|
1
|
Haughton S, Saravanan K, McDonald LA, Rose JW, Berney S, Berlowitz DJ, Rollinson TC, Graco M. Acceptability of a physiotherapy-led intensive prone positioning service in intensive care: A qualitative study with multidisciplinary clinicians. Aust Crit Care 2025; 38:101162. [PMID: 39892067 DOI: 10.1016/j.aucc.2024.101162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 12/19/2024] [Accepted: 12/21/2024] [Indexed: 02/03/2025] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic resulted in an increased number of patients with COVID-19-related respiratory failure requiring prone positioning. To reduce pressure on nursing and medical staff in the intensive care unit (ICU), a physiotherapy-led intensive prone positioning (PhLIP) service was implemented. OBJECTIVES The aim of this study was to explore the acceptability of the PhLIP service from the perspective of nurses and doctors working in the ICU and the physiotherapists who delivered the service. METHODS A qualitative evaluation was conducted using semistructured interviews and focus groups, guided by the theoretical framework of acceptability (TFA). Participants included doctors, nurses, and physiotherapists who interacted with or delivered the PhLIP service. RESULTS A total of 19 interviews (eight doctors and 11 physiotherapists) and four focus groups (13 nurses) were conducted. Eleven themes were identified within the eight domains of the TFA. Overall, the PhLIP team was highly valued and appreciated (TFA: affective attitude); enabled high-quality care and improved ICU efficiency (TFA: perceived effectiveness); reduced risks to patients and staff (TFA: perceived safety and risk); and was empowering for the clinicians involved (TFA: self-efficacy). Being in the PhLIP team was physically and mentally exhausting, and the service put strain on the physiotherapy department due to reallocation of staff (TFA: burden). Having trust in the physiotherapists leading the prone positioning service was a key influence on nursing and medical acceptance of the service. CONCLUSION The PhLIP team delivered an acceptable service that improved clinical care and efficiency during the COVID-19 pandemic. Other ICUs should consider the availability, skills, and confidence in the team selected to implement an intensive prone positioning service, should the need arise again. Researchers using the TFA to explore acceptability of healthcare innovations should also consider the recipients' trust in those delivering the intervention.
Collapse
Affiliation(s)
- Stacey Haughton
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
| | - Krisha Saravanan
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Luke A McDonald
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia; Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
| | - Joleen W Rose
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia; Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
| | - Sue Berney
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - David J Berlowitz
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Thomas C Rollinson
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia; Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Marnie Graco
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| |
Collapse
|
|
2
|
Jones C, Rotherham H, Udy A, Neto AS, Chaves N, Campbell L, Brown A, Ibrahim A, Burrell A. The relationship between administratively recorded ethnicity and outcomes for people admitted to Australian intensive care units with COVID-19. Aust Crit Care 2025; 38:101228. [PMID: 40273709 DOI: 10.1016/j.aucc.2025.101228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 03/05/2025] [Accepted: 03/07/2025] [Indexed: 04/26/2025] Open
Abstract
BACKGROUND The relationship between ethnicity and mortality of patients critically ill with COVID-19 in Australia has not been described. Defining those communities at the highest risk of severe COVID-19 may assist with formulating effective public health policy and may improve the equitable delivery of health care in Australia. OBJECTIVE The aim of this study was to describe the baseline characteristics, treatments, and outcomes of administratively recorded ethnic groups admitted to Australian intensive care units with confirmed COVID-19 infection. METHODS This was a retrospective, multicentre, cohort analysis of adult patients admitted primarily due to COVID-19 to the 78 intensive care units participating in the Short Period Incidence Study of Severe Acute Respiratory Infection Australia from February 2020 to May 2022. The main outcome measure was in-hospital mortality. RESULTS Of 4621 eligible patients admitted to intensive care units, the proportion of ethnic groups were White (38%), Middle Eastern (15%), Asian (10%), Other (10%), Aboriginal and Torres Strait Islander (3.3%), Black (1.1%), and Unknown (22%). Rates of vaccination, mechanical ventilation, and admission varied significantly between each group over the course of the pandemic (p < 0.01). However, after adjusting by age, body mass index, Acute Physiology And Chronic Health Evaluation II, the number of coexisting disorders, time from hospital to intensive care admission, vaccination, use of mechanical ventilation and centres, and week of admission as random effects, the only ethnicity independently associated with mortality was the "Other" group (risk difference: 5.27 [confidence interval: 0.54 to 10.01], p = 0.029). CONCLUSION This study demonstrates that the outcomes of patients critically ill with COVID-19 for most ethnic groups were broadly similar, with the exception of the "Other" group who had a higher in-hospital mortality rate.
Collapse
Affiliation(s)
- Carys Jones
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Hannah Rotherham
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.
| | - Andrew Udy
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nadia Chaves
- cohealth, Melbourne, VIC, Australia; Alfred Health, Melbourne, VIC, Australia
| | - Lewis Campbell
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Charles Darwin University, Darwin, NT, Australia
| | - Alex Brown
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia; Indigenous Genomics, Telethon Kids Institute, Perth, WA, Australia
| | - Aaliya Ibrahim
- COVID-19 Epidemiology and Surveillance Section, Office of Health Protection, Department of Health and Aged Care, Australia
| | - Aidan Burrell
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| |
Collapse
|
|
3
|
Smith RJ, Ghosh AN, Said S, van Haren FM, Laffey JG, Doig GS, Santamaria JD, Dixon B. A randomised, open-label trial of nebulised unfractionated heparin in patients mechanically ventilated for COVID-19. Anaesth Intensive Care 2025:310057X251322783. [PMID: 40148075 DOI: 10.1177/0310057x251322783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2025]
Abstract
Nebulised unfractionated heparin (UFH) might reduce time to ventilator separation in patients with COVID-19 by reducing virus infectivity, pulmonary coagulopathy, and inflammation, but clinical trial data are limited. Between 1 July 2020 and 23 March 2022, we conducted, at two hospitals in Victoria, Australia, a randomised, parallel-group, open-label, controlled trial of nebulised UFH. Eligible patients were aged 18 years or more, intubated, under intensive care unit management, had a PaO2 to FIO2 ratio of 300 or less, had acute opacities affecting at least one lung quadrant and attributed to COVID-19, and were polymerase chain reaction-positive for SARS-CoV-2 or had further testing planned. The target sample size was 270, however, the trial was stopped due to slow recruitment. There were 50 enrolments, all of whom were analysed. The median age was 55 (interquartile range (IQR) 46-64) years, 28 (56%) were males, and 46 (92%) had acute respiratory distress syndrome. Twenty-seven (54%) were randomised to nebulised heparin and 23 (46%) to standard care. Nebulised UFH was administered to the heparin group on 6 (IQR 4-10) days; median daily dose of 83 (IQR 75-88) kIU. The primary outcome, time to separation from invasive ventilation to day 28 adjusted for the competing risk of death, was not significantly different between groups but took numerically longer in the nebulised heparin group (12.0, standard deviation (SD) 10.4 days versus 7.4, SD 6.9 days; hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.31 to 1.01, P = 0.052). One patient died by day 28 in each group, fewer than expected. Time to separation from invasive ventilation among survivors to day 28 occurred more quickly than expected in the standard care group and was, without correction for multiple comparisons, significantly slower in the heparin group (11.3, SD 10.0 days, n = 26 versus 6.4, SD 5.2 days, n = 22; HR 0.52, 95% CI 0.30 to 0.92, P = 0.024). Nebulised heparin did not reduce time to ventilator separation in intubated adult patients with COVID-19. The study is limited by the small sample size and potential for sampling bias. Further study is required.
Collapse
Affiliation(s)
- Roger J Smith
- Department of Critical Care Medicine, St Vincent's Hospital Melbourne, Fitzroy VIC, Australia
| | | | - Simone Said
- Intensive Care Unit, Northern Hospital, Epping, VIC, Australia
| | - Frank Mp van Haren
- Medical School, Australian National University, Canberra, ACT, Australia
| | - John G Laffey
- Anaesthesia and Intensive Care Medicine, Galway University Hospitals and University of Galway, Galway, Ireland
| | - Gordon S Doig
- Northern Clinical School Intensive Care Research Unit, University of Sydney, St Leonards, NSW, Australia
| | - John D Santamaria
- Department of Critical Care Medicine, St Vincent's Hospital Melbourne, Fitzroy VIC, Australia
| | - Barry Dixon
- Department of Critical Care Medicine, St Vincent's Hospital Melbourne, Fitzroy VIC, Australia
| |
Collapse
|
|
4
|
Rollinson TC, McDonald LA, Rose J, Eastwood G, Costa-Pinto R, Modra L, Akinori M, Bacolas Z, Anstey J, Bates S, Bradley S, Dumbrell J, French C, Ghosh A, Haines K, Haydon T, Hodgson CL, Holmes J, Leggett N, McGain F, Moore C, Nelson K, Presneill J, Rotherham H, Said S, Young M, Zhao P, Udy A, Serpa Neto A, Chaba A, Bellomo R. Complications associated with prone positioning in mechanically ventilated COVID-19 patients: A multicentre, retrospective observational study. Aust Crit Care 2025; 38:101117. [PMID: 39406618 DOI: 10.1016/j.aucc.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 08/16/2024] [Accepted: 09/05/2024] [Indexed: 01/18/2025] Open
Abstract
BACKGROUND AND AIMS Prone positioning is commonly applied to improve gas exchange in mechanically ventilated patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Whilst prone positioning is effective, specific complications may arise. We aimed to assess the prevalence of specific complications related to prone positioning in patients mechanically ventilated for COVID-19-related ARDS. DESIGN Multicentre, retrospective observational study. METHODS Multi-centre observational study of mechanically ventilated patients with COVID-19-related ARDS admitted to intensive care units in Melbourne, Australia, from August to November 2021. Data on baseline characteristics, prone positioning, complications, and patient outcomes were collected. RESULTS We assessed 553 prone episodes in 220 patients across seven sites (mean ± standard deviation age: 54 ± 13 years, 61% male). Overall, 58% (127/220) of patients experienced at least one prone-positioning-related complication. Pressure injury was the most prevalent (n = 92/220, 42%) complication reported. Factors associated with increased risk of pressure injury were male sex (adjusted odds ratio = 1.15, 95% confidence interval: [1.02-1.31]) and the total number of prone episodes (adjusted odds ratio = 1.11, 95% confidence interval: [1.07-1.15]). Device dislodgement was the next most common complication, occurring in 28 of 220 (13%) patients. There were no nerve or retinal injuries reported. CONCLUSIONS Pressure injuries and line dislodgement were the most prevalent complications associated with prone positioning of patients mechanically ventilated for COVID-19. The risk of pressure injuries was associated with male sex and the number of prone positioning episodes.
Collapse
Affiliation(s)
- Thomas C Rollinson
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia.
| | - Luke A McDonald
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia
| | - Joleen Rose
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia
| | - Glenn Eastwood
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Rahul Costa-Pinto
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Lucy Modra
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Maeda Akinori
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - Zoe Bacolas
- Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia
| | - James Anstey
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Samantha Bates
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia
| | - Scott Bradley
- Department of Intensive Care, Alfred Health, VIC, Australia; Department of Physiotherapy, Alfred Health, VIC, Australia
| | - Jodi Dumbrell
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Craig French
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia
| | - Angaj Ghosh
- Department of Intensive Care, Northern Health, VIC, Australia
| | - Kimberley Haines
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia; Department of Physiotherapy, Western Health, VIC, Australia
| | - Tim Haydon
- Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Carol L Hodgson
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Health, VIC, Australia; Department of Physiotherapy, Alfred Health, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Jennifer Holmes
- Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Nina Leggett
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia; Department of Physiotherapy, Western Health, VIC, Australia
| | - Forbes McGain
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia
| | - Cara Moore
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Jeffrey Presneill
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Hannah Rotherham
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Simone Said
- Department of Intensive Care, Northern Health, VIC, Australia
| | - Meredith Young
- Department of Intensive Care, Alfred Health, VIC, Australia
| | - Peinan Zhao
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Andrew Udy
- Department of Intensive Care, Alfred Health, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Ary Serpa Neto
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Anis Chaba
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia; Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
|
5
|
Johnston B, Rotherham H, Zhao P, Burrell A, Udy A. Prone positioning of nonintubated patients with COVID-19 in Australian intensive care units. CRIT CARE RESUSC 2024; 26:241-248. [PMID: 39781490 PMCID: PMC11704085 DOI: 10.1016/j.ccrj.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 01/02/2025]
Abstract
Objective To describe the use of and outcomes from awake prone positioning (APP) in nonintubated patients with COVID-19 in Australian intensive care units (ICUs) in comparison to those who did not receive APP, and to explore the temporal relationship between publication of APP research and changes in clinical practice. Design Multicentre, observational cohort study. Setting Seventy-eight Australian ICUs participating in SPRINT-SARI Australia. Participants Adult patients with confirmed COVID-19 admitted to ICU from 27 February 2020 until 30 June 2022. Main outcomes measures Proportion of patients receiving APP, rates of invasive ventilation, hospital length of stay (LOS), in-hospital mortality. Results 4711 patients were included in the analysis, of whom 28.6% (1347/4711) underwent APP. Use of APP rapidly increased during the Delta wave and then subsequently declined. Over this period, there were a total of 30 publications on APP. APP patients received a median of 2 (IQR 1-4) days prone positioning, were less unwell (median APACHE-II 13.0 vs. 15.0, p < 0.001), and were less likely to require invasive ventilation (27.9% vs. 34.9%, p < 0.001). Overall, there was no difference in hospital LOS (median 14 vs. 13 days, P = 0.420) or in-hospital mortality (HR 0.95, 0.8-1.11) in those that did and did not receive APP. However, in patients requiring invasive ventilation after their first day in the ICU, not receiving APP was associated with earlier time to intubation (median 1 vs. 3 days, p < 0.001) and lower adjusted in-hospital mortality (HR 0.70, CI 0.54-0.90). Conclusions APP was rapidly adopted into practice within Australian ICUs during the COVID-19 pandemic at the same time as a growing number of publications on the topic. A lower frequency of invasive ventilation was noted with APP overall, but in those who eventually required this intervention, APP was associated with greater risk-adjusted in-hospital mortality.
