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

{"title":"Estimation of Excess Mortality Resulting from Use of a Ventilator Triage Protocol Under Sars-CoV-2 Pandemic Surge Conditions","authors":"J. Grand-Clément, V. Goyal, C. W. Chan, M. Gong, E.C. Chuang, J.-T. Chen, P. Cuartas","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2589","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2589","url":null,"abstract":"Rationale: COVID-19 hospitalizations continue to surge rapidly throughout the world. Given the high morbidity and mortality and prolonged duration of illness experienced by patients with respiratory failure due to COVID-19, shortages of ventilators are expected. In New York State, the Crisis Standards of Care guidelines were codified by the New York State Taskforce on Life and the Law in the 2015 Ventilator Triage Guidelines (NYS guidelines). These guidelines outline clinical criteria for triage, including exclusion criteria and stratification of patients using the Sequential Organ Failure Assessment (SOFA) score. We aimed to estimate the excess mortality that would be associated with implementation of triage processes using this protocol. Methods: We included all 5,028 patients who were admitted with COVID-19 in three acute care hospitals at a single academic medical center in the Bronx from March 1, 2020 to May 27, 2020 during the peak of the pandemic surge in New York City. Importance sampling was used to estimate the likelihood of patient trajectories under the NYS guidelines and estimate survival rates. Pessimistic and optimistic estimations were derived to account for potential unobserved confounders. Overall estimated survival was then calculated over a range of hypothetical ventilator shortages (e.g. if it has not been possible to acquire the additional ventilators that were procured in the Spring) from 85-100% availability of the total ventilator capacity of these facilities. Results: The average age of the sample was 64.2 (SD 16.2) and 47% were female. The observed survival rate was 74.16%. A total of 721 patients (14%) required mechanical ventilation during admission. If there has been a ventilator shortfall with ventilator capacity at 85% and the NYS guidelines were enacted in this setting, the estimated survival would be between 70.3% (pessimistic estimation) and 71.5% (optimistic estimation) (Figure 1). Conclusions: A shortfall of ventilators at 85% ventilator capacity requiring implementation of the NYS guidelines triage protocol would have resulted in 2.7-3.9% excess mortality in hospitalized patients with COVID-19 during the pandemic surge, or 134-194 additional deaths. This study is limited by the exclusion of COVID-19 negative patients, who would be in the triage pool in an actual triage situation. Future directions include using this data set to compare NYS guideline performance to other triage strategies including first-come first-served and random allocation to better understand the utility of SOFA score-based triage strategies.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"18 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":"122216256","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":"Hospitalized COVID-19 Patients with Active Lymphoma Have Eight Times Higher Risk of Death Than COVID-19 Controls","authors":"A.M. Vagonis, A. MacMillan, M. Kashiouris, P. Jackson, H. Mahmud, R. Uber, M. Mahashabde, P. Nana-Sinkam","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2598","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2598","url":null,"abstract":"BACKGROUND: Over 790,000 patients in the United States are currently living with or are in remission from lymphoma. It is established that lymphoma patients are at greater risk for both bacterial and viral infections. While there is limited research examining the risk of COVID-19 infection in patients with an active malignancy, even fewer studies have examined those with active lymphoma. This study aimed to examine the all-cause mortality of COVID-19 patients with active lymphoma compared to hospitalized COVID-19 control patients. METHODS: We performed a retrospective case-control and cohort study of adult inpatients diagnosed with COVID-19 infection in a tertiary, academic referral center in Richmond, Virginia. We analyzed the unadjusted and adjusted association of patients with active lymphoma diagnosis and all-cause hospital mortality. We performed multiple logistic regressions adjusting for age, gender, race, the month at presentation, which captures the health system's adaptation, and the remaining 30 individual diagnostic categories of the Elixhauser comorbidity index. We externally validated our findings using compiled data from 657 institutions across the United States on patients with lymphoma hospitalized for COVID-19. RESULTS: Among 628 inpatients with COVID-19, 1.1% (7) had active lymphoma. The unadjusted mortality of patients with lymphoma was 57.1% compared to 8.4% of the corresponding patients without lymphoma. The unadjusted OR for hospital death was 15.6 (95% CI 3.2 to 67, P=0.001). The adjusted OR of death in patients with lymphoma was 79.5 (95% 6.4 to 983, P= 0.001). The average adjusted mortality in patients with lymphoma was 