Ventilation In Intensive Care Unit Research Articles

The First Report of Chryseobacterium gleum Caused Ventriculoperitoneal-shunt Infection in a Child.

To The Editors: Ventriculoperitoneal (VP) shunt is one of the most widely used and effective methods in the treatment of hydrocephalus in childhood. VP shunt infections have been observed in approximately 3.2%–25%, and Chryseobacterium spp. is a rare cause of VP shunt infections.1,2 Herein, we report the first VP shunt infection caused by Chryseobacterium gleum. A 12-month-old female (corrected age 8 months) born via spontaneous vaginal delivery, weighed 700 g at 25 weeks of gestation, was admitted to our emergency department with a fever with a maximum peak temperature of 39°C, projectile vomiting, and decreased oral intake. Her history included long-term ventilation in the neonatal intensive care unit with a diagnosis of moderate bronchopulmonary dysplasia. At 4 months of age, she developed intraventricular hemorrhage and progressive hydrocephalus, and a VP shunt was inserted. She had several episodes of VP shunt infections caused by S. epidermidis and S. aureus. At admission, the patient was febrile, tachycardic (heart rate, 160/min) and tachypneic (respiratory rate of 48/min). Physical examination showed weakness, lethargy and sleepiness. Her total Glasgow Coma Scale score was 12 (E3V4M5). Laboratory tests were as follows: white blood cell (WBC) count: 12.5 × 103/μL (neutrophil 37% and lymphocyte 54%), C-reactive protein: 20 mg/L, procalcitonin: 0.09 μg/L. The cerebrospinal fluid (CSF) WBC count was 120/mm3, protein 107 mg/dL and glucose 42 mg/dL. With the preliminary diagnoses of sepsis and shunt infection, intravenous (IV) cefotaxime (300 mg/kg/day) and IV vancomycin (60 mg/kg/day) was initiated empirically. Peripheral/catheter blood cultures and CSF samples were inoculated into aerobic and anaerobic culture bottles (BacT/ALERT, BioMérieux, Durham, USA). The patient underwent VP shunt externalization. The blood and urine cultures were negative during the patient’s follow-up. Chryseobacterium gleum was isolated in the CSF, shunt and ventricular catheter tip cultures on the 3rd day of treatment. The organism had high-level minimum inhibitory concentration (MIC) levels for meropenem (MIC = 32 μg/mL), imipenem (MIC = 32 μg/mL) and piperacillin-tazobactam (MIC = 250 μg/mL). MIC level of ciprofloxacin was 0.125 μg/mL and trimethoprim-sulfamethoxazole was 0.5 μg/mL. Cefotaxime and vancomycin were switched to IV trimethoprim/sulphamethoxazole (5 mg/kg every 6 hours) and ciprofloxacin (10 mg/kg every 8 hours). On the 5th day of the combined therapy, the patient’s CSF sample was evaluated and showed a WBC count of 30/mm3, glucose 42 mg/dL and protein 360 mg/ dL, and the CSF culture was sterile. Antibiotics were continued for 21 days. The patient was clinically stable, and no adverse effects or seizures were observed during or after the treatment. The extra ventricular drainage was removed, the VP shunt was inserted following 2 consecutive negative CSF cultures, and the patient was discharged. Chryseobacterium species are common in nature but are not found in human flora. Most cases are nosocomial and are frequently associated with immunosuppression or implantable devices. Chryseobacterum gleum is typically a low-virulence organism that can cause serious infections. It has been reported that Chryseobacterum gleum can cause infections such as central-line-associated bloodstream infection, community-acquired pneumonia and urinary tract infection in adults.3–5 Unlike previous reports, Chryseobacterium was isolated in the cerebrospinal fluid in our study. Chryseobacterum gleum commonly colonizes mechanical devices, causing device-associated infections, and can form biofilm. According to this study, VP shunt may be a risk factor for Chryseobacterium gleum infections. This report emphasizes the significance of Chryseobacterium species as a causative agent of a wide range of infections, and VP shunts can pose a risk for this agent. Data on the management of Chryseobacterium is limited. Antimicrobial susceptibility testing guidelines for Chryseobacterium infections should be developed for more effective and accurate treatment.