Collapse
Affiliation(s)
- Barry Johnston
- Department of Intensive Care, Royal Melbourne Hospital, Parkville, Australia
- Department of Critical Care, The University of Melbourne, Parkville, Australia
| | - Hannah Rotherham
- Department of Intensive Care, Royal Melbourne Hospital, Parkville, Australia
- Department of Critical Care, The University of Melbourne, Parkville, Australia
| | - Peinan Zhao
- Australian and New Zealand Intensive Care – Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne Australia
| | - Aidan Burrell
- Australian and New Zealand Intensive Care – Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne Australia
- Department of Intensive Care, The Alfred Hospital, Melbourne, Australia
| | - Andrew Udy
- Australian and New Zealand Intensive Care – Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne Australia
- Department of Intensive Care, The Alfred Hospital, Melbourne, Australia
| |
Collapse
|
|
6
|
Hitch D, Angeles MR, Lau E, Nicola-Richmond K, Bennett C, Said CM, Holton S, Haines K, Rasmussen B, Pepin G, Richards K, Hensher M. Hospital costs of COVID-19, post-COVID-19 condition and other viral pneumonias: a cost comparison analysis. Med J Aust 2024; 221 Suppl 9:S23-S30. [PMID: 39489521 DOI: 10.5694/mja2.52465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 08/27/2024] [Indexed: 11/05/2024]
Abstract
OBJECTIVES To compare hospital admission costs for coronavirus disease 2019 (COVID-19) cases to hospital admission costs for other viral pneumonia cases in Australia, and to describe hospital admission costs for post-COVID-19 condition. DESIGN, SETTING, PARTICIPANTS A cost comparison analysis of hospital admissions due to COVID-19 or other viral pneumonias between 1 January 2020 and 30 June 2021 at Victorian public health acute and subacute services. MAIN OUTCOME MEASURES Demographic characteristics, clinical outcomes (including diagnoses, impairment, subacute admission, intensive care unit admissions, ventilation, and length of stay) and cost data (including diagnostic-related groups, and total, direct and indirect costs). RESULTS During the study period, 3197 patients were admitted to hospital due to COVID-19 and 15 761 were admitted for other viral pneumonias. Admissions for COVID-19 cost 29% more than admissions for other viral pneumonias. Admissions for COVID-19 requiring intensive care unit admission incurred significantly higher mean costs (A$120 504 or US$90 595) compared with those not requiring intensive care unit admission (A$19 634 or US$14 761). The adjusted cost of admissions related to post-COVID-19 condition was A$11 090 or US$8 337, and these admissions were significantly more likely to be elective. Direct costs accounted for most of the costs for all groups, and admissions for post-COVID-19 condition used less allied health services than other groups. CONCLUSIONS Given its recent emergence, cases of acute COVID-19 and post-COVID-19 condition have had a significant additional financial impact on Australian hospitals. Further studies are required to understand long term costs and identify trends over time in the context of increased vaccination rates and subsequent variants of severe acute respiratory syndrome coronavirus 2.
Collapse
Affiliation(s)
- Danielle Hitch
- Deakin University, Geelong, VIC
- Western Health, Melbourne, VIC
| | | | | | | | | | - Catherine M Said
- Western Health, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Sara Holton
- Deakin University, Geelong, VIC
- Western Health, Melbourne, VIC
| | | | | | | | | | | |
Collapse
|
|
7
|
Erbay Dalli Ö, Akça Doğan D, Bayram R, Pehlivan S, Yildiz H. Practices of the ABCDEF care bundle in intensive care units as reported by nurses: A cross-sectional study from Turkey. Nurs Crit Care 2024; 29:974-986. [PMID: 37581265 DOI: 10.1111/nicc.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Recent critical care guidelines recommended the evidence-based ABCDEF care bundle for intensive care unit (ICU) patients. However, limited information is available on the implementation of the bundle in Turkish ICUs. AIM To assess the current practices of the ABCDEF care bundle as reported by ICU nurses. STUDY DESIGN A cross-sectional study using a web-based survey was conducted. Researchers invited nurses with at least 1 year of ICU experience to participate by sending the link to the research questionnaires they created in Google Forms to the one ICU nurse association and one communication group of which they are members. RESULTS A total of 342 ICU nurses completed the survey. Although 92% of the participants performed pain assessments in their ICUs, 52.7% reported not using protocols. Based on the responses of the nurses, spontaneous awakening and breathing trials are performed in 88.8% and 92.4%, respectively, of ICUs. Fewer than half of the participants reported following a sedation protocol in their ICUs. Only 54.7% of ICU nurses surveyed reported routinely monitoring patients for delirium. It was reported that early mobilization was practised in 68.7% of ICUs, but non-ventilated patients were mobilized more frequently (70.2%), and 9.7% of ICUs had mobilization teams. Family members were actively involved in 95% of ICUs; however, 9.7% used dedicated staff to support families and 3.5% reported that their unit was open 24 h/day for visits. CONCLUSIONS While the implementation of most pain and sedation evaluations in ICUs were reported by nurses, many of them did not use structured delirium assessments. There is a need to encourage early mobilization programs and family participation. RELEVANCE TO CLINICAL PRACTICE Health institutions can improve patient care and outcomes by establishing and standardizing a protocol for each component of the ABCDEF care bundle in ICUs.
Collapse
Affiliation(s)
- Öznur Erbay Dalli
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
| | - Derya Akça Doğan
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
| | - Rıdvan Bayram
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
| | - Seda Pehlivan
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
| | - Hicran Yildiz
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
| |
Collapse
|
|
8
|
Brown A, Udy A, Kirk M, Bennett S, Chavan S, Huckson S, Pilcher D. Outcomes for people admitted to Australian and New Zealand intensive care units with primary, exacerbating, or incidental SARS-CoV-2 infections, 2022-23: a retrospective analysis of ANZICS data. Med J Aust 2024; 221:209-216. [PMID: 39019483 DOI: 10.5694/mja2.52390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 01/15/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVES To compare in-hospital mortality and intensive care unit (ICU) length of stay for people admitted to Australian and New Zealand ICUs during 2022-23 with coronavirus disease 2019 (COVID-19) pneumonitis, incidental or exacerbating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, or without SAR-CoV-2 infections. STUDY DESIGN Retrospective cohort study; analysis of Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database data. SETTING, PARTICIPANTS Adults (16 years or older) admitted to participating ICUs in Australia or New Zealand, 1 January 2022 - 30 June 2023. MAJOR OUTCOME MEASURES The primary outcome was in-hospital mortality, the secondary outcome ICU length of stay, each by SARS-CoV-2 infection attribution classification: primary COVID-19; exacerbating SARS-CoV-2 infection (SARS-CoV-2 infection was a contributing factor to the primary cause of ICU admission); incidental SARS-CoV-2 infections (SARS-CoV-2 infection detected during ICU admission but did not contribute to admission diagnosis); no SARS-CoV-2 infection. RESULTS A total of 207 684 adults were admitted to 195 Australian and New Zealand ICUs during 2022-23; 2674 people (1.3%) had incidental SARS-CoV-2 infections, 4923 (2.4%) exacerbating infections, and 3620 (1.7%) primary COVID-19. Unadjusted in-hospital mortality for people with incidental SARS-CoV-2 infections (288 deaths, 10.8%) was lower than for those with exacerbating infections (928 deaths, 18.8%) or primary COVID-19 (830 deaths, 22.9%), but higher than for patients without SARS-CoV-2 infections (15 486 deaths, 7.9%). After adjusting for illness severity, frailty, geographic region, and type of hospital, mortality was higher for patients with incidental SARS-CoV-2 infections (adjusted odds ratio [aOR], 1.28; 95% confidence interval [CI], 1.10-1.50), exacerbating infections (aOR, 1.35; 95% CI, 1.22-1.48), or primary COVID-19 (aOR, 2.54; 95% CI, 2.30-2.81) than for patients without SARS-CoV-2 infections. After adjusting for diagnosis and illness severity, ICU stays were longer for people with incidental (mean difference, 3.3 hours; 95% CI, 2.4-4.2 hours) or exacerbating infections (0.8 hours; 95% CI, 0.2-1.5 hours) than for those without SARS-CoV-2 infections. CONCLUSION Risk-adjusted in-hospital mortality and ICU length of stay are higher for people admitted to intensive care who have concomitant SARS-CoV-2 infections than for people who do not.
Collapse
Affiliation(s)
- Alastair Brown
- Australia and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
- St Vincent's Hospital, Melbourne, VIC
| | - Andrew Udy
- Australia and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
- The Alfred, Melbourne, VIC
| | - Martyn Kirk
- Australian Department of Health and Aged Care, Canberra, ACT
| | - Sonya Bennett
- Australian Department of Health and Aged Care, Canberra, ACT
| | - Shaila Chavan
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC
| | - Sue Huckson
- Australia and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC
| | - David Pilcher
- St Vincent's Hospital, Melbourne, VIC
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC
| |
Collapse
|
|
9
|
Haber R, Ghezzawi M, Puzantian H, Haber M, Saad S, Ghandour Y, El Bachour J, Yazbeck A, Hassanieh G, Mehdi C, Ismail D, Abi-Kharma E, El-Zein O, Khamis A, Chakhtoura M, Mantzoros C. Mortality risk in patients with obesity and COVID-19 infection: a systematic review and meta-analysis. Metabolism 2024; 155:155812. [PMID: 38360130 DOI: 10.1016/j.metabol.2024.155812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
Obesity is a risk factor for severe respiratory diseases, including COVID-19 infection. Meta-analyses on mortality risk were inconsistent. We systematically searched 3 databases (Medline, Embase, CINAHL) and assessed the quality of studies using the Newcastle-Ottawa tool (CRD42020220140). We included 199 studies from US and Europe, with a mean age of participants 41.8-78.2 years, and a variable prevalence of metabolic co-morbidities of 20-80 %. Exceptionally, one third of the studies had a low prevalence of obesity of <20 %. Compared to patients with normal weight, those with obesity had a 34 % relative increase in the odds of mortality (p-value 0.002), with a dose-dependent relationship. Subgroup analyses showed an interaction with the country income. There was a high heterogeneity in the results, explained by clinical and methodologic variability across studies. We identified one trial only comparing mortality rate in vaccinated compared to unvaccinated patients with obesity; there was a trend for a lower mortality in the former group. Mortality risk in COVID-19 infection increases in parallel to an increase in BMI. BMI should be included in the predictive models and stratification scores used when considering mortality as an outcome in patients with COVID-19 infections. Furthermore, patients with obesity might need to be prioritized for COVID-19 vaccination.
Collapse
Affiliation(s)
- Rachelle Haber
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malak Ghezzawi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Houry Puzantian
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Hariri School of Nursing, American University of Beirut, Beirut, Lebanon.
| | - Marc Haber
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sacha Saad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Yara Ghandour
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Anthony Yazbeck
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Celine Mehdi
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Dima Ismail
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Elias Abi-Kharma
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ola El-Zein
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
| | - Assem Khamis
- Hull York Medical School, University of Hull, York, United Kingdom
| | - Marlene Chakhtoura
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Christos Mantzoros
- Beth Israel Deaconess Medical Center and Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
|
10
|
Chapple LAS, Ridley EJ, Ainscough K, Ballantyne L, Burrell A, Campbell L, Dux C, Ferrie S, Fetterplace K, Fox V, Jamei M, King V, Serpa Neto A, Nichol A, Osland E, Paul E, Summers MJ, Marshall AP, Udy A. Nutrition delivery across hospitalisation in critically ill patients with COVID-19: An observational study of the Australian experience. Aust Crit Care 2024; 37:422-428. [PMID: 37316370 PMCID: PMC10176103 DOI: 10.1016/j.aucc.2023.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/28/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Data on nutrition delivery over the whole hospital admission in critically ill patients with COVID-19 are scarce, particularly in the Australian setting. OBJECTIVES The objective of this study was to describe nutrition delivery in critically ill patients admitted to Australian intensive care units (ICUs) with coronavirus disease 2019 (COVID-19), with a focus on post-ICU nutrition practices. METHODS A multicentre observational study conducted at nine sites included adult patients with a positive COVID-19 diagnosis admitted to the ICU for >24 h and discharged to an acute ward over a 12-month recruitment period from 1 March 2020. Data were extracted on baseline characteristics and clinical outcomes. Nutrition practice data from the ICU and weekly in the post-ICU ward (up to week four) included route of feeding, presence of nutrition-impacting symptoms, and nutrition support received. RESULTS A total of 103 patients were included (71% male, age: 58 ± 14 years, body mass index: 30±7 kg/m2), of whom 41.7% (n = 43) received mechanical ventilation within 14 days of ICU admission. While oral nutrition was received by more patients at any time point in the ICU (n = 93, 91.2% of patients) than enteral nutrition (EN) (n = 43, 42.2%) or parenteral nutrition (PN) (n = 2, 2.0%), EN was delivered for a greater duration of time (69.6% feeding days) than oral and PN (29.7% and 0.7%, respectively). More patients received oral intake than the other modes in the post-ICU ward (n = 95, 95.0%), and 40.0% (n = 38/95) of patients were receiving oral nutrition supplements. In the week after ICU discharge, 51.0% of patients (n = 51) had at least one nutrition-impacting symptom, most commonly a reduced appetite (n = 25; 24.5%) or dysphagia (n = 16; 15.7%). CONCLUSION Critically ill patients during the COVID-19 pandemic in Australia were more likely to receive oral nutrition than artificial nutrition support at any time point both in the ICU and in the post-ICU ward, whereas EN was provided for a greater duration when it was prescribed. Nutrition-impacting symptoms were common.
Collapse
Affiliation(s)
- Lee-Anne S Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia.
| | - Emma J Ridley
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Kate Ainscough
- University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland
| | - Lauren Ballantyne
- Nutrition and Dietetic Department, Bendigo Health, Bendigo, Victoria, Australia
| | - Aidan Burrell
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Lewis Campbell
- Intensive Care Unit, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Claire Dux
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Australia; School of Human Movements and Nutrition Science, University of Queensland, Brisbane, Australia
| | - Suzie Ferrie
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; School of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Kate Fetterplace
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Victoria, Australia; The University of Melbourne, Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Virginia Fox
- Nutrition and Dietetic Department, Bendigo Health, Bendigo, Victoria, Australia
| | - Matin Jamei
- Intensive Care Unit, Nepean Hospital, Sydney, New South Wales, Australia
| | - Victoria King
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ary Serpa Neto
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alistair Nichol
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland; Nutrition and Dietetic Department, Bendigo Health, Bendigo, Victoria, Australia; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Emma Osland
- Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia; School of Human Movements and Nutrition Science, University of Queensland, Brisbane, Australia
| | - Eldho Paul
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew J Summers
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea P Marshall
- Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia; Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Andrew Udy
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
|
11
|
Rollinson TC, McDonald LA, Rose J, Eastwood G, Costa-Pinto R, Modra L, Maeda A, Bacolas Z, Anstey J, Bates S, Bradley S, Dumbrell J, French C, Ghosh A, Haines K, Haydon T, Hodgson C, Holmes J, Leggett N, McGain F, Moore C, Nelson K, Presneill J, Rotherham H, Said S, Young M, Zhao P, Udy A, Chaba A, Bellomo R, Neto AS. Magnitude and time to peak oxygenation effect of prone positioning in ventilated adults with COVID-19 related acute hypoxemic respiratory failure. Acta Anaesthesiol Scand 2024; 68:361-371. [PMID: 37944557 DOI: 10.1111/aas.14356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/14/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Prone positioning may improve oxygenation in acute hypoxemic respiratory failure and was widely adopted in COVID-19 patients. However, the magnitude and timing of its peak oxygenation effect remain uncertain with the optimum dosage unknown. Therefore, we aimed to investigate the magnitude of the peak effect of prone positioning on the PaO2 :FiO2 ratio during prone and secondly, the time to peak oxygenation. METHODS Multi-centre, observational study of invasively ventilated adults with acute hypoxemic respiratory failure secondary to COVID-19 treated with prone positioning. Baseline characteristics, prone positioning and patient outcome data were collected. All arterial blood gas (ABG) data during supine, prone and after return to supine position were analysed. The magnitude of peak PaO2 :FiO2 ratio effect and time to peak PaO2 :FIO2 ratio effect was measured. RESULTS We studied 220 patients (mean age 54 years) and 548 prone episodes. Prone positioning was applied for a mean (±SD) 3 (±2) times and 16 (±3) hours per episode. Pre-proning PaO2 :FIO2 ratio was 137 (±49) for all prone episodes. During the first episode. the mean PaO2 :FIO2 ratio increased from 125 to a peak of 196 (p < .001). Peak effect was achieved during the first episode, after 9 (±5) hours in prone position and maintained until return to supine position. CONCLUSIONS In ventilated adults with COVID-19 acute hypoxemic respiratory failure, peak PaO2 :FIO2 ratio effect occurred during the first prone positioning episode and after 9 h. Subsequent episodes also improved oxygenation but with diminished effect on PaO2 :FIO2 ratio. This information can help guide the number and duration of prone positioning episodes.
