Critical Care Explorations最新文献

{"title":"A New Dosing Frontier: Retrospective Assessment of Effluent Flow Rates and Residual Renal Function Among Critically Ill Patients Receiving Continuous Renal Replacement Therapy","authors":"Damini Lakshmipathy, Xiaoyi Ye, J. Kuti, David P. Nicolau, Tomefa E. Asempa","doi":"10.1097/cce.0000000000001065","DOIUrl":"https://doi.org/10.1097/cce.0000000000001065","url":null,"abstract":"\u0000 \u0000 In 2020, cefiderocol became the first Food and Drug Administration-approved medication with continuous renal replacement therapy (CRRT) dosing recommendations based on effluent flow rates (Q\u0000 E). We aimed to evaluate the magnitude and frequency of factors that may influence these recommendations, that is, Q\u0000 E intrapatient variability and residual renal function.\u0000 \u0000 \u0000 \u0000 Retrospective observational cohort study.\u0000 \u0000 \u0000 \u0000 ICUs within Hartford Hospital (890-bed, acute-care hospital) in Connecticut from 2017 to 2023.\u0000 \u0000 \u0000 \u0000 Adult ICU patients receiving CRRT for greater than 72 hours.\u0000 \u0000 \u0000 \u0000 CRRT settings including Q\u0000 E and urine output (UOP) were extracted from the time of CRRT initiation (0 hr) and trends were assessed. To assess the impact on antibiotic dosing, cefiderocol doses were assigned to 0 hour, 24 hours, 48 hours, and 72 hours Q\u0000 E values per product label, and the proportion of antibiotic dose changes required as a result of changes in inpatient’s Q\u0000 E was evaluated. Among the 380 ICU patients receiving CRRT for greater than 72 hours, the median (interquartile range) 0 hour Q\u0000 E was 2.96 (2.35–3.29) L/hr. Approximately 9 Q\u0000 E values were documented per patient per 24-hour window. Q\u0000 E changes of greater than 0.75 L/hr were observed in 21.6% of patients over the first 24 hours and in 7.9% (24–48 hr) and 5.8% (48–72 hr) of patients. Approximately 40% of patients had UOP greater than 500 mL at 24 hours post-CRRT initiation. Due to Q\u0000 E changes within 24 hours of CRRT initiation, a potential cefiderocol dose adjustment would have been warranted in 38% of patients (increase of 21.3%; decrease of 16.6%). Q\u0000 E changes were less common after 24 hours, warranting cefiderocol dose adjustments in less than 15% of patients.\u0000 \u0000 \u0000 \u0000 Results highlight the temporal and variable dynamics of Q\u0000 E and prevalence of residual renal function. Data also demonstrate a risk of antibiotic under-dosing in the first 24 hours of CRRT initiation due to increases in Q\u0000 E. For antibiotics with Q\u0000 E-based dosing recommendations, empiric dose escalation may be warranted in the first 24 hours of CRRT initiation.\u0000","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":" 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140217998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic Determinants of Cardiac Surgery-Associated Acute Kidney Injury","authors":"S. Demirjian, Faisal G. Bakaeen, W.H. Wilson Tang, Chase Donaldson, Jonathan J. Taliercio, Anne Huml, Crystal A. Gadegbeku, A. M. Gillinov, Steven Insler","doi":"10.1097/cce.0000000000001063","DOIUrl":"https://doi.org/10.1097/cce.0000000000001063","url":null,"abstract":"\u0000 \u0000 Examine the: 1) relative role of hemodynamic determinants of acute kidney injury (AKI) obtained in the immediate postcardiac surgery setting compared with established risk factors, 2) their predictive value, and 3) extent mediation via central venous pressure (CVP) and mean arterial pressure (MAP).\u0000 \u0000 \u0000 \u0000 Retrospective observational study. The main outcome of the study was moderate to severe AKI, per kidney disease: improving global outcomes, within 14 days of surgery.\u0000 \u0000 \u0000 \u0000 U.S. academic medical center.\u0000 \u0000 \u0000 \u0000 Adult patients undergoing cardiac surgery between January 2000 and December 2019 (n = 40,426) in a single U.S.-based medical center. Pulmonary artery catheter measurements were performed at a median of 102 minutes (11, 132) following cardiopulmonary bypass discontinuation.\u0000 \u0000 \u0000 \u0000 None.