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

{"title":"Evaluation of Droplet and Aerosol Dispersion Under High Flow Nasal Cannula With or Without Surgical Mask","authors":"K. Yamamoto, T. Takazono, R. Okamoto, S. Morimoto, N. Hosogaya, M. Tashiro, T. Miyazaki, K. Yanagihara, K. Izumikawa, H. Mukae","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2608","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2608","url":null,"abstract":"Rationale: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), transmit by droplet and aerosol particles. Droplets and aerosol generation during the oxygen delivery methods such as high flow oxygen therapy (HFNC) and noninvasive positive pressure ventilation (NPPV) during COVID-19 respiratory care, may poses a risk of increasing transmission to healthcare workers. We aimed to evaluate droplet and aerosol dispersion associated with oxygen delivery modes, and further to verify the effect of surgical mask (SM) on preventing particle dispersion.Methods: Two experiments were performed at the laboratory of Shin Nippon Air Technologies, Japan, to visualize (Experiment 1) and to quantify (Experiment 2) dispersing particles. Three (Experiment 1) and five (Experiment 2) healthy Japanese male volunteers aged 30-40s and non-smokers, were recruited. For visualization study (Experiment 1), dispersing particles (>5μm) were recorded by ultra-high sensitive video camera 'eye scope'. For quantification study (Experiment 2), two types of micro-particle detection panel 'Type S' which counts particles > 0.5μm or >5μm were used under air-controlled room with down-flow of 0.3m/sec to avoid contamination of dusts and to drop aerosols on Type S panel. Five patterns of oxygen delivery modalities (No device, 5L/min of nasal cannula, 30L/min or 60L/min of HFNC, 10L/min of oxygen mask, and NPPV) with and without SM, while three breathing patterns (rest breathing, speaking, and coughing) were recorded. The differences in continuous numbers between corresponding two groups were analyzed by ratio paired t-test. A P-value <0.05 was considered as statistically significant.Results: Droplets were able to visualize at further than 50cm while speaking, and further than 1m while coughing. Without SM, droplets were more visible with nasal cannula compared to HFNC. SM effectively reduced droplets under each oxygen delivery modes, and they are hard to visualize even in speaking or coughing. In NPPV mode, floating droplets were visible while coughing. Droplets and aerosols were counted 10-times more while coughing compared to speaking. SM significantly reduced both of droplets and aerosol dispersion while speaking or coughing regardless of oxygen delivery mode. Reduction rate of dispersion under HFNC was higher compared to nasal cannula. 60L/min of HFNC did not increase droplets or aerosol dispersion by counts or by distance compared to 30L/min of HFNC. SM effectively reduced over 90% of droplets and over 95% of aerosols during HFNC mode.Conclusions: SM over HFNC mode may be used safely in appropriate infection control setting and recommended for acute hypoxemic respiratory failure in COVID-19 patients.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"74 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":"114536120","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 Emergent Endotracheal Intubation During the Novel Coronavirus 2019 Pandemic","authors":"P. Nauka, A. Shiloh, L. Eisen, D. Fein","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2601","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2601","url":null,"abstract":"Introduction: Both international and institutional guidelines regarding intubation practices during the COVID-19 pandemic advocate for interventions that maximize first pass success and minimize infectious risk to operators. The impact of the advocated practice changes remains unknown. We conducted a retrospective study to determine how the COVID-19 pandemic has changed outcomes associated with emergent endotracheal intubation (EEI). Methods: We conducted a retrospective cohort study examining patients admitted to Montefiore Medical Center (Bronx, NY) between July 19, 2019 and May 1, 2020. Patients were eligible for inclusion if they underwent an EEI performed outside the operating room by the critical care service. Exclusion criteria included intubations performed in the emergency room, pediatric patients or repeat intubations of the same patient. The patient cohort was split into a pandemic group undergoing intubation after March 11, 2020 and a historical control group intubated prior to this date. The primary outcome was the rate of first pass success (FPS). Secondary outcomes included periprocedural adverse events and mortality within 24 hours following the procedure. Logistic regression was used to compare the primary outcome against the exposure variable with correction for