Collapse
Affiliation(s)
- Thomas C Rollinson
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Luke A McDonald
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
| | - Joleen Rose
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
| | - Glenn Eastwood
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Rahul Costa-Pinto
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lucy Modra
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Akinori Maeda
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
| | - Zoe Bacolas
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
| | - James Anstey
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Samantha Bates
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
| | - Scott Bradley
- Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Jodi Dumbrell
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Craig French
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
| | - Angaj Ghosh
- Department of Intensive Care, Northern Health, Melbourne, Victoria, Australia
| | - Kimberley Haines
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - Tim Haydon
- Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Jennifer Holmes
- Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Nina Leggett
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - Forbes McGain
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
| | - Cara Moore
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kathleen Nelson
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Jeffrey Presneill
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Hannah Rotherham
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Simone Said
- Department of Intensive Care, Northern Health, Melbourne, Victoria, Australia
| | - Meredith Young
- Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia
| | - Peinan Zhao
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Andrew Udy
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia
| | - Anis Chaba
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ary Serpa Neto
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
|
12
|
Rollinson TC, McDonald LA, Rose J, Eastwood G, Costa-Pinto R, Modra L, Maeda A, Bacolas Z, Anstey J, Bates S, Bradley S, Dumbrell J, French C, Ghosh A, Haines K, Haydon T, Hodgson CL, Holmes J, Leggett N, McGain F, Moore C, Nelson K, Presneill J, Rotherham H, Said S, Young M, Zhao P, Udy A, Neto AS, Chaba A, Bellomo R. Neuromuscular blockade and oxygenation changes during prone positioning in COVID-19. J Crit Care 2024; 79:154469. [PMID: 37992464 DOI: 10.1016/j.jcrc.2023.154469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Neuromuscular blockers (NMBs) are often used during prone positioning to facilitate mechanical ventilation in COVID-19 related ARDS. However, their impact on oxygenation is uncertain. METHODS Multi-centre observational study of invasively ventilated COVID-19 ARDS adults treated with prone positioning. We collected data on baseline characteristics, prone positioning, NMB use and patient outcome. We assessed arterial blood gas data during supine and prone positioning and after return to the supine position. RESULTS We studied 548 prone episodes in 220 patients (mean age 54 years, 61% male) of whom 164 (75%) received NMBs. Mean PaO2:FiO2 (P/F ratio) during the first prone episode with NMBs reached 208 ± 63 mmHg compared with 161 ± 66 mmHg without NMBs (Δmean = 47 ± 5 mmHg) for an absolute increase from baseline of 76 ± 56 mmHg versus 55 ± 56 mmHg (padj < 0.001). The mean P/F ratio on return to the supine position was 190 ± 63 mmHg in the NMB group versus 141 ± 64 mmHg in the non-NMB group for an absolute increase from baseline of 59 ± 58 mmHg versus 34 ± 56 mmHg (padj < 0.001). CONCLUSION During prone positioning, NMB is associated with increased oxygenation compared to non-NMB therapy, with a sustained effect on return to the supine position. These findings may help guide the use of NMB during prone positioning in COVID-19 ARDS.
Collapse
Affiliation(s)
- Thomas C Rollinson
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia.
| | - Luke A McDonald
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia
| | - Joleen Rose
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia
| | - Glenn Eastwood
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Rahul Costa-Pinto
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Lucy Modra
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Akinori Maeda
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - Zoe Bacolas
- Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia
| | - James Anstey
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Samantha Bates
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia
| | - Scott Bradley
- Department of Intensive Care, Alfred Health, VIC, Australia; Department of Physiotherapy, Alfred Health, VIC, Australia
| | - Jodi Dumbrell
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Craig French
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia
| | - Angaj Ghosh
- Department of Intensive Care, Northern Health, VIC, Australia
| | - Kimberley Haines
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia; Department of Physiotherapy, Western Health, VIC, Australia
| | - Tim Haydon
- Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Carol L Hodgson
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Health, VIC, Australia; Department of Physiotherapy, Alfred Health, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Jennifer Holmes
- Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Nina Leggett
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia; Department of Physiotherapy, Western Health, VIC, Australia
| | - Forbes McGain
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Western Health, VIC, Australia
| | - Cara Moore
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Jeffrey Presneill
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Hannah Rotherham
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Simone Said
- Department of Intensive Care, Northern Health, VIC, Australia
| | - Meredith Young
- Department of Intensive Care, Alfred Health, VIC, Australia
| | - Peinan Zhao
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Andrew Udy
- Department of Intensive Care, Alfred Health, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Ary Serpa Neto
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Anis Chaba
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia; Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
|
13
|
Aktiz Bıçak E, Oğlak SC. Clinical characterisation and management outcome of obstetric patients following intensive care unit admission for COVID-19 pneumonia. J OBSTET GYNAECOL 2023; 43:2218915. [PMID: 37289641 DOI: 10.1080/01443615.2023.2218915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/03/2023] [Indexed: 06/10/2023]
Abstract
This study aims to examine the clinical characteristics and mortality-related factors of obstetric patients, who were taken to the intensive care unit due to Coronavirus Disease 2019 (COVID-19). This study included 31 patients in the peripartum period with COVID-19 pneumonia, followed up in the intensive care unit (ICU) from March 2020 to December 2020. Symptoms, laboratory values, intensive care unit duration of stay, complications, the requirement of non-invasive and invasive mechanical ventilation, and mortality were recorded. The mean age was 30.7 ± 6.2 years and the mean gestational age was 31.1 ± 6.4 weeks. Among the patients, 25.8% had a fever, 87.1% had a cough, 96.8% had dyspnoea and 77.4% had tachypnoea. Seventeen patients (54.8%) had mild, 6 (19.4%) had moderate and 8 (25.8%) had severe pulmonary involvement on computed tomography. Sixteen (51.6%) patients required high-frequency oscillatory ventilation, 6 (19.3%) patients required continuous positive airway pressure, and 5 (16.1%) patients required invasive mechanical ventilation. Sepsis complicated by septic shock and multiorgan failure occurred in 4 patients and all of them died. The ICU duration of stay was 4.9 ± 4.3 days. We have found that older maternal age, obesity, high LDH, AST, ALT, ferritin, leukocyte, CRP, and procalcitonin values, and severe lung involvement were mortality-related factors.Impact statementWhat is already known on this subject? Pregnant women are in the high-risk group for Covid-19 disease and its complications. Although most pregnant women are asymptomatic, severe infection-related hypoxia can cause serious foetal and maternal problems.What do the results of this study add? When we examined the literature, we found that the number of studies on pregnant women with severe Covid-19 infection was limited. For this reason, with our study results, we aim to contribute to the literature by determining the biochemical parameters and patient-related factors associated with severe infection and mortality in pregnant patients with severe Covid-19 infection.What are the implications of these findings for clinical practice and/or further research? With our study results, predisposing factors for the development of severe Covid-19 infection in the pregnant patient population and biochemical parameters that are early indicators of severe infection were determined. In this way, pregnant women in the high-risk group can be followed closely and the necessary treatments can be started quickly so disease-related complications and mortality can be reduced.
Collapse
Affiliation(s)
- Esra Aktiz Bıçak
- Department of Anesthesiology and Reanimation, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Süleyman Cemil Oğlak
- Department of Obstetrics and Gynaecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| |
Collapse
|
|
14
|
Rollinson TC, Rose J, McDonald LA, Green C, Topple M, Warrillow S, Modra L, Costa-Pinto R, Berney S. The PhLIP team: Feasibility of a physiotherapy-led intensive prone positioning team initiative during the COVID-19 pandemic. Aust Crit Care 2023; 36:974-979. [PMID: 36934044 PMCID: PMC9922573 DOI: 10.1016/j.aucc.2023.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/22/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic resulted in a surge of patients with refractory hypoxaemic respiratory failure being admitted to the intensive care unit (ICU). Prone positioning can improve oxygenation but requires a team of skilled personnel to complete safely. Critical care physiotherapists (PTs) are ideally suited to lead proning teams, due to their expertise in moving critically unwell, invasively ventilated patients. OBJECTIVES The aim of this study was to describe the feasibility of implementing a physiotherapy-led intensive proning (PhLIP) team to support the critical care team during surges. METHODS This study involves descriptive evaluation of feasibility and implementation of the PhLIP team, a novel model of care, during the Delta wave of the COVID-19 pandemic, through a retrospective, observational audit of PhLIP team activity, ICU clinical activity, and a description of clinical outcomes. RESULTS Between 17 September and 19 November 2021, 93 patients with COVID-19 were admitted to the ICU. Fifty-one patients (55%) were positioned prone, a median [interquartile range] 2 [2, 5] times, for a mean (±standard deviation) duration of 16 (±2) h, across 161 episodes. Twenty-three PTs were upskilled and deployed to the PhLIP team, adding 2.0 equivalent full time to the daily service. Ninety-four percent of prone episodes (154) were led by the PhLIP PTs with a median 4 [interquartile range: 2, 8] turns per day. Potential airway adverse events occurred on three occasions (1.8%) and included an endotracheal tube leak, displacement, and obstruction. Each incident was promptly managed without prolonged impact on the patient. No manual handling injuries were reported. CONCLUSION The implementation of a physiotherapy-led proning team was safe and feasible and can release critical care-trained medical and nursing staff to other duties in the ICU.
Collapse
Affiliation(s)
- Thomas C Rollinson
- Department of Physiotherapy, Division of Allied Health, Austin Health, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Victoria, Australia.
| | - Joleen Rose
- Department of Physiotherapy, Division of Allied Health, Austin Health, Victoria, Australia
| | - Luke A McDonald
- Department of Physiotherapy, Division of Allied Health, Austin Health, Victoria, Australia
| | - Cara Green
- Department of Intensive Care, Austin Health, Victoria, Australia
| | - Michelle Topple
- Department of Intensive Care, Austin Health, Victoria, Australia
| | - Stephen Warrillow
- Department of Critical Care, The University of Melbourne, Victoria, Australia; Department of Intensive Care, Austin Health, Victoria, Australia
| | - Lucy Modra
- Department of Critical Care, The University of Melbourne, Victoria, Australia; Department of Intensive Care, Austin Health, Victoria, Australia
| | - Rahul Costa-Pinto
- Department of Critical Care, The University of Melbourne, Victoria, Australia; Department of Intensive Care, Austin Health, Victoria, Australia
| | - Sue Berney
- Department of Physiotherapy, Division of Allied Health, Austin Health, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Victoria, Australia
| |
Collapse
|
|
15
|
Markey P, Bayliss J, Jones D, Trauer J, Pilcher D, Ademi Z. Estimating Australian Hospitalization Ratios and Costs for Wildtype SARS-CoV-2 in 2020. Curr Probl Cardiol 2023; 48:101917. [PMID: 37394203 DOI: 10.1016/j.cpcardiol.2023.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
Utilizing a retrospective cohort study of SARS-CoV-2 wildtype (Wuhan) strain, we aimed to 1) utilize the unique Australian experience of temporarily eliminating SARS-CoV-2 to document and estimate the hospitalization demand; and 2) estimate the inpatient hospital costs associated with treatment. Case data was based on Victoria Australia from March 29 to December 31, 2020. Outcomes measures included hospitalization demand and case fatality ratio and inpatient hospitalization costs. Population adjusted results indicated that 10.2% (CI 9.9%-10.5%) required ward only admission, 1.0% (CI 0.9%-1.1%) required ICU admission plus 1.0% (CI 0.9%-1.1%) required ICU with mechanical ventilation. The overall case fatality ratio was 2.9% (CI 2.7%-3.1%). Mean ward only patient costs ranged from $22,714 to $57,100 per admission whilst ICU patient costs ranged from $37,228 to $140,455. With delayed, manageable outbreaks and public health measures leading to temporary elimination of community transmission, the Victorian COVID-19 data provides insight into initial pandemic severity and hospital costs.
Collapse
Affiliation(s)
- Peter Markey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia.
| | | | - Daryl Jones
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Austin Hospital, Heidelberg, Victoria, Australia
| | - James Trauer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - David Pilcher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- Alfred Hospital, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
|
16
|
Dharan NJ, Sasson SC, Ahlenstiel G, Andersen CR, Bloch M, Buckland G, Hamad N, Han WM, Kelleher AD, Long GV, Matthews GV, Mina MM, Papot E, Petoumenos K, Swaminathan S, Withers B, Yun J, Polizzotto MN, on behalf of the CORIA Study Group. Clinical and laboratory features of COVID-19 illness and outcomes in immunocompromised individuals during the first pandemic wave in Sydney, Australia. PLoS One 2023; 18:e0289907. [PMID: 37910527 PMCID: PMC10619805 DOI: 10.1371/journal.pone.0289907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023] Open
Abstract
People with immunocompromising conditions are at increased risk of SARS-CoV-2 infection and mortality, however early in the pandemic it was challenging to collate data on this heterogenous population. We conducted a registry study of immunocompromised individuals with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection from March-October 2020 in Sydney, Australia to understand clinical and laboratory outcomes in this population prior to the emergence of the Delta variant. 27 participants were enrolled into the study including people with a haematologic oncologic conditions (n = 12), secondary immunosuppression (N = 8) and those with primary or acquired immunodeficiency (i.e. HIV; N = 7). All participants had symptomatic COVID-19 with the most common features being cough (64%), fever (52%) and headache (40%). Five patients demonstrated delayed SARS-CoV-2 clearance lasting three weeks to three months. The mortality rate in this study was 7% compared to 1.3% in the state of New South Wales Australia during the same period. This study provides data from the first eight months of the pandemic on COVID-19 outcomes in at-risk patient groups.
Collapse
Affiliation(s)
- Nila J. Dharan
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sarah C. Sasson
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- NSW Health Pathology, Newcastle, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Golo Ahlenstiel
- Blacktown Hospital, Blacktown, New South Wales, Australia
- Western Sydney University, Penrith, New South Wales, Australia
| | - Christopher R. Andersen
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Mark Bloch
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Holdsworth House Medical Practice, Darlinghurst, New South Wales, Australia
| | | | - Nada Hamad
- St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- School of Medicine, Sydney, University of Notre Dame, Chippendale, New South Wales, Australia
| | - Win Min Han
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Anthony D. Kelleher
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | - Georgina V. Long
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gail V. Matthews
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | - Michael M. Mina
- Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia
| | - Emmanuelle Papot
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kathy Petoumenos
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sanjay Swaminathan
- Westmead Hospital, Westmead, New South Wales, Australia
- Blacktown Hospital, Blacktown, New South Wales, Australia
- Western Sydney University, Penrith, New South Wales, Australia
| | - Barbara Withers
- St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | - James Yun
- School of Medicine, Sydney, University of Notre Dame, Chippendale, New South Wales, Australia
- Nepean Hospital, Kingswood, New South Wales, Australia
| | - Mark N. Polizzotto
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
| | | |
Collapse
|
|
17
|
Yavuz T, Orhan S, Rollas K, Toksoy CK, Kazan ED, Bozkurt E, Cosgun İG, Yavasoglu F. Evaluation of clinical features and laboratory findings in critical intensive care unit patients with severe coronavirus disease-19 who underwent extracorporeal cytokine adsorption. Ther Apher Dial 2023; 27:890-897. [PMID: 37177852 DOI: 10.1111/1744-9987.14001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/03/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
AIM To evaluate the inflammatory parameters and oxygenation in severe coronavirus disease-19 patients who underwent extracorporeal cytokine adsorption (CA). METHODS Patients who underwent extracorporeal CA for cytokine storm were included in the study. The changes in oxygenation, laboratory parameters, and mortality rates were investigated. RESULTS Thirty-six patients were included in the study. The hemoglobin, thrombocyte, and C-reactive protein (CRP) decreased, and PaO2 /FiO2 ratio increased (p < 0.001; p < 0.01; p < 0.001; p = 0.04, respectively). Twelve (33.3%) patients received a single session, 24 (66.6%) received 2 or more sessions. CRP and fibrinogen levels decreased, and PaO2 /FIO2 ratio increased in the single session group (p = 0.04; p = 0.04; p = 0.01, respectively). In the multi-session group, the hemoglobin, platelet, procalcitonin, and CRP levels decreased, and PaO2 /FIO2 ratio increased (p < 0.01; p = 0.02; p = 0.02; p < 0.01; p = 0.01, respectively). Day 15, 30, and 90 mortality rates were 61.1%, 83.3%, and 88.9%. CONCLUSION CA with hemoperfusion reduced CRP and improved oxygenation; however, mortality rates were high.