\u0000 \u0000 \u0000 \u0000 The median age of the cohort was 67 years (58, 75), and 33% were female; 70% had chronic hypertension, 29% had congestive heart failure, and 3% had chronic kidney disease. In a multivariable model, which included comorbidities and traditional intraoperative risk factors, CVP (p < 0.0001), heart rate (p < 0.0001), cardiac index (p < 0.0001), and MAP (p < 0.0001), were strong predictors of AKI, and superseded factors such as surgery type and cardiopulmonary bypass duration. The cardiac index had a significant interaction with heart rate (p = 0.026); a faster heart rate had a differentiating effect on the relationship of cardiac index with AKI, where a higher heart rate heightened the risk of AKI primarily in patients with low cardiac output. There was also significant interaction observed between CVP and MAP (p = 0.009); where the combination of elevated CVP and low MAP had a synergistic effect on AKI incidence.\u0000 \u0000 \u0000 \u0000 Hemodynamic factors measured within a few hours of surgery showed a strong association with AKI. Furthermore, determinants of kidney perfusion, namely CVP and arterial pressure are interdependent; as are constituents of stroke volume, that is, cardiac output and heart rate.\u0000","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":" 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140218629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Differences in Accuracy of Predictive Models for High-Flow Nasal Cannula Failure in COVID-19","authors":"Philip Yang, I.A. Gregory, Chad Robichaux, Andre L. Holder, Greg S. Martin, Annette M. Esper, R. Kamaleswaran, Judy W. Gichoya, S. Bhavani","doi":"10.1097/cce.0000000000001059","DOIUrl":"https://doi.org/10.1097/cce.0000000000001059","url":null,"abstract":"\u0000 \u0000 To develop and validate machine learning (ML) models to predict high-flow nasal cannula (HFNC) failure in COVID-19, compare their performance to the respiratory rate-oxygenation (ROX) index, and evaluate model accuracy by self-reported race.\u0000 \u0000 \u0000 \u0000 Retrospective cohort study.\u0000 \u0000 \u0000 \u0000 Four Emory University Hospitals in Atlanta, GA.\u0000 \u0000 \u0000 \u0000 Adult patients hospitalized with COVID-19 between March 2020 and April 2022 who received HFNC therapy within 24 hours of ICU admission were included.\u0000 \u0000 \u0000 \u0000 None.\u0000 \u0000 \u0000 \u0000 Four types of supervised ML models were developed for predicting HFNC failure (defined as intubation or death within 7 d of HFNC initiation), using routine clinical variables from the first 24 hours of ICU admission. Models were trained on the first 60% (n = 594) of admissions and validated on the latter 40% (n = 390) of admissions to simulate prospective implementation. Among 984 patients included, 317 patients (32.2%) developed HFNC failure. eXtreme Gradient Boosting (XGB) model had the highest area under the receiver-operator characteristic curve (AUROC) for predicting HFNC failure (0.707), and was the only model with significantly better performance than the ROX index (AUROC 0.616). XGB model had significantly worse performance in Black patients compared with White patients (AUROC 0.663 vs. 0.808, p = 0.02). Racial differences in the XGB model were reduced and no longer statistically significant when restricted to patients with nonmissing arterial blood gas data, and when XGB model was developed to predict mortality (rather than the composite outcome of failure, which could be influenced by biased clinical decisions for intubation).\u0000 \u0000 \u0000 \u0000 Our XGB model had better discrimination for predicting HFNC failure in COVID-19 than the ROX index, but had racial differences in accuracy of predictions. Further studies are needed to understand and mitigate potential sources of biases in clinical ML models and to improve their equitability.