65% compared with 8.4% among patients of equivalent age, gender, race, month of presentation and comorbidities. From aggregate data of COVID-19 patients across 657 US institutions, the average mortality for patients with lymphoma was 41.07% (95% CI 36.8 to 45.3) and for patients without lymphoma was 12.11% (95% CI 12.7 to 11.5). CONCLUSION: Our results show that, of those patients hospitalized for COVID-19 infection, the patients with active lymphoma have a nearly 8-fold increased risk of death compared to their non-lymphoma counterparts when adjusted for age, gender, race, month of presentation, and other comorbidities. External validation data demonstrated a greater than 3-fold increased risk of death in COVID-19 patients with active lymphoma compared to non-lymphoma patients. This research highlights the importance of mitigation strategies, such as social distancing and masking, to decrease the risk of COVID-19 infection in lymphoma patients and may have implications for prioritizing vaccines or therapies in the future. FIGURE:.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"19 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132871566","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":"Thromboelastography (TEG) in COVID-19 Patients - Not All Hypercoagulable","authors":"I. Yousef, P. Desai, S. Sehgal, R. Gupta, M. Gordon, M. Weir, N. Ali, G. Criner, A. Rao, P. Rali","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2580","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2580","url":null,"abstract":"Introduction COVID-19 can lead to a severe inflammatory response and cytokine storm, which is associated with activation of blood coagulation, platelets, and endothelium leading to a severe prothrombotic state. Recent studies have interpreted TEG parameters of increased maximum amplitude (MA) and alpha angle (AA) as indicating a hypercoagulable pattern in patients with COVID-19. The definition of hypercoagulability in literature has been variable while some have used increased MA, others used increased coagulation index (CI) as a surrogate for a hypercoagulable state. Here we report our center experience using TEG to evaluate coagulation in COVID-19 patients. Methods Retrospective analysis of 37 critically ill patients that were evaluated using TEG on a single occasion along with standard coagulation tests. We defined hypercoagulable pattern as CI > 3;hypocoagulable pattern was defined as CI <-3;and normal pattern if CI was between-3-3. Results TEG patterns were interpreted as hypercoagulable in 5 (13.5%), normal in 22 (59.5%) and hypocoagulable in 10 (27%) patients using the TEG coagulation index (CI). MA and AA were elevated in 13 (35.1%) and 10 (27%) patients, respectively, and both were elevated in 8 (21.6%). Discussion Our results show a normal TEG pattern in most of our critically ill COVID-19 patients based on CI (Figure 1);only 5 (13.5%) showed a hypercoagulable pattern. These findings differ from previous reports of TEG in COVID-19 patients, where a hypercoagulable TEG pattern was shown in 83-90% of patients, in these reports interpretation of hypercoagulability was based on AA or MA. We used the CI to define a hypercoagulable state, which has been used to define hypercoagulability in orthopedic surgery and during pregnancy. An elevated MA or AA was seen in only 15 (40%) of our patients. Plasma fibrinogen, an acute-phase reactant, is also elevated in COVID-19 patients. The mean fibrinogen level in our patients was 364 mg/dl, which is lower than those reported by Panigada and Mortus, where mean fibrinogen levels were 680 and 740 mg/dl, respectively. The high MA may reflect the high fibrinogen observed in COVID-19 patients and this may explain the differences in the number of patients considered as “hypercoagulable” in our cohort compared to others. Conclusion;Our study in COVID-19 patients advances a caution in the interpretation of TEG parameters and its use as an indicator of a hypercoagulable state in COVID-19 patients.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":" 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132094022","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":"Hypothyroidism Associated with Triple Mortality in Patients Hospitalized with COVID-19","authors":"R. Uber, A. MacMillan, M. Kashiouris, P. Jackson, H. Mahmud, A.M. Vagonis, M. Mahashabde, P. Nana-Sinkam","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2593","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2593","url":null,"abstract":"BACKGROUND: Many conditions have been associated with severe COVID-19 disease. To date, the risk associated with pre-existing hypothyroidism remains unclear. Hypothyroidism affects the innate immune system. Patients with hypothyroidism have higher circulating inflammatory markers, which are associated with increased mortality in COVID-19. A prior study did not find a significant difference in the risk of hospitalization or death in patients with pre-existing hypothyroidism. This study aims to investigate a possible association between pre-existing hypothyroidism and death from COVID-19. METHODS: We performed a retrospective cohort study of adult inpatients diagnosed with SARS-CoV-2 infection in a