Ventilator Utilization Research Articles

Mortality and its associated factors among mechanically ventilated adult patients in the intensive care units of referral hospitals in Northwest Amhara, Ethiopia, 2023.

Worldwide, nearly half of the patients admitted to intensive care units require ventilatory support. Despite advances in intensive care unit patient management and mechanical ventilator utilization, the odds of mortality among mechanically ventilated patients are higher in resource-limited settings. Little is known about the mortality of patients on mechanical ventilation outside the capital of Ethiopia. This study aimed to assess mortality and its associated factors among mechanically ventilated adult patients in intensive care units. An institutional-based cross-sectional study was conducted on mechanically ventilated patients in intensive care units from 1 February 2020 to 1 March 2023. A simple random sampling technique was used to select 434 patients' charts. A data extraction tool designed on the Kobo toolbox, a smartphone data collection platform, was used to collect the data. The data were exported into Microsoft Excel 2019 and then into Stata 17 for data management and analysis. Descriptive statistics were used to summarize the characteristics of the study participants. A bivariable logistic regression was conducted, and variables with p ≤ 0.20 were recruited for multivariable analysis. Statistical significance was declared at p < 0.05, and the strength of associations was summarized using an adjusted odds ratio with 95% confidence intervals. A total of 404 charts of mechanically ventilated patients were included, with a completeness rate of 93.1%. The overall proportion of mortality was 62.87%, with a 95% CI of (58.16-67.58). In the multivariable logistic regression, age 41-70 years (AOR: 4.28, 95% CI: 1.89-9.62), sepsis (AOR: 2.43, 95% CI: 1.08-5.46), reintubation (AOR: 2.76, 95% CI: 1.06-7.21), and sedation use (AOR: 0.41, 95% CI: 0.18-0.98) were found to be significant factors associated with the mortality of mechanically ventilated patients in the intensive care unit. The magnitude of mortality among mechanically ventilated patients was high. Factors associated with increased odds of death were advanced age, sepsis, and reintubation. However, sedation use was a factor associated with decreased mortality. Healthcare professionals in intensive care units should pay special attention to patients with sepsis, those requiring reintubation, those undergoing sedation, and those who are of advanced age.

Predictive risk factors for one-year mortality in idiopathic inflammatory myopathy patients with interstitial lung disease: A retrospective, single-center cohort study.

This study aimed to analyze the risk factors for mortality of idiopathic inflammatory myopathy (IIM) patients admitted with interstitial lung disease (ILD) to guide rapid and accurate judgment of clinical prognosis. This retrospective, single-center cohort study was conducted with 135 participants (37 males, 98 females; mean age: 54.8±11.1 years; range, 24 to 85 years) between June 1, 2016, and June 30, 2021. The participants were categorized into the survival group (n=111) and nonsurvivors (n=24) according to whether they survived during the one-year follow-up. The independent risk factors for mortality in one year after discharge were analyzed. Receiver operating characteristic curve analysis was used to determine the accuracy of oxygenation index at baseline combined with pulmonary infection (PI) at follow-up to indicate death in IIM-ILD patients. Compared to the survival group, nonsurvivors were older (p=0.006) and had a higher proportion of anti-MDA5 (melanoma differentiation-associated protein 5) positivity (p<0.001). The ILD duration was shorter (p=0.006), the oxygenation index was lower (p<0.001), and the intensive care unit occupancy rate (p<0.001) and ventilator utilization rate (p<0.001) were elevated in nonsurvivors compared to the survival group. Oxygenation index at baseline (odds ratio [OR]=1.021, 95% confidence interval [CI]: 1.001-1.023, p=0.040) and PI (clinical judgment) at follow-up (OR=16.471, 95% CI: 1.565-173.365, p=0.020) were found as independent risk factors for death in the year after discharge in IIM inpatients with ILD. An oxygenation index ≤279 mmHg at baseline combined with PI at follow-up exhibited a promising predictive value for all-cause death in IIM-ILD patients within one year. Oxygenation index at baseline and PI during follow-up were independent risk factors for death of IIM-ILD patients within one year after discharge. Patients with an oxygenation index ≤279 mmHg at baseline had an increased risk of death once they developed PI during the one-year follow-up.