potential confounders. Results: The final cohort consisted of 478 patients undergoing EEI during the pandemic and 782 prior to the pandemic. Baseline characteristics are summarized in Table 1. During the pandemic, operators were more likely to utilize neuromuscular blockade (86.0% vs 46.2%;P<0.001), video laryngoscopy (89.3% vs 53.3%;P<0.001) and sedation (90.1% vs 77.8%;P<0.001). FPS occurred more frequently during the pandemic (96.4% vs 82.9%, OR 5.61, 95%CI: 3.34-9.42;P<0.001). The higher rate of FPS persisted after multivariable adjustment (adjusted OR 4.40, 95%CI: 2.46-7.87;P<0.001). Patients undergoing intubation during the pandemic were more likely to have a periprocedural complication (29.1% vs 14.1%, adjusted OR 2.16, 95%CI: 1.46-3.18;P<0.001) which was mainly driven by hypoxemia (25.7% vs 8.2%, adjusted OR 2.78, 95%CI: 1.78-4.35;P<0.001). There was no difference in the 24-hour mortality rate during the pandemic (19.3% vs 18.3%, adjusted OR 1.26, 95%CI: 0.86-1.84;P=0.23). Conclusions: Emergency intubation during the COVID-19 pandemic was associated with a higher rate of FPS. This improved procedural success may in part be attributed to changes in intubation practice. The observed practice changes and improved procedural success did not correlate with improvement in peri-procedural adverse events, an observation that may stem from the differences between the studied cohorts such as the tendency of patients with COVID-19 to be prone to hypoxemia. (Table Presented).","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"108 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":"133560660","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":"The Palliative Paradigm - A Safety Net Hospital Experience with Covid-19","authors":"D. Bhowmik, L. Pereira, L. Shaiova, S. Sahni","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2594","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2594","url":null,"abstract":"Rationale: The Covid-19 pandemic is the worst healthcare event seen this century amassing a high toll of human life. Covid-19 infection is most commonly associated with acute hypoxic respiratory failure, often requiring intubation leading to multi-organ failure and death. Palliative medicine, during the pandemic, more than ever became in demand especially in ICU settings with a steep increase in consults for pain and symptom management, prognosis clarification and goals of care. We decided to analyze the effect on our palliative medicine service at a safety net hospital at the initial epicenter of the Covid-19 pandemic. Material and Methods: We conducted a retrospective analysis of the Palliative Medicine service at Brookdale University Hospital Medical Center in the months before and after the pandemic from November 2019 to May 2020. We analyzed the number of consults placed per month and the use of IV methadone, novel to our institution used to address breathlessness and pain. To assess the increase in palliative consults we used a linear regression model over time transcending the start of the Covid-19 pandemic. We also queried the orders of intravenous methadone use utilizing pharmacological records, which was only used under the discretion of palliative care and in end of life or terminal settings as is would address breathlessness. Results: Retrospective analysis revealed that in the months leading up to the pandemic including November 2019 through February 2020 there were an average of 80.25± 8.08 palliative consults placed a month. In the months during the initial peak of the Covid-19 pandemic including March and April 2020 there were an average of 162.0± 69 consults per month which then reduced to 69 consults in the month of May 2020. A linear regression calculation was performed which showed an equation of y = 30.6+21.9714X (R2= 0.7794 p=.067). Intravenous methadone was not used prior to the pandemic which was noted to have been ordered 14 times in April 2020 for breathlessness and pain management. Conclusion: We found an increase in the amount of palliative consults placed during the Covid-19 pandemic though not statistically significant with an eventual downtrend. This is thought to be due to distressing symptoms in an acutely life threatening illness and the need for early consultation due to the knowledge and unique skill set that palliative specialists possess. Physicians in acute care settings need be comfortable to consult palliative services early in management.","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":"134317151","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":"A Description of Post Intensive Care Syndrome in COVID19 Survivors","authors":"K. Kommaraju, M. Biehl, E. Bishop, J. Veith, K. Sarin, J. O’Brien, K. Bash, M. Holztrager","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2588","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2588","url":null,"abstract":"RATIONALE: Over 40 million people have recovered from COVID-19. Many of them are intensive care unit (ICU) survivors who are known to frequently face Post Intensive Care Syndrome (PICS), a constellation of new or worsening physical, mental and cognitive impairments that occur after ICU stay. There is scarce data describing PICS in COVID-19 survivors. The Cleveland Clinic established a new Post ICU Recovery Clinic (PIRC) that began seeing COVID-19 survivors in May 2020. The objective of this abstract is to report the incidence of PICS in COVID-19 ICU survivors.METHODS: A retrospective chart review of all COVID-19 patients seen in PIRC from December 2019 to September 2020 was performed. In-hospital variables collected included demographics and clinical course. PIRC visit variables collected included oxygen requirement, scores on several validated questionnaires screening for depression, anxiety, post-traumatic stress disorder (PTSD), cognitive function, instrumental and activities of daily living (iADL and ADL), 6-minute walk test, pulmonary function tests, and change in occupational and driving status. Statistics reported reflect exclusion of the missing data points. RESULTS: A total of 63 patients were seen in PIRC. COVID-19 ICU survivors comprised of 83% (n= 52) and of these, 46.2% (n = 24) had ARDS. Our population was 58% male with near equal Caucasian and African American distribution. The median hospital and ICU length of stay was as 12.5 (IQR 9.0-18.5) and 6 (3.0-12.0) days respectively. PIRC visits took place roughly two months after hospital discharge and 61% (n=31) were virtual visits. Twenty one (45%) patients had a new oxygen requirement, six (38%) had new mild or moderate cognitive impairment as identified by the Montreal Cognitive Assessment (MOCA), 11(52%) screened positive for new anxiety or depression as identified by the Patient Health Questionnaire-4 (PHQ-4), three patients screened positive for new PTSD as identified by the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) or Impact of Event Scale-Revised (IES-R) survey. Majority were independent in all ADL and iADL (91% and 71% respectively). Median distance on 6-minute walk test, % predicted of FEV1, FVC, TLC, and DLCO was 1205 feet, 86.2, 79.7, 74.9, and 62.4 respectively. From the 64% of patients who were working and 94% who were driving prior to hospitalization, only 26% and 78% had returned to those activities respectively. CONCLUSIONS: COVID-19 ICU survivors experience every aspect of PICS two months after hospital discharge. These survivors require comprehensive evaluation to facilitate diagnosis and identify treatments to promote holistic recovery.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"144 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":"125224370","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":"Discharge D-Dimer and Mortality Following Admission for 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.a2572","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2572","url":null,"abstract":"Background: Coronavirus disease 19 is known to be associated with increased incidence of thromboembolic disease. D-Dimer elevation is commonly identified on presentation. We looked at discharge D-Dimer if it correlated with mortality Methods: We analyzed all adults between March and September 2020 who were discharged alive after presentation to the emergency department or admission to the hospital for COVID19 infection within the University Hospitals Health System in Northeast Ohio. Discharge d-dimer was defined as the last d-dimer within 15 days of discharge from hospital. Kaplan-Meier and cox regression analyses were performed to explore the association with mortality. Results: A total of 560 patients were included. Mean age was 58±18 years. A total of 97 patients were managed in the intensive care unit, 424 were managed as inpatient, and 39 patients were managed in the emergency department. The median time between last d-dimer and discharge date was 0 [-2 to 0] days. The median discharge d-dimer was 840 [505-1580] ng/ml. At a median follow-up of 124 days, 100 patients died (90-day mortality of 5%). The 90-day mortality was 1% for tertile 1, 3% for tertile 2, and 12% for tertile 3 of last d-dimer, figure. Compared with tertile 1, patients in tertile 3 of discharge d-dimer had 10-fold higher mortality (age-adjusted HR 9.62 [2.11-43.92], P<0.001). In Discharge d-dimer had a good discriminative power for mortality (AUC=0.80). A discharge d-dimer of 1717 ng/ml was determined to be the best threshold for mortality (sensitivity of 70% and specificity of 81%). Conclusions: Patients discharged with high D-Dimer are at increased risk of death. We speculate that this elevation is a reflection of hypercoagulability resulting in thromboembolic events and poor outcome. Further studies to determine the role of out-patient anticoagulation in