tertiary, academic referral center in Richmond, Virginia. We analyzed the unadjusted and adjusted association of patients with a past medical history of hypothyroidism and all-cause hospital mortality. We performed adjusted logistic regressions adjusting for age, gender, race, the month at presentation (an adaptation of the health system), and the remaining 30 individual diagnostic categories of the Elixhauser comorbidity index. RESULTS: Fifty-three (8.2%) of the 649 COVID-19 inpatients had hypothyroidism. Patients with hypothyroidism were, on average, 15.3 years older (95% CI 10.3 to 20.4 years). The unadjusted mortality of patients with hypothyroidism was 22.6% compared with 7.4% in patients without hypothyroidism. The unadjusted mortality OR was 3.5 (95% CI 1.7 to 7.2, P=0.001). The adjusted OR for death was 3.6 (95% CI 1.4 to 9.3, P=0.007, abstract figure). The average adjusted mortality was 18.6% for patients with hypothyroidism compared with 7.8% in patients with equivalent age, gender, race, remaining comorbidities, and month of presentation. CONCLUSION: Our results suggest that pre-existing hypothyroidism is associated with a three-fold risk of death in patients hospitalized with COVID-19. There are conflicting reports in the literature on the association between hypothyroidism and severe COVID-19. Earlier descriptive studies did not report rates of thyroid disease in their cohorts. Further research is needed on the pathophysiology and effects of SARS-CoV-2 infection in hypothyroid individuals.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"7 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":"121211680","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":"N-Acetyl Cysteine versus Standard of Care for Non-Acetaminophen Induced Acute Liver Injury: A Systematic Review and Meta-Analysis","authors":"R. Baniya, D. Shrestha, P. Budhathoki, A. Adhikari, A. Poudel, B. Aryal, P. Prasai, Y. Sedhai","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2573","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2573","url":null,"abstract":"","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"39 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":"116192178","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":"Titration of Mechanical Ventilation in Supine Compared to Prone Position Reveals Different Respiratory Mechanics Behavior in Covid19 Patients","authors":"C. Morais, G. Alcala, R. Santiago, H. Wanderley, E. Diaz Delgado, R. Di Fenza, B. Safaee Fakhr, S. Gianni, R. Kacmarek, L. Berra","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2606","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2606","url":null,"abstract":"INTRODUCTION: The prone position and protective lung ventilation are the only interventions to improve survival in Acute Respiratory Distress Syndrome (ARDS) patients. Due to early reports during the COVID-pandemic showing dramatic improvements in oxygenation, the use of prone position has been broadly adopted in intubated patients around the globe. However, it remains unclear on whether titration of ventilation should be reassessed when the patient is repositioned. Therefore, the objective of this study was to characterize the response of respiratory mechanics in supine and prone positions during a decremental end-expiratory positive pressure trial in COVID-19 related ARDS patients. METHODS: This is a retrospective analysis of patients with COVID-19 related ARDS under invasive mechanical ventilation in supine and prone positions. The study was approved by the Investigational Review Board at the Massachusetts General Hospital and by the Ethics and Research Committee at Heart Institute (InCor) from the University of São Paulo. Prone position was recommended based on hypoxia, measured as PaO2/FIO2 ratio (< 150 mmHg). Patients were sedated, and under volume-controlled ventilation (5-6 mL/Kg PBW). Airway pressure, flow, esophageal pressure and electrical impedance tomography (EIT) were recorded. A decremental PEEP trial was performed on supine and prone position. RESULTS: We included 10 patients with COVID-19 related ARDS. Median age was 62 years (range, 35-72), 5 patients (50%) were female, and BMI was 35 (range, 27-46). After 24 hours of intubation, median PaO2/FIO2 was 174 mmHg (IQR, 166-192), PEEP was 10 cmH2O (IQR, 10-14.5), and static compliance of respiratory system (CRS) was 28.5 mL/cmH2O (IQR, 24.2-35.7). The time interval between intubation and the supine-prone assessment was 7 days (IQR, 5-10). During the supine/prone assessment, a variety of CRS responses were observed among patients (Figure 1). Overall, the highest CRS was 44 mL/cmH2O (IQR, 29-57) in supine and 52 mL/cmH2O (IQR, 39-67) in prone position. At the highest CRS, from supine to prone position: lung compliance (CL) increased by 15 mL/cmH2O (IQR, 13-31), suggesting lung recruitment, and chest wall compliance (CCW) was reduced by 28 ml/cmH2O (IQR, 14-48) indicating external compression of the chest;and end-expiratory transpulmonary pressure (PLend-exp) increased from-3.4 cmH2O (IQR,-4.6 to-2.5) to 0.4 cmH2O (IQR, 0.1-3.0) suggesting decreased pleural pressure. CONCLUSION: Patients with COVID-19 related ARDS assessed in supine and prone positions