Perceived responsibility for mechanical ventilation and weaning decisions in intensive care units in the Kingdom of Saudi Arabia.

Optimizing patient outcomes and reducing complications require constant monitoring and effective collaboration among critical care professionals. The aim of the present study was to describe the perceptions of physician directors, respiratory therapist managers and nurse managers regarding the key roles, responsibilities and clinical decision-making related to mechanical ventilation and weaning in adult Intensive Care Units (ICUs) in the Kingdom of Saudi Arabia (KSA). A multi-centre, cross-sectional self-administered survey was sent to physician directors, respiratory therapist managers and nurse managers of 39 adult ICUs at governmental tertiary referral hospitals in 13 administrative regions of the KSA. The participants were advised to discuss the survey with the frontline bedside staff to gather feedback from the physicians, respiratory therapists and nurses themselves on key mechanical ventilation and weaning decisions in their units. We performed T-test and non-parametric Mann-Whitney U tests to test the physicians, respiratory therapists, and nurses' autonomy and influence scores, collaborative or single decisions among the professionals. Moreover, logistic regressions were performed to examine organizational variables associated with collaborative decision-making. The response rate was 67% (14/21) from physician directors, 84% (22/26) from respiratory therapist managers and 37% (11/30) from nurse managers. Physician directors and respiratory therapist managers agreed to collaborate significantly in most of the key decisions with limited nurses' involvement (P<0.01). We also found that physician directors were perceived to have greater autonomy and influence in ventilation and waning decision-making with a mean of 8.29 (SD±1.49), and 8.50 (SD±1.40), respectively. The key decision-making was implemented mainly by physicians and respiratory therapists in collaboration. Nurses had limited involvement. Physician directors perceived higher autonomy and influence in ventilatory and weaning decision-making than respiratory therapist managers and nurse managers. A critical care unit's capacity to deliver effective and safe patient care may be improved by increasing nurses' participation and acknowledging the role of respiratory therapists in clinical decision-making regarding mechanical ventilation and weaning.

Poor Outcomes of Patients From Delayed Care After Ground Level Falls.

Ground level falls are a common cause of morbidity and mortality in trauma patients. Delayed presentation in many conditions has been proven to lead to worsened outcomes. Currently, there are limited data on outcomes of those who have a delayed presentation after a ground level fall. This study was a retrospective analysis of the Trauma Registry at our center. Any adult patient who presented after a ground level fall was grouped based on their time to presentation post-injury: less than or greater than 24h. Age, gender, hospital length of stay (LOS), intensive care unit (ICU) LOS, mechanical ventilation days, Injury Severity Score, and mortality were patient characteristics gathered. A Student's t-test and Chi-squared testing were utilized to determine the presence of significant differences between the groups. Significance was set at P < .05. Two hundred of 4018 patients had delayed presentation. Those with delayed presentation were more likely to be male (P = .028), younger in age (71 vs 74years old, P < .01), had greater hospital LOS (6 vs. 5, P < .01), ICU LOS (5 vs. 3, P < .01), and mechanical ventilation days (13 vs. 5days, P < .01). They also had higher ISS (8 vs. 7, P < .01), and mortality was significantly higher in those who presented after 24h (P = .034). Patients with delayed presentation after a ground level fall have worsened Injury Severity Scores and outcomes to include hospital and ICU LOS, ventilator days, and overall mortality.