reducing this risk are needed.","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":"126616692","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":"Long-Term Acute Care Hospital Outcomes of Mechanically Ventilated Patients with COVID-19","authors":"M. Saad, F. Laghi, J. Brofman, N. Undevia, H. Shaikh","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2603","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2603","url":null,"abstract":"Background: Patients with coronavirus disease 2019 (COVID-19) requiring prolonged mechanical ventilation are commonly weaned at long-term acute care hospitals (LTACHs). Data on the clinical characteristics and outcomes of these patients is lacking. Objectives: To describe for the first-time clinical characteristics and outcomes of a cohort of patients with COVID-19 transferred to two Chicago-area LTACHs for weaning from prolonged ventilation during the initial three months of the city's outbreak. Methods: Out of 88 consecutive COVID-19 patients transferred to the LTACHs from April 17, 2020 to June 30, 2020, 73 required weaning from prolonged ventilation. Demographic, clinical, and laboratory data were collected and analyzed. Final date of follow-up was November 30, 2020. Results: Prior to LTACH transfer, median (interquartile range) number of ventilator days of COVID-19 patients was 34 (27.0-40.5). Median age was 62.0 years (55.0-71.5);26 (35.6%) patients were women. Sixty-seven (91.8%) had a least one comorbidity, most commonly hypertension (58.9%) and diabetes (52.1%). Fifty-six (76.7%) patients were successfully weaned in 7.5 days (4.0-17.8). LTACH mortality was 9.6%. As of November 30, 2020, 1 COVID-19 patient (1.4%) was still in the LTACHs, 15 (20.5%) were discharged home, 50 (68.5%) discharged to other facilities. Conclusion: Most COVID-19 patients transferred to two Chicagoarea LTACHs successfully weaned from prolonged mechanical ventilation.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"9 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":"130905493","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 Noninvasive Ventilation Versus High Flow Nasal Cannula for Covid-19 Related Acute Hypoxemic Respiratory Failure","authors":"S. Pearson, M. Stutz, P. Lecompte-Osorio, K. Wolfe, A. Pohlman, J.B. Hall, J. Kress, B. Patel","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2599","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2599","url":null,"abstract":"RATIONALE: A high percentage of patients with Covid-19 associated acute hypoxemic respiratory failure (AHRF) receive invasive mechanical ventilation, which is associated with a high mortality. Noninvasive ventilation (NIV) offers an alternative to invasive mechanical ventilation, though its role in both de novo AHRF and pandemic viral pneumonia has been controversial. Our group has previously demonstrated that NIV delivered by helmet reduces endotracheal intubation rates and improves mortality in patients with acute respiratory distress syndrome when compared to facemask NIV in a randomized controlled clinical trial (1). Limited data are available on the comparative efficacy of noninvasive respiratory support strategies in patients with AHRF due to Covid-19. NIV by helmet interface offers a promising strategy for these patients and may avert the need for endotracheal intubation. METHODS: All patients with Covid-19 associated AHRF admitted to the intensive care unit and managed initially with noninvasive respiratory support between March 1 and July 31, 2020 were identified. Those who received helmet NIV were matched with patients who received HFNC (high flow nasal cannula) using propensity scores in a 1:1 ratio without replacement. Baseline characteristics and therapies that differed on univariable analysis were used for matching. After matching, univariable analysis was conducted comparing the HFNC and helmet NIV groups. RESULTS: 78 patients initially managed with HFNC and 31 patients managed with helmet NIV (excluding 7 patients who received helmet NIV after intubation) were identified. Matching resulted in similar groups according to baseline characteristics and therapies received. The primary composite outcome of intubation or inhospital mortality occurred in 20 (64.5%) patients in the helmet group and 20 (64.5%) patients in the control group (absolute difference, 0%;95% CI,-23.4% to 23.4%;p=1.00). In-hospital mortality in the helmet NIV group was similar to that of the HFNC control group (absolute difference-9.7%;95% CI,-34.4% to 15.0%;p=0.45). In patients treated with helmet NIV, gas exchange improved significantly following application with an increase in the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen from 72 to 141 (mean difference, 69;95% CI 26 to 112;p=0.003). CONCLUSIONS: While limited by the small sample size and observational nature, there was no significant difference observed in outcomes of patients with Covid-19 associated AHRF managed with helmet NIV compared to HFNC. After application of helmet NIV, a significant improvement in gas exchange was observed. REFERENCES: 1. Patel BK, et al. JAMA, 2016.