDataSUS. The information was accessed in May 2022. The following variables were considered: age, sex, hospitalization, presence of a risk factor, ICU stay, use of ventilatory support, and final classification in the individual registration form of SARS cases due to COVID-19. Cases and deaths were stratified into five age groups (0-19 years, 20-39 years, 40-59 years, 60-79 years, and ≥80 years) and by place of residence (metropolitan area or interior). The HMR had as numerator the absolute number of deaths by SARS associated with covid-19; and, as a denominator, the absolute number of cases of SARS due to covid-19 according to the year of occurrence, area of residence, age bracket, sex, hospitalization, presence of a risk factor, ICU admission, and use of ventilatory support. There was a significant increase in HMR due to SARS associated with COVID-19 in 2021 in all age groups, except 0-19 years and ≥80 years, as well as among individuals admitted to an ICU and who used invasive ventilatory support, both in metropolitan areas as well as in the interior. There was a worsening of the epidemiological scenario in 2021 with an increase in HMR. However, no differences were identified between the metropolitan regions and the interior of the country.

Desigualdade socioeconômica na letalidade e no cuidado hospitalar de crianças e adolescentes internados por COVID-19 no Brasil

To analyze the association of hospital case fatality rate and care received by children and adolescents hospitalized for COVID-19 with the gross domestic product (GDP) per capita of Brazilian municipalities and regions of residence. Data were collected from the Influenza Epidemiological Surveillance Information System and the Brazilian Institute of Geography and Statistics. The dichotomous outcomes analyzed were hospital case fatality rate of COVID-19, biological samples collected for COVID-19 diagnosis, X-rays, computed tomography (CT) scans, use of ventilatory support, and intensive care unit hospitalization. The covariates were municipal GDP per capita and the Brazilian region of residence. Poisson regression was used for the outcomes recorded in 2020 and 2021 in Brazil, covering the two COVID-19 waves in the country, adjusted for age and gender. The hospital case fatality rate was 7.6%. In municipalities with lower GDP per capita deciles, the case fatality rate was almost four times higher among children and twice as high in adolescents compared to cities with higher deciles. Additionally, residents of municipalities with lower GDP per capita had fewer biological samples collected for diagnosis, X-ray examinations, and CT scans. We found regional disparities associated with case fatality rate, with worse indicators in the North and Northeast regions. The findings remained consistent over the two COVID-19 waves. Municipalities with lower GDP per capita, as well as the North and Northeast regions, had worse indicators of hospital case fatality rate and care.

COVID-19 severe acute respiratory syndrome in Brazilian newborns in 2020-2021.

To describe the clinical characteristics of cases of COVID-19 severe acute respiratory syndrome (SARS) in Brazilian newborns (NBs) in 2020 and 2021, recorded in the Influenza Epidemiological Surveillance Information System (Sistema de Informação da Vigilância Epidemiológica da Gripe - SIVEP-Gripe). The variables analyzed were gender, race/skin color, hospitalization, intensive care unit (ICU) admission, use of ventilatory support, signs and symptoms (fever, cough, O2 saturation<95%, dyspnea, respiratory distress, diarrhea, and vomiting), progress (death or cure), risk factors/comorbidities. Categorical variables were expressed as absolute and relative frequencies. We found 1,649 records of COVID-19 SARS in NBs, with a predominance of multiracial babies in both years. The most frequent symptoms in 2020 and 2021 were, respectively: respiratory distress (67.0 and 69.7%), fever (46.3 and 46.2%), and cough (37.0 and 46.3%). In 2020, 30.5% of patients received invasive ventilatory support; in 2021, this number was 41.6%. In addition, more than 55% of cases required ICU admission, and over 16% died. We emphasize the high proportion of cases that required intensive care and progressed to death.