A Study to Correlate the ETCO2 and ABG in Predicting Metabolic Acidosis Among Patient on Mechanical Ventilation in Intensive Care Unit

Background: Capnography is an essential instrument for tracking metabolic and respiratory activity. According to the the ETCO2 level to predict metabolic acidosis with patient with mechanical ventilation admitted in ICU. Purpose: The purpose of current study was to predict the metabolic acidosis among patient on mechanical ventilator support. Materials and methods; A study was descriptive-analytical study design, was conducted in the host institution of Saveetha Medical College and Hospitals. There were 60 samples in ICU using purposive sampling techniques on the inclusion criteria within 24 hours of admission. In ICU collect data from every intubated patient with mechanical ventilator support along with ETCO2 probe connecting to the Endotracheal tube, Monitoring capnography values and comparison with the ABG values to predict metabolic acidosis. Results: Out of 60 samples with respect to capnography with EtCO2 the mean score of Bicarbonate level among patients with metabolic acidosis was 21.97±3.37 and the mean score of ETCO2 was 44.70±7.24. The calculated Karl Pearson’s Correlation value of r = -0.303 shows a negative correlation which was found to be statistically significant at p

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19.

We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death.The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death.

A Comparison of Intubation and Airway Complications Between COVID-19 and Non-COVID-19 Critically Ill Subjects.

Introduction The number of subjects infected with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout the western hemisphere increased exponentially in the later months of 2020.With this increase in infection, the number of subjects requiring advanced ventilatory support increased concomitantly.We decided to compare the survival rates between coronavirus disease 2019 (COVID-19) subjects versus non-COVID-19 subjects undergoing intubation in the intensive care unit (ICU).We hypothesized that COVID-19 subjects would have lower rates of survival post-intubation. Methods We screened all subjects admitted to the adult critical care unit between January 2020and June 2020 to determine if they met the inclusion criteria.These subjects were required to be spontaneously ventilating upon admission and eventually required intubation.Subjects were selected from our electronic health record (EHR) system EPIC© (Epic Systems, Verona, WI) through a retrospectiveICU admission analysis.We identified and included 267 non-COVID-19 subjects and 56 COVID-19 subjects.Our primary outcome of interest was intubation-related mortality.We defined intubation mortality as unexpected death (within 48 hours of intubation).Our secondary outcomes were the length of stay in the ICU, length of time requiring ventilator support, and proportion of subjects requiring tracheostomy placement. Results Compared to non-coronavirus disease (COVID) subjects, COVID subjects were more likely to be intubated for acute respiratory distress.COVID subjects had longer stays in the ICU and longer ventilator duration than non-COVID subjects.COVID-positive subjects had a decreased hazard ratio for mortality (HR = 0.42, 95% CI: 0.20-0.87, P < 0.05) and increased chances of survival compared to non-COVID subjects. Conclusions We showed therates of intubation survival were no different between the COVID and non-COVID groups.We attribute this finding to intubation preparation, a multidisciplinary team approach, and having the most experienced provider lead the intubation process.

Ventilator Associated Pneunomia in Neonatal Intensive Care Unit: Occurrence and Risk Factors

Objectives: To examine the occurrence of pneumonia linked with a ventilator in the neonatal intensive care unit and to determine the related risk factors. Study design: A cross-sectional study Place and Duration: This study was conducted at Aga Khan University hospital from May 2021 to May 2022 Methodology: This study includes a total of 70 participants admitted in neonatal intensive care unit. All the patients were put under the ventilator for more than 2 days. At the time of admission, the X-ray of the chest was performed, and it was also performed every day. When certain organisms were present on the tracheal aspirate, ventilator-associated pneumonia (VAP) was diagnosed. After 2 days of ventilation, microbial analysis and gram staining were done for tracheal aspirates. They were later examined to determine the occurrence of nosocomial pneumonia and what are the risk factors linked with it. A Chi-square test and t-test were conducted to examine all the data. A confidence level of 0.05 was set. Results: Pneumonia associated with the ventilator occurred in 31.4% of the participants where a large number had developed it between 4-14 days after intubation. There were certain risk factors that were determined in our research. They include the use of H2 blockers, invasive lines, low PaO2/FiO2, and re-intubation. There were two things (use of steroids and enteral feeding through nasogastric) that were not linked with the occurrence of this pneumonia. The patients who were in the group of ventilator-associated pneumonia were having a longer time period of stay and mechanical ventilation. Conclusion: The occurrence of pneumonia associated with ventilators is high. Those patients who were having above mentioned risk factors should require pay special attention towards prevention. Keywords: pneumonia, ventilators, ventilator associated pneumonia, neonatal intensive care unit