Collapse
Affiliation(s)
- Tunzala Yavuz
- Intensive Care Unit, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
- Department of Anesthesiology and Reanimation, Intensive Care Unit, SBU Tepecik Training and Research Hospital, İzmir, Turkey
| | - Semiha Orhan
- Intensive Care Unit, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Kazim Rollas
- Department of Anesthesiology and Reanimation, Intensive Care Unit, SBU Tepecik Training and Research Hospital, İzmir, Turkey
| | - Cansu Koseoglu Toksoy
- Department of Neurology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Elif Dizen Kazan
- Department of İnternal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Erhan Bozkurt
- Department of İnternal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - İbrahim Guven Cosgun
- Department of Chest Diseases, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Filiz Yavasoglu
- Department of İnternal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| |
Collapse
|
|
18
|
Marano D, Amaral Y, Rebelo F, Abranches A, Vilarim M, Moreira MEL. The effect of obesity on the mortality of hospitalized adults with COVID-19 considering the human development index: A systematic review and meta-analysis. Obes Rev 2023; 24:e13591. [PMID: 37341377 DOI: 10.1111/obr.13591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 04/03/2023] [Accepted: 05/21/2023] [Indexed: 06/22/2023]
Abstract
The objective of this study is to verify the association between obesity and mortality in hospitalized patients with SARS-CoV-2 taking into account the Human Development Index (HDI). A search was performed in the PubMed, Virtual Health Library (Lilacs/Bireme/VHL Brazil), Embase, Web of Science, and Scopus databases from inception to May 2022. To be eligible, studies had to have cohort or case-control designs, be conducted with hospitalized adults (≥18 years old), and evaluate mortality rates between with obesity and without obesity individuals with SARS-CoV-2 confirmed by laboratory tests. The analyses were performed in Stata 12.0 using relative risk (RR) as a summary measure. Heterogeneity was explored by meta-regression and subgroup analyses considering the HDI, age, sex, and follow-up period. Out of 912 studies screened, 49 studies were eligible for qualitative synthesis, and 33 studies were eligible for quantitative analysis, representing 42,905 patients. The mortality risk from SARS-CoV-2 was higher in individuals with obesity compared with without obesity individuals only in the subgroups of patients <60 years old (RR = 1.31; 95% CI 1.18-1.45, I2 = 0.0%) and living in countries with a low HDI (RR = 1.28; 95% CI 1.10-1.48, I2 = 45.4%).
Collapse
Affiliation(s)
- Daniele Marano
- Clinical Research Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Yasmin Amaral
- Graduate Program in Applied Research on Children and Women's Health, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Fernanda Rebelo
- Clinical Research Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Andrea Abranches
- Graduate Program in Applied Research on Children and Women's Health, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Marina Vilarim
- Graduate Program on Child and Woman Health, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Maria Elizabeth Lopes Moreira
- Clinical Research Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| |
Collapse
|
|
19
|
Plummer MP, Rait L, Finnis ME, French CJ, Bates S, Douglas J, Bhurani M, Broadley T, Trapani T, Deane AM, Udy AA, Burrell AJC. Diabetes mellitus, glycaemic control, and severe COVID-19 in the Australian critical care setting: A nested cohort study. Aust Crit Care 2023; 36:579-585. [PMID: 35820985 PMCID: PMC9125138 DOI: 10.1016/j.aucc.2022.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Internationally, diabetes mellitus is recognised as a risk factor for severe COVID-19. The relationship between diabetes mellitus and severe COVID-19 has not been reported in the Australian population. OBJECTIVE The objective of this study was to determine the prevalence of and outcomes for patients with diabetes admitted to Australian intensive care units (ICUs) with COVID-19. METHODS This is a nested cohort study of four ICUs in Melbourne participating in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia project. All adult patients admitted to the ICU with COVID-19 from 20 February 2020 to 27 February 2021 were included. Blood glucose and glycated haemoglobin (HbA1c) data were retrospectively collected. Diabetes was diagnosed from medical history or an HbA1c ≥6.5% (48 mmol/mol). Hospital mortality was assessed using logistic regression. RESULTS There were 136 patients with median age 58 years [48-68] and median Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 14 [11-19]. Fifty-eight patients had diabetes (43%), 46 patients had stress-induced hyperglycaemia (34%), and 32 patients had normoglycaemia (23%). Patients with diabetes were older, were with higher APACHE II scores, had greater glycaemic variability than patients with normoglycaemia, and had longer hospital length of stay. Overall hospital mortality was 16% (22/136), including nine patients with diabetes, nine patients with stress-induced hyperglycaemia, and two patients with normoglycaemia. CONCLUSION Diabetes is prevalent in patients admitted to Australian ICUs with severe COVID-19, highlighting the need for prevention strategies in this vulnerable population.
Collapse
Affiliation(s)
- Mark P Plummer
- Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australia; Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - Louise Rait
- Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Mark E Finnis
- Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Craig J French
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
| | - Samantha Bates
- Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
| | - James Douglas
- Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
| | - Mansi Bhurani
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Tessa Broadley
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Adam M Deane
- Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australia; Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Aidan J C Burrell
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
|
20
|
Tiruvoipati R, Akkanti B, Dinh K, Barrett N, May A, Kimmel J, Conrad SA. Extracorporeal Carbon Dioxide Removal With the Hemolung in Patients With Acute Respiratory Failure: A Multicenter Retrospective Cohort Study. Crit Care Med 2023; 51:892-902. [PMID: 36942957 PMCID: PMC10262985 DOI: 10.1097/ccm.0000000000005845] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVES Extracorporeal carbon dioxide removal (ECCO 2 R) devices are effective in reducing hypercapnia and mechanical ventilation support but have not been shown to reduce mortality. This may be due to case selection, device performance, familiarity, or the management. The objective of this study is to investigate the effectiveness and safety of a single ECCO 2 R device (Hemolung) in patients with acute respiratory failure and identify variables associated with survival that could help case selection in clinical practice as well as future research. DESIGN Multicenter, multinational, retrospective review. SETTING Data from the Hemolung Registry between April 2013 and June 2021, where 57 ICUs contributed deidentified data. PATIENTS Patients with acute respiratory failure treated with the Hemolung. The characteristics of patients who survived to ICU discharge were compared with those who died. Multivariable logistical regression analysis was used to identify variables associated with ICU survival. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 159 patients included, 65 (41%) survived to ICU discharge. The survival was highest in status asthmaticus (86%), followed by acute respiratory distress syndrome (ARDS) (52%) and COVID-19 ARDS (31%). All patients had a significant reduction in Pa co2 and improvement in pH with reduction in mechanical ventilation support. Patients who died were older, had a lower Pa o2 :F io2 (P/F) and higher use of adjunctive therapies. There was no difference in the complications between patients who survived to those who died. Multivariable regression analysis showed non-COVID-19 ARDS, age less than 65 years, and P/F at initiation of ECCO 2 R to be independently associated with survival to ICU discharge (P/F 100-200 vs <100: odds ratio, 6.57; 95% CI, 2.03-21.33). CONCLUSIONS Significant improvement in hypercapnic acidosis along with reduction in ventilation supports was noted within 4 hours of initiating ECCO 2 R. Non-COVID-19 ARDS, age, and P/F at commencement of ECCO 2 R were independently associated with survival.
Collapse
Affiliation(s)
| | - Bindu Akkanti
- Department of Medicine, Division of Critical Care, Pulmonary and Sleep, University of Texas McGovern Medical School, Houston, TX
- Advanced Cardiopulmonary Therapeutics and Transplantation, University of Texas Health-Houston, Houston, TX
| | - Kha Dinh
- Department of Medicine, Division of Critical Care, Pulmonary and Sleep, University of Texas McGovern Medical School, Houston, TX
- Advanced Cardiopulmonary Therapeutics and Transplantation, University of Texas Health-Houston, Houston, TX
| | - Nicholas Barrett
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | | | | | - Steven A Conrad
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA
| |
Collapse
|
|
21
|
Jalil Y, Ferioli M, Dres M. The COVID-19 Driving Force: How It Shaped the Evidence of Non-Invasive Respiratory Support. J Clin Med 2023; 12:jcm12103486. [PMID: 37240592 DOI: 10.3390/jcm12103486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
During the COVID-19 pandemic, the use of non-invasive respiratory support (NIRS) became crucial in treating patients with acute hypoxemic respiratory failure. Despite the fear of viral aerosolization, non-invasive respiratory support has gained attention as a way to alleviate ICU overcrowding and reduce the risks associated with intubation. The COVID-19 pandemic has led to an unprecedented increased demand for research, resulting in numerous publications on observational studies, clinical trials, reviews, and meta-analyses in the past three years. This comprehensive narrative overview describes the physiological rationale, pre-COVID-19 evidence, and results of observational studies and randomized control trials regarding the use of high-flow nasal oxygen, non-invasive mechanical ventilation, and continuous positive airway pressure in adult patients with COVID-19 and associated acute hypoxemic respiratory failure. The review also highlights the significance of guidelines and recommendations provided by international societies and the need for further well-designed research to determine the optimal use of NIRS in treating this population.
Collapse
Affiliation(s)
- Yorschua Jalil
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
- Departamento de Ciencias de la Salud, Carrera de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Martina Ferioli
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy
| | - Martin Dres
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| |
Collapse
|
|
22
|
Wang N, Liu L, He W, Shang N, Li J, Qin Z, Du X. Circulating mid-regional proadrenomedullin is a predictor of mortality in patients with COVID-19: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:305. [PMID: 37158819 PMCID: PMC10165584 DOI: 10.1186/s12879-023-08275-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/24/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Although there is increasing understanding of the changes in the laboratory parameters of Coronavirus disease 2019 (COVID-19), the correlation between circulating Mid-regional Proadrenomedullin (MR-proADM) and mortality of patients with COVID-19 is not fully understood. In this study, we conducted a systematic review and meta-analysis to evaluate the prognostic value of MR-proADM in patients with COVID-19. METHODS The PubMed, Embase, Web of Science, Cochrane Library, Wanfang, SinoMed and Chinese National Knowledge Infrastructure (CNKI) databases were searched from 1 January 2020 to 20 March 2022 for relevant literature. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess quality bias, STATA was employed to pool the effect size by a random effects model, and potential publication bias and sensitivity analyses were performed. RESULTS 14 studies comprising 1822 patients with COVID-19 met the inclusion criteria, there were 1145 (62.8%) males and 677 (31.2%) females, and the mean age was 63.8 ± 16.1 years. The concentration of MR-proADM was compared between the survivors and non-survivors in 9 studies and the difference was significant (P < 0.01), I2 = 46%. The combined sensitivity was 0.86 [0.73-0.92], and the combined specificity was 0.78 [0.68-0.86]. We drew the summary receiver operating characteristic (SROC) curve and calculated the area under curve (AUC) = 0.90 [0.87-0.92]. An increase of 1 nmol/L of MR-proADM was independently associated with a more than threefold increase in mortality (odds ratio (OR) 3.03, 95% confidence interval (CI) 2.26-4.06, I2 = 0.0%, P = 0.633). The predictive value of MR-proADM for mortality was better than many other biomarkers. CONCLUSION MR-proADM had a very good predictive value for the poor prognosis of COVID-19 patients. Increased levels of MR-proADM were independently associated with mortality in COVID-19 patients and may allow a better risk stratification.
Collapse
Affiliation(s)
- Na Wang
- Emergency department of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China
| | - Lushan Liu
- Emergency department of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China
| | - Wei He
- Emergency department of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China
| | - Na Shang
- Emergency department of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China
| | - Junyu Li
- Emergency department of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China
| | - Zhou Qin
- Emergency department of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China
| | - Xiaoxia Du
- Department of neurorehabilitation of China Rehabilitation Research Center, Capital Medical University, no.10 Jiaomen north Street, Fengtai District, Beijing, 100068, China.
| |
Collapse
|
|
23
|
Otto M, Britton PN, Serpa Neto A, Erickson S, Festa M, Crawford NW, Burrell AJC, Udy AA. COVID-19 related ICU admissions in paediatric and young adult patients in Australia: a national case series 2020-2022. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023:100763. [PMID: 37360865 PMCID: PMC10102812 DOI: 10.1016/j.lanwpc.2023.100763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/05/2023] [Accepted: 03/24/2023] [Indexed: 06/28/2023]
Abstract
Background COVID-19 pandemic research efforts have focused on disease phenotypes in adults. A distinct spectrum of illness has been documented in paediatric populations. We aimed to review paediatric intensive care unit (ICU) admissions in Australia, across differing variant predominant phases of the pandemic. Methods Data reported to the Short PeRiod IncideNce sTudy of Severe Acute Respiratory Infection (SPRINT-SARI) Australia, across 49 ICUs from February 2020 to June 2022 were extracted. We defined 'child' as patients aged <12 years, 'adolescent' as patients aged 12-17 years, and 'young adult' as patients aged 18-25 years. Findings We identified 226 paediatric ICU admissions with COVID-19, representing 3.9% of ICU admissions across the study period. Comorbidity was present in 34.6% of children, 51.4% of adolescents, and 48.7% of young adults. The need for respiratory support was highest in young adults. While 28.3% of patients <18 years required invasive ventilation, in-hospital mortality in paediatric patients was 3.6%. During the Omicron period, there was an increase in the annualised incidence of age-specific COVID-19 ICU admissions per 100,000 population, albeit a decrease in the incidence per 1000 SARS-CoV-2 notifications. Interpretation This study demonstrated an appreciable burden of COVID-19 in paediatric patients. Adolescent patients presented phenotypically similar to young adults, however, illness severity was lower in younger cohorts. The Omicron phase of the pandemic demonstrated an increased age-specific population incidence of COVID-19 ICU admissions, albeit a reduced incidence when based on SARS-CoV-2 notifications. Funding SPRINT-SARI Australia is supported by the Department of Health, Commonwealth of Australia [Standing Deed SON60002733].