Description of health patterns of fully vaccinated older adults hospitalized due to COVID-19 in Brazil through association rules

The coronavirus disease 2019 (COVID-19) is a global public health problem. Since the beginning of the pandemic, notified in March 2020, Brazil has shown high lethality from the disease in older adults. From 2012 to 2018, the country showed an increase of 20% in the older adults’ population. Despite the completeness of vaccine protocols against COVID-19 in the country, there is evidence that this age group, associated with the presence of comorbidities, can be a predictor of the occurrence of hospitalization and severe symptoms due to COVID-19. In this direction, this paper aimed to identify patterns and relationships between symptoms, comorbidities, gender, Intensive Care Unit (ICU) admission, and survival status of older adults, fully vaccinated against COVID-19, hospitalized in Brazil. For this purpose, we perform association rules mining on the OpenDataSUS database. For the group of patients with comorbidity, associations with conditions of oxygen saturation (SpO2) &lt;95%, dyspnea and death were predominant; The female sex was associated with survival and the presence of comorbidities, while the male sex with death and admission to the ICU; for patients admitted to the ICU and who died, associations with SpO2&lt;95%, dyspnea, presence of comorbidities and use of ventilatory support were found. The association rule mining procedure has been shown to be useful in surveying the hospitalization profile of these patients.

Short-term cognitive loading deteriorates breathing pattern and gas exchange in adult patients with congenital central hypoventilation syndrome.

Human PHOX2B mutations result in life-threatening sleep-related hypoventilation (congenital central hypoventilation syndrome, CCHS). Most patients retain ventilatory activity when awake through a respiratory-related cortical network. We hypothesised that this need to mobilise cortical resources to breathe would lead to breathing-cognition interferences during cognitive loading. Seven adult CCHS patients (five women; median age 21) performed standard neuropsychological tests (paced auditory serial addition test - calculation capacity, working memory, sustained and divided attention; trail making test - visuospatial exploration capacity, cognitive processing speed, attentional flexibility; Corsi block-tapping test - visuospatial memory, short-term memory, working memory) during unassisted breathing and under ventilatory support. Ventilatory variables and transcutaneous haemoglobin oxygen saturation were recorded. Cortical connectivity changes between unassisted breathing and ventilatory support were assessed using electroencephalographic recordings (EEG). Baseline performances were lower than expected in individuals of this age. During unassisted breathing, cognitive loading coincided with increased breathing variability, and decreases in oxygen saturation inversely correlated with an increasing number of apnoeic cycles per minute (rho -0.46, 95% CI -0.76 to -0.06, p=0.01). During ventilatory support, cognitive tasks did not disrupt breathing pattern and were not associated with decreased oxygen saturation. Ventilatory support was associated with changes in EEG cortical connectivity but not with improved test performances. Acute cognitive loads induce oxygen desaturation in adult CCHS patients during unassisted breathing, but not under ventilatory support. This justifies considering the use of ventilatory support during mental tasks in CCHS patients to avoid repeated episodes of hypoxia.

P193 Candidemia in coronavirus disease 2019 patients in a university hospital in Buenos Aires, Argentina

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMIt is known that the incidence and epidemiology of candidemia vary according to different geographic regions and/or hosts. Between 1998 and 2019, the incidence in a university hospital in the city of Buenos Aires Argentina, ‘HCJSM’, was 2.19/1000 discharges. The coronavirus disease 2019 (COVID-19) pandemic altered the previously recognized course of severe infections, including candidemia.ObjectiveThe aim of this report is to determine the incidence of candidemia in critically ill COVID-19 patients, and the clinical and microbiological aspects of these episodes hospitalized at HCJSM.MethodsThe source documents of this retrospective study are medical records from patients with Sars-Cov-2 and candidemia who were diagnosed between March 1, 2020 and June 30, 2021. At the onset of the pandemic, the HCJSM began admitting patients with COVID-19, and elective procedures were canceled. Demographic, clinical, and laboratory data were reviewed. All data were analyzed using RStudio, a statistical computing platform (version 4.0.2).ResultsDuring the period under review, 61 episodes of candidemia were identified: 23 episodes (39.7%) in COVID-19 patients, and 38 episodes (60,3%) in no COVID-19 patients. Incidence (x 1000 admission) in no COVID-19 patients was 2.5 (38/14 903): in COVID-19 patients 14.4 (23/1595) and in COVID-19–ICU was 42.3 (20/472). The average age of patients is of 65 years (32-84 range years). The time from admission to ICU to the development of candidemia had a median of 18 days (RIC 9-23). A total of 87.5% of the patients had been on mechanical ventilation and 100% of the patients received broad-spectrum antibiotics and had catheters. Episodes were caused by C. parapsilosis (39.7%), C. albicans (35%), C. glabrata (14%), and other species of Candida (11%). A total of 62% of COVID-19 patients who developed episodes of candidemia died during the period under examination. The survival likelihood at 30 days of COVID-19 patients who developed candidemia was higher for C. parapsilosis episodes and lower for C. glabrata episodes.ConclusionThe incidence of candidemia showed an increase in COVID-19 hospitalized severe patients. The use of broad-spectrum antibiotics, the presence of catheters, and the use of ventilatory support in COVID-19 patients were the risk factors most associated with the development of candidemia. Although the number of episodes of candidemia is low, without the strength of statistical analysis, it is important to consider that the likelihood of survival of patients with episodes of candidemia varies according to the species recovered.