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. European Society of Intensive Care Medicine, European Respiratory Society.

Weaning from mechanical ventilation in intensive care units: a call for new international consensus guidelines

In The Lancet Respiratory Medicine, Tài Pham and colleagues1 report the results of the WEAN SAFE study, aiming to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. WEAN SAFE was an international, multicentre, prospective, observational study including 5869 critically ill adult patients, conducted in 481 intensive care units in 50 countries.1 The authors can be congratulated for this large convenience sample reporting novel and important findings.

Long-term respiratory follow-up of ICU hospitalized COVID-19 patients: Prospective cohort study.

Coronavirus disease (COVID-19) survivors exhibit multisystemic alterations after hospitalization. Little is known about long-term imaging and pulmonary function of hospitalized patients intensive care unit (ICU) who survive COVID-19. We aimed to investigate long-term consequences of COVID-19 on the respiratory system of patients discharged from hospital ICU and identify risk factors associated with chest computed tomography (CT) lesion severity. A prospective cohort study of COVID-19 patients admitted to a tertiary hospital ICU in Brazil (March-August/2020), and followed-up six-twelve months after hospital admission. Initial assessment included: modified Medical Research Council dyspnea scale, SpO2 evaluation, forced vital capacity, and chest X-Ray. Patients with alterations in at least one of these examinations were eligible for CT and pulmonary function tests (PFTs) approximately 16 months after hospital admission. Primary outcome: CT lesion severity (fibrotic-like or non-fibrotic-like). Baseline clinical variables were used to build a machine learning model (ML) to predict the severity of CT lesion. In total, 326 patients (72%) were eligible for CT and PFTs. COVID-19 CT lesions were identified in 81.8% of patients, and half of them showed mild restrictive lung impairment and impaired lung diffusion capacity. Patients with COVID-19 CT findings were stratified into two categories of lesion severity: non-fibrotic-like (50.8%-ground-glass opacities/reticulations) and fibrotic-like (49.2%-traction bronchiectasis/architectural distortion). No association between CT feature severity and altered lung diffusion or functional restrictive/obstructive patterns was found. The ML detected that male sex, ICU and invasive mechanic ventilation (IMV) period, tracheostomy and vasoactive drug need during hospitalization were predictors of CT lesion severity(sensitivity,0.78±0.02;specificity,0.79±0.01;F1-score,0.78±0.02;positive predictive rate,0.78±0.02; accuracy,0.78±0.02; and area under the curve,0.83±0.01). ICU hospitalization due to COVID-19 led to respiratory system alterations six-twelve months after hospital admission. Male sex and critical disease acute phase, characterized by a longer ICU and IMV period, and need for tracheostomy and vasoactive drugs, were risk factors for severe CT lesions six-twelve months after hospital admission.

Ciprofol: A Novel Alternative to Propofol in Clinical Intravenous Anesthesia?

Ciprofol is a novel compound that was independently developed in China. According to the Chinese product instructions approved by the China National Medical Products Administration and the information of official website, indications for ciprofol include sedation and anesthesia during the surgical/procedure of nontracheal intubation, induction and maintenance of general anesthesia, and sedation during intensive care. Ciprofol is a short-acting intravenous sedative based on the structural modification of propofol. Ciprofol has high efficacy, good selectivity, and fewer adverse reactions, indicating good clinical application potential. A series of clinical studies have been conducted to evaluate the sedative effect of ciprofol in various procedures and settings, including gastroscopy and colonoscopy, fiber-optic bronchoscopy, general anesthesia in elective surgeries, and mechanical ventilation in intensive care units. This review summarizes the chemical structure, pharmacodynamics, and pharmacokinetic properties of ciprofol. We also assessed the efficacy and safety of ciprofol by synthesizing the relevant clinical trial data.