\u0000","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"364 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140274299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unifying Fluid Responsiveness and Tolerance With Physiology: A Dynamic Interpretation of the Diamond–Forrester Classification","authors":"Jon-Émile S. Kenny, Ross Prager, Philippe Rola, K. Haycock, J. Basmaji, Glenn Hernández","doi":"10.1097/CCE.0000000000001022","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001022","url":null,"abstract":"Point of care ultrasound (POCUS) is a first-line tool to assess hemodynamically unstable patients, however, there is confusion surrounding intertwined concepts such as: “flow,” “congestion,” “fluid responsiveness (FR),” and “fluid tolerance.” We argue that the Frank–Starling relationship is clarifying because it describes the interplay between “congestion” and “flow” on the x-axis and y-axis, respectively. Nevertheless, a single, simultaneous assessment of congestion and flow via POCUS remains a static approach. To expand this, we propose a two-step process. The first step is to place the patient on an ultrasonographic Diamond–Forrester plot. The second step is a dynamic assessment for FR (e.g., passive leg raise), which individualizes therapy across the arc of critical illness.","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":" 3","pages":"e1022"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138616331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge and Practice Gaps in Pediatric Neurocritical Care Nursing: Lessons Learned From a Specialized Educational Boot Camp","authors":"Nathan Chang, Amelia Sperber, May Casazza, Leslie Ciraulo, Prathyusha Teeyagura, Lindsey Rasmussen","doi":"10.1097/CCE.0000000000001018","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001018","url":null,"abstract":"OBJECTIVES: Pediatric neurocritical care (PNCC) is a quickly growing subspecialty within pediatric critical care medicine. Standards for care, education, and application of neuromonitoring technologies in PNCC are still being developed. We sought to identify and improve knowledge deficits in neurocritical care with an educational boot camp for nurses. SETTING: Quaternary children’s hospital with 36 PICU beds. DESIGN: Preinterventional and postinterventional study. METHODS: A 2-day boot camp course covering neurologic and neurosurgical topics pertinent to PNCC was provided to 46 pediatric acute and critical care nurses divided into three cohorts over 3 years. Participant characteristics were collected, and precourse and postcourse knowledge assessments were administered. RESULTS: Regarding participant characteristics, neither critical care registered nurse certification nor years of nursing experience were associated with better precourse baseline knowledge. Knowledge gaps spanned bedside neurologic assessments, physiologic goals in brain injury, and side effects of neurocritical care medications. In postcourse assessments, all participants showed improvement in scores, and most participants sustained improvements after 6 months. Nurses reported significant improvement in self-reported confidence in caring for the PNCC population. We also observed shorter ICU lengths of stay, decreased hospital incident reports, and decreased time to stroke imaging, although these programmatic metrics cannot be credited to nursing education alone. CONCLUSIONS: PNCC programs should include nursing expertise in the field. However, topics specific to PNCC may not be adequately addressed by existing general critical care nursing education and certification. A multimodal educational boot camp can be an effective method to improve nursing knowledge in PNCC. Our results demonstrate that specialty nursing education in PNCC is both innovative and feasible, with the potential to improve patient care. Further research is needed to determine the benefits of specialty education on quality of care and clinical outcomes.","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138614914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Surge Strain and Pandemic Progression on Prognostication by an Established COVID-19–Specific Severity Score","authors":"Christina Yek, Jing Wang, J. Fintzi, A. Mancera, Michael B. Keller, S. Warner, S. Kadri","doi":"10.1097/CCE.0000000000001021","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001021","url":null,"abstract":"IMPORTANCE: Many U.S. State crisis standards of care (CSC) guidelines incorporated Sequential Organ Failure Assessment (SOFA), a sepsis-related severity score, in pandemic triage algorithms. However, SOFA performed poorly in COVID-19. Although