Low skeletal muscle radiodensity and neutrophil-to-lymphocyte ratio as predictors of poor outcome in patients with COVID-19

Inflammatory states and body composition changes are associated with a poor prognosis in many diseases, but their role in coronavirus disease 2019 (COVID-19) is not fully understood. To assess the impact of low skeletal muscle radiodensity (SMD), high neutrophil-to-lymphocyte ratio (NLR) and a composite score based on both variables, on complications, use of ventilatory support, and survival in patients with COVID-19. Medical records of patients hospitalized between May 1, 2020, and July 31, 2020, with a laboratory diagnosis of COVID-19 who underwent computed tomography (CT) were retrospectively reviewed. CT-derived body composition measurements assessed at the first lumbar vertebra level, and laboratory tests performed at diagnosis, were used to calculate SMD and NLR. Prognostic values were estimated via univariate and multivariate logistic regression analyses and the Kaplan–Meier curve. The study was approved by the local Institutional Review Board (CAAE 36276620.2.0000.5404). A total of 200 patients were included. Among the patients assessed, median age was 59 years, 58% were men and 45% required ICU care. A total of 45 (22.5%) patients died. Multivariate logistic analysis demonstrated that a low SMD (OR 2.94; 95% CI 1.13–7.66, P = 0.027), high NLR (OR 3.96; 95% CI 1.24–12.69, P = 0.021) and both low SMD and high NLR (OR 25.58; 95% CI 2.37–276.71, P = 0.008) combined, were associated with an increased risk of death. Patients who had both low SMD and high NLR required more mechanical ventilation (P < 0.001) and were hospitalized for a longer period (P < 0.001). Low SMD, high NLR and the composite score can predict poor prognosis in patients with COVID-19, and can be used as a tool for early identification of patients at risk. Systemic inflammation and low muscle radiodensity are useful predictors of poor prognosis, and the assessment of these factors in clinical practice should be considered.

The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study

BackgroundAcute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients’ ED management and short-term outcomes.MethodsThis was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression.ResultsOf the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p < 0.001), more often female (56.4% vs. 42.1%, p = 0.002) and had more dementia (18.7% vs. 7.2%, p < 0.001). On admission, EMS patients had more often confusion (14.2% vs. 2.1%, p < 0.001) and higher respiratory rate (24/min vs. 21/min, p = 0.014; respiratory rate > 30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11–5.81, p = 0.027).ConclusionMost acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality.

The Relationship between Vitamin D Levels and Clinical Outcomes of Neonatal Sepsis in Haji Adam Malik Hospital Medan, Indonesia

BACKGROUND: Vitamin D deficiency in neonates is associated with neonatal sepsis incidence. It is also significantly correlated to the increased risk in the outcomes of sepsis, such as mortality, length of hospital stay, and use of ventilatory support. AIM: The aim of the study is to observe the relationship between Vitamin D levels and clinical outcomes of sepsis in the neonatal unit. METHODS: An analytical cross-sectional study was conducted to neonates in neonatology Haji Adam Malik hospital from June 2019 to February 2020. A Chi-square test was carried out to observe the relationship between Vitamin D levels and sepsis outcomes, and a Mann-Whitney test was done to assess the significance between Vitamin D levels and length of hospital stay. RESULTS: Among 41 full-term and pre-term neonates, there were 75.6% (31/41) neonates with Vitamin D deficiency, while 24.4% (10/41) had normal Vitamin D levels and did not suffer from deficiency. The relationship of Vitamin D levels with mortality, use of ventilatory support, length of stay, and blood culture was p = 0.660 (95% confidence interval [CI] = 0.810–1.677), p = 0.013 (p &lt; 0.05), p = 0.940 (median 21 days), and p =0.712 (95% CI = 0.623–1.353), respectively. CONCLUSION: Vitamin D deficiency had a significant relationship with ventilatory support requirement as one of the sepsis outcomes in neonates.