Machine learning models for predicting severe COVID-19 outcomes in hospitals

The aim of this observational retrospective study is to improve early risk stratification of hospitalized Covid-19 patients by predicting in-hospital mortality, transfer to intensive care unit (ICU) and mechanical ventilation from electronic health record data of the first 24 h after admission. Our machine learning model predicts in-hospital mortality (AUC = 0.918), transfer to ICU (AUC = 0.821) and the need for mechanical ventilation (AUC = 0.654) from a few laboratory data of the first 24 h after admission. Models based on dichotomous features indicating whether a laboratory value exceeds or falls below a threshold perform nearly as good as models based on numerical features. We devise completely data-driven and interpretable machine-learning models for the prediction of in-hospital mortality, transfer to ICU and mechanical ventilation for hospitalized Covid-19 patients within 24 h after admission. Numerical values of.CRP and blood sugar and dichotomous indicators for increased partial thromboplastin time (PTT) and glutamic oxaloacetic transaminase (GOT) are amongst the best predictors.

Anticoagulation therapy in hospitalized patients with COVID-19: a meta-analysis of randomized clinical trials.

Thromboembolic events are common in hospitalized patients with COVID-19, suggesting that SARS-CoV-2 infection may be related to a prothrombotic state. Several clinical trials evaluating different anticoagulation strategies were developed. Thus, we proposed conducting a meta-analysis of randomized clinical trials that evaluated the efficacy and safety of therapeutic anticoagulation with heparins in hospitalized patients with COVID-19. We searched PubMed, Cochrane, and Epistemonikos for studies published until December 22, 2022. Nine studies compared prophylactic/intermediate anticoagulation versus therapeutic anticoagulation with heparins were included. Four efficacy and one safety endpoints were analyzed: all-cause mortality, thromboembolic events, pulmonary embolism, need of intensive care unit or non-invasive ventilation, and major bleeding. Compared with prophylactic/intermediate anticoagulation, therapeutic anticoagulation with heparins was not associated with a reduction in all-cause mortality and need of intensive care unit or non-invasive ventilation in hospitalized patients with COVID-19, but showed a reduction in the number of thromboembolic events (RR 0.54, 95% CI 0.41-0.71, I2 = 0 %) and pulmonary embolisms (RR 0.37, 95% CI 0.24-0.57, I2 = 0 %), besides an increase in major bleeding (RR 1.67, 95% CI 1.05-2.64, I2 = 0 %). This meta-analysis did not show a reduction in all-cause mortality in hospitalized patients with COVID-19 who received anticoagulation with heparin at a therapeutic dose compared to those who received a prophylactic/intermediate dose, as well as no significant differences were found in the need of intensive care unit admission or use of non-invasive ventilation. There was, however, a reduction in thromboembolic events, pulmonary embolism, and increased bleeding (Tab. 1, Fig. 5, Ref. 31). Keywords: COVID-19, anticoagulation, heparins, meta-analysis.

Spectrum and outcome of the use of noninvasive ventilation in a pediatric cardiac intensive care unit: A single-center experience.