Increased ventilator utilization, ventilator-associated pneumonia, and mortality in non-COVID patients during the pandemic

Background This study examined ventilator utilization, ventilator-associated pneumonia (VAP) incidence, and mortality among non-COVID patients requiring mechanical ventilation during 2019 and 2020. Methods The Nationwide Inpatient Sample database was queried for adult hospitalizations with mechanical ventilation using ICD-10 procedure codes, excluding COVID-19 patients and minors. VAP rates were calculated per 1000 adults ventilated. Outcomes included ventilation rates, VAP incidence, and mortality odds between prepandemic and pandemic-exposed hospitalizations. Results Analyzing 1,533,775 hospitalizations, the pandemic-exposed had more male patients (57.6% vs 56.2%, P < 0.001) and nonelective admissions (95.4% vs 94.1%; P < 0.001). Non-COVID patients had a 4.5% increase in ventilator utilization in the pandemic compared with the prepandemic period (P < 0.001). Pandemic VAP incidence was 17 cases per 1000 adults ventilated, compared to 11 cases in the prepandemic period (P < 0.001). Mortality rates increased from 26.9% to 31.4%, with 314 mortalities per 1000 ventilated pandemic patients compared with 269 in the prepandemic period (adjusted odds ratio 1.13; 95% confidence interval 1.12–1.15; P < 0.001). Conclusion Significant ventilator utilization, VAP rates, and mortality increases occurred during the COVID-19 pandemic.

Establishing a national indicator-based surveillance system for hospital bed utilization by COVID-19 patients in the Philippines.

In March 2020, the Philippine Department of Health (DOH) designed and rapidly implemented a national surveillance system for the utilization of hospital beds by patients with coronavirus disease (COVID-19) to produce complete and timely data for use by various levels of governance in response to the COVID-19 pandemic. The DOH launched the DOH DataCollect (DDC) Bed Tracker system, a web-based application that collects information from all 1906 public and private hospitals and infirmaries across the country using a modular data collection tool. Data on the maximum number of occupied COVID-19-designated beds (n=28 261), hospital bed utilization rate (71.7%), and mechanical ventilator number (n=1846) and utilization rate (58.5%) were recorded in September 2021 during the Delta surge of cases in the Philippines. Data on human resources, personal protective equipment and supplies, and other operational indicators were added to the system during various modifications. Information from the DDC was used to inform the COVID-19 response and operations at national and local levels and facilitated research at academic and nongovernmental agencies. The development of the DDC system demonstrates that an effective surveillance system for use by all health-care facilities is achievable through strong national leadership, the use of available technology and adaptive information systems, and the establishment of networks across different health facilities and stakeholders.

Continuity of care and treatment intensity at the end of life in Swiss cancer patients.

Continuity of care (COC) was shown to be associated with fewer hospitalizations. We aimed to evaluate whether COC was associated with intensive intervention(s) at the end of life (IEOL), a preference-sensitive outcome, in cancer patients. The study is based on claims data of patients with incident use of anti-neoplastics in Switzerland. COC Index, Usual Provider Continuity score, Sequential Continuity index and Modified Modified Continuity Index were calculated based on consultations with the usual ambulatory care physician. Treatment intensity was evaluated in the last 6 months of life, and COC was evaluated in months 18-6 before death in those who died between 24 and 54 months after incident cancer. IEOL comprised life-sustaining interventions (cardiac catheterization, cardiac assistance device implantation, pulmonary artery wedge monitoring, cardiopulmonary resuscitation/cardiac conversion, gastrostomy, blood transfusion, dialysis, mechanical ventilator utilization and intravenous antibiotics) and measures specifically used in cancer patients (last dose of chemotherapy ≤14 days of death, a new chemotherapy regimen starting <30 days before death, ≥1 emergency visit in the last month of life, ≥1 hospital admission or spending >14 days in hospital in the last month of life and death in an acute-care hospital). All COC scores were inversely associated with the occurrence of an IEOL, as were older age, homecare nursing utilization and density of ambulatory care physicians. For COC Index, odds ratio was 0.55 (95% confidence interval 0.37-0.83). COC scores were consistently and inversely related to IEOL. The study supports efforts to improve COC for cancer patients at their end of life.

