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Malaeb R, Haider A, Abdulateef M, Hameed M, Daniel U, Kabilwa G, Seyni I, Ahmadana KE, Zelikova E, Porten K, Godard A. High mortality rates among COVID-19 intensive care patients in Iraq: insights from a retrospective cohort study at Médecins Sans Frontières supported hospital in Baghdad. Front Public Health 2023; 11:1185330. [PMID: 37719728 PMCID: PMC10501727 DOI: 10.3389/fpubh.2023.1185330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Background The Coronavirus Disease 2019 (COVID-19) pandemic has highlighted the challenges of the healthcare system in Iraq, which has limited intensive care unit beds, medical personnel, and equipment, contributing to high infection rates and mortality. The main purpose of the study was to describe the clinical characteristics, the length of Intensive Care Unit (ICU) stay, and the mortality outcomes of COVID-19 patients admitted to the ICU during the first wave and two subsequent surges, spanning from September 2020 to October 2021, in addition to identify potential risk factors for ICU mortality. Methods This retrospective cohort study analyzed data from COVID-19 patients admitted to the COVID-19 ICU at Al-Kindi Ministry of Health hospital in Baghdad, Iraq, between September 2020 and October 2021. Results The study included 936 COVID-19 patients admitted to the ICU at Al-Kindi Hospital. Results showed a high mortality rate throughout all waves, with 60% of deaths due to respiratory failure. Older age, male gender, pre-existing medical conditions, ICU procedures, and complications were associated with increased odds of ICU mortality. The study also found a decrease in the number of complications and ICU procedures between the first and subsequent waves. There was no significant difference in the length of hospital stay between patients admitted during different waves. Conclusion Despite improvements in critical care practices, the mortality rate did not significantly decrease during the second and third waves of the pandemic. The study highlights the challenges of high mortality rates among critical COVID-19 patients in low-resource settings and the importance of effective data collection to monitor clinical presentations and identify opportunities for improvement in ICU care.
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Affiliation(s)
- Rami Malaeb
- Department of Epidemiology and Training, Epicentre, Dubai, United Arab Emirates
| | - Amna Haider
- Department of Epidemiology and Training, Epicentre, Dubai, United Arab Emirates
| | | | - Mustafa Hameed
- Médecins Sans Frontières, Operational Centre Paris, Baghdad, Iraq
| | - Uche Daniel
- Médecins Sans Frontières, Operational Centre Paris, Baghdad, Iraq
| | - Gabriel Kabilwa
- Médecins Sans Frontières, Operational Centre Paris, Baghdad, Iraq
| | - Ibrahim Seyni
- Médecins Sans Frontières, Operational Centre Paris, Baghdad, Iraq
| | - Khalid E. Ahmadana
- Médecins Sans Frontières, Operational Centre Paris, Dubai, United Arab Emirates
| | - Evgenia Zelikova
- Médecins Sans Frontières, Operational Centre Paris, Paris, France
| | - Klaudia Porten
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Aurelie Godard
- Médecins Sans Frontières, Operational Centre Paris, Paris, France
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Sinha SS, Bohula EA, Diepen SVAN, Leonardi S, Mebazaa A, Proudfoot AG, Sionis A, Chia YW, Zampieri FG, Lopes RD, Katz JN. The Intersection Between Heart Failure and Critical Care Cardiology: An International Perspective on Structure, Staffing, and Design Considerations. J Card Fail 2022; 28:1703-1716. [PMID: 35843489 DOI: 10.1016/j.cardfail.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
The overall patient population in contemporary cardiac intensive care units (CICUs) has only increased with respect to patient acuity, complexity, and illness severity. The current population has more cardiac and noncardiac comorbidities, a higher prevalence of multiorgan injury, and consumes more critical care resources than previously. Patients with heart failure (HF) now occupy a large portion of contemporary tertiary or quaternary care CICU beds around the world. In this review, we discuss the core issues that relate to the care of critically ill patients with HF, including global perspectives on the organization, designation, and collaboration of CICUs regionally and across institutions, as well as unique models for provisioning care for patients with HF within a health care setting. The latter includes a discussion of traditional and emerging models, specialized HF units, the makeup and implementation of multidisciplinary team-based decision-making, and cardiac critical care admission and triage practices. This article illustrates the ways in which critically ill patients with HF have helped to shape contemporary CICUs throughout the world and explores how these very patients will similarly help to inform the future maturation of these specialized critical care units. Finally, we will critically examine broad, contemporary, international models of HF and cardiac critical care delivery in North America, Europe, South America, and Asia, and conclude with opportunities for the further investigation and generation of evidence for care delivery.
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Affiliation(s)
- Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Erin A Bohula
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sean VAN Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sergio Leonardi
- Fondazione IRCCS Policlinico San Matteo, Pavia and University of Pavia, Pavia, Italy
| | - Alexandre Mebazaa
- Université de Paris, Inserm 942 MASCOT, APHP Hôpitaux Universitaires Saint-Louis-Lariboisière, Paris, France
| | - Alastair G Proudfoot
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Clinic For Anaesthesiology & Intensive Care, Charité-Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Univesität zu, Berlin, Germany
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Yew Woon Chia
- Cardiac Intensive Care Unit, Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Fernando G Zampieri
- HCor Research Institute, São Paulo, Brazil Intensive Care Unit, Federal University of São Paulo, Brazil
| | - Renato D Lopes
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina; Brazilian Clinical Research Institute (BCRI), Sao Paulo, Brazil
| | - Jason N Katz
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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Quintairos A, Rezende EADC, Soares M, Lobo SMA, Salluh JIF. Leveraging a national cloud-based intensive care registry for COVID-19 surveillance, research and case-mix evaluation in Brazil. Rev Bras Ter Intensiva 2022; 34:205-209. [PMID: 35946649 DOI: 10.5935/0103-507x.20220016-pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/20/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Amanda Quintairos
- Departamento de Terapia Intensiva e Programa de Pós-Gradução em Medicina Translacional, Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil
| | | | - Marcio Soares
- Departamento de Terapia Intensiva e Programa de Pós-Gradução em Medicina Translacional, Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil
| | - Suzana Margareth Ajeje Lobo
- Departamento de Terapia Intensiva, Hospital de Base de São José do Rio Preto, Faculdade de Medicina de Rio Preto - São José do Rio Preto (SP), Brasil
| | - Jorge Ibrain Figueira Salluh
- Departamento de Terapia Intensiva e Programa de Pós-Gradução em Medicina Translacional, Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil
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