1
|
Manrique S, Claverias L, Magret M, Masclans JR, Bodi M, Trefler S, Canadell L, Díaz E, Sole-Violan J, Bisbal-Andrés E, Natera RG, Moreno AA, Vallverdu M, Ballesteros JC, Socias L, Vidal FG, Sancho S, Martin-Loeches I, Rodriguez A. Timing of intubation and ICU mortality in COVID-19 patients: a retrospective analysis of 4198 critically ill patients during the first and second waves. BMC Anesthesiol 2023; 23:140. [PMID: 37106321 PMCID: PMC10133910 DOI: 10.1186/s12871-023-02081-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The optimal time to intubate patients with SARS-CoV-2 pneumonia has not been adequately determined. While the use of non-invasive respiratory support before invasive mechanical ventilation might cause patient-self-induced lung injury and worsen the prognosis, non-invasive ventilation (NIV) is frequently used to avoid intubation of patients with acute respiratory failure (ARF). We hypothesized that delayed intubation is associated with a high risk of mortality in COVID-19 patients. METHODS This is a secondary analysis of prospectively collected data from adult patients with ARF due to COVID-19 admitted to 73 intensive care units (ICUs) between February 2020 and March 2021. Intubation was classified according to the timing of intubation. To assess the relationship between early versus late intubation and mortality, we excluded patients with ICU length of stay (LOS) < 7 days to avoid the immortal time bias and we did a propensity score and a cox regression analysis. RESULTS We included 4,198 patients [median age, 63 (54‒71) years; 71% male; median SOFA (Sequential Organ Failure Assessment) score, 4 (3‒7); median APACHE (Acute Physiology and Chronic Health Evaluation) score, 13 (10‒18)], and median PaO2/FiO2 (arterial oxygen pressure/ inspired oxygen fraction), 131 (100‒190)]; intubation was considered very early in 2024 (48%) patients, early in 928 (22%), and late in 441 (10%). ICU mortality was 30% and median ICU stay was 14 (7‒28) days. Mortality was higher in the "late group" than in the "early group" (37 vs. 32%, p < 0.05). The implementation of an early intubation approach was found to be an independent protective risk factor for mortality (HR 0.6; 95%CI 0.5‒0.7). CONCLUSIONS Early intubation within the first 24 h of ICU admission in patients with COVID-19 pneumonia was found to be an independent protective risk factor of mortality. TRIAL REGISTRATION The study was registered at Clinical-Trials.gov (NCT04948242) (01/07/2021).
Collapse
Affiliation(s)
- Sara Manrique
- Critical Care Department - Hospital Universitario de Tarragona Joan XXIII, Mallafre Guasch 4, Tarragona, 43005, Spain.
- Rovira i Virgili University, Tarragona, Spain.
| | - Laura Claverias
- Critical Care Department - Hospital Universitario de Tarragona Joan XXIII, Mallafre Guasch 4, Tarragona, 43005, Spain
| | - Mónica Magret
- Critical Care Department - Hospital Universitario de Tarragona Joan XXIII, Mallafre Guasch 4, Tarragona, 43005, Spain
- URV/IISPV, Tarragona, Spain
| | | | - María Bodi
- Critical Care Department - Hospital Universitario de Tarragona Joan XXIII, Mallafre Guasch 4, Tarragona, 43005, Spain
- URV/IISPV, Tarragona, Spain
| | - Sandra Trefler
- Critical Care Department - Hospital Universitario de Tarragona Joan XXIII, Mallafre Guasch 4, Tarragona, 43005, Spain
- URV/IISPV, Tarragona, Spain
| | - Laura Canadell
- URV/IISPV, Tarragona, Spain
- Pharmacy Department - Hospital Universitario de Tarragona Joan XXIII, Tarragona, Spain
| | - Emili Díaz
- Critical Care Department - Hospital Parc Tauli, Sabadell, Spain
| | - Jordi Sole-Violan
- Critical Care Department - Hospital Dr. Negrin, Las Palmas de Gran Canaria, Spain
- Universidad Fernando Pessoa- Canarias, Las Palmas, Spain
| | | | | | | | | | | | - Lorenzo Socias
- Critical Care Department Hospital - Hospital Son Llatzer, Palma de Mallorca, Spain
| | | | - Susana Sancho
- Critical Care Department Hospital -Hospital Universitari i Politènic la Fe, Valencia, Spain
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
| | - Alejandro Rodriguez
- Critical Care Department - Hospital Universitario de Tarragona Joan XXIII, Mallafre Guasch 4, Tarragona, 43005, Spain
- URV/IISPV, Tarragona, Spain
| |
Collapse
|
2
|
Corradi F, Brusasco C. The puzzle of non-invasive respiratory support in COVID-19. Minerva Anestesiol 2023; 89:7-9. [PMID: 36745117 DOI: 10.23736/s0375-9393.22.17152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy -
| | - Claudia Brusasco
- Anesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Genoa, Italy
| |
Collapse
|
3
|