disease-specific scores may perform better, their prognostic utility over time and in overcrowded care settings remains unclear. OBJECTIVES: We evaluated prognostication by the modified 4C (m4C) score, a COVID-19–specific prognosticator that demonstrated good predictive capacity early in the pandemic, as a potential tool to standardize triage across time and hospital-surge environments. DESIGN: Retrospective observational cohort study. SETTING: Two hundred eighty-one U.S. hospitals in an administrative healthcare dataset. PARTICIPANTS: A total of 298,379 hospitalized adults with COVID-19 were identified from March 1, 2020, to January 31, 2022. m4C scores were calculated from admission diagnosis codes, vital signs, and laboratory values. MAIN OUTCOMES AND MEASURES: Hospital-surge index, a severity-weighted measure of COVID-19 caseload, was calculated for each hospital-month. Discrimination of in-hospital mortality by m4C and surge index-adjusted models was measured by area under the receiver operating characteristic curves (AUC). Calibration was assessed by training models on early pandemic waves and measuring fit (deviation from bisector) in subsequent waves. RESULTS: From March 2020 to January 2022, 298,379 adults with COVID-19 were admitted across 281 U.S. hospitals. m4C adequately discriminated mortality in wave 1 (AUC 0.779 [95% CI, 0.769–0.789]); discrimination was lower in subsequent waves (wave 2: 0.772 [95% CI, 0.765–0.779]; wave 3: 0.746 [95% CI, 0.743–0.750]; delta: 0.707 [95% CI, 0.702–0.712]; omicron: 0.729 [95% CI, 0.721–0.738]). m4C demonstrated reduced calibration in contemporaneous waves that persisted despite periodic recalibration. Performance characteristics were similar with and without adjustment for surge. CONCLUSIONS AND RELEVANCE: Mortality prediction by the m4C score remained robust to surge strain, making it attractive for when triage is most needed. However, score performance has deteriorated in recent waves. CSC guidelines relying on defined prognosticators, especially for dynamic disease processes like COVID-19, warrant frequent reappraisal to ensure appropriate resource allocation.","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":" 48","pages":"e1021"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138617566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Vasospasm After Subarachnoid Hemorrhage: Respective Short-Term Effects of Induced Arterial Hypertension and its Combination With IV Milrinone: A Proof-of-Concept Study Using Transcranial Doppler Ultrasound.","authors":"Karim Lakhal,&nbsp;Marion H Fresco,&nbsp;Antoine Hivert,&nbsp;Bertrand Rozec,&nbsp;Julien Cadiet","doi":"10.1097/CCE.0000000000000973","DOIUrl":"10.1097/CCE.0000000000000973","url":null,"abstract":"<p><strong>Objectives: </strong>It is unclear whether IV milrinone relaxes spasmed cerebral arteries and therefore reduces cerebral blood mean velocity (V_mean). In patients treated for cerebral vasospasm, we aimed to assess and delineate the respective impacts of induced hypertension and its combination with IV milrinone on cerebral hemodynamics as assessed with transcranial Doppler.</p><p><strong>Design: </strong>Observational proof-of-concept prospective study.</p><p><strong>Setting: </strong>ICU in a French tertiary care center.</p><p><strong>Patients: </strong>Patients with aneurysmal subarachnoid hemorrhage who received induced hypertension (mean arterial blood pressure [MBP] of 100-120 mm Hg) and IV milrinone (0.5 µg/kg/min) for moderate-to-severe cerebral vasospasm. We excluded patients who underwent invasive angioplasty or milrinone discontinuation within 12 hours after the diagnosis of vasospasm.