The pediatric cardiac intensive care unit (PCICU) frequently uses noninvasive ventilation (NIV). There are several reasons for its use, including prophylactic use right after the patient has been extubated. It is also used when patients are experiencing acute respiratory failure due to either cardiac or noncardiac reasons but are still able to maintain their airways. The objective of this study was to understand the spectrum of use of NIV following congenital cardiac surgery and analyze the outcome. A retrospective observational study was conducted in a 14-bed PCICU, reviewing data from August 2019 to August 2022. Among 1750 congenital cardiac surgeries, 523 patients (29.9%) received NIV. The median age of the population was 2.5 months. Factors such as higher Risk-Adjusted Classification for Congenital Heart Surgery-1 category, longer intraoperative cardiopulmonary bypass time, and aortic cross-clamp time were associated with increased NIV use. Preoperative ventilator needs, infections, genetic syndromes, diaphragmatic paralysis, high vasoactive inotrope score (VIS) in the first 24 h, neonatal age, and weight <5 kg were independently associated with increased NIV need. The NIV group had a longer intensive care unit (ICU) stay compared to non-NIV patients. The success rate of NIV was 84%, with 440 successful cases and 83 failures. The mortality rate in the success and failure groups was not significantly different (5.27% vs. 6.0%). NIV is widely used in PCICU, but it is associated with longer ICU stays. It proves beneficial after congenital cardiac surgery, especially for patients with specific risk factors. However, NIV may not directly impact mortality rates, suggesting that other factors contribute to patient survival.

Severe Acute Respiratory Syndrome Coronavirus 2 Infection Symptoms in Pregnancy and Maternal and Neonatal Complications Due to COVID-19: A Systematic Review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnant women is associated with severe maternal and neonatal complications including maternal and newborn death. This review aimed to assess the SARS-CoV-2 infection symptoms during pregnancy as well as maternal and neonatal complications in Iran. A developing and low-income country and a systematic review. International scientific databases including PubMed, Web of Science, Scopus and Google Scholar were searched in a systematic review manner. Two independent researchers were checked and identified articles from September 2019 to September 2022 based on eligibility criteria and quality appraisal. The results of review were reported in two sections including maternal and neonatal outcomes. Descriptive statistics was used for statistical analysis. Seventeen studies including 870 pregnant mothers with COVID-19 met the eligibility criteria and were reviewed. The main maternal consequences of COVID-19 were intensive care unit (ICU) admission, pre-term delivery, maternal death, pre-mature rupture of membranes, pre-eclampsia, intrauterine growth retardation and stillbirth. Neonatal ICU admission, newborn death, neonatal sepsis, low birth weight and respiratory distress syndrome, tachypnoea, asphyxia and pneumothorax were the most common outcomes of COVID-19 infection in offspring of pregnant subjects. Pregnant mothers with COVID-19 infection are at higher risk of being admitted to the ICU and mechanical ventilation and consequently maternal and neonatal death. Comparing the maternal and foetal consequences in different ethnicities, regions and countries may be related to the socioeconomic status of people and should be considered with respect to different determines. Moreover, the maternal and neonatal complications due to COVID-19 infection in Iran and other developing countries seem to be higher than other countries.

Postoperative Period of Myocardial Revascularization Surgery: Retrospective Cohort Study of a Single Center.

Risk factors and postoperative complications can worsen the condition of patients undergoing coronary artery bypass grafting; some of these factors and complications are closely related to mortality rate. To describe clinical factors and outcomes related to mortality of patients undergoing coronary artery bypass grafting and on invasive mechanical ventilation. This is a single-center retrospective data analysis of patients who underwent coronary artery bypass grafting on invasive mechanical ventilation between 2013 and 2019. Data regarding clinical characteristics, postoperative complications, intensive care unit and mechanical ventilation time, and their relationship with mortality were analyzed. Four hundred seventy-two patients who underwent coronary artery bypass grafting entered the study. Their mean age was 62.3 years, and mean body mass index was 27.3. The mortality rate was 4%. Fifty percent of the patients who had ventilator-associated pneumonia died. Considering the patients who underwent hemotherapy and hemodialysis, 20% and 33% died, respectively. Days of intensive care unit stay and high Acute Physiology and Chronic Health Evaluation score and Simplified Acute Physiology Score were significantly related to death. Factors and clinical conditions such as the patients' age, associated comorbidities, the occurrence of ventilator-associated pneumonia, length of stay in the intensive care unit, and mechanical ventilation time are related to higher mortality in patients undergoing coronary artery bypass grafting.