COVID-19 Pandemic Preparedness in Egypt's Teaching Hospitals: A Needs Assessment Study.

IntroductionRegular collection and monitoring of data describing the dynamics of the utilization of healthcare services, especially in teaching hospitals (TH), which provide model quality medical services, are critical for COVID-19 pandemic preparedness.MethodsThe researchers analyzed data and information derived from service statistics reports from June 1st to July 15th, 2020 in terms of hospital resources, as well as utilization patterns of beds, ICU, and ventilators, for 11 screening hospitals affiliated with the General Organization of Teaching Hospitals and institutes in Egypt assigned by the Ministry of Health and Population to provide medical care for COVID-19 patients. Hospital indicators in terms of COVID-19 screening services, as well as utilization patterns of inpatient beds, ICU beds, and ventilators were computed.ResultsA total of 78,869 non-medical personnel and 2,176 medical personnel were presented with COVID-19 triage symptoms. Investigations conducted in the targeted 11 hospitals delineated that 22.2% of non-medical personnel and 27.9% of medical personnel were COVID-19 PCR-confirmed cases. The inpatient bed occupancy rate was 70% for non-medical patients and 67% for medical staff patients. For ICU, the bed occupancy rate was 92 % for non-medical patients and 88% for medical patients. Among the confirmed cases, 38% of medical patients utilized a ventilator vs. 36% of medical personnel cases. Hospital ranking according to utilization pattern among non-medical personnel, Hospital H ranked first in terms of the high load of screening services. Hospital C ranked first regarding the number of confirmed cases, whereas Hospital D ranked first for high ICU utilization among all teaching hospital ICU cases. With respect to medical personnel, Hospital G ranked first for the high load of screening services for the total studied cases. Hospital G ranked first for the number of confirmed cases. Hospital B ranked first regarding high ICU utilization among all teaching hospital ICU cases.ConclusionTeaching hospitals have demonstrated preparedness for the COVID-19 pandemic by maintaining an inpatient bed occupancy rate of 70% or less and ventilator utilization at <40% of confirmed cases. However, the ICU bed occupancy rate was more than 90% indicating a shortage of resources. In addition, there is variance across hospitals regarding caseload for resource reallocation decisions.

Bariatric surgery and total knee/hip arthroplasty: an analysis of the impact of sequence and timing on outcomes

BackgroundPatients with morbid obesity may require both bariatric surgery and total knee/hip arthroplasty (TKA/THA). How to sequence these two procedures with better outcomes remains largely unstudied.MethodsThis cohort study extracted claims...

Outcomes of atrial fibrillation in patients with COVID-19 pneumonia: A systematic review and meta-analysis.

BackgroundRecently, emerging evidence has suggested that atrial fibrillation (AF) has an epidemiological correlation with coronavirus disease 2019 (COVID-19). However, the clinical outcomes of AF in COVID-19 remain inconsistent and inconclusive. The aim of this study was to provide a comprehensive description of the impact of AF on the prognosis of patients with COVID-19 pneumonia.MethodsThree electronic databases (PubMed, Embase, and Web of Science) were searched for eligible studies as of March 1, 2021. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the associations between AF (preexisting and new-onset) and in-hospital mortality, post-discharge mortality, and ventilator use.ResultsA total of 36 individual studies were incorporated into our meta-analysis. The combined results revealed that preexisting AF was associated with increased in-hospital mortality (pooled OR: 2.07; 95% CI: 1.60–2.67; p < 0.001), post-discharge mortality (pooled OR: 2.69; 95% CI: 1.24–5.83; p < 0.05), and ventilator utilization (pooled OR: 4.53; 95% CI: 1.33–15.38; p < 0.05) in patients with COVID-19. In addition, our data demonstrated that new-onset AF during severe acute respiratory syndrome coronavirus 2 infection was significantly correlated with increased mortality (pooled OR: 2.38; 95% CI: 2.04–2.77; p < 0.001).ConclusionsThe presence of AF is correlated with adverse outcomes in patients with COVID-19 pneumonia, which deserves increased attention and should be managed appropriately to prevent adverse outcomes.