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"13 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":"125395527","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 a Nationwide Mass Casualty Event on Intensive Care Units: Clinical Outcomes and Associated Cost-of-Care in the First Six Months of Response to SARS-CoV-2","authors":"A. Henning, D. Williams, D. Shore, M. Memmi","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2590","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2590","url":null,"abstract":"RATIONALE: Mass casualty events (MCE) are situations that overwhelm local capacity and lead to morbidity and mortality. The SARS-CoV-2 pandemic (COVID-19) can be considered a nationwide sustained MCE that affected multiple aspects of healthcare. We hypothesized that the surge of patients and lack of preparation for MCEs resulted in increased patient length of stay (LOS), complications, mortality, and costs associated with care for critically ill patients. METHODS: A multicenter, retrospective cohort study compared patients admitted to an intensive care unit (ICU) in 2019 to 2020. The timeframe was March to August. In 2020, this was the first six months of the nationwide response to COVID-19. 2019 was the historical control. Data were collected from the Vizient Clinical Data Base/Resource Manager™ (CDB/RM) (Irving, TX), a national database of patient outcomes and cost-data from over 700 tertiary/quaternary and community hospitals. Data is reported with an associated severity of illness score. The total number of ICU admissions, complication percentage, ICU LOS, observed and expected LOS, LOS index (ratio of observed-to-expected LOS), observed and expected mortality rate, mortality index (ratio of observed-to-expected mortality), total cost of admission, observed and expected direct cost of admission, and direct cost index (ratio of observed-to-expected direct cost) were collected. Inclusion criteria were all medical centers with complete datasets for the timeframe. All major geographic regions of the United States were included. IBM SPSS Statistics for Windows, version 27.0 (Armonk, NY) was used to summarize data with mean and standard deviation. Independent sample two-sided t-tests were used to compare subgroup means. All cost data were adjusted for inflation using the consumer price index. RESULTS: Twenty health systems and 42,397 patients were included in the study. There was a significant increase from 2019 to 2020 in patient outcomes and cost-of-care (table 1). In 2020, ICU LOS was longer compared to 2019;this was highest at tertiary centers [1.5 days longer] and metropolitan hospitals [1.2 days longer]. There was 1.4% increase in complication rates;this was highest in community hospitals [1.8%] and hospitals in urban regions [1.8%]. On average, the total cost of admission per ICU patient was $5,522 more in 2020. This was highest for tertiary academic centers [$6,870] followed by metropolitan hospitals [$6,469], community hospitals [$4,945] and rural hospitals [$4,102]. CONCLUSION: The MCE caused by the SARS-CoV-2 virus resulted in increased adverse outcomes and cost-of-care for patients admitted to an ICU during the first six months of disaster response.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"104 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":"124059176","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":"How Would New York Ventilator Reallocation Policies Perform During a COVID-19 Surge? An Observational Cohort Study","authors":"B. C. Walsh, D. Pradhan","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2584","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2584","url":null,"abstract":"COVID-19 has created significant strain on the supply of healthcare resources and, during the spring surge in New York City, many hospitals prepared resource allocation policies should the demand for ventilators exceed supply. In such circumstances, resources should remain allocated to patients most likely to survive. Understanding how these guidelines perform is an important consideration in disaster planning. Numerous allocation guidelines exist however nearly all utilize a Sequential Organ Failure Assessment (SOFA) score. We sought to evaluate the performance of ventilator reallocation by applying the New York State Ventilator Allocation Guidelines (NYVAG) to a large cohort of COVID-19 patients. Our retrospective cohort included 895 intubated COVID-19 patients admitted to an academic system in New York City. SOFA scores were calculated for every day of mechanical ventilation. Per NYVAG, patients would have their ventilator reallocated at 48 hours if their interval