Ventilator Associated Pneunomia in Neonatal Intensive Care Unit: Occurrence and Risk Factors

Objectives: To examine the occurrence of pneumonia linked with a ventilator in the neonatal intensive care unit and to determine the related risk factors. Purpose of study: To better identify the associated morbidity and mortality, pathophysiology, and recommended measures to avoid this disease, paediatric VAP diagnosis methods must become more standardized and exact. Study design: A cross-sectional study Place and Duration: This study was conducted at Aga Khan University hospital from May 2021 to May 2022 Methodology: This study includes a total of 70 participants admitted in neonatal intensive care unit. All the patients were put under the ventilator for more than 2 days. At the time of admission, the X-ray of the chest was performed, and it was also performed every day. When certain organisms were present on the tracheal aspirate, ventilator-associated pneumonia (VAP) was diagnosed. After 2 days of ventilation, microbial analysis and gram staining were done for tracheal aspirates. They were later examined to determine the occurrence of nosocomial pneumonia and what are the risk factors linked with it. A Chi-square test and t-test were conducted to examine all the data. A confidence level of 0.05 was set. Results: Pneumonia associated with the ventilator occurred in 31.4% of the participants where a large number had developed it between 4-14 days after intubation. There were certain risk factors that were determined in our research. They include the use of H2 blockers, invasive lines, low PaO2/FiO2, and re-intubation. There were two things (use of steroids and enteral feeding through nasogastric) that were not linked with the occurrence of this pneumonia. The patients who were in the group of ventilator-associated pneumonia were having a longer time period of stay and mechanical ventilation. Practical implication: In newborn and paediatric intensive care units, VAP continues to be a significant and unresolved problem. The results of this study will highlight the numerous elements that significantly contribute to ventilator-associated pneumonia. Conclusion: The occurrence of pneumonia associated with ventilators is high. Those patients who were having above mentioned risk factors should require pay special attention towards prevention. Keywords: pneumonia, ventilators, ventilator associated pneumonia, neonatal intensive care unit

Worse In-Hospital Outcomes Among Patients With Heart Failure (HF) and Concomitant Influenza Infection.

A sizable proportion of heart failure (HF) admissions is precipitated by respiratory infections. Influenza has been linked to higher rates of HF hospitalizations and in-hospital morbidity and mortality. We aimto describe the in-hospital outcomes of systolic HF vs. diastolic HF admissions with concomitant influenza infection in US hospitalizations from 2016 to 2017. Materials and Methods:We queried the National Inpatient Sample (NIS) from 2016 to 2017 for discharge diagnosis for SHF and DHF and influenza per ICD-10 CM codes. Using binominal logistic regression analysis and adjusting for demographic and comorbid conditions, we compared the outcomes of SHF vs. DHF admissions with concomitant influenza as an independent risk factor for inpatient mortality, acute respiratory failure, ICU admission,assisted ventilation, as well as length of stay, and total hospital costs. A total of 7,490,596 HF weighted admissions were analyzed, among which 0.9% had concomitant influenza infection. SHF and DHF admissions with influenza had higher mortality, ICU admission, ventilation assistance, and acute respiratory failure when compared to those without influenza. Among influenza admissions, those with SHF had higher mortality (6.6% vs. 5%, adjusted odds ratio - aOR 1.31, p<0.001) compared to DHF. While intensive care unit (ICU) admission(7.8% vs. 5.2%, aOR 1.30, p<0.001) and ventilation assistance rates (22.1% vs. 18.9%, aOR 1.15, p<0.001) were greater among SHF patients with influenza, acute respiratory failure was more common amongst diastolic HF with influenza (46.6% vs. 51.2%, aOR 0.86, p<0.001).Finally, SHF patients with concomitant influenza had higher inpatient costs ($82,788) when compared to diastolic HF patients ($66,373) and a longer in-hospital stay (7.29 days compared to 6.98 days in the diastolic HF group)p <0.001. Concomitant influenza infection in hospitalized patients with HF is associated with higher mortality, ICU admission, and the need for assisted ventilation, especially in those with SHF. A greater emphasis on vaccination against influenza may improve in-patient outcomes among HF patients.