Mumtaz A, Rehman E, Rahaman MA, Rehman S. Inflammatory biomarkers and cardiac injury in COVID-19 patients. Front Public Health 2022; 10:1024535. [PMID: 36505005 PMCID: PMC9729944 DOI: 10.3389/fpubh.2022.1024535] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Cardiac injury has received considerable attention due to the higher risk of morbidity and mortality associated with coronavirus disease. However, in a developing country, there is a scarcity of data on cardiac injury in COVID-19 patients related to inflammatory biomarkers. Methods Therefore, the present research retrospectively analyzes data from three territorial hospitals in Pakistan's Punjab province to investigate the potential impact of the cardiac injury on the mortality and severity of COVID-19-infected patients. We evaluated 2,051 patients between January 16 and April 18, 2022, with confirmed COVID-19. The in-hospital mortality recorded for the selected sample size was about 16.28%. Results The majority of the participants were identified as male (64%) with a median age of 65 years. Also, fever, fatigue, and dyspnea were reported as common symptoms. An aggregate of 623 patients (30.38%) had a cardiac injury, and when these patients are compared to those without cardiac injury, the participants were significantly older and had more comorbidities with higher leukocyte counts, elevated levels of C-reactive protein, interleukin-6, procalcitonin, myohemoglobin, creatinine kinase-myocardial band, serum creatinine, high-sensitivity troponin-I, N-terminal pro-B-type natriuretic peptide had a significant amount of multiple ground-glass opacity and bilateral pulmonary infiltration in radiographic results. Participants with heart injury required more non-invasive or invasive mechanical respiration than those who did not have a cardiac injury. Individuals with cardiac injury had higher rates of sepsis, acute respiratory distress syndrome (ARDS), d-dimer concentration, and respiratory failure than those without cardiac injury. Patients who had had a cardiac injury died at a higher rate than those who had not suffered cardiac damage. In the multivariable logistic regression analysis, participants with cardiac injury showed greater odds of COVID-19 mortality and were found associated with older age (OR = 1.99, 95% CI = 0.04-3.19), elevated cardiac troponin I (OR = 18.64, 95% CI = 13.16-23.01), the complication of sepsis (OR = 10.39, 95% CI = 7.41-13.39) and ARDS (OR = 6.65, 95% CI = 4.04-8.91). Conclusion Cardiac injury is a frequent complication among patients with coronavirus-induced infection in Punjab, Pakistan, and it is significantly linked to a greater risk of in-hospital mortality.
Collapse
Affiliation(s)
- Ayesha Mumtaz
- School of Public Administration, Hangzhou Normal University, Hangzhou, China
| | - Erum Rehman
- Department of Mathematics, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Mohammad Anisur Rahaman
- College of Public Administration, Zhejiang University, Hangzhou, China
- Department of Sociology, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
| | - Shazia Rehman
- Department of Biomedical Sciences, Pak-Austria Fachhochschule, Institute of Applied Sciences and Technology, Haripur, Pakistan
| |
Collapse
|
4
|
Fletcher JJ, Aughenbaugh A, Svabek C, Hahn PY, Grifka RG. Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome. J Int Med Res 2022; 50:3000605221135446. [PMID: 36324277 PMCID: PMC9634208 DOI: 10.1177/03000605221135446] [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] [Indexed: 11/05/2022] Open
Abstract
Objective To determine the incidence and significance of ventilator avoidance in
patients with critical coronavirus disease 2019 (COVID-19). Methods This prospective observational cohort study evaluated hospital mortality and
1-year functional outcome among critically ill patients with severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated acute respiratory
distress syndrome (ARDS). The explanatory variable was ventilator avoidance,
modeled as ‘initial refusal’ of intubation (yes/no). Modified Rankin Scale
(mRS) scores were obtained from surviving patients (or their surrogates) via
phone or email questionnaire. Results Among patients for whom intubation was recommended
(n = 102), 40 (39%) initially refused (95% confidence
interval [CI] 30%, 49%). The risk of death was 79.3% (49/62) in those who
did not initially refuse intubation compared with 77.5% (31/40) in those who
initially refused, with an adjusted odds ratio for death of 1.27 (95% CI
0.47, 3.48). The distribution of 1-year mRS scores was not significantly
different between groups. Conclusion Among critically ill patients with COVID-19-associated ARDS, ventilator
avoidance was common, but was not associated with increased in-hospital
mortality or 1-year functional outcome.
Collapse
Affiliation(s)
- Jeffrey J Fletcher
- Department of Critical Care
Medicine, University of Michigan Health West, Wyoming, MI, USA,Department of Neurosurgery,
University of Michigan Medical School, Ann Arbor, MI, USA,Jeffrey J Fletcher, University of Michigan
Health West, Critical Care Medicine, 5900 Byron Center Ave, Wyoming, MI 49519,
USA.
| | - Arielle Aughenbaugh
- Michigan State University College
of Osteopathic Medicine, East Lansing, MI, USA
| | - Catherine Svabek
- Department of Research, University
of Michigan Health West, Wyoming, MI, USA
| | - Peter Y Hahn
- Department of Critical Care
Medicine, University of Michigan Health West, Wyoming, MI, USA
| | - Ronald G Grifka
- Department of Research, University
of Michigan Health West, Wyoming, MI, USA
| |
Collapse
|
5
|
Sanfilippo F, Dean Gopalan P, Hasanin A. The COVID-19 pandemic: A gateway between one world and the next! Anaesth Crit Care Pain Med 2022; 41:101131. [PMID: 35878869 PMCID: PMC9306261 DOI: 10.1016/j.accpm.2022.101131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy.
| | - P Dean Gopalan
- Discipline of Anaesthesiology and Critical Care, University of KwaZulu Natal, Durban, South Africa
| | - Ahmed Hasanin
- Department of Anaesthesia and critical care medicine, Cairo University, Cairo, Egypt
| |
Collapse
|