TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI最新文献

{"title":"Predicting Peak and Cumulative Ventilator Need for COVID-19 in the US: Development of an Epidemiological Model","authors":"R. Gondalia, B. Lee, M. Barrett, A. Benjafield, L. Kaye, C. Nunez, A. Malhotra","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2610","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2610","url":null,"abstract":"Rationale: The COVID-19 pandemic has caused major challenges for healthcare. The availability of mechanical ventilators was particularly problematic early on, with discussion about the appropriateness of invasive mechanical (IMV) vs. non-invasive ventilation (NIV) in the management of COVID-19. Various prediction models were developed, but few projected COVID-19-related ventilator use. We aimed to estimate peak and cumulative IMV and NIV need in the US through May 2021. Methods: We used a modified Susceptible-Infected-Recovered model with four additional compartments: exposed (E), in-hospital NIV, in-hospital IMV, and NIV or CPAP (HNIV/CPAP) treated out-of-hospital, based on published ventilator use patterns for COVID-19. Three scenarios (best-, moderate-, and worst-case) were modeled to reflect levels of intervention (e.g., shelter-in-place) effectiveness and compliance. Results included initial peak date, peak ventilator events, ventilator shortfall and timing of subsequent waves. Model performance was compared with estimates of IMV use back-calculated from observed mortality data, assuming a 75% mortality rate for patients on an IMV in the ICU based on published estimates. Results: At the start of the pandemic, the US was estimated to have 62,188 full-featured IMV;22,976 NIV;88,462 non full-featured devices in hospitals for use as surge devices;plus 12,700 in the Strategic National Stockpile. The moderate-case scenario aligned most closely to back-calculated IMV use based on observed mortality, and suggested that initial peak ventilator need occurred around May 1, 2020, requiring 94,472 inhospital ventilators (40,930 IMV;53,541 NIV) and 7,931 HNIV/CPAP. In this scenario, the US had sufficient IMV (+21,258) but there may have been a shortfall of 30,565 in-hospital NIV, triggering surge use in some locations. The US is estimated to have 1,915,217 cumulative ventilator use events by May 2021, of which 688,549 are IMV events and 1,226,668 are NIV+HNIV/CPAP events. At least two subsequent waves were estimated to occur prior to May 2021: fall of 2020 and early 2021. Conclusion: We estimated the US may need to utilize surge devices to have sufficient in-hospital NIV during peak need periods. Although IMV supplies seem generally adequate, improved strategies to track and share equipment, i.e., move ventilators from centers with surplus to centers in need, should be developed. This model may inform resource planning and allocation for which patients require ventilators in subsequent waves. Further validation will be beneficial using observed data for hospitalization, ventilator utilization and mortality, as well as adjustments for shifting trends in clinical practice such as use of high-flow nasal cannula.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129669775","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":"Change in D-Dimer and Mortality in Patients admitted with Coronavirus Disease 19 (COVID19)","authors":"R. Hejal, O. Giddings, A. Popa, C. Teba, A. John, T. Carman, S. Al-Kindi","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2576","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2576","url":null,"abstract":"Background: Coronavirus disease 19 is a complex multisystem disease that continues to spread rapidly across the world. It is associated with elevations in inflammatory markers including the one produced during fibrinolysis, namely D-Dimer. Reports have shown marked elevations in this protein fragment particularly in severe disease. We report our observations regarding change in D-Dimer and effect on mortality over time. Methods: We analyzed all adults between March and September 2020 who were admitted or managed in the emergency department for COVID19 infection within the University Hospitals Health System in Northeast Ohio. Delta d-dimer was defined as the change in d-dimer (Δd-dimer) from day of presentation to the maximum value between day 1 to 6 post admissions. Kaplan-Meier and cox regression analyses were performed to explore the association with mortality. Receiver operating characteristics were used to estimate discrimination power for mortality. Results: A total of 442 patients were included. Mean age was 64±16 years. A total of 93 patients were managed in the intensive care unit, 324 were managed as inpatient, and 25 patients were managed in the emergency department. The median admission d-dimer was 1169 [645-2208] ng/ml, and Δd-dimer was 75 [-334 to 717]. At a median follow-up of 108 days, 100 patients died (30-day mortality of 21%). The 30-day mortality was 12.3% for tertile 1, 12.2% for tertile 2, and 39.1% for tertile 3 of Δd-dimer, (Figure). Compared with tertile 1, patients in tertile 3 of Δd-dimer had 4-fold higher mortality (age-adjusted HR 3.77 [2.30-6.18], P<0.001). In multivariable analysis, Δd-dimer but not admission d-dimer (P=0.36) was associated with mortality after adjusting for age (per 1000 ng/mL increase: HR 1.017 [1.008-1.027], P<0.001). Δd-dimer had a good discriminative power for mortality (AUC=0.70). An increase in d-dimer of 540 ng/ml was determined to be the best threshold for mortality (sensitivity of 62% and specificity of 80%). Conclusions: Serial monitoring of D-Dimer during hospitalization to assess for change over time is a reliable prognostic marker for mortality in COVID-19 patients. Using it as an indicator to initiate therapeutic anticoagulation requires investigation.