Collapse
Affiliation(s)
- Madeleine Otto
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, Australia
| | - Philip N Britton
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead and Faculty of Medicine and Health, University of Sydney, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, Australia
| | - Simon Erickson
- Department of Critical Care Medicine, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, Australia
| | - Marino Festa
- Kids Critical Care Research, Department of Paediatric Intensive Care, The Children's Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW, Australia
| | - Nigel W Crawford
- SAEFVIC, Infection & Immunity, Murdoch Children's Research Institute, and Immunisation Service, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Grattan Street, Parkville, VIC, Australia
| | - Aidan J C Burrell
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, Australia
| | - Andrew A Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, Australia
| |
Collapse
|
|
24
|
Cini C, Neto AS, Burrell A, Udy A. Inter-hospital transfer and clinical outcomes for people with COVID-19 admitted to intensive care units in Australia: an observational cohort study. Med J Aust 2023. [PMID: 37037671 DOI: 10.5694/mja2.51917] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVES To examine the association between inter-hospital transfer and in-hospital mortality among people with coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) in Australia. DESIGN Retrospective cohort study; analysis of data collected for the Short Period Incidence Study of Severe Acute Respiratory Illness (SPRINT-SARI) Australia study. SETTING, PARTICIPANTS People with COVID-19 admitted to 63 ICUs, 1 January 2020 - 1 April 2022. MAIN OUTCOME MEASURES Primary outcome: in-hospital mortality; secondary outcomes: ICU and hospital lengths of stay and frequency of selected complications. RESULTS Of 5207 people with records in the SPRINT-SARI Australia database at 1 April 2022, 328 (6.3%) had been transferred between hospitals, 305 (93%) during the third pandemic wave. Compared with patients not transferred, their median age was lower (53 years; interquartile range [IQR], 45-61 years v 60 years; IQR, 46-70 years), their median body mass index higher (32.5 [IQR, 27.2-39.0] kg/m2 v 30.1 [IQR, 25.7-35.7] kg/m2 ), and fewer had received a COVID-19 vaccine (22% v 44.9%); their median APACHE II scores were similar (14.0; IQR, 12.0-18.0 v 14.0; IQR, 10.0-19.0). Bacterial pneumonia (64.7% v 29.0%) and bacteraemia (27% v 8%) were more frequent in transferred patients, as was the need for more intensive ICU interventions, including invasive mechanical ventilation (71.2% v 38.1%) and extra-corporeal membrane oxygenation (26% v 1.7%). Crude ICU (19% v 14.9%) and in-hospital mortality (19% v 18.4%) were similar for patients who were or were not transferred; median lengths of ICU (20.0 [IQR, 11.2-40.3] days v 4.6 [IQR, 2.1-10.1] days) and hospital stay (29.7 [IQR, 18.1-49.6] days v 12.3 [IQR, 7.3-21.0] days) were longer for transferred patients. In the multivariable regression analysis, in-hospital mortality risk was lower for transferred patients (risk difference [RD], -5.0 percentage points; 95% confidence interval [CI] -10 to -0.03 percentage points), but not in the propensity score-adjusted analysis (RD, -3.4 [95% CI, -8.9 to 2.1] percentage points). CONCLUSIONS Among people with COVID-19 admitted to ICUs, patients transferred from another hospital required more intense interventions and remained in hospital longer, but were not at greater risk of dying in hospital than the patients who were not transferred.
Collapse
Affiliation(s)
| | - Ary S Neto
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
- Austin Hospital, Melbourne, VIC
| | - Aidan Burrell
- Alfred Health, Melbourne, VIC
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
| | - Andrew Udy
- Alfred Health, Melbourne, VIC
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
| |
Collapse
|
|
25
|
Chandel A, Leazer S, Alcover KC, Farley J, Berk J, Jayne C, Mcnutt R, Olsen M, Allard R, Yang J, Johnson C, Tripathi A, Rechtin M, Leon M, Williams M, Sheth P, Messer K, Chung KK, Collen J. Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis. Crit Care Explor 2023; 5:e0876. [PMID: 36890875 PMCID: PMC9988289 DOI: 10.1097/cce.0000000000000876] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support. DATA SOURCES A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021. STUDY SELECTION Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients. DATA EXTRACTION Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included. DATA SYNTHESIS One hundred fifty-seven studies evaluating 948,309 patients were included. The CFR for in-hospital mortality, ICU mortality, MV, RRT, and ECMO were 25.9% (95% CI: 24.0-27.8%), 37.3% (95% CI: 34.6-40.1%), 51.6% (95% CI: 46.1-57.0%), 66.1% (95% CI: 59.7-72.2%), and 58.0% (95% CI: 46.9-68.9%), respectively. MV (52.7%, 95% CI: 47.5-58.0% vs 31.3%, 95% CI: 16.1-48.9%; p = 0.023) and RRT-related mortality (66.7%, 95% CI: 60.1-73.0% vs 50.3%, 95% CI: 42.4-58.2%; p = 0.003) decreased from 2020 to 2021. CONCLUSIONS We present updated estimates of CFR for patients hospitalized and requiring intensive care for the management of COVID-19. Although mortality remain high and varies considerably worldwide, we found the CFR in patients supported with MV significantly improved since 2020.
Collapse
Affiliation(s)
- Abhimanyu Chandel
- Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD
| | - Sahar Leazer
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
- The Metis Foundation, San Antonio, TX
| | - Karl C Alcover
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Josiah Farley
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Joshua Berk
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Christopher Jayne
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Ryan Mcnutt
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Meredith Olsen
- Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD
| | - Rhonda Allard
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Jiahong Yang
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Caitlyn Johnson
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Ananya Tripathi
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Maria Rechtin
- Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD
| | - Mathew Leon
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Mathias Williams
- Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD
| | - Phorum Sheth
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Kyle Messer
- Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Jacob Collen
- Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| |
Collapse
|
|
26
|
Mermiri M, Mavrovounis G, Laou E, Papagiannakis N, Pantazopoulos I, Chalkias A. Association of vasopressors with mortality in critically ill patients with COVID-19: a systematic review and meta-analysis. ANESTHESIOLOGY AND PERIOPERATIVE SCIENCE 2023; 1:10. [PMCID: PMC10122723 DOI: 10.1007/s44254-023-00013-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 09/17/2024]
Abstract
Exogenous catecholamines may have pronounced side effects and affect physiological cascades. The aim of this study was to investigate the effect of vasopressors on mortality of critically ill patients with coronavirus disease 2019 (COVID-19). A systematic search of PubMed, Scopus, and ClinicalTrials.gov was conducted for relevant articles until December 2022. Eligibility criteria were randomized controlled and non-randomized trials. The primary outcome was in-hospital and 30-day mortality. The quality of studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool, while paired meta-analysis was used to estimate the pooled risk ratios (RR) along with their 95% Confidence Interval (95% CI). Analyses of 22 studies (n = 8034) revealed that vasopressor use is associated with mortality compared to no vasopressor therapy [RR (95%CI): 4.30 (3.21, 5.75); p < 0.001]. In-hospital and 30-day mortality are significantly higher in patients who receive vasopressors [RR (95%CI): 4.60 (2.47, 8.55); p < 0.001 and RR (95%CI): 2.97 (1.72, 5.14); p < 0.001, respectively]. Also, analyses of data from 10 studies (n = 3519) revealed that vasopressor use is associated with acute kidney injury [RR (95%CI): 3.17 (2.21, 4.54); p < 0.001]. In conclusion, current use of vasopressors in critically ill patients with COVID-19 may be associated with higher in-hospital mortality, 30-day mortality, and incidence rate of acute kidney injury. Further research is required to estimate the correlation of specific vasopressor characteristics (type, timing, dose, combination) with adverse effects and mortality in this population.
Collapse
Affiliation(s)
- Maria Mermiri
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41110 Larisa, Biopolis Greece
| | - Georgios Mavrovounis
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Eleni Laou
- Department of Anesthesiology, Agia Sophia Children’s Hospital, Athens, Greece
| | - Nikolaos Papagiannakis
- First Department of Neurology, Medical School, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Pantazopoulos
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41110 Larisa, Biopolis Greece
- Outcomes Research Consortium, Cleveland, OH 44195 USA
| |
Collapse
|
|
27
|
Kabia AU, Li P, Jin Z, Tan X, Liu Y, Feng Y, Yu K, Hu M, Jiang D, Cao G. The effects of hypertension on the prognosis of coronavirus disease 2019: a systematic review and meta-analysis on the interactions with age and antihypertensive treatment. J Hypertens 2022; 40:2323-2336. [PMID: 35950998 PMCID: PMC9640264 DOI: 10.1097/hjh.0000000000003266] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 05/02/2022] [Accepted: 06/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hypertension and angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) have been reported to be associated with the prognosis of COVID-19, but the findings remain controversial. Here, we conducted a systematic review to summarize the current evidence. METHODS We retrieved all the studies by MEDLINE via PubMed, CENTRAL, and Embase using the MeSH terms until 30 April 2021. A fixed or random effect model was applied to calculate pooled adjusted odds ratio (AOR) with 95% confidence interval (CI). Interactive analysis was performed to identify the interaction effect of hypertension and age on in-hospital mortality. RESULTS In total, 86 articles with 18 775 387 COVID-19 patients from 18 countries were included in this study. The pooled analysis showed that the COVID-19 patients with hypertension had increased risks of in-hospital mortality and other adverse outcomes, compared with those without hypertension, with an AOR (95% CI) of 1.36 (1.28-1.45) and 1.32 (1.24-1.41), respectively. The results were mostly repeated in countries with more than three independent studies. Furthermore, the effect of hypertension on in-hospital mortality is more evident in younger and older COVID-19 patients than in 60-69-year-old patients. ACEI/ARBs did not significantly affect the mortality and adverse outcomes of COVID-19 patients, compared with those receiving other antihypertensive treatments. CONCLUSION Hypertension is significantly associated with an increased risk of in-hospital mortality and adverse outcomes in COVID-19. The effect of hypertension on in-hospital mortality among consecutive age groups followed a U-shaped curve. ACEI/ARB treatments do not increase in-hospital mortality and other poor outcomes of COVID-19 patients with hypertension.
Collapse
Affiliation(s)
| | | | | | | | - Yilong Liu
- School of Basic Medicine Sciences, Second Military Medical University
| | - Yuqi Feng
- School of Basic Medicine Sciences, Second Military Medical University
| | - Keyao Yu
- School of Basic Medicine Sciences, Second Military Medical University
| | | | - Dongming Jiang
- Shanghai East Hospital, Key Laboratory of Arrhythmias, Ministry of Education, Tongji University School of Medicine, Tongji University, Shanghai, China
| | | |
Collapse
|
|
28
|
Karri R, Chen YPP, Burrell AJC, Penny-Dimri JC, Broadley T, Trapani T, Deane AM, Udy AA, Plummer MP, for the SPRINT-SARI Australia Investigators. Machine learning predicts the short-term requirement for invasive ventilation among Australian critically ill COVID-19 patients. PLoS One 2022; 17:e0276509. [PMID: 36288359 PMCID: PMC9604987 DOI: 10.1371/journal.pone.0276509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 10/07/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE(S) To use machine learning (ML) to predict short-term requirements for invasive ventilation in patients with COVID-19 admitted to Australian intensive care units (ICUs). DESIGN A machine learning study within a national ICU COVID-19 registry in Australia. PARTICIPANTS Adult patients who were spontaneously breathing and admitted to participating ICUs with laboratory-confirmed COVID-19 from 20 February 2020 to 7 March 2021. Patients intubated on day one of their ICU admission were excluded. MAIN OUTCOME MEASURES Six machine learning models predicted the requirement for invasive ventilation by day three of ICU admission from variables recorded on the first calendar day of ICU admission; (1) random forest classifier (RF), (2) decision tree classifier (DT), (3) logistic regression (LR), (4) K neighbours classifier (KNN), (5) support vector machine (SVM), and (6) gradient boosted machine (GBM). Cross-validation was used to assess the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of machine learning models. RESULTS 300 ICU admissions collected from 53 ICUs across Australia were included. The median [IQR] age of patients was 59 [50-69] years, 109 (36%) were female and 60 (20%) required invasive ventilation on day two or three. Random forest and Gradient boosted machine were the best performing algorithms, achieving mean (SD) AUCs of 0.69 (0.06) and 0.68 (0.07), and mean sensitivities of 77 (19%) and 81 (17%), respectively. CONCLUSION Machine learning can be used to predict subsequent ventilation in patients with COVID-19 who were spontaneously breathing and admitted to Australian ICUs.
Collapse
Affiliation(s)
- Roshan Karri
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Yi-Ping Phoebe Chen
- Faculty of Science, Technology and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Aidan J. C. Burrell
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Tessa Broadley
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Adam M. Deane
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Andrew A. Udy
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark P. Plummer
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australia
- * E-mail:
| | | |
Collapse
|
|
29
|
Jacques T, Deshpande K. How intensive care has adapted to the changing face of COVID-19 in Australia. Med J Aust 2022; 217:348-349. [PMID: 35661167 PMCID: PMC9347722 DOI: 10.5694/mja2.51600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Theresa Jacques
- St George HospitalSydneyNSW
- University of New South WalesSydneyNSW
| | - Kush Deshpande
- St George HospitalSydneyNSW
- University of New South WalesSydneyNSW
| |
Collapse
|
|
30
|
Begum H, Neto AS, Alliegro P, Broadley T, Trapani T, Campbell LT, Cheng AC, Cheung W, Cooper DJ, Erickson SJ, French CJ, Litton E, McAllister R, Nichol A, Palermo A, Plummer MP, Rotherham H, Ramanan M, Reddi B, Reynolds C, Webb SAR, Udy AA, Burrell A. People in intensive care with COVID-19: demographic and clinical features during the first, second, and third pandemic waves in Australia. Med J Aust 2022; 217:352-360. [PMID: 35686307 PMCID: PMC9347520 DOI: 10.5694/mja2.51590] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To compare the demographic and clinical features, management, and outcomes for patients admitted with COVID-19 to intensive care units (ICUs) during the first, second, and third waves of the pandemic in Australia. DESIGN, SETTING, AND PARTICIPANTS People aged 16 years or more admitted with polymerase chain reaction-confirmed COVID-19 to the 78 Australian ICUs participating in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia project during the first (27 February - 30 June 2020), second (1 July 2020 - 25 June 2021), and third COVID-19 waves (26 June - 1 November 2021). MAIN OUTCOME MEASURES Primary outcome: in-hospital mortality. SECONDARY OUTCOMES ICU mortality; ICU and hospital lengths of stay; supportive and disease-specific therapies. RESULTS 2493 people (1535 men, 62%) were admitted to 59 ICUs: 214 during the first (9%), 296 during the second (12%), and 1983 during the third wave (80%). The median age was 64 (IQR, 54-72) years during the first wave, 58 (IQR, 49-68) years during the second, and 54 (IQR, 41-65) years during the third. The proportion without co-existing illnesses was largest during the third wave (41%; first wave, 32%; second wave, 29%). The proportion of ICU beds occupied by patients with COVID-19 was 2.8% (95% CI, 2.7-2.9%) during the first, 4.6% (95% CI, 4.3-5.1%) during the second, and 19.1% (95% CI, 17.9-20.2%) during the third wave. Non-invasive (42% v 15%) and prone ventilation strategies (63% v 15%) were used more frequently during the third wave than during the first two waves. Thirty patients (14%) died in hospital during the first wave, 35 (12%) during the second, and 281 (17%) during the third. After adjusting for age, illness severity, and other covariates, the risk of in-hospital mortality was similar for the first and second waves, but 9.60 (95% CI, 3.52-16.7) percentage points higher during the third than the first wave. CONCLUSION The demographic characteristics of patients in intensive care with COVID-19 and the treatments they received during the third pandemic wave differed from those of the first two waves. Adjusted in-hospital mortality was highest during the third wave.