revels a variety response to prone position on CRS during decremental PEEP trial, suggesting the necessity to reassess the PEEP when the patient is repositioned. (Table Presented).","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"24 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":"114913214","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 COVID-19 Pandemic on Crude Mortality Rates Associated with Acute Kidney Injury Requiring Continuous Renal Replacement Therapy: A Single-Center Study","authors":"D. Perez Ingles, Á. Illescas, N. Perryman Collins, N. Jordyn A, J. Marinaro, C. Argyropoulos, J. P. Teixeira","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2582","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2582","url":null,"abstract":"RATIONALE Acute kidney injury requiring renal replacement therapy (AKI-RRT) in the intensive care unit (ICU) is associated with significant mortality, with short-term death rates often exceeding 50% in modern cohtorts.1 Similarly high mortality with AKI-RRT has been reported in multiple U.S. cohorts of patients with coronavirus disease 2019 (COVID-19)2-4, but none have specifically focused on the outcomes of AKI treated with continuous RRT (CRRT) in the ICU or compared the outcomes of AKI-CRRT to COVID-negative controls. METHODS We carried out a retrospective review of all patients admitted to the University of New Mexico Hospital and initiated on CRRT in January to October 2020 and compared outcomes between those with and without symptomatic COVID-19. Patients felt to be incidentally infected with COVID-19 and those with end-stage kidney disease (ESKD) were excluded. Crude death rates in AKI-CRRT patients with and without COVID-19 were compared by chisquared test. Patients discharged before 30 days were assumed alive at 30 days. RESULTSA total of 102 patients were treated with 103 CRRT treatments over the 10-month period. Of these, two felt to be incidentally infected were excluded. Ten with ESKD, including three with COVID-19, were also excluded. Of the remaining 90 with AKI-CRRT, 30 were treated for symptomatic COVID-19 starting in April 2020 and had 30-day and in-hospital mortality rates of 67.7% and 80.0%, respectively. Of the 60 COVID-19-negative patients with AKI-CRRT, the 30-day and in-hospital mortality rates were 58.3 and 63.3%, respectively (p = 0.44 and = 0.11, respectively, versus COVID-positive patients). When broken into pre-pandemic and post-pandemic groups, the 30-day and in-hospital death rates for AKI-CRRT in COVID-negative patients were 56.5% and 60.9% in January to March and 59.5% and 64.9% in April to October, respectively (p = &gt;0.05 for both comparisons). CONCLUSIONS These data confirm the high mortality associated with AKI-CRRT in the setting of severe COVID-19. Though not statistically significant in this limited sample, the trend for higher in-hospital mortality in COVID-19 patients suggests the mortality of AKI-CRRT in this setting may be higher than other ICU patients. Notably, the mortality of AKI-CRRT in COVIDnegative patients did not significantly differ before and after the start of the pandemic. Overall, while conclusions about the independent effect of COVID-19 are limited with these unadjusted data, awareness of the high mortality of AKI-CRRT in the setting of COVID-19 may be useful in discussing prognosis and goals of care in these patients.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"16 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":"125319919","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":"Invasive Ventilation and Increased COVID-19 Mortality: A Propensity-Score Matched Retrospective Cohort Study","authors":"A. Parish, J. West, N. Caputo, J. Zhang, D. Singer","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2602","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2602","url":null,"abstract":"Rationale: There has been controversy about the timing and safety of intubation and mechanical ventilation in coronavirus disease (COVID-19).Objectives: To determine the effect of intubation and mechanical ventilation on all-cause, in-hospital mortality for COVID-19 patients.Methods: Retrospective cohort study of adult patients who tested positive for COVID-19 in the emergency department and were subsequently admitted to one of 11 New York City municipal hospitals. Patients with do not intubate orders were excluded.Measurements and Main Results: Data from 6591 COVID-19 patients were included;of these, 1633 (25%) were intubated overall and 791 (12%) were intubated within 48 hours of triage. After controlling for likely confounders, intubation rates for COVID-19 patients varied significantly across hospitals and decreased as the pandemic progressed. After nearest neighbor propensity score matching, intubation within 48 hours of triage was associated with higher allcause mortality (hazard ratio = 1.34, 1.09 to 1.65, p = 0.006), as was intubation at any time point (hazard ratio = 1.22, 1.02 to 1.45, p = 0.026). These results remained robust to multiple sensitivity analyses.Conclusions: Intubation and mechanical ventilation was associated with increased mortality in COVID-19 patients. Further caution should be taken in attempting to avoid intubating these patients.