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129900189","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":"Ventilator Type in a Respiratory Pandemic: Does It Make a Difference?","authors":"R. Durrance, K. Johnson, U. Dhamrah, M. Davila-Molino, R. Sawyer, P. Ram, D. Papademetriou, A. Astua","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2609","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2609","url":null,"abstract":"Introduction: When COVID-19 was declared a pandemic by the WHO in early 2020, the United States was only beginning to focus on the potential impact of the disease. Elmhurst Hospital Center in New York City became the “epicenter of the epicenter” at the height of the first wave. In order to meet the demand of a large surge of acutely ill patients requiring mechanical ventilation for hypoxemic respiratory failure, widespread collaboration resulted in the use of different types of ventilators, including those designed primarily for patient transport. While typical ICU ventilators give extensive graphical and numeric information with respect to patient and vent parameters, travel ventilators do not. Therefore, utilization of these ventilators outside of their intended spectrum of use has the potential to compromise patient care. Barotrauma is a relatively common complication of ventilated patients with critical COVID-19 infections, which raises the concern that the use of travel ventilators could compound the risk. Materials and Methods: A retrospective analysis of patients with COVID-19 pneumonia admitted and intubated for respiratory failure from March 2 to May 9, 2020 was undertaken. Clinical and demographic information, incidence of barotrauma with respect to ventilator type, and mortality were evaluated using non-parametric analysis as appropriate. Time-to-event analysis was performed for both barotrauma and mortality with respect to ventilator type. Results: Of 335 patients identified, 313 had sufficient data available. Median age was 61 years and males made up 81.5% of the population. Overall mortality was 81%. Age was associated with greater mortality (p=0.047), but there was no mortality difference with respect to sex, BMI, or with respect to known comorbid risk factors. Travel ventilators were associated with longer length of stay (p=0.0002), a longer time intubated (p=0.0009), but also a longer time to intubation (p=0.014). No significant difference in incidence of barotrauma (p=0.18), pneumothorax (p=0.35), or mortality (p=0.52) by ventilator type was observed. Barotrauma was associated with a longer length of stay (p=0.0001) and days intubated (p=0.0001), but not with time from admission to intubation or increased risk mortality. Conclusion: Adaptation is required by healthcare providers during a pandemic, especially the utilization of available critical resources including ventilators. While adaptation to new equipment with different original intended uses and capabilities presents its own set of intrinsic challenges, the extended use of Transport Ventilators was not associated with an increase in barotrauma or mortality. (Table Presented).","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128011012","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":"Code Status Orders in Patients Admitted to the Intensive Care Unit Due to Coronavirus Disease 2019","authors":"E. Moin, D. Okin, S. Jesudasen, N. Dandawate, A. Gavralidis, L. Chang, A. Witkin, K. Hibbert, A. Kadar, P. Gordan, L. Bebell, P. Lai, G. A. Alba","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2592","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2592","url":null,"abstract":"RATIONALE: Patients with coronavirus disease 2019 (COVID-19) are frequently admitted to the intensive care unit (ICU) where goals of care conversations may result in changes in code status. Previous work has described how changes in code status in ICU patients influence objective measures like length of stay and mortality and the subjective experiences of patients and surrogates. To date, no study has described the code statuses of ICU patients with COVID-19. METHODS: A retrospective cohort study was performed of all patients admitted to the ICU at three hospitals in Boston, Massachusetts confirmed to have COVID-19 by positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction test between March 11, 2020, and May 31, 2020. Differences in code status at admission were examined. Continuous variables are presented as median and interquartile