Collapse
Affiliation(s)
| | - Ary S Neto
- Australian and New Zealand Intensive Care Research CentreMelbourneVIC
| | | | | | - Tony Trapani
- Monash UniversityMelbourneVIC
- Alfred HealthMelbourneVIC
| | - Lewis T Campbell
- Royal Darwin HospitalDarwinNT
- Menzies School of Health ResearchDarwinNT
| | | | | | - D James Cooper
- Monash UniversityMelbourneVIC
- Australian and New Zealand Intensive Care Research CentreMelbourneVIC
- Alfred HealthMelbourneVIC
| | | | | | | | | | | | | | | | | | - Mahesh Ramanan
- Prince Charles HospitalBrisbaneQLD
- Caboolture HospitalCabooltureQLD
| | | | | | | | - Andrew A Udy
- Monash UniversityMelbourneVIC
- Australian and New Zealand Intensive Care Research CentreMelbourneVIC
| | | |
Collapse
|
|
31
|
Montiel-Nava C, Tregnago M, Marshall J, Sohl K, Curran AB, Mahurin M, Warne-Griggs M, WHO CST Team, Dixon P. Implementing the WHO caregivers skills training program with caregivers of autistic children via telehealth in rural communities. Front Psychiatry 2022; 13:909947. [PMID: 36101706 PMCID: PMC9464274 DOI: 10.3389/fpsyt.2022.909947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background For families with autistic children living in rural areas, limited access to services partly results from a shortage of providers and extensive travel time. Telehealth brings the possibility of implementing alternative delivery modalities of Parent Mediated Interventions (PMIs) with the potential to decrease barriers to accessing services. This study aimed to evaluate the feasibility and acceptability of implementing the World Health Organization-Caregivers Skills Training program (WHO-CST) via an online, synchronous group format in rural Missouri. Methods We used a mixed methods design to collect qualitative and quantitative data from caregivers and program facilitators at baseline and the end of the program, following the last home visit. Caregivers of 14 autistic children (3-7 years), residents of rural Missouri, completed nine virtual sessions and four virtual home visits. Results Four main themes emerged from the focus groups: changes resulting from the WHO-CST, beneficial aspects of the program, advantages and disadvantages of the online format, and challenges to implementing the WHO-CST via telehealth. The most liked activity was the demonstration (36%), and the least liked was the practice with other caregivers. From baseline to week 12, communication skills improved in both frequency (p < 0.05) and impact (p < 0.01), while atypical behaviors decreased (p < 0.01). For caregivers' outcomes, only confidence in skills (p < 0.05) and parental sense of competence (p < 0.05) showed a positive change. Conclusion Our results support the feasibility of implementing the WHO-CST program via telehealth in a US rural setting. Caregivers found strategies easy to follow, incorporated the program into their family routines, and valued the group meetings that allowed them to connect with other families. A PMI such as the WHO-CST, with cultural and linguistic adaptations and greater accessibility via telehealth-plays an essential role in closing the treatment gap and empowering caregivers of autistic children.
Collapse
Affiliation(s)
- Cecilia Montiel-Nava
- Department of Psychological Science, University of Texas Rio Grande Valley-Edinburg, Edinburg, TX, United States
| | | | | | - Kristin Sohl
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, United States
- ECHO Autism Communities, University of Missouri School of Medicine, Columbia, MO, United States
| | - Alicia Brewer Curran
- ECHO Autism Communities, University of Missouri School of Medicine, Columbia, MO, United States
| | - Melissa Mahurin
- ECHO Autism Communities, University of Missouri School of Medicine, Columbia, MO, United States
| | - Melissa Warne-Griggs
- Missouri Telehealth Network, School of Medicine University of Missouri, Columbia, MO, United States
| | - WHO CST Team
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | |
Collapse
|
|
32
|
Otto M, Burrell AJ, Serpa Neto A, Alliegro PV, Trapani T, Cheng A, Udy AA. Clinical Characteristics and Outcomes of Critically Ill Patients with 1, 2 and 3 doses of Vaccination against COVID-19 in Australia. Intern Med J 2022; 53:330-338. [PMID: 35841294 PMCID: PMC9349669 DOI: 10.1111/imj.15884] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/03/2022] [Indexed: 01/08/2023]
Abstract
Background Vaccination has been shown to be highly effective in preventing death and severe disease from severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Currently few studies have directly compared vaccinated and unvaccinated patients with severe COVID‐19 in the intensive care unit (ICU). Aims Our aim was to compare the clinical characteristics and outcomes of vaccine recipients and unvaccinated patients with SARS‐CoV‐2 infection admitted to the ICU in a nationwide setting. Materials and Methods Data were extracted from the Short PeRiod IncideNce sTudy of Severe Acute Respiratory Infection Australia, in 57 ICUs during Delta and Omicron predominant periods of the COVID‐19 pandemic. The primary outcome was in‐hospital mortality. Secondary outcomes included duration of mechanical ventilation, ICU length of stay, hospital length of stay, and ICU mortality. Results 2,970 patients were admitted to ICU across participating sites from 26 June 2021 to 8 February 2022. 1,134 (38.2%) patients were vaccine recipients, and 1,836 (61.8%) patients were unvaccinated. Vaccine recipients were older, more comorbid, and less likely to require organ support. Unadjusted in‐hospital mortality was greater in the vaccinated cohort. After adjusting for age, gender and comorbid status, no statistically significant association between in‐hospital or ICU mortality, and vaccination status, was apparent. Conclusion We found COVID‐19 infection can cause severe disease and death in vaccine recipients, though comorbid status and older age were significant contributors to mortality. Organ support requirements and the number of deaths were highest in the unvaccinated cohort. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Madeleine Otto
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Aidan Jc Burrell
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Patricia Villodre Alliegro
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Allen Cheng
- Infection Prevention and Healthcare Epidemiology Unit, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Infectious Diseases Epidemiology, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Andrew A Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | | |
Collapse
|
|
33
|
Feldman C, Waterer G. When should corticosteroids be used for COVID-19 infection? Eur Respir J 2022; 60:60/1/2103222. [PMID: 35835475 DOI: 10.1183/13993003.03222-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Charles Feldman
- Dept of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Grant Waterer
- East Metropolitan Health Service, Perth, Australia.,Royal Perth Bentley Group, Perth, Australia.,University of Western Australia, Perth, Australia.,Northwestern University, Evanston, IL, USA.,Curtin University, Perth, Australia.,Edith Cowan University, Perth, Australia
| |
Collapse
|
|
34
|
Grove K, Edgar DW, Chih H, Harrold M, Natarajan V, Mohd S, Hurn E, Cavalheri V. Greater In-Hospital Care and Early Rehabilitation Needs in People with COVID-19 Compared with Those without COVID-19. J Clin Med 2022; 11:jcm11133602. [PMID: 35806891 PMCID: PMC9267535 DOI: 10.3390/jcm11133602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 12/10/2022] Open
Abstract
↔This study aims to compare the characteristics, in-hospital data and rehabilitation needs between those who tested positive versus negative for COVID-19 during hospitalisation with suspected COVID-19. In this cross-sectional study, a convenience sample of adults admitted to Western Australian tertiary hospitals with suspected COVID-19 was recruited. Participants were grouped according to their polymerase chain reaction (PCR) test result into COVID-19 positive (COVID+) and COVID-19 negative (COVID−) groups. Between-group comparisons of characteristics of the participants and hospital admission data were performed. Sixty-five participants were included (38 COVID+ and 27 COVID−; 36 females [55%]). Participants in the COVID+ group had greater acute hospital length of stay (LOS) (median [25−75th percentile] 10 [5−21] vs. 3 [2−5] days; p < 0.05] and only those with COVID+ required mechanical ventilation (8 [21%] participants). Twenty-one percent of the COVID+ participants were discharged to inpatient rehabilitation (7% of the COVID− participants). Of note, pre-existing pulmonary disease was more prevalent in the COVID− group (59% vs. 13%; p < 0.05). Within the COVID+ group, when compared to participants discharged home, those who required inpatient rehabilitation had worse peripheral oxygen saturation (SpO2) on admission (86 ± 5.7% vs. 93 ± 3.8%; p < 0.05) and longer median LOS (30 [23−37] vs. 7 [4−13] days; p < 0.05). Despite having less people with pre-existing pulmonary disease, the COVID+ group required more care and rehabilitation than the COVID− group. In the COVID+ group, SpO2 on hospital presentation was associated with LOS, critical care needs, mechanical ventilation duration and the need for inpatient rehabilitation.
Collapse
Affiliation(s)
- Kristen Grove
- Department of Physiotherapy, Royal Perth Hospital, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA 6000, Australia; (K.G.); (M.H.)
| | - Dale W. Edgar
- Department of Physiotherapy, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia; (D.W.E.); (V.N.)
- Burn Injury Research Node, University of Notre Dame Australia, Fremantle, WA 6160, Australia
- Division of Surgery, Medical School, University of Western Australia, Crawley, WA 6009, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia
| | - HuiJun Chih
- Curtin School of Population Health, Curtin University, Bentley, WA 6102, Australia;
- Western Australian Health Translation Network, Perth, WA 6009, Australia
| | - Meg Harrold
- Department of Physiotherapy, Royal Perth Hospital, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA 6000, Australia; (K.G.); (M.H.)
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia
| | - Varsha Natarajan
- Department of Physiotherapy, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia; (D.W.E.); (V.N.)
| | - Sheeraz Mohd
- Department of Cardiology, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia;
| | - Elizabeth Hurn
- Department of Physiotherapy, Sir Charles Gairdner Hospital, North Metropolitan Health Service, Nedlands, WA 6009, Australia;
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia
- Allied Health, South Metropolitan Health Service, Murdoch, WA 6150, Australia
- Correspondence:
| |
Collapse
|
|
35
|
Johnston C, Subramaniam A, Orosz J, Burrell A, Neto AS, Young M, Bailey M, Pilcher D, Udy A, Jones D. Intensive care admissions following rapid response team reviews in patients with COVID-19 in Australia. CRIT CARE RESUSC 2022; 24:106-115. [PMID: 38045596 PMCID: PMC10692595 DOI: 10.51893/2022.2.oa1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To evaluate the epidemiology of rapid response team (RRT) reviews that led to intensive care unit (ICU) admissions, and to evaluate the frequency of in-hospital cardiac arrests (IHCAs) among ICU patients with confirmed coronavirus disease 2019 (COVID-19) in Australia. Design: Multicentre, retrospective cohort study. Setting: 48 public and private ICUs in Australia. Participants: All adults (aged ≥ 16 years) with confirmed COVID-19 admitted to participating ICUs between 25 January and 31 October 2020, as part of SPRINT-SARI (Short PeRiod IncideNce sTudy of Severe Acute Respiratory Infection) Australia, which were linked with ICUs contributing to the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD). Main outcome measures and results: Of the 413 critically ill patients with COVID-19 who were analysed, 48.2% (199/413) were admitted from the ward and 30.5% (126/413) were admitted to the ICU following an RRT review. Patients admitted following an RRT review had higher Acute Physiology and Chronic Health Evaluation (APACHE) scores, fewer days from symptom onset to hospitalisation (median, 5.4 [interquartile range (IQR), 3.2-7.6] v 7.1 days [IQR, 4.1-9.8]; P < 0.001) and longer hospitalisations (median, 18 [IQR, 11-33] v 13 days [IQR, 7-24]; P < 0.001) compared with those not admitted via an RRT review. Admissions following RRT review comprised 60.3% (120/199) of all ward-based admissions. Overall, IHCA occurred in 1.9% (8/413) of ICU patients with COVID-19, and most IHCAs (6/8, 75%) occurred during ICU admission. There were no differences in IHCA rates or in ICU or hospital mortality rates based on whether a patient had a prior RRT review or not. Conclusions: This study found that RRT reviews were a common way for deteriorating ward patients with COVID-19 to be admitted to the ICU, and that IHCA was rare among ICU patients with COVID-19.
Collapse
Affiliation(s)
- Craig Johnston
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Ashwin Subramaniam
- Intensive Care Unit, Frankston Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Judit Orosz
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Aidan Burrell
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Meredith Young
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - David Pilcher
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- ANZICS Centre for Outcome and Resource Evaluation (CORE), Melbourne, VIC, Australia
| | - Andrew Udy
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Daryl Jones
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- Intensive Care Unit, Austin Hospital, Melbourne, VIC, Australia
| |
Collapse
|
|
36
|
Showler L, Rait L, Chan M, Tondello M, George A, Tascone B, Presneill JJ, MacIsaac CM, Abdelhamid YA, Deane AM. Communication with bereaved family members after death in the ICU: the CATHARTIC randomised clinical trial. CRIT CARE RESUSC 2022; 24:116-127. [PMID: 38045592 PMCID: PMC10692614 DOI: 10.51893/2022.2.oa2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: It is uncertain whether psychological distress in the family members of patients who die during an intensive care unit (ICU) admission may be improved by bereavement interventions. In this trial, relatives' symptoms of anxiety and depression after 6 months were measured when allocated to three commonly used bereavement follow-up strategies. Design: Single-centre, randomised, three parallel-group trial. Setting: A tertiary ICU in Australia. Participants: Relatives of patients who died in the ICU. Interventions: Relatives received bereavement follow-up 4 weeks after the death using a condolence letter, short telephone call or no contact. Main outcome measures: The primary outcome was the total Hospital Anxiety and Depression Scale (HADS-T) score. Secondary outcomes estimated anxiety, depression, complicated grief, post-traumatic stress, and satisfaction with ICU care. Results: Seventy-one relatives participated (24 had no contact, 19 were contacted by letter and 28 by telephone 4 weeks after the death). The mean HADS-T score for no contact was 16.1 (95% CI, 12.4-19.8). Receipt of a letter was associated with a mean HADS-T increase of 1.4 (4.0 decrease to 6.8 increase), and a condolence call was accompanied by a mean decrease of 1.6 (6.6 decrease to 3.4 increase; P > 0.5). Non-significant differences were observed for all secondary outcomes. Conclusions: Anxiety and depression at 6 months in the relatives of patients who died in the ICU was not meaningfully alleviated by receipt of either a condolence letter or telephone call. Trial registration: Australia New Zealand Clinical Trials Registry (ACTRN12619000917134).
Collapse
Affiliation(s)
- Laurie Showler
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Louise Rait
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Michael Chan
- Department of Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Mark Tondello
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Alastair George
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Brianna Tascone
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Jeffrey J. Presneill
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher M. MacIsaac
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Yasmine Ali Abdelhamid
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Adam M. Deane
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
|
37
|
Singh R, Rathore SS, Khan H, Karale S, Chawla Y, Iqbal K, Bhurwal A, Tekin A, Jain N, Mehra I, Anand S, Reddy S, Sharma N, Sidhu GS, Panagopoulos A, Pattan V, Kashyap R, Bansal V. Association of Obesity With COVID-19 Severity and Mortality: An Updated Systemic Review, Meta-Analysis, and Meta-Regression. Front Endocrinol (Lausanne) 2022; 13:780872. [PMID: 35721716 PMCID: PMC9205425 DOI: 10.3389/fendo.2022.780872] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
Background Obesity affects the course of critical illnesses. We aimed to estimate the association of obesity with the severity and mortality in coronavirus disease 2019 (COVID-19) patients. Data Sources A systematic search was conducted from the inception of the COVID-19 pandemic through to 13 October 2021, on databases including Medline (PubMed), Embase, Science Web, and Cochrane Central Controlled Trials Registry. Preprint servers such as BioRxiv, MedRxiv, ChemRxiv, and SSRN were also scanned. Study Selection and Data Extraction Full-length articles focusing on the association of obesity and outcome in COVID-19 patients were included. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used for study selection and data extraction. Our Population of interest were COVID-19 positive patients, obesity is our Intervention/Exposure point, Comparators are Non-obese vs obese patients The chief outcome of the study was the severity of the confirmed COVID-19 positive hospitalized patients in terms of admission to the intensive care unit (ICU) or the requirement of invasive mechanical ventilation/intubation with obesity. All-cause mortality in COVID-19 positive hospitalized patients with obesity was the secondary outcome of the study. Results In total, 3,140,413 patients from 167 studies were included in the study. Obesity was associated with an increased risk of severe disease (RR=1.52, 95% CI 1.41-1.63, p<0.001, I2 = 97%). Similarly, high mortality was observed in obese patients (RR=1.09, 95% CI 1.02-1.16, p=0.006, I2 = 97%). In multivariate meta-regression on severity, the covariate of the female gender, pulmonary disease, diabetes, older age, cardiovascular diseases, and hypertension was found to be significant and explained R2 = 40% of the between-study heterogeneity for severity. The aforementioned covariates were found to be significant for mortality as well, and these covariates collectively explained R2 = 50% of the between-study variability for mortality. Conclusions Our findings suggest that obesity is significantly associated with increased severity and higher mortality among COVID-19 patients. Therefore, the inclusion of obesity or its surrogate body mass index in prognostic scores and improvement of guidelines for patient care management is recommended.