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":" 40","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120830805","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":"Characteristics and Outcomes of In-Hospital Cardiac Arrests in Patients with SARS-CoV-2 Infection","authors":"K. L. Richards, A. Mcclafferty, R. Singh, J. Herlihy, M. Senussi, A. Omranian","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2597","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2597","url":null,"abstract":"Background: Cardiopulmonary resuscitation poses unique challenges in patients with SARS-CoV-2 infection who develop in-hospital cardiac arrest (IHCA). Recent studies have shown variable rates of survival for IHCA in patients with COVID-19. Our study aims to describe and compare characteristics and outcomes of patients with and without COVID-19 who developed IHCA. Methods: In this single-center retrospective study, we studied 162 adult patients from Baylor St. Luke's Medical Center in Houston, Texas during the first COVID-19 surge (March to August 2020). Eligible patients were those with IHCA who were identified through the Getting with the Guidelines-Resuscitation registry. Patients with Do-Not-Resuscitate orders were excluded. Demographics, comorbidities, and IHCA characteristics were determined and abstracted from electronic health records. Characteristics and outcomes of COVID and non-COVID patients were compared. Results: Thirty-one COVID and 131 non-COVID IHCA occurred at Baylor St. Luke's Medical Center from March to April 2020. Age was similar between the groups, with higher male predominance in the COVID arrest group (81% vs 55%, p=0.005). There was a significantly higher proportion of Hispanic (32% vs 15%) and Asian patients (13% vs 3%) and a lower proportion of black (19% vs 37%) and white patients (29% vs 41%) in the group of COVID arrests. The COVID IHCA group had less comorbid heart failure (16% vs 47%, p =0.005), right ventricular dysfunction (16% vs 34%, p=0.13), COPD (0 vs 13%, p=0.034) and malignancy (3% vs 19%, p=0.031), but higher rates of diabetes (74% vs 42%, p=0.002) and asthma (16% vs 1%, p<0.001). The COVID IHCA group had higher oxygen requirements on admission (median FiO2 0.36 vs 0.21, p=0.01) and at the time of cardiac arrest (median FiO2 0.4 vs 1.0, p<0.001) and there was a trend toward arrests later in the hospital stay when compared to the non-COVID IHCA group (30% occurring in the first 72 hours vs 42%, respectively). IHCA survival was lower in those with COVID (55% vs 74%, p=0.035). Conclusion: There were significant differences in demographics and comorbidities between patients with and without COVID-19 who developed IHCA at our institution. Survival rates were lower in COVID patients, though our institution's 19% rate of survival to discharge is higher than those of previous studies.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"106 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":"116333751","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":"Role of Co-Trimoxazole in Patients with COVID-19 with Acute Respiratory Failure Requiring Non-Invasive Ventilation: A Single Center Experience","authors":"S. Singh, P. Kumar, T. John","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2617","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2617","url":null,"abstract":"IntroductionCOVID-19 may become a potentially life threatening condition presenting with acute respiratory failure secondary to acute respiratory distress syndrome mediated by cytokine storm syndrome. There are no effective evidence based treatment available for this condition except steroids. The mainstay of treatment is only supportive. MethodsData from consecutive, newly diagnosed patients with COVID-19 with acute respiratory failure on non-invasive ventilation receiving oral co-trimoxazole in addition to standard therapy presenting to the Intensive Care Unit of IQ City Medical College Hospital, Durgapur, West Bengal, India between June 2020 and October 2020 was retrospectively collected. Results142 patients were identified (Age (59±13 years), 81% Male and BMI (28±2)). Co-morbidities included hypertension (60%, n=85), diabetes mellitus (40%, n=57), coronary artery disease(11%, n=15), chronic obstructive pulmonary disease (9%, n=13), chronic kidney disease (3%, n=4) and cancer (0.70%, n=1). The commonest symptom was breathlessness which was present in 100% of patients. 16% (n=23) patients required intubation with mean length of stay in hospital of 10±4 days and an inpatient mortality of 13% (n=18). There was a significant fall in the C Reactive protein after 7 days of treatment with co-trimoxazole (mean 193±39mg/L (day 0) vs 37±42mg/L (day 7), p<0.001). ConclusionThis case series suggests that co-trimoxazole may potentially improve outcomes in patients with severe to critical COVID-19. This may be due to its antimicrobial and anti-inflammatory properties. A randomized control trial in patients with severe COVID-19 on cotrimoxazole is underway.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"21 4 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":"134129077","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}