SOFA score increased, did not change from an initial SOFA of 8-11, or was greater than 11. At 120 hours it would be reallocated if their SOFA score worsened or was greater than 7. At 168 hours and every subsequent 48 hours it would be reallocated if their SOFA score worsened. Ventilator reallocation was simulated and no reallocation was made for any patient. The average SOFA (n=895) at the time of intubation was 7.1 ± 3.6. At the 48-hour reassessment (average SOFA 8.2 ± 3.6, n=759), 436 (57%) patients would have their ventilator reallocated, 145 (33%) of whom would later survive to discharge. At the 120-hour reassessment (average SOFA 7.8 ± 3.6, n=264) 173 (66%) of the 264 remaining simulated ventilated patients would have their ventilators reallocated, 83 (48%) of whom would later survive to discharge. At the 168-hour reassessment (average SOFA 7.8 ± 3.6, n=80) 66 (83%) of the 80 simulated remaining ventilated patients would have their ventilators reallocated. Overall, 685 patients (77%) of the starting cohort would have had their ventilator reallocated at some time during the first 168 hours of mechanical ventilation, 268 (40%) of whom survived to discharge. Our simulated study found that the application of NYVAG to the COVID-19 surge at one academic system would have resulted in a significant portion of ventilated patients having had their ventilators reallocated. This may be deeply concerning as a significant portion of patients ultimately survived to discharge. These results call for further confirmatory studies and have implications for optimal resource allocation strategies during pandemics.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"21 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":"117037217","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":"Long-Term Psychological and Cognitive Outcomes of Patients with COVID-19","authors":"D. Douglas, K. Wolfe, M. Stutz, S. Pearson, P. Lecompte-Osorio, J. Lin, C. Ward, C. Thompson, P. Herbst, A. Pohlman, J.B. Hall, J. Kress, B. Patel","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2574","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2574","url":null,"abstract":"Rationale: Intensive care unit (ICU) survivorship has well documented physical disability1,2 psychological sequelae, and cognitive dysfunction3,4 all combined under the umbrella of Post-Intensive Care Syndrome (PICS). The COVID-19 pandemic is concerning for overwhelming health care resources in the short-term, but the longterm consequences of this large cohort of patients surviving critical illness remains ill-defined. It also remains unclear if the unique context of health care delivery such as lack of visitors and cohorting patients during the pandemic exacerbates the psychological and cognitive impairments of PICS. Methods: All patients admitted to the ICU with COVID-19 were eligible for enrollment in this prospective observational study. We performed a global assessment of cognitive function (using the Montreal Cognitive Assessment tool (T-MoCA)), posttraumatic stress disorder (using the Impact event scale (IES-Revised)), and depression/anxiety (using Hospital Anxiety and Depression scale (HADS)) in ICU survivors at 6 months after hospital discharge. Interviews were conducted via telephone or in-person when possible. Results: From April 10, 2020 thru November 17th, 2020 one hundred patients were enrolled upon hospital discharge. Eighty-two patients reached the 6-month milestone after hospital discharge and 22 (26.8%) of these patients required invasive mechanical ventilation. Of this eligible cohort, seven patients died, two were cognitively unable to complete the evaluations, four refused to participate, and thirteen were lost to follow-up. Fifty-six patients completed the evaluation with 74.7% follow-up (56/75 alive patients). Symptoms of probable post-traumatic stress disorder were reported in 2 patients (3.6%). Depression and Anxiety was reported in 5 patients (8.9%) respectively. Cognitive impairment was present in 47.3% of patients with a median T-MoCA score of 18 [15.5-19]. There was no difference in T-MoCA scores based on whether patients required invasive mechanical ventilation (IMV) (IMV 17 [15-20.5] vs not intubated 18 [16-19];p=0.89). Conclusions: Our preliminary long-term follow-up data suggest that symptoms of post-traumatic stress after COVID-19 infection are rare. In addition, less than 10% of patients reported anxiety and depression six months after hospital discharge. Interestingly, cognitive impairment as measured by T-MOCA was present in almost half of the patients. Further follow-up on the long term effects of COVID-19 related critical illness is warranted as we adapt during this pandemic.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"30 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":"129204662","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}