range (IQR, 1st-3rd) and categorical variables are presented as numbers with percentages. The Mann-Whitney U test was performed for continuous variables and the chi-square test (or Fisher Exact, when appropriate) for categorical variables. RESULTS: A total of 459 patients were admitted to the ICU, of which 421 (91.7%) were Full Code. The median age differed significantly between patients who had a Do Not Resuscitate (DNR) order and those who were Full Code [80.5 (IQR 64-97) versus 62 (IQR 40-84), p < 0.001]. There were no differences in gender or BMI. At admission, sequential organ failure assessment (SOFA) and simplified acute physiology score (SAPS II) scores were significantly higher in patients with DNR orders (p = 0.028, p < 0.001 respectively). The median Pao2 / Fio2 ratio at admission was 163 (IQR 43-283) and did not differ between groups. Patients who had DNR orders were more likely to be non-Latinx (86.8% vs 50.4%, p < 0.001), white (81.6% vs 54.2%, p < 0.012), and English-speaking (78.9% vs 48.5%, p < 0.001). Patients admitted from a private home, rather than a facility, were significantly more likely to be Full Code (85.0% vs 36.8%, p < 0.001). CONCLUSIONS: In our cohort, patients with DNR orders at admission were older, white, and non-Latinx, consistent with prior research in general ICU populations. We further identified a significant relationship between primary language and code status. Due to the unique barriers to communication imposed by the COVID-19 pandemic, and pre-existing barriers to communication with patients with limited English proficiency, our results highlight the necessity of specific interventions to overcome these challenges.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134256915","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":"Helmet Continuous Positive Airway Pressure (CPAP) Delivered in Non-ICU Settings Can Provide Safe, Effective Care in Patients with Covid-19 Pneumonia. A Retrospective Study of CPAP Use on a Re-Purposed Medical Ward","authors":"E. Cartwright, R. Snow, S. Mahendran, L. Redmond","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2604","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2604","url":null,"abstract":"RationaleSARS-Cov-2 (Covid-19) has constituted an unprecedented challenge to healthcare systems worldwide, including the allocation of finite ICU capacity to those most likely to benefit. Continuous positive airway pressure (CPAP) is frequently used in acute hypoxic respiratory failure (aHRF) and has been recommended for use in patients with Covid-19 pneumonia. We describe our experience using helmet CPAP (StarMed, Italy) on a general respiratory ward re-purposed to provide additional CPAP capacity during the height of the UK's first wave of Covid-19 admissions. MethodSingle-centre retrospective cohort study of all patients with Covid-19 pneumonia admitted for CPAP in a non-ICU setting. All patients admitted through the duration of the ward's re-purposing were included. CPAP was used according to a local Covid-19 aHRF pathway that was modelled upon expert guidance. All patients had a treatment escalation plan (TEP) agreed prior to starting CPAP. A mixture of wall oxygen and air was used to achieve target FiO2. All patients were managed using noninvasive monitoring including continuous pulse oximetry. The primary outcome studied was survival to discharge from hospital. ResultsA total of 67 patients were admitted for CPAP between the 29th March and the 6th May 2020-the duration for which the ward was repurposed. Two-thirds of patients (65.7% 45/67) were candidates for intubation and mechanical ventilation (IMV). Of these, 64.4% (29/45) survived to discharge from hospital with CPAP support alone. 31.1% of patients (14/45) required escalation to IMV, of whom 50% (7/14) survived to discharge. The overall survival in the IMV suitable group was 80% (36/45). Of those who were not suitable for IMV (34.3%, 23/67), the survival rate to discharge was 26% (6/23). ∗ Derived from the arterial blood gas prior to commencement of CPAP Amongst those who went on to require IMV, we found no statistically significant differences between those who survived to discharge and those who did not, when comparing P:F ratios, APACHE II scores or mean CPAP hours prior to commencing IMV. Conclusions This is a large single-centre cohort study of the use of helmet CPAP in a non-ICU setting. The overall survival through to discharge of the 80% (36/45) eligible for escalation to IMV compares favourably with the contemporaneous UK's ICNARC report of 82% survival to discharge in patients receiving only basic respiratory support. Our results also demonstrate that helmet CPAP can be safely deployed in non-ICU settings to provide effective additional CPAP capacity as part of the pandemic response.