Risk Factors for Pneumothorax in Ventilated Neonates Admitted to Neonatal Intensive Care Unit (NICU)

Background: Pneumothorax (PTX) is a common complication and potentially life threatening condition for neonates in the neonatal intensive care unit (NICU). The use of ventilatory support and neonatal resuscitation procedures with positive pressure is deemed necessary. Aim of work: The aim of this study is to identify the risk factors which predispose or relate to pneumothorax in neonates admitted in NICU of AL-Azhar Assuit University Hospital and the outcome of this problem. Patients and Methods: This is a retrospective descriptive study was carried out on mechanically ventilated neonates admitted to NICU of AL-Azhar Assuit University Hospital during the period from 1st January 2018 to 1st January 2020. Results: On studying the demographic and clinical characteristics of cases and risk factors implicated in incidence of pneumothorax, it’s reported that 41.7% of cases were males, 75% born by caesarean section, most of cases with gestational age < 34 weeks, with birth weight < 2 kilogram. Respiratory distress syndrome (RDS) was the most prevalent underlying lung disease, as 75% of pneumothorax patients were having RDS, probably being the most common cause of admission and need for ventilatory support. During admission, 4 patients died with mortality rate 33.3% of all patients presenting with pneumothorax. Conclusion:The incidence of PTX was high due to positive pressure ventilation. It was higher in neonates on synchronized intermittent mechanical ventilation (SIMV) than on continuous positive airway pressure (CPAP) in preterm infants, in those of elective CS and neonates with low birth weight. Respiratory distress syndrome was the most prevalent underlying lung disease. Mortality was high due to lower birth weight and gestational age, the need of these patients to mechanical ventilation and more severe chest condition than other patients. Recommendation:Intensive care for neonates who develop pneumothorax is necessary as they have higher mortality rates.

P0416 / #1612: VENTILATORY SUPPORT WITH HIGH FLOW NASAL CANNULA IN PEDIATRIC PATIENTS WITH RISK FACTORS FOR EXTUBATION FAILURE, EXPERIENCE IN THE PEDIATRIC CRITICAL CARE UNIT.

Aims & Objectives: To describe the use of ventilatory support with high-flow nasal cannulas in pediatric patients with risk factors for extubation failure. Methods: Observational, descriptive, cross-sectional and retrospective study. Results: Data were collected from 44 patients from the pediatric intensive care unit from July 2018 to January 2020 at the Mexican National Institute of Pediatrics, patients were grouped by age, the main pathologies that conditioned admission were classified, being the most frequent the respiratory pathology 36%, cardiovascular 21% and neurological 21%, were identified as main risks of extubation failure, prolonged ventilation 32%, and severe malnutrition 26%, the average of the days of mechanical ventilation was 19, and the average of days of ventilatory support with high-flow nasal cannulas was 11, the rate of failure to extubation with ventilatory support with high-flow nasal cannula was 6%. Conclusions: High flow nasal cannula ventilation does improve extubation tolerance, according to our work we found that the percentage of extubation failure was only 6%, which can reach around 20% in other centers according to the reported world literature.

COVID-19 and death of older adults in the Northeast region of Brazil: a survival analysis

Objective: to analyze survival and factors associated with increased risk of death for older adults diagnosed with COVID-19, living in the Northeast region of Brazil. Method: retrospective observational study developed with secondary data provided by the Brazilian Ministry of Health, between June 14 and December 26, 2020. The Kaplan-Meyer method, the time-dependent cox regression model was used, including covariates (age, sex, skin color, comorbidities, admission to the ICU, ventilatory support). Results: out of 9,306 individuals analyzed, 55.9% died and 44.1% survived. The highest risk of death was observed for those aged 80-89 (HR=1.95), brown-skinned (HR=1.99), with immunodeficiency (HR=1.259) or kidney disease (HR=1.147), admitted to the ICU (HR=1,795) and in use of ventilatory support (HR=1606). Conclusion: among older adults residing in the Northeast region of Brazil, there was a higher risk of death from COVID-19 for octogenarians, brown-skinned, with comorbidities, hospitalization in the ICU, followed by the use of ventilatory support. The creation of health prevention strategies that identify older adults with these profiles is suggested to prevent deaths in future pandemic situations.