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>V_mean was measured at vasospasm diagnosis (T_DIAGNOSIS), after the induction of hypertension (T_HTN), and 1 (T_{HTN+MILRINONE_H1}) and 12 hours after the adjunction of IV milrinone (T_{HTN+MILRINONE_H12}). Thirteen patients were included. Median V_mean was significantly lower (<i>p</i> < 0.01) at T_{HTN+MILRINONE_H1} (99 [interquartile range (IQR) 89; 134] cm.s^-1) and T_{HTN+MILRINONE_H12} (85 [IQR 73-127] cm/s) than at T_DIAGNOSIS (136 [IQR 115-164] cm/s) and T_HTN (148 [IQR 115-183] cm/s), whereas T_DIAGNOSIS and T_HTN did not significantly differ. In all patients but one, V_mean at T_{HTN+MILRINONE_H1} was lower than its value at T_DIAGNOSIS (<i>p</i> = 0.0005). V_mean-to-MBP and V_mean-to-cardiac output (CO) ratios (an assessment of V_mean regardless of the level of MBP [<i>n</i> = 13] or CO [<i>n</i> = 7], respectively) were, respectively, similar at T_DIAGNOSIS and T_HTN but were significantly lower after the adjunction of milrinone (<i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>The induction of arterial hypertension was not associated with a significant decrease in V_mean, whereas the adjunction of IV milrinone was, regardless of the level of MBP or CO. This suggests that IV milrinone may succeed in relaxing spasmed arteries.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 9","pages":"e0973"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/eb/0e/cc9-5-e0973.PMC10503695.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10635638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of Synthetic Human Angiotensin II for Catecholamine-Resistant Vasodilatory Shock in Critically Ill Children: A Single-Center Retrospective Case Series.","authors":"Oguzhan Tezel, Tamara K Hutson, Katja M Gist, Ranjit S Chima, Stuart L Goldstein, Natalja L Stanski","doi":"10.1097/CCE.0000000000000978","DOIUrl":"10.1097/CCE.0000000000000978","url":null,"abstract":"<p><strong>Objectives: </strong>To describe our institutional experience utilizing adjunctive synthetic angiotensin II in critically ill children with catecholamine-resistant vasodilatory shock (CRVS).</p><p><strong>Design: </strong>Single-center, retrospective case series.</p><p><strong>Setting: </strong>PICU and cardiac ICU (CICU) at a large, quaternary children's hospital in the United States.</p><p><strong>Patients: </strong>Twenty-three pediatric patients with CRVS who were prescribed synthetic angiotensin II at the discretion of bedside clinicians from January 2018 to April 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Twenty-three patients (20 in PICU, 3 in CICU) with a median age of 10.4 years (interquartile range [IQR] 1.5-18.5) received angiotensin II over the study period, 70% of whom died. At the time of angiotensin II initiation, 17 patients (74%) were receiving one or more forms of extracorporeal therapy, and median Pediatric Logistic Organ Dysfunction-2 Score-2 in the prior 24 hours was 9 (IQR 7-11). The median time between initiation of the first vasoactive agent and angiotensin II was 127 hours (IQR 13-289), and the median total norepinephrine equivalent (NED) at initiation was 0.65 μg/kg/min (IQR 0.36-0.78). The median duration of therapy was 27 hours (IQR 4-68), and at each timepoint assessed, patients had median improvement in NED and mean arterial pressure (MAP) with treatment. Survivors initiated angiotensin II nearly 3 days earlier in vasoactive course (91.5 hr vs 161 hr, <i>p</i> = 0.23), and had both greater reduction in NED (-75% [IQR -96 to -50] vs +2.1% [IQR -55 to 33], <i>p</i> = 0.008) and greater increase in MAP (+15 mm Hg [IQR 10-27] vs -1.5 mm Hg [IQR -27 to 18], <i>p</i> = 0.052) at angiotensin II discontinuation.</p><p><strong>Conclusions: </strong>We demonstrate reduction in NED and improved MAP following initiation of angiotensin II in critically ill children with CRVS. Further prospective work is needed to examine optimal timing of angiotensin II initiation, appropriate patient selection, and safety in this population.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 9","pages":"e0978"},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fb/48/cc9-5-e0978.PMC10499081.