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114994972","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":"COVID-19 and Obesity in Atlanta","authors":"W. Neveu, V. Sueblinvong, A. Mehta, B. Emory COVID-19 Quality and Clinical Research Colla","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2591","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2591","url":null,"abstract":"Introduction: Obesity is a complex disease that exhibits alteration in immune function. Due to the imbalance between anti-and pro-inflammatory mediators secreted by adipocytes and immune cells, the scales are tipped toward a chronic inflammatory state. As the body mass index (BMI) increases, the visceral adipocytes have been found to secrete higher levels of pro-inflammatory cytokines such as interleukin (IL-) 6, which contribute to alterations in coagulation signaling. These findings raise concerns that obesity-mediated inflammation may be responsible for the observed findings of higher risk of severity from SARS-CoV-2 in this population. This study examines the effect of obesity on levels of inflammatory markers and severity of illness from COVID-19 in a cohort of critically ill patients. Methods: Data were collected from the electronic medical record (EMR) by the Emory COVID-19 Quality and Clinical Research Collaborative. We analyzed data of patients admitted with COVID-19 within the Emory Healthcare System between March 6, 2020 and May 5, 2020 who spent any time in the intensive care unit during their hospitalization. We used the Chi-square test to determine if death or intubation were associated with obesity (BMI > 30) and t-tests when comparing inflammatory markers between obese and non-obese patients. Multivariate logistic regression was completed to evaluate the role of BMI and severity of illness on death. Results: Results for BMI were available for 285 patients in the cohort, and 149 patients (52.3%) were considered obese with a BMI of 30 or greater. Obese patients in our cohort were younger on average by 10 years (59 years vs. 69 years, p<0.0001), and there was no significant difference in gender. Intubation rates were significantly higher in the obese population (80.5% vs. 64.7%, p=0.0026), and death rates were significantly lower in this group with a BMI greater than 30 (26.2% vs. 43.4%, p=0.0022). Values for inflammatory markers (CRP, IL-6, D-dimer, and WBC) were not significantly different between obese and nonobese individuals. Multivariate logistic regression analysis determined that patients with higher BMIs had a significantly lower risk of mortality when controlled for severity of illness as indicated by sequential organ failure assessment (SOFA) score and age (OR 0.94, 95% CI 0.90-0.98, p=0.0014). Conclusions: In our cohort of critically ill patients with COVID-19, obesity is associated with a greater risk of mechanical ventilation, but a lower risk of death even when accounting for severity of illness and age.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128526955","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":"Incidence of PTSD in COVID-19 Survivors of Critical Illness and the Therapeutic Efficacy of Steroids in the Prevention of PTSD","authors":"A. Cho, S. Korzan, S. Viola, A. Levine","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2596","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2596","url":null,"abstract":"RATIONALE: Post Traumatic Stress Disorder (PTSD) is characterized by intense, disturbing thoughts and flashbacks to traumatic events that can significantly reduce quality of life. An estimated 25-44% of survivors of critical illness develop clinically significant PTSD. Trauma leads to decreased glucocorticoid levels and upregulation of the cortisol receptor sensitivity, which may explain the hyper-arousal and avoidance seen in PTSD. Exogenous steroids may help attenuate this change. Previously published studies demonstrate steroids' efficacy in preventing PTSD when given during hospitalization. Data on PTSD specifically in patients hospitalized with Coronavirus-19 (COVID-19) remains sparse whilst utilization of corticosteroid in these patients is growing. Here we describe the incidence of PTSD in critically ill survivors of COVID-19 and explore steroids' role in the prevention of PTSD. METHODS: This is a multicenter retrospective cohort study of patients admitted to the University of Maryland Medical System for critical illness due to COVID-19 between March-December, 2020 and seen for follow up in the post-COVID clinic. Patient's demographic data, underlying medical conditions, and therapies received during hospitalization were collected and manually extracted through retrospective chart review. Patients were screened for PTSD via PTSD Checklist 5 (PCL-5) in outpatient setting. Those with PCL-5 score of 33 or greater were considered to have probable PTSD. We calculated descriptive statistics of demographic and clinical characteristics and performed nonparametric comparisons between groups using the Fishers exact test for categorical variables and the Mann Whitney U test for discrete variables. RESULTS: Twenty-eight patients were included in the study. Age ranged from 29 to 75 years old. Half of patients were female, 50% were African American, 28.6% Caucasian, 10.7% were Hispanic or Latino, and 10.7% were Asian. Four patients (14.3%) required extracorporeal membrane oxygenation (ECMO), seventeen (60.7%) required mechanical ventilation. The majority (78.6%) of the patients received solumedrol, hydrocortisone, prednisone, or dexamethasone as therapy for Acute Respiratory Distress Syndrome (ARDS), shock, or COVID-19 pneumonia. Seven patients developed PTSD (25%). There was no difference in demographics, past medical history, or ECMO utilization when comparing patients with and without PTSD. There was no difference in the usage of steroids (dose or duration) when comparing patients with and without PTSD. CONCLUSION: The incidence of PTSD in COVID-19 survivors is in line with the historical rate of PTSD in the general population of critical illness survivors. The use of corticosteroids had no effect on reducing the incidence of PTSD or the PCL-5 scores in this cohort of patients.