The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network.

To determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infection (HAI) incidence in US hospitals, national- and state-level standardized infection ratios (SIRs) were calculated for each quarter in 2020 and compared to those from 2019. Central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), select surgical site infections, and Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia laboratory-identified events reported to the National Healthcare Safety Network for 2019 and 2020 by acute-care hospitals were analyzed. SIRs were calculated for each HAI and quarter by dividing the number of reported infections by the number of predicted infections, calculated using 2015 national baseline data. Percentage changes between 2019 and 2020 SIRs were calculated. Supporting analyses, such as an assessment of device utilization in 2020 compared to 2019, were also performed. Significant increases in the national SIRs for CLABSI, CAUTI, VAE, and MRSA bacteremia were observed in 2020. Changes in the SIR varied by quarter and state. The largest increase was observed for CLABSI, and significant increases in VAE incidence and ventilator utilization were seen across all 4 quarters of 2020. This report provides a national view of the increases in HAI incidence in 2020. These data highlight the need to return to conventional infection prevention and control practices and build resiliency in these programs to withstand future pandemics.

Analysis of the Effects of COVID-19 Mask Mandates on Hospital Resource Consumption and Mortality at the County Level.

Coronavirus disease 2019 (COVID-19) threatens vulnerable patient populations, resulting in immense pressures at the local, regional, national, and international levels to contain the virus. Laboratory-based studies demonstrate that masks may offer benefit in reducing the spread of droplet-based illnesses, but few data are available to assess mask effects via executive order on a population basis. We assess the effects of a county-wide mask order on per-population mortality, intensive care unit (ICU) utilization, and ventilator utilization in Bexar County, Texas. We used publicly reported county-level data to perform a mixed-methods before-and-after analysis along with other sources of public data for analyses of covariance. We used a least-squares regression analysis to adjust for confounders. A Texas state-level mask order was issued on July 3, 2020, followed by a Bexar County-level order on July 15, 2020. We defined the control period as June 2 to July 2 and the postmask order period as July 8, 2020-August 12, 2020, with a 5-day gap to account for the median incubation period for cases; longer periods of 7 and 10 days were used for hospitalization and ICU admission/death, respectively. Data are reported on a per-100,000 population basis using respective US Census Bureau-reported populations. From June 2, 2020 through August 12, 2020, there were 40,771 reported cases of COVID-19 within Bexar County, with 470 total deaths. The average number of new cases per day within the county was 565.4 (95% confidence interval [CI] 394.6-736.2). The average number of positive hospitalized patients was 754.1 (95% CI 657.2-851.0), in the ICU was 273.1 (95% CI 238.2-308.0), and on a ventilator was 170.5 (95% CI 146.4-194.6). The average deaths per day was 6.5 (95% CI 4.4-8.6). All of the measured outcomes were higher on average in the postmask period as were covariables included in the adjusted model. When adjusting for traffic activity, total statewide caseload, public health complaints, and mean temperature, the daily caseload, hospital bed occupancy, ICU bed occupancy, ventilator occupancy, and daily mortality remained higher in the postmask period. There was no reduction in per-population daily mortality, hospital bed, ICU bed, or ventilator occupancy of COVID-19-positive patients attributable to the implementation of a mask-wearing mandate.

Does enhanced environmental cleaning reduce carbapenem-resistant Acinetobacter baumannii colonization in the intensive care unit?