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10268100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Center Experience With Lung Transplant Evaluation Referrals of Acute Respiratory Distress Syndrome Patients During the COVID-19 Pandemic: How Do You Make Up For Lost Time?","authors":"Emily J Cerier, Takahide Toyoda, Colleen McNulty, Anne O'Boye, Chitaru Kurihara, Ankit Bharat, Nandita R Nadig","doi":"10.1097/CCE.0000000000000965","DOIUrl":"10.1097/CCE.0000000000000965","url":null,"abstract":"<p><p>Transfer of select, medically refractory acute respiratory distress syndrome patients to lung transplant centers requires extensive resources. Here, we report 270 consecutive lung transplant patient referrals to our center for medically refractory ARDS from June 2021 to April 2022, following the implementation of clinical care pathways for intake of these patients. Eighty-seven of 270 patients (32.2%) met screening criteria and were evaluated for transfer within a median of 12 days, during which 38 of 87 patients (43.7%) died and 12 of 87 patients (13.8%) transferred elsewhere. Thirty-seven of 87 patients (42.5%) were accepted for transfer of which 16 of 37 patients (43.2%) successfully transferred to our center with a median transfer waiting period of 12 days. Because of resource constraints, 21 of 37 accepted patients (56.8%) could not be transferred of which 9 of 21 patients (42.9%) died while waiting. Nine of 16 transferred patients (56.2%) eventually underwent lung transplantation with over 80% 6-month survival. ARDS patients referred for transplantation have high risk of mortality and, therefore, require well-described pathways for evaluation and transfer.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 9","pages":"e0965"},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/a9/cc9-5-e0965.PMC10489292.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10225168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Patients With an International Classification of Diseases, 10th Edition Discharge Diagnosis Code for Sepsis Different in Regard to Demographics and Outcome Variables When Comparing Those With Sepsis Only to Those Also Diagnosed With COVID-19 or Those With a COVID-19 Diagnosis Alone?","authors":"David F Gaieski,&nbsp;Jumpei Tsukuda,&nbsp;Parker Maddox,&nbsp;Michael Li","doi":"10.1097/CCE.0000000000000964","DOIUrl":"https://doi.org/10.1097/CCE.0000000000000964","url":null,"abstract":"<p><strong>Objectives: </strong>We analyzed whether patients with the International Classification of Diseases, 10th Edition (ICD-10) discharge diagnosis code for sepsis are different in regard to demographics and outcome variables when comparing those with sepsis only to those also diagnosed with COVID-19 or those with a COVID-19 diagnosis alone.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Nine hospitals in an academic health system.</p><p><strong>Patients: </strong>Patients with a final ICD-10 discharge diagnostic code for sepsis only, a diagnosis of COVID-19-only, or a final sepsis ICD-10 discharge code + a diagnosis of COVID-19 admitted to the hospital were analyzed for demographic and outcome differences between the cohorts.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 11,395 patients met inclusion criteria: 6,945 patients (60.9%) were ICD-10 sepsis code only, 3,294 patients (28.9%) were COVID-19 diagnosis-only, and 1,153 patients (10.1%) were sepsis ICD-10 code + COVID-19 diagnosis. Comparing sepsis ICD-10 code + COVID-19 diagnosis patients to sepsis ICD-10 code only and COVID-19 diagnosis-only patients, the sepsis ICD-10 code + COVID-19 diagnosis patients were: older (69 [58-78] vs 67 [56-77] vs 64 [51-76] yr), less likely to be female (40.3% vs 46.7% vs 49.5%), more frequently admitted to the ICU (59.3% [684/1,153] vs 54.9% [1,810/3,297] vs 15% [1,042/6,945]), more frequently required ventilatory support (39.3% [453/1,153] vs 31.8% [1,049/3,297] vs 6.0% [417/6,945]), had longer median hospital length of stay (9 [5,16] vs 5 [3,8] vs 7. [4,13] d), and were more likely to die in the hospital (39.2% [452/1,153] vs 22.3% [735/3,297] vs 6.4% [444/6,945]).</p><p><strong>Conclusions: </strong>During the COVID-19 pandemic the sickest cohort of patients was those receiving an explicit ICD-10 code of sepsis + a COVID-19 diagnosis. A significant percentage of COVID-19 diagnosis-only patients appear to have been under-coded as they received a level of critical care (ICU admission; intubation) suggestive of the presence of acute organ dysfunction during their admission.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 9","pages":"e0964"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/8a/cc9-5-e0964.PMC10461943.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10119712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}