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125462121","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":"Rates of AKI in ICU Patients Admitted Under Suspicion for COVID-19 Do Not Differ by SARS-CoV2 Status or SARS-CoV-2 Genomic Load","authors":"F. Farias, L. Zelnick, M. Thau, T. West, W. Liles, C. Mikacenic, E. Morrell, M. Wurfel, P. Bhatraju","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2575","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2575","url":null,"abstract":"Rationale: Since the onset of coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), studies have suggested a high incidence of acute kidney injury (AKI) among patients with COVID-19. However, these studies lack contemporaneously enrolled critically ill patients to understand whether high rates of AKI are unique to COVID-19. It is also unknown whether the risk of AKI is related to SARS-CoV-2 genomic load. Methods: We prospectively enrolled a cohort of patients admitted to the ICU with suspicion of COVID-19 (persons under investigation) from April to September 2020. Of these patients, 78 (46%) tested positive for SARS-CoV-2 (COVID-19) and 91 (54%) tested negative (non-COVID-19). AKI was defined as an increase ≥ 0.3 mg/dL in 48 hours or ≥ 50% increase in serum creatinine (sCr) measured during hospitalization compared to a 'baseline' sCr measured at study enrollment. New dialysis was defined as initiation of dialysis during hospitalization. SARS-CoV-2 qRT-PCR was performed across four different platforms with comparable cycle threshold (Ct) values. Ct values were a semiquantitative measure of genomic load with an inverse relationship of Ct to genomic load. We used relative risk regression to determine if there was an increased risk of AKI in COVID-19 compared to non-COVID-19 and whether SARS-CoV-2 genomic load was associated with AKI. Analyses were adjusted for age, sex, body mass index, and APACHE III scores. Results: Rates of AKI and new dialysis were similar in COVID-19 compared to non-COVID-19 (AKI: n=23 (29%) vs n=24 (26%) and Dialysis: n=8 (10%) vs n=6 (6%). Unadjusted and adjusted analyses demonstrated a non-significant difference in risk of AKI (adjusted RR = 1.04 (95% CI: 0.65-1.66) or new dialysis (adjusted RR = 1.55 (95% CI 0.58-4.12) in COVID-19 compared to non-COVID-19. We had Ct values available prior to ICU admission in 47 patients. In unadjusted and adjusted analyses, a 10-unit decrement in Ct values was not associated with AKI (adjusted RR = 0.40 (95% CI: 0.14-1.14) or new dialysis (adjusted RR = 0.96 (95% CI: 0.23-2.69) (Figure 1). Conclusions: Our study demonstrates that rates of AKI and new dialysis in ICU patients with COVID-19 are similar to rates in non-COVID-19 ICU patients. Moreover, the lack of association between Ct values and AKI in COVID-19, suggests that immune and host response to SARS-CoV-2 may contribute more to risk of AKI in ICU patients rather than the pathogen itself.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"127 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131870224","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":"Effect of COVID-19 Pandemic on the Use of Video Laryngoscopy During Tracheal Intubation of Critically Ill Adults","authors":"A. Davis, M. Semler, M. Brewer, J. Dargin, K. Doerschug, B. Driver, S. Dutta, S. Ghamande, J. Gaillard, K. Gibbs, A. Ginde, C. Hughes, D. Janz, A. Khan, D. Page, M. Prekker, T. Rice, D. Russell, W. Self, S. Trent, D. Vonderhaar, J. R. West, H. White, M. Whitson, J. Casey, the Pragmatic Critical Care Research Group","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2615","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2615","url":null,"abstract":"Rationale: Significant variability exists in the use of direct versus video laryngoscopy for the intubation of critically ill adults. Concerns regarding risks of infection to healthcare providers have led many experts to recommend the use of video laryngoscopy for intubation of patients with COVID-19. This recommendation is based on the belief that using video laryngoscopy allows more physical distance between the operator and the patient, potentially decreasing the risk to providers. Information on the effect of the COVID-19 pandemic on intubation practices is currently limited. Methods: We conducted a survey of intubation practices in 21 emergency departments and intensive care units participating in either of two randomized trials (clinicaltrials.gov identifiers: NCT03928925 