To evaluate the impact of enhanced environmental cleaning (two times per day) compared with conventional cleaning on the acquisition of carbapenem-resistant Acinetobacter baumannii (CRAB) in a highly endemic intensive care unit (ICU). The intervention consisted of alternating environmental cleaning and conventional cleaning every 3 months during the study period from July 2018 to June 2019. CRAB acquisition was assessed using incidence and prevalence rates, and colonization pressure. The incidence rates of CRAB with and without enhanced cleaning were 16.3 and 13.9 cases per 1000 population, respectively; and the prevalence rates were 66.9 and 61.7 cases per 1000 population, respectively. Colonization pressure was 53.3% with enhanced cleaning and 51.3% without enhanced cleaning. No association was found between enhanced environmental cleaning and the incidence (P=0.156), prevalence (P=0.888) and colonization pressure (P=0.825) of CRAB acquisition. The ventilator utilization ratio increased the colonization pressure of CRAB acquisition (P=0.010, β coefficient=0.37). The proportion of new nurses with <3 years of clinical practice experience was positively correlated with the incidence and prevalence of CRAB acquisition. Enhanced environmental cleaning alone failed to reduce CRAB acquisition in a highly endemic ICU. The ventilator utilization ratio may be of more importance than environmental cleaning. Inexperienced nurses may need to be monitored regarding infection control activities in addition to hand hygiene adherence.

Evaluation of ventilator associated events in critically ill patients with invasive mechanical ventilation: A prospective cohort study at a resource limited setting in Northern India.

The primary aim of this study was to identify the modifiable risk factors for acquiring ventilator associated events (VAE). Secondary aims were to investigate the intensive care unit (ICU) course and impact of VAE on patient outcome. This prospective, observational single center cohort study included 247 patients on mechanical ventilation for 4 calendar days at a 20-bed ICU between January 2018-June 2019. VAE occurred in 59 episodes (rate 11.3 per 1000 ventilator-days). The Ventilator Utilization Ratio (VUR) was 0.57. The median time to onset of VAE was 6days. Sepsis was the most common reason for initiating patients on invasive mechanical ventilation (IMV). Cumulative fluid balance ≥2l (Odds Ratio 30.92; 95% CI 9.82-97.37) and greater number of days with vasopressor support (Odds Ratio 1.92; 95% CI 1.57-2.36) within 7days of initiating IMV were significant risk factors for acquiring VAE (p<0.001). VAE cases were ventilated for significantly more days (20 vs 14days, p=0.001, had longer days of ICU stay (29 vs 18days; p=0.002) and higher hospital mortality (p=0.02). Klebsiella pneumoniae was the most common isolate (N=28) and 32.1% were colistin resistant. Prospective intervention studies are needed to determine if targeting these risk factors can lower VAE rates in our setting.

Rates of Ventilator Associated Pneumonia in Saudi Ministry of Health Hospitals; A Two-year Multi-Center Study

BACKGROUND: Although the rates of ventilator associated pneumonia (VAP) have been estimated in Saudi Arabia, however national surveillance data for VAP has never been reported earlier. OBJECTIVES: To estimate VAP rates and ventilator utilization ratios in 105 Ministry of health (MOH) hospitals and to benchmark them with International Standards. METHODS: It was a prospective surveillance study in 15 different types of intensive care units (ICUs) between January 2018 and December 2019. The data were entered into the health electronic surveillance network (HESN) program. The methods of US National Healthcare Safety Network (NHSN) and the Gulf Cooperation Council (GCC) center for infection control were used. RESULTS: During two years of surveillance covering 1,469,658 patient-days and 569,961 ventilator-days, a total 1,694 VAP events were identified. The overall MOH VAP rate was 2.97 (95% confidence 2.83-3.11) per 1000 ventilator-days and the overall ventilator utilization ratio was 0.39 (95% confidence 0.387- 0.389). VAP rates were highest in adult medical (4.40), pediatric cardiothoracic (3.64), and adult medical surgical ICUs (3.61). VAP standardized infection ratio across all types of ICUs in MOH hospitals were 29% lower than GCC hospitals, 78% lower than International Nosocomial Infection Control Consortium (INICC) hospitals, and 191% higher than NHSN hospitals. Ventilator standardized utilization ratio in all types of ICUs in MOH hospitals were 19% lower than GCC hospitals, 32% higher than INICC hospitals, and 50% higher than NHSN hospitals. CONCLUSIONS: Using huge standardized data, the current report can serve as a unique national VAP benchmark, fostering a culture of competitiveness between the hospitals and regions.