Collapse
Affiliation(s)
- Romil Singh
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Sawai Singh Rathore
- Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur, India
| | - Hira Khan
- Department of Neurology, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Smruti Karale
- Department of Internal Medicine, Government Medical College-Kolhapur, Kolhapur, India
| | - Yogesh Chawla
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
| | - Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Abhishek Bhurwal
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States
| | - Aysun Tekin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States
| | - Nirpeksh Jain
- Department of Emergency Medicine, Marshfield Clinic, Marshfield, WI, United States
| | - Ishita Mehra
- Department of Internal Medicine, North Alabama Medical Center, Florence, AL, United States
| | - Sohini Anand
- Department of Internal Medicine, Patliputra Medical College and Hospital, Dhanbad, India
| | - Sanjana Reddy
- Department of Internal Medicine, Gandhi Medical College, Secunderabad, India
| | - Nikhil Sharma
- Department of Nephrology, Mayo Clinic, Rochester, MI, United States
| | - Guneet Singh Sidhu
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MI, United States
| | | | - Vishwanath Pattan
- Department of Medicine, Division of Endocrinology and Metabolism, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States
| | - Vikas Bansal
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MI, United States
| |
Collapse
|
|
38
|
Kılınç G, Atasoy AA. Evaluation of Patients Treated in Intensıve Care Due to COVID-19: A Retrospective Study. Infect Chemother 2022; 54:328-339. [PMID: 35794718 PMCID: PMC9259901 DOI: 10.3947/ic.2022.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/06/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The aim of this study is to report the demographic characteristics, clinical features, treatment protocols, comorbidities, imaging findings, prognosis and factors affecting mortality in critically ill patients with coronavirus disease 2019 (COVID-19) in the intensive care unit. MATERIALS AND METHODS This retrospective cohort study consists of adult (≥18 years old) patients hospitalized in a tertiary hospital intensive care unit of with COVID-19. The independent effects of possible factors identified in previous analyzes on survival were analyzed using univariate and multivariate logistic regression analysis. RESULTS The mean age of all patients was 70.2 ± 13.9 years. Of the 200 patients, 139 (69.5%) had died. White blood cells (19.2 ± 76.1 × 109 per L), neutrophil/lymphocyte ratio (15.4 ± 65.1), d-dimer (2,558.4 ± 4,574.2 ng/mL), ferritin (1,481.2 ± 4,447.4 μg/L) and C-reactive protein (CRP) (12.1 ± 11.9 mg/dL) levels were high at the time of admission. According to the results of univariate regression analysis; presence of additional disease (odds ratio [OR]: 3.837; P = 0.015), older age (OR: 1.027; P = 0.015), reverse transcriptase-polymerase chain reaction (RT-PCR) positivity (OR: 2.58; P = 0.019), higher heart rate (OR = 1.027; P = 0.028), higher APACHE II score (OR: 1.049; P = 0.012), higher sequential organ failure assessement (SOFA) score(OR: 1.479; P = 0.014), high d-dimer levels (OR: 3.180; P <0.001) and high CRP levels (OR: 1.035; P = 0.028) increases the risk of death. When patients with full data for all variables in the multivariate logistic regression model were evaluated; positive RT-PCR (OR=4.105; P = 0.005), older age (OR: 1.033; P = 0.024), higher heart rate (OR: 1.042; P = 0.006), higher (SOFA) score (OR: 1.477; P <0.001), high d-dimer levels at admission (OR: 3.459; P = 0.002) and diabetes mellitus (OR: 3.433; P = 0.035) increase the risk of death. CONCLUSION Mortality of critically ill patients with COVID-19 pneumonia was high (69.5%). Older patients and acute respiratory distress syndrome were at higher risk of death. High SOFA score, high d-dimer at admission, and presence of diabetes mellitus were associated with high mortality.
Collapse
Affiliation(s)
- Gökhan Kılınç
- Department of Anesthesiology and Reanimation Intensive Care, Balıkesir Atatürk City Hospital, Balıkesir, Turkey.
| | - Aslı Akcan Atasoy
- Department of Anesthesiology and Reanimation Intensive Care, Balıkesir Atatürk City Hospital, Balıkesir, Turkey
| |
Collapse
|
|
39
|
Hodgson CL, Higgins AM, Bailey MJ, Mather AM, Beach L, Bellomo R, Bissett B, Boden IJ, Bradley S, Burrell A, Cooper DJ, Fulcher BJ, Haines KJ, Hodgson IT, Hopkins J, Jones AYM, Lane S, Lawrence D, van der Lee L, Liacos J, Linke NJ, Gomes LM, Nickels M, Ntoumenopoulos G, Myles PS, Patman S, Paton M, Pound G, Rai S, Rix A, Rollinson TC, Tipping CJ, Thomas P, Trapani T, Udy AA, Whitehead C, Anderson S, Neto AS. Comparison of 6-Month Outcomes of Survivors of COVID-19 versus Non-COVID-19 Critical Illness. Am J Respir Crit Care Med 2022; 205:1159-1168. [PMID: 35258437 PMCID: PMC9872799 DOI: 10.1164/rccm.202110-2335oc] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/02/2022] [Indexed: 01/27/2023] Open
Abstract
Rationale: The outcomes of survivors of critical illness due to coronavirus disease (COVID-19) compared with non-COVID-19 are yet to be established. Objectives: We aimed to investigate new disability at 6 months in mechanically ventilated patients admitted to Australian ICUs with COVID-19 compared with non-COVID-19. Methods: We included critically ill patients with COVID-19 and non-COVID-19 from two prospective observational studies. Patients were eligible if they were adult (age ⩾ 8 yr) and received ⩾24 hours of mechanical ventilation. In addition, patients with COVID-19 were eligible with a positive laboratory PCR test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Measurements and Main Results: Demographic, intervention, and hospital outcome data were obtained from electronic medical records. Survivors were contacted by telephone for functional outcomes with trained outcome assessors using the World Health Organization Disability Assessment Schedule 2.0. Between March 6, 2020, and April 21, 2021, 120 critically ill patients with COVID-19, and between August 2017 and January 2019, 199 critically ill patients without COVID-19, fulfilled the inclusion criteria. Patients with COVID-19 were older (median [interquartile range], 62 [55-71] vs. 58 [44-69] yr; P = 0.019) with a lower Acute Physiology and Chronic Health Evaluation II score (17 [13-20] vs. 19 [15-23]; P = 0.011). Although duration of ventilation was longer in patients with COVID-19 than in those without COVID-19 (12 [5-19] vs. 4.8 [2.3-8.8] d; P < 0.001), 180-day mortality was similar between the groups (39/120 [32.5%] vs. 70/199 [35.2%]; P = 0.715). The incidence of death or new disability at 180 days was similar (58/93 [62.4%] vs. 99/150 [66/0%]; P = 0.583). Conclusions: At 6 months, there was no difference in new disability for patients requiring mechanical ventilation for acute respiratory failure due to COVID-19 compared with non-COVID-19. Clinical trial registered with www.clinicaltrials.gov (NCT04401254).
Collapse
Affiliation(s)
- Carol L. Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
- Department of Intensive Care and Hyperbaric Medicine and
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Alisa M. Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Michael J. Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Anne M. Mather
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Lisa Beach
- Department of Physiotherapy (Allied Health), the Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
- Department of Critical Care, School of Medicine, and
- Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Victoria, Australia
| | - Bernie Bissett
- Discipline of Physiotherapy, University of Canberra, Canberra, Australian Capital Territory, Australia
- Physiotherapy Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Ianthe J. Boden
- Physiotherapy Department, Launceston General Hospital, Launceston, Tasmania, Australia
- School of Medicine, University of Tasmania, Tasmania, Australia
| | - Scott Bradley
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Aidan Burrell
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
- Department of Intensive Care and Hyperbaric Medicine and
| | - D. James Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
- Department of Intensive Care and Hyperbaric Medicine and
| | - Bentley J. Fulcher
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Kimberley J. Haines
- Department of Critical Care, School of Medicine, and
- Physiotherapy Department, Western Health, Melbourne, Victoria, Australia
| | - Isabelle T. Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Jack Hopkins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Alice Y. M. Jones
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Stuart Lane
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
- Intensive Care Medicine, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Drew Lawrence
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | | | - Jennifer Liacos
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Natalie J. Linke
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Lonni Marques Gomes
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Marc Nickels
- Physiotherapy Department, Princess Alexandra Hospital, Metro South Health, Queensland, Australia
| | | | - Paul S. Myles
- Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Shane Patman
- Faculty of Medicine, Nursing and Midwifery, Health Sciences, and Physiotherapy, the University of Notre Dame Australia, Perth, Western Australia, Australia
| | - Michelle Paton
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
- Department of Physiotherapy, Monash Health, Melbourne, Victoria, Australia
| | - Gemma Pound
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
- Physiotherapy Department, St. Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Sumeet Rai
- Canberra Health Services, Canberra, Australian Capital Territory, Australia
- Medical School, Australia National University, Canberra, Australian Capital Territory, Australia
| | - Alana Rix
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Thomas C. Rollinson
- Medical School, Australia National University, Canberra, Australian Capital Territory, Australia
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Claire J. Tipping
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Peter Thomas
- Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Andrew A. Udy
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
- Department of Intensive Care and Hyperbaric Medicine and
| | - Christina Whitehead
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
- Intensive Care Medicine, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Shannah Anderson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
- Department of Critical Care, School of Medicine, and
- Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Victoria, Australia
- Department of Physiotherapy, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia; and
| |
Collapse
|
|
40
|
Kim KW, Wang X, Adhikari A, Yeang M, Jenkins F, Naing Z, Walker GJ, Foster CSP, Stelzer-Braid S, Deveson I, Craig ME, Tedla N, Bull RA, Martinello M, Pinto AN, Chan R, Turville S, Rawlinson WD, van Hal S. Persistent high-level shedding of cultivable SARS-CoV-2 Delta virus 33 days after onset of COVID-19 in a hospitalized patient with pneumonia. J Med Virol 2022; 94:4043-4046. [PMID: 35509147 PMCID: PMC9347799 DOI: 10.1002/jmv.27832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Ki Wook Kim
- Virology Research and Diagnostics Laboratories, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, 2031, Australia.,Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Xinye Wang
- Virology Research and Diagnostics Laboratories, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, 2031, Australia.,School of Medical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Anurag Adhikari
- School of Medical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia.,The Kirby Institute for Infection and Immunity, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Malinna Yeang
- Virology Research and Diagnostics Laboratories, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, 2031, Australia
| | - Frances Jenkins
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
| | - Zin Naing
- Virology Research and Diagnostics Laboratories, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, 2031, Australia
| | - Gregory J Walker
- Virology Research and Diagnostics Laboratories, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, 2031, Australia.,School of Medical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Charles S P Foster
- Virology Research and Diagnostics Laboratories, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, 2031, Australia.,School of Medical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Sacha Stelzer-Braid
- Virology Research and Diagnostics Laboratories, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, 2031, Australia.,School of Medical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ira Deveson
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, NSW, 2010, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2000, Australia
| | - Maria E Craig
- Virology Research and Diagnostics Laboratories, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, 2031, Australia.,Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, 2145, Australia
| | - Nicodemus Tedla
- School of Medical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Rowena A Bull
- School of Medical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia.,The Kirby Institute for Infection and Immunity, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Marianne Martinello
- School of Medical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia.,The Kirby Institute for Infection and Immunity, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Angie N Pinto
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
| | - Raymond Chan
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
| | - Stuart Turville
- School of Medical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia.,The Kirby Institute for Infection and Immunity, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - William D Rawlinson
- Virology Research and Diagnostics Laboratories, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, 2031, Australia.,Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia.,School of Medical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia.,School of Biotechnology and Biomolecular Sciences, Faculty of Science, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Sebastiaan van Hal
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2000, Australia
| |
Collapse
|
|
41
|
Burrell AJ, Neto AS, Udy A, Pellegrino V, Hodgson C. Six-month outcomes following venovenous ECMO for severe COVID-19 and viral pneumonitis: 2019-2020 Australian experience. CRIT CARE RESUSC 2022; 24:83-86. [PMID: 38046848 PMCID: PMC10692629 DOI: 10.51893/2022.1.oa10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To compare the characteristics, treatments and 6-month functional outcomes of patients with coronavirus disease 2019 (COVID-19) versus non-COVID-19 viral pneumonitis supported by venovenous extracorporeal membrane oxygenation (VV-ECMO). Design: Prospective, observational cohort study in seven intensive care units (ICUs) across Australia. Participants: Patients admitted to participating ICUs with laboratory-confirmed COVID-19 or viral pneumonitis requiring VV-ECMO. Results: From 30 March 2019 to 31 December 2020, 13 patients were initiated on VV-ECMO for COVID-19 and 23 were initiated for non-COVID-19 viral pneumonitis. Patients with COVID-19 were older and had a longer duration from intubation to ECMO initiation, but had similar illness severity and APACHE IV scores at the time of initiation. Overall disability, health-related quality of life, and mortality were similar, but ICU and hospital length of stay were significantly longer in patients with COVID-19. Conclusions: Six-month functional outcomes and mortality were similar between COVID-19 and viral pneumonitis patients treated with VV-ECMO. However, length of stay was longer in COVID-19 patients, which may have resource implications.
Collapse
Affiliation(s)
- Aidan J.C. Burrell
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew Udy
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Vincent Pellegrino
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
| |
Collapse
|
|
42
|
Sundararajan K, Bi P, Milazzo A, Poole A, Reddi B, Mahmood MA. Preparedness and response to COVID-19 in a quaternary intensive care unit in Australia: perspectives and insights from frontline critical care clinicians. BMJ Open 2022; 12:e051982. [PMID: 35121600 PMCID: PMC8819546 DOI: 10.1136/bmjopen-2021-051982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This study was conducted to explore the perspectives and opinions of intensive care unit (ICU) nurses and doctors at a COVID-19-designated pandemic hospital concerning the preparedness and response to COVID-19 and to consolidate the lessons learnt for crisis/disaster management in the future. DESIGN A qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs). Purposeful sampling was conducted to identify participants. A semistructured guide was used to facilitate IDIs with individual participants. Two FGDs were conducted, one with the ICU doctors and another with the ICU nurses. Thematic analysis identified themes and subthemes informing about the level of preparedness, response measures, processes, and factors that were either facilitators or those that triggered challenges. SETTING ICU in a quaternary referral centre affiliated to a university teaching COVID-19-designated pandemic hospital, in Adelaide, South Australia. PARTICIPANTS The participants included eight ICU doctors and eight ICU nurses for the IDIs. Another 16 clinicians participated in FGDs. RESULTS The study identified six themes relevant to preparedness for, and responses to, COVID-19. The themes included: (1) staff competence and planning, (2) information transfer and communication, (3) education and skills for the safe use of personal protective equipment, (4) team dynamics and clinical practice, (5) leadership, and (6) managing end-of-life situations and expectations of caregivers. CONCLUSION Findings highlight that preparedness and response to the COVID-19 crisis were proportionate to the situation's gravity. More enablers than barriers were identified. However, opportunities for improvement were recognised in the domains of planning, logistics, self-sufficiency with equipment, operational and strategic oversight, communication and managing end-of-life care.