and NCT03787732) within the Pragmatic Critical Care Research Group. At each site, the site investigator estimated the prevalence of various airway practices among 3 groups of patients: 1) patients intubated prior to the COVID-19 pandemic, 2) patients intubated with known or suspected COVID-19, and 3) patients intubated during the pandemic without known or suspected COVID-19. The site investigator provided information on use of personal protective equipment, preintubation fluid bolus administration, preoxygenation, sedative choice, paralytic choice, approach to oxygenation from induction to intubation, approach to laryngoscopy, bougie use, primary operator, and ancillary staff present. The primary outcome was the proportion of intubations at a study site that was estimated to be performed using video laryngoscopy. Results: We received responses from 19 of 21 sites (90%). Investigators reported that video laryngoscopy was used in a median of 65% of intubations [IQR: 50-76%] at their site prior to the pandemic compared with a median of 100% of intubations [IQR: 76-100%] for patients with known or suspected COVID-19 (p= 0.0002). Prior to the pandemic only 2 sites (10.5%) reported using exclusively video laryngoscopy, compared to 10 sites (52.6%) that reported using exclusively video laryngoscopy for COVID-19 patients. For patients without known or suspected COVID-19, use of video versus direct laryngoscopy did not differ significantly between patients intubated before the pandemic and patients intubated during the pandemic. Conclusions: Among patients intubated at 19 emergency departments and intensive care units participating in two ongoing clinical trials, we found that the perceived use of video laryngoscopy was greater for patients with known or suspected COVID-19 compared to patients intubated prior to the pandemic, whereas perceived use of video laryngoscopy for patients without COVID-19 during the pandemic was similar to use prior to the pandemic.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130555265","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":"Barotrauma in Mechanically Ventilated Patients with COVID-19-Related Respiratory Failure","authors":"J. Graham, D. Willms","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2614","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2614","url":null,"abstract":"Rationale Barotrauma has been observed in ARDS patients with COVID-19 at greater incidence than ARDS not related to COVID-19, despite low-volume ventilation. We analyzed data of intubated patients with confirmed COVID-19 and bilateral opacities, to determine risk factors for barotrauma, with consideration to demographic information, pre-existing conditions, certain laboratory findings, therapies and ventilation parameters. Methods Data for this pilot study were collected from a convenience sampling of patients at a multicenter healthcare system in southern California between March and May 2020. Cases of Barotrauma were identified by intensivists providing care, and a denominator was selected from a larger database. Data from this retrospective review of the electronic health record included demographics (age, gender, height, weight and ethnicity), certain medications and therapies, select serum lab values, ventilation parameters and survival. Cases were grouped as Barotrauma vs. no Barotrauma. T tests and chi square were used as tests of difference, Pearson r and eta were used as tests of association. Results Twenty-two cases had complete data available for analysis. Mean age was 62(+/-15.8), 31.8% female, and mean P/f ratio was 112.3(+/-42.6). Of the total sample, 13 (59.1%) patients expired. Thirteen cases (59.1%) suffered barotrauma, and 9(40.1%) did not. Serum ferritin (p = 0.046, η = 1.0) and administration of convalescent plasma (p = 0.011, r = 0.555), were statistically significant and highly correlated in the barotrauma group. Certain ventilation parameters were also statistically significant and highly correlated with barotrauma including fiO2 (p = 0.027, η = 0.759), PIP (p = 0.004, η = 0.855), Pplat (p = 0.002, η = 0.835), Pdrive (p = 0.003, η = 0.772), Cstat (p = 0.044, η = 0.893) and Pmean (p = 0.029, η = 0.804). Of the 13 cases included with Barotrauma, 9 (69.2%) had pneumothorax, 8 (61.5%) had pneumomediastinum, 7 (53.8%) had subcutaneous emphysema, 1 (7.7%) had pneumopericardium and 1 (7.7%) had pneumoperitoneum. Eight cases (61.5%) had multiple subtypes of barotrauma. Mean VT (mL/kg) was 6.9mL and median days to onset of barotrauma after intubation was 2 days. Conclusions Our analysis supports other findings associating ventilation parameters with the incidence of barotrauma in COVID-19 related illness. Although there is literature available to link elevated serum ferritin to COVID-19 related illness, its relationship to barotrauma has not been established. Convalescent plasma administration is not otherwise associated with barotrauma in the current literature. These findings should be confirmed by a larger, well powered investigation.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126889472","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}