Retrospective Assessment of Ventilator-Associated Pneumonias due to Acinetobacter baumannii in an Oncology Hospital.

Objectives:Ventilator-associated pneumonia (VAP) is associated with significant morbidity and mortality in critically ill patients and leads to increases in health-care costs. However, it is preventable, and hospitals can decrease VAP rates. This study aims to retrospectively assess VAP rates in the intensive care unit of Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital of the University of Health Sciences, with reference to Acinetobacter baumannii, one of the causative organisms.Methods:This study enrolled a total of 2277 patients hospitalized between the years of 2011 and 2015. The required data were collected by reviewing medical files of the patients through computerized hospital databases. VAP rate and ventilator utilization (VU) ratio were calculated using the United States Center for Disease Control National Healthcare Safety Network methodology.Results:Of the study patients, 302 (13.26%) were seen to have developed VAP. Among these patients, 191 (63.25%) were microbiologically diagnosed VAP caused by A. baumannii. Pooled means of VU ratio and VAP rate were 0.70 and 22.91, respectively.Conclusion:The results of this study will motivate the infection control committee of the study hospital to assess current infection control program and strategies so that high VAP rate in the study intensive care unit can be reduced to the minimum possible level.

448. Disproportionate Burden of COVID-19 on Latinx Residents among Hospitalized Patients at San Francisco’s Public Health Hospital

BackgroundSan Francisco implemented one of the earliest shelter-in-place public health mandates in the U.S., with flattened curves of diagnoses and deaths. We describe demographics, clinical features and outcomes of COVID-19 patients admitted to a public health hospital in a high population-density city with an early containment response.MethodsWe analyzed inpatients with COVID-19 admitted to San Francisco General Hospital (SFGH) from 3/5/2020–5/11/2020. SFGH serves a network of >63,000 patients (32% Latinx/24% Asian/19% African American/19% Caucasian). Demographic and clinical data through 5/18/2020 were abstracted from hospital records, along with ICU and ventilator utilization, lengths of stay, and in-hospital deaths.ResultsOf 157 admitted patients, 105/157 (67%) were male, median age was 49 (range 19-96y), and 127/157 (81%) of patients with COVID-19 were Latinx. Crowded living conditions were common: 60/157 (38%) lived in multi-family shared housing, 12/1578 (8%) with multigenerational families, and 8/157 (5%) were homeless living in shelters. Of 102 patients with ascertained occupations, most had frontline essential jobs: 23% food service, 14% construction/home maintenance, and 10% cleaning. Overall, 86/157 (55%) of patients lived in neighborhoods home to majority Latinx and African-American populations. Overall, 45/157 (29%) of patients needed ICU care, and 26/157 (17%) required mechanical ventilation; 20/26 (77%) of ventilated patients were successfully extubated, and 137/157 (87%) were discharged home. Median hospitalization duration was 4 days (IQR, 2–10), and only 6/157 (4%) patients died in hospital.ConclusionIn San Francisco, where early COVID-19 mitigation was enacted, we report a stark, disproportionate COVID-19 burden on Latinx patients, who accounted for 81% of hospitalizations despite making up only 32% of the patient base and 15% of San Francisco’s total population. Latinx inpatients frequently lived in high-density settings, increasing household risk, and frequently worked essential jobs, potentially limiting the opportunity to effectively distance from others. We also report here favorable clinical outcomes and low overall mortality. However, an effective COVID-19 response must urgently address racial and ethnic disparities.Disclosures All Authors: No reported disclosures

A reference guide to rapidly implementing an institutional dashboard for resource allocation and oversight during COVID-19 pandemic surge.