Collapse
Affiliation(s)
- Krishnaswamy Sundararajan
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alexis Poole
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Benjamin Reddi
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mohammad Afzal Mahmood
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| |
Collapse
|
|
43
|
van Haren FMP, Laffey JG, Artigas A, Page C, Schultz MJ, Cosgrave D, McNicholas B, Smoot TL, Nunes Q, Richardson A, Yoon HJ, van Loon LM, Ghosh A, Said S, Panwar R, Smith R, Santamaria JD, Dixon B. Can nebulised HepArin Reduce morTality and time to Extubation in Patients with COVID-19 Requiring invasive ventilation Meta-Trial (CHARTER-MT): Protocol and Statistical Analysis Plan for an investigator-initiated international meta-trial of prospective randomised clinical studies. Br J Clin Pharmacol 2022; 88:3272-3287. [PMID: 35106809 PMCID: PMC9303761 DOI: 10.1111/bcp.15253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 01/06/2022] [Accepted: 01/22/2022] [Indexed: 12/15/2022] Open
Abstract
There is significant interest in the potential for nebulised unfractionated heparin (UFH) as a novel therapy for patients with COVID-19 induced acute hypoxaemic respiratory failure requiring invasive ventilation. The scientific and biological rationale for nebulised heparin stems from the evidence for extensive activation of coagulation resulting in pulmonary microvascular thrombosis in COVID-19 pneumonia. Nebulised delivery of heparin to the lung may limit alveolar fibrin deposition and thereby limit progression of lung injury. Importantly, laboratory studies show that heparin can directly inactivate the SARS-CoV-2 virus, thereby prevent its entry into and infection of mammalian cells. UFH has additional anti-inflammatory and mucolytic properties that may be useful in this context. METHODS AND INTERVENTION: The Can nebulised HepArin Reduce morTality and time to Extubation in Patients with COVID-19 Requiring invasive ventilation Meta-Trial (CHARTER-MT) is a collaborative prospective individual patient data analysis of on-going randomised controlled clinical trials across several countries in 5 continents, examining the effects of inhaled heparin in patients with COVID-19 requiring invasive ventilation on various endpoints. Each constituent study will randomise patients with COVID-19 induced respiratory failure requiring invasive ventilation. Patients are randomised to receive nebulised heparin or standard care (open label studies) or placebo (blinded placebo-controlled studies) while under invasive ventilation. Each participating study collect a pre-defined minimum dataset. The primary outcome for the meta-trial is the number of ventilator-free days up to day 28 day, defined as days alive and free from invasive ventilation. ETHICS AND DISSEMINATION: The meta-trial is registered at ClinicalTrials.gov ID NCT04545541. Each contributing study is individually registered and has received approval of the relevant ethics committee or institutional review board. Results of this study will be shared with the WHO, published in scientific journals, and presented at scientific meetings.
Collapse
Affiliation(s)
- Frank M P van Haren
- Australian National University, Canberra, Australia.,University of New South Wales, Sydney, Australia.,Intensive Care Unit, St George Hospital, Sydney, Australia
| | - John G Laffey
- Anaesthesia and Intensive Care Medicine, School of Medicine, and Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, Biomedical Sciences Building, National University of Ireland Galway, Galway, Ireland.,Department of Anaesthesia, University Hospital Galway, Saolta Hospital Group, Ireland
| | - Antonio Artigas
- Critical Center, Corporació Sanitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Clive Page
- Sackler Institute of Pulmonary Pharmacology, King's College London, UK
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Nuffield Department of Medicine, Oxford University, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - David Cosgrave
- Department of Anaesthesia, University Hospital Galway, Saolta Hospital Group, Ireland
| | - Bairbre McNicholas
- Department of Anaesthesia, University Hospital Galway, Saolta Hospital Group, Ireland
| | | | - Quentin Nunes
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | - Angajendra Ghosh
- Intensive Care Unit, The Northern Hospital, Melbourne, Australia
| | - Simone Said
- Intensive Care Unit, The Northern Hospital, Melbourne, Australia
| | | | - Roger Smith
- Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Australia
| | - John D Santamaria
- Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Barry Dixon
- Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Australia
| |
Collapse
|
|
44
|
Characteristics and Outcomes of Patients With Frailty Admitted to ICU With Coronavirus Disease 2019: An Individual Patient Data Meta-Analysis. Crit Care Explor 2022; 4:e0616. [PMID: 35072081 PMCID: PMC8769107 DOI: 10.1097/cce.0000000000000616] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Supplemental Digital Content is available in the text. Frailty is often used in clinical decision-making for patients with coronavirus disease 2019, yet studies have found a variable influence of frailty on outcomes in those admitted to the ICU. In this individual patient data meta-analysis, we evaluated the characteristics and outcomes across the range of frailty in patients admitted to ICU with coronavirus disease 2019.
Collapse
|
|
45
|
Saghafi F, West S, Lopez V, Cleary M. Mental Health Impacts of Family Members Isolated from Patients in the ICU during the Coronavirus Disease (COVID-19) Pandemic. Issues Ment Health Nurs 2022; 43:87-90. [PMID: 33956563 DOI: 10.1080/01612840.2021.1919807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Farida Saghafi
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, New South Wales, Australia
| | - Sancia West
- College of Health and Medicine, University of Tasmania, Sydney, New South Wales, Australia
| | - Violeta Lopez
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, New South Wales, Australia.,School of Nursing, Hubei University of Medicine, Shiyan, China
| | - Michelle Cleary
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, New South Wales, Australia
| |
Collapse
|
|
46
|
Talley NJ. Welcome to 2022: the Year of the Tiger! Med J Aust 2021; 216:20-23. [PMID: 34972246 DOI: 10.5694/mja2.51366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 01/22/2023]
|
|
47
|
Knížatová N, Massányi M, Roychoudhury S, Guha P, Greifová H, Tokárová K, Jambor T, Massányi P, Lukáč N. Is there impact of the SARS-CoV-2 pandemic on steroidogenesis and fertility? Physiol Res 2021; 70:S161-S175. [PMID: 34913350 DOI: 10.33549/physiolres.934756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In December of 2019, several cases of unknown atypical respiratory diseases emerged in Wuhan, Hubei Province in China. After preliminary research, it was stated that the disease is transmittable between humans and was named COVID-19. Over the course of next months, it spread all over the world by air and sea transport and caused a global pandemic which affects life of everyone now-a-days. A large number of countries, have since been forced to take precautions such as curfews, lockdowns, wearing facemasks etc. Even with vaccines being produced in mass numbers, lack of targeted therapy continues to be a major problem. According to studies so far it seems that elderly people are more vulnerable to severe symptoms while children tend to by asymptomatic or have milder form the disease. In our review, we focused on gathering data about the virus itself, its characteristics, paths of transmission, and its effect on hormone production and secretion. In such, there is insufficient information in the literature worldwide, especially the ones that focus on the effect of COVID-19 on individual organs systems within the human body. Hence, the present evidence-based study focused on the possible effects of COVID-19 on adrenal gland and gonads i.e. on the process of steroidogenesis and fertility.
Collapse
Affiliation(s)
- N Knížatová
- Institute of Applied Biology, Faculty of Biotechnology and Food Sciences, Slovak University of Agriculture in Nitra, Nitra, Slovak Republic.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
48
|
Durie ML, Neto AS, Burrell AJ, Cooper DJ, Udy AA. ISARIC-4C Mortality Score overestimates risk of death due to COVID-19 in Australian ICU patients: a validation cohort study. CRIT CARE RESUSC 2021; 23:403-413. [PMID: 38046684 PMCID: PMC10692605 DOI: 10.51893/2021.4.oa5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To assess the performance of the UK International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) Coronavirus Clinical Characterisation Consortium (4C) Mortality Score for predicting mortality in Australian patients with coronavirus disease 2019 (COVID-19) requiring intensive care unit (ICU) admission. Design: Multicentre, prospective, observational cohort study. Setting: 78 Australian ICUs participating in the SPRINT-SARI (Short Period Incidence Study of Severe Acute Respiratory Infection) Australia study of COVID-19. Participants: Patients aged 16 years or older admitted to participating Australian ICUs with polymerase chain reaction (PCR)-confirmed COVID-19 between 27 February and 10 October 2020. Main outcome measures: ISARIC-4C Mortality Score, calculated at the time of ICU admission. The primary outcome was observed versus predicted in-hospital mortality (by 4C Mortality and APACHE II). Results: 461 patients admitted to a participating ICU were included. 149 (32%) had complete data to calculate a 4C Mortality Score without imputation. Overall, 61/461 patients (13.2%) died, 16.9% lower than the comparable ISARIC-4C cohort in the United Kingdom. In patients with complete data, the median (interquartile range [IQR]) 4C Mortality Score was 10.0 (IQR, 8.0-13.0) and the observed mortality was 16.1% (24/149) versus 22.9% median predicted risk of death. The 4C Mortality Score discriminatory performance measured by the area under the receiver operating characteristic curve (AUROC) was 0.79 (95% CI, 0.68-0.90), similar to its performance in the original ISARIC-4C UK cohort (0.77) and not superior to APACHE II (AUROC, 0.81; 95% CI, 0.75-0.87). Conclusions: When calculated at the time of ICU admission, the 4C Mortality Score consistently overestimated the risk of death for Australian ICU patients with COVID-19. The 4C Mortality Score may need to be individually recalibrated for use outside the UK and in different hospital settings.
Collapse
Affiliation(s)
- Matthew L. Durie
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Aidan J.C. Burrell
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - D. Jamie Cooper
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew A. Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
|
49
|
Ramanan M, Burrell A, Paul E, Trapani T, Broadley T, McGloughlin S, French C, Udy A. Nosocomial infections amongst critically ill COVID-19 patients in Australia. JOURNAL OF CLINICAL VIROLOGY PLUS 2021; 1:100054. [PMID: 35262030 PMCID: PMC8582097 DOI: 10.1016/j.jcvp.2021.100054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the frequency of nosocomial infections including hospital-acquired pneumonia (HAP) and bloodstream infection (BSI), amongst critically ill patients with COVID-19 infection in Australian ICUs and to evaluate associations with mortality and length of stay (LOS). Methods The effect of nosocomial infections on hospital mortality was evaluated using hierarchical logistic regression models to adjust for illness severity and mechanical ventilation. Results There were 490 patients admitted to 55 ICUs during the study period. Adjusted odds ratio (OR) for hospital mortality was 1.61 (95% confidence interval (CI) 0.61-4.27, p = 0.3) when considering BSI, and 1.76 (95% CI 0.73-4.21, p = 0.2) for HAP. The average adjusted ICU LOS was significantly longer for patients with BSI (geometric mean 9.0 days vs 6.3 days, p = 0.04) and HAP (geometric mean 13.9 days vs 6.0 days p<0.001). Conclusion Nosocomial infection rates amongst patients with COVID-19 were low and their development was associated with a significantly longer ICU LOS.
Collapse
Affiliation(s)
- Mahesh Ramanan
- Caboolture Hospital, 120 McKean Street, Caboolture, Queensland, Australia
- Critical Care Division, The George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, New South Wales, 2042, Australia
- School of Medicine, University of Queensland, St. Lucia, Queensland, 4072, Australia
| | - Aidan Burrell
- Department of Epidemiology and Preventative Medicine, School of Public Health, Monash University, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553St Kilda Road, Melbourne, Victoria, Australia
| | - Eldho Paul
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553St Kilda Road, Melbourne, Victoria, Australia
| | - Tony Trapani
- Department of Epidemiology and Preventative Medicine, School of Public Health, Monash University, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553St Kilda Road, Melbourne, Victoria, Australia
| | - Tessa Broadley
- Department of Epidemiology and Preventative Medicine, School of Public Health, Monash University, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553St Kilda Road, Melbourne, Victoria, Australia
| | - Steve McGloughlin
- Department of Epidemiology and Preventative Medicine, School of Public Health, Monash University, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553St Kilda Road, Melbourne, Victoria, Australia
| | - Craig French
- Western Health, Furlong Road, St Albans, Victoria, Australia
| | - Andrew Udy
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553St Kilda Road, Melbourne, Victoria, Australia
| |
Collapse
|
|
50
|
Karakike E, Giamarellos-Bourboulis EJ, Kyprianou M, Fleischmann-Struzek C, Pletz MW, Netea MG, Reinhart K, Kyriazopoulou E. Coronavirus Disease 2019 as Cause of Viral Sepsis: A Systematic Review and Meta-Analysis. Crit Care Med 2021; 49:2042-2057. [PMID: 34259663 PMCID: PMC8594513 DOI: 10.1097/ccm.0000000000005195] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Coronavirus disease 2019 is a heterogeneous disease most frequently causing respiratory tract infection, which can induce respiratory failure and multiple organ dysfunction syndrome in its severe forms. The prevalence of coronavirus disease 2019-related sepsis is still unclear; we aimed to describe this in a systematic review. DATA SOURCES MEDLINE (PubMed), Cochrane, and Google Scholar databases were searched based on a prespecified protocol (International Prospective Register for Systematic Reviews: CRD42020202018). STUDY SELECTION Studies reporting on patients with confirmed coronavirus disease 2019 diagnosed with sepsis according to sepsis-3 or according to the presence of infection-related organ dysfunctions necessitating organ support/replacement were included in the analysis. The primary end point was prevalence of coronavirus disease 2019-related sepsis among adults hospitalized in the ICU and the general ward. Among secondary end points were the need for ICU admission among patients initially hospitalized in the general ward and the prevalence of new onset of organ dysfunction in the ICU. Outcomes were expressed as proportions with respective 95% CI. DATA EXTRACTION Two reviewers independently screened and reviewed existing literature and assessed study quality with the Newcastle-Ottawa Scale and the Methodological index for nonrandomized studies. DATA SYNTHESIS Of 3,825 articles, 151 were analyzed, only five of which directly reported sepsis prevalence. Noting the high heterogeneity observed, coronavirus disease 2019-related sepsis prevalence was 77.9% (95% CI, 75.9-79.8; I2 = 91%; 57 studies) in the ICU, and 33.3% (95% CI, 30.3-36.4; I2 = 99%; 86 studies) in the general ward. ICU admission was required for 17.7% (95% CI, 12.9-23.6; I2 = 100%) of ward patients. Acute respiratory distress syndrome was the most common organ dysfunction in the ICU (87.5%; 95% CI, 83.3-90.7; I2 = 98%). CONCLUSIONS The majority of coronavirus disease 2019 patients hospitalized in the ICU meet Sepsis-3 criteria and present infection-associated organ dysfunction. The medical and scientific community should be aware and systematically report viral sepsis for prognostic and treatment implications.
Collapse
Affiliation(s)
- Eleni Karakike
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Miltiades Kyprianou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Carolin Fleischmann-Struzek
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Mihai G Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, The Netherlands
- Department of Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Konrad Reinhart
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| |
Collapse
|