Transition from intensive care unit to a portable ventilatorin children with severe bronchopulmonary dysplasia.

As the population of ventilator-dependent children (VDC) with tracheostomies due to underlying severe bronchopulmonary dysplasia grows, there is an increasing need to shift the care of these children from hospital to home. Transitioning the ventilator-dependent child from the hospital to home is a complex process that requires coordination between the medical team and the family. One crucial step in the process is transitioning from an Intensive care unit (ICU) ventilator to a portable home ventilator (PHV). The Clinical team needs to understand the nuances in transitioning to PHV, including assessing readiness to transition and choosing the optimum settings on an available home ventilator. In recent years, various ventilator modes have been available in PHV that can help achieve synchronous breathing to allow for adequate gas exchange for the infant. This review details some approaches to asses readiness to transition and the process of Transition along with commonly used modes of support available in PHV, as well as the primary and secondary settings in which we should be mindful in supporting a child with chronic respiratory failure in the home setting.

117: DIFFERENCES IN POST-INTENSIVE CARE SYNDROME SEQUELAE BETWEEN ARDS AND COVID ARDS SURVIVORS

Introduction: Post-intensive care syndrome (PICS) is a disorder with psychological sequalae often seen in acute respiratory distress syndrome (ARDS) survivors after intensive care unit (ICU) stays. Studies have reported post-traumatic stress disorder (PTSD) in up to 39% of ARDS survivors, and 66% have anxiety. COVID-19 respiratory failure often mirrors ARDS. We hypothesized that PICS symptoms would be worse in COVID ARDS secondary to longer ventilator hours and social isolation. Methods: The cross-sectional study enrolled survivors of ARDS and COVID ARDS admitted after 01/01/20 for a pilot study to screen for PICS. We recruited participants through Facebook ARDS survivor groups. Participants completed the Impact of Events Scale-R (PTSD), Patient Health Questionnaire-9 (PHQ-9; depression), and General Anxiety Disorder-7 (GAD-7). Independent-Samples Mann-Whitney U and Chi-Square tests were used to examine group differences. Results: We analyzed data from 16 participants (ARDS 44%; COVID ARDS 56%); median age 34.5; 63% female; 88% white, 13% Hispanic. COVID ARDS had higher median ICU days (46 vs. 10) and ventilator days (35 vs. 8) than ARDS (p=.32). Family visitation occurred in 78% of COVID vs 86% ARDS (p=.69). Clinical PTSD noted in 56% COVID ARDS compared to 29% ARDS; p=.03). Moderate depression or higher noted in 46% of survivors with no difference between groups (p=.65). Moderate anxiety or higher noted in 44% of survivors; no difference between groups (p=.20). Of those working, 38% of COVID ARDS and 14% of ARDS were unable to return to work after discharge (p=.31). Conclusions: Both groups exhibited PTSD, anxiety, and depression, impacting their ability to return to work. COVID survivors were nearly twice as likely to screen positive for clinically significant PTSD; differences in PTSD may be explained by longer ICU stays and ventilator time. Interventions to reduce PTSD and early treatment for PTSD may be needed. Group differences for ICU days and ventilator days were clinically significant; statistical significance likely impacted by sample size. COVID ARDS survivors were less likely to have visitors, which may have contributed to PICS sequelae. It is unclear if personal protective equipment and strict isolation may have impacted visitation and contributed to higher PTSD in the COVID ARDS group.