ObjectivesWe develop a dashboard that leverages electronic health record (EHR) data to monitor intensive care unit patient status and ventilator utilization in the setting of the COVID-19 pandemic.Materials and methodsData visualization software is used to display information from critical care data mart that extracts information from the EHR. A multidisciplinary collaborative led the development.ResultsThe dashboard displays institution-level ventilator utilization details, as well as patient-level details such as ventilator settings, organ-system specific parameters, laboratory values, and infusions.DiscussionComponents of the dashboard were selected to facilitate the determination of resources and simultaneous assessment of multiple patients. Abnormal values are color coded. An overall illness assessment score is tracked daily to capture illness severity over time.ConclusionThis reference guide shares the architecture and sample reusable code to implement a robust, flexible, and scalable dashboard for monitoring ventilator utilization and illness severity in intensive care unit ventilated patients.

Evaluation of 3 year surveillance of device associated infections in a neonatal intensive care unit

Aim: The aim of this study was to determine the rates of healthcare associated infections (HAIs) and device associated healthcare associated infections (DA-HAIs) as well as the rates of invasive device utilization in a neonatal intensive care unit (NICU); and to compare findings with national and international reports.&#x0D; Materials and methods: A total of 1984 patients who admitted to NICU between January 2016 and December 2018 were enrolled. We retrospectively analysed patient’s characteristics, etiologic pathogens and antibiotic susceptibility, mortality from medical charts and infection control committee surveillance reports. Infections were defined using the standart Centers for Disease Control and Prevention criteria.&#x0D; Results: During the 3-year period, total 98 HAI cases 69 of which were DA-HAI were detected. The overall incidence of HAIs was 4.9% and rate was 3.7 per 1000 patient days. The most common HAI was blood stream infection (BSI) (n=64, 65.3%) of those 52 were central line-associated (CLA). The CLA-BSI rate was 8.6 per 1000 central line days with central line utilization ratio of 0.22. Ventilator associated pneumonia (VAP) rate was 5.1 per 1000 ventilator days with ventilator utilization ratio of 0.12. The most common pathogens were Klebsiella pneumonia. (38.9%), Staphylococcus epidermidis (22.1%) and Candida spp. (11.6%). The overall mortality rate was 3%. The HAI-related mortality rate was 9.2%.&#x0D; Conclusion: Our findings highlight the importance of an surveillance approach in the NICU setting. HAI rates were lower than the rates reported from developing countries. However, with device utilization rates similar to those in developed countries our HAI rates were higher than that of the developed countries. Continous monitoring and implementation of necessary precautions are essential to decrease the rates of HAIs.

Critically Ill Adults With Coronavirus Disease 2019 in New Orleans and Care With an Evidence-Based Protocol

BackgroundCharacteristics of critically ill adults with coronavirus disease 2019 (COVID-19) in an academic safety net hospital and the effect of evidence-based practices in these patients are unknown.Research QuestionWhat are the outcomes of critically ill adults with COVID-19 admitted to a network of hospitals in New Orleans, Louisiana, and what is an evidence-based protocol for care associated with improved outcomes?Study Design and MethodsIn this multi-center, retrospective, observational cohort study of ICUs in four hospitals in New Orleans, Louisiana, we collected data on adults admitted to an ICU and tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 9, 2020 and April 14, 2020. The exposure of interest was admission to an ICU that implemented an evidence-based protocol for COVID-19 care. The primary outcome was ventilator-free days.ResultsThe initial 147 patients admitted to any ICU and tested positive for SARS-CoV-2 constituted the cohort for this study. In the entire network, exposure to an evidence-based protocol was associated with more ventilator-free days (25 days; 0-28) compared with non-protocolized ICUs (0 days; 0-23, P = .005), including in adjusted analyses (P = .02). Twenty patients (37%) admitted to protocolized ICUs died compared with 51 (56%; P = .02) in non-protocolized ICUs. Among 82 patients admitted to the academic safety net hospital’s ICUs, the median number of ventilator-free days was 22 (interquartile range, 0-27) and mortality rate was 39%.InterpretationCare of critically ill COVID-19 patients with an evidence-based protocol is associated with increased time alive and free of invasive mechanical ventilation. In-hospital survival occurred in most critically ill adults with COVID-19 admitted to an academic safety net hospital’s ICUs despite a high rate of comorbidities.

Delirium and Adverse Outcomes in Hospitalized Patients with COVID-19.

BACKGROUNDLittle is known about the association between acute mental changes and adverse outcomes in hospitalized adults with COVID‐19.OBJECTIVESTo investigate the occurrence of delirium in hospitalized patients with COVID‐19 and explore its association with adverse outcomes.DESIGNLongitudinal observational study.SETTINGTertiary university hospital dedicated to the care of severe cases of COVID‐19 in São Paulo, Brazil.PARTICIPANTSA total of 707 patients, aged 50 years or older, consecutively admitted to the hospital between March and May 2020.MEASUREMENTSWe completed detailed reviews of electronic medical records to collect our data. We identified delirium occurrence using the Chart‐Based Delirium Identification Instrument (CHART‐DEL). Trained physicians with a background in geriatric medicine completed all CHART‐DEL assessments. We complemented our baseline clinical information using telephone interviews with participants or their proxy. Our outcomes of interest were in‐hospital death, length of stay, admission to intensive care, and ventilator utilization. We adjusted all multivariable analyses for age, sex, clinical history, vital signs, and relevant laboratory biomarkers (lymphocyte count, C‐reactive protein, glomerular filtration rate, D‐dimer, and albumin).RESULTSOverall, we identified delirium in 234 participants (33%). On admission, 86 (12%) were delirious. We observed 273 deaths (39%) in our sample, and in‐hospital mortality reached 55% in patients who experienced delirium. Delirium was associated with in‐hospital death, with an adjusted odds ratio of 1.75 (95% confidence interval = 1.15–2.66); the association held both in middle‐aged and older adults. Delirium was also associated with increased length of stay, admission to intensive care, and ventilator utilization.CONCLUSIONDelirium was independently associated with in‐hospital death in adults aged 50 years and older with COVID‐19. Despite the difficulties for patient care during the pandemic, clinicians should routinely monitor delirium when assessing severity and prognosis of COVID‐19 patients.

Cancellation of Elective Surgery and Intensive Care Unit Capacity in New York State: A Retrospective Cohort Analysis.

BACKGROUND:In response to the coronavirus disease 2019 (COVID-19) pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Yet the potential impact of suspending elective surgery on ICU bed capacity is unclear.METHODS:We retrospectively reviewed 5 years of New York State data on ICU usage. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions) and by geographic location (New York metropolitan region versus the rest of New York State). Data are presented as absolute numbers and percentages and all adult and pediatric ICU patients were included.RESULTS:Overall, ICU admissions in New York State were seen in 10.1% of all hospitalizations (n = 1,232,986/n = 12,251,617) and remained stable over a 5-year period from 2011 to 2015. Among n = 1,232,986 ICU stays, sources of ICU admission included elective surgery (13.4%, n = 165,365), emergent/urgent admissions/trauma surgery (28.0%, n = 345,094), and medical admissions (58.6%, n = 722,527). Ventilator utilization was seen in 26.3% (n = 323,789/n = 1232,986) of all ICU patients of which 6.4% (n = 20,652), 32.8% (n = 106,186), and 60.8% (n = 196,951) was for patients from elective, emergent, and medical admissions, respectively. New York City holds the majority of ICU bed capacity (70.0%; n = 2496/n = 3566) in New York State.CONCLUSIONS:Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State. Suspension of elective surgeries in response to the COVID-19 pandemic may thus have a minor impact on ICU capacity when compared to other sources of ICU admission such as emergent/urgent admissions/trauma surgery and medical admissions. More study is needed to better understand how best to maximize ICU capacity for pandemics requiring heavy use of critical care resources.