Acute and Critical Care最新文献

{"title":"Mechanically ventilated COVID-19 patients admitted to the intensive care unit in the United States with or without respiratory failure secondary to COVID-19 pneumonia: a retrospective comparison of characteristics and outcomes.","authors":"Jesse A Johnson,&nbsp;Kashka F Mallari,&nbsp;Vincent M Pepe,&nbsp;Taylor Treacy,&nbsp;Gregory McDonough,&nbsp;Phue Khaing,&nbsp;Christopher McGrath,&nbsp;Brandon J George,&nbsp;Erika J Yoo","doi":"10.4266/acc.2022.01123","DOIUrl":"https://doi.org/10.4266/acc.2022.01123","url":null,"abstract":"<p><strong>Background: </strong>There is increasing heterogeneity in the clinical phenotype of patients admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19,) and reasons for mechanical ventilation are not limited to COVID pneumonia. We aimed to compare the characteristics and outcomes of intubated patients admitted to the ICU with the primary diagnosis of acute hypoxemic respiratory failure (AHRF) from COVID-19 pneumonia to those patients admitted for an alternative diagnosis.</p><p><strong>Methods: </strong>Retrospective cohort study of adults with confirmed SARS-CoV-2 infection admitted to nine ICUs between March 18, 2020, and April 30, 2021, at an urban university institution. We compared characteristics between the two groups using appropriate statistics. We performed logistic regression to identify risk factors for death in the mechanically ventilated COVID-19 population.</p><p><strong>Results: </strong>After exclusions, the final sample consisted of 319 patients with respiratory failure secondary to COVID pneumonia and 150 patients intubated for alternative diagnoses. The former group had higher ICU and hospital mortality rates (57.7% vs. 36.7%, P<0.001 and 58.9% vs. 39.3%, P<0.001, respectively). Patients with AHRF secondary to COVID-19 pneumonia also had longer ICU and hospital lengths-of-stay (12 vs. 6 days, P<0.001 and 20 vs. 13.5 days, P=0.001). After risk-adjustment, these patients had 2.25 times higher odds of death (95% confidence interval, 1.42-3.56; P=0.001).</p><p><strong>Conclusions: </strong>Mechanically ventilated COVID-19 patients admitted to the ICU with COVID-19-associated respiratory failure are at higher risk of hospital death and have worse ICU utilization outcomes than those whose reason for admission is unrelated to COVID pneumonia.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ee/60/acc-2022-01123.PMC10497897.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10238551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of patients with COVID-19 requiring extracorporeal membrane oxygenation and continuous renal replacement therapy in the United States.","authors":"Carlos R Franco Palacios,&nbsp;Rudiona Hoxhaj,&nbsp;Catlyn Thigpen,&nbsp;Jeffrey Jacob,&nbsp;Atul Bhatnagar,&nbsp;Asif Saberi","doi":"10.4266/acc.2023.00115","DOIUrl":"https://doi.org/10.4266/acc.2023.00115","url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease 2019 (COVID-19) infection is associated with significant morbidity and mortality. Some patients develop severe acute respiratory distress syndrome and kidney failure requiring the combination of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT).</p><p><strong>Methods: </strong>Retrospective cohort study of 127 consecutive patients requiring combined ECMO and CRRT support in intensive care units at an ECMO center in Marietta, GA, United States.</p><p><strong>Results: </strong>Sixty and 67 patients with and without COVID-19, respectively, required ECMO-CRRT support. After adjusting for confounding variables, patients with COVID-19 had increased mortality at 30 days (hazard ratio [HR], 5.19; 95% confidence interval [CI], 2.51-10.7; P<0.001) and 90 days (HR, 6.23; 95% CI, 2.60-14.9; P<0.001).</p><p><strong>Conclusions: </strong>In this retrospective study, patients with COVID-19 who required ECMO-CRRT had increased mortality when compared to patients without COVID-19.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f4/7a/acc-2023-00115.PMC10497892.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10238552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of inflammatory immune responses in patients with septic shock receiving vitamin C, hydrocortisone, and thiamine: clustering analysis in Korea.","authors":"Seung-Hun You,&nbsp;Oh Joo Kweon,&nbsp;Sun-Young Jung,&nbsp;Moon Seong Baek,&nbsp;Won-Young Kim","doi":"10.4266/acc.2023.00507","DOIUrl":"https://doi.org/10.4266/acc.2023.00507","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is characterized by heterogeneous immune responses that may evolve during the course of illness. This study identified inflammatory immune responses in septic patients receiving vitamin C, hydrocortisone, and thiamine.</p><p><strong>Methods: </strong>This was a single-center, post-hoc analysis of 95 patients with septic shock who received the vitamin C protocol. Blood samples were drawn on days 1-2, 3-4, and 6-8 after shock onset. Group-based multi-trajectory modeling was used to identify immune trajectory groups.</p><p><strong>Results: </strong>The median age was 78 years (interquartile range, 70-84 years), and 56% were male. Clustering analysis identified group 1 (n=41), which was characterized by lower interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-10 levels, and these levels remained stationary or mildly increased until day 7. Conversely, group 2 (n=54) expressed initially higher IL-6, TNF-α, and IL-10 levels that decreased rapidly by day 4. There was a nonsignificant increase in lymphocyte count and a decrease in C-reactive protein level until day 7 in group 2. The intensive care unit mortality rate was significantly lower in group 2 (39.0% vs. 18.5%, P=0.03). Group 2 also had a significantly higher decrease in the mean (standard deviation) vasopressor dose (norepinephrine equivalent: -0.09±0.16 μg/kg/min vs. -0.23±0.31 μg/kg/min, P<0.001) and Sequential Organ Failure Assessment score (0±5 vs. -4±3, P=0.002) between days 1 and 4.</p><p><strong>Conclusions: </strong>There may be different subphenotypes in septic patients receiving the vitamin C protocol.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b4/20/acc-2023-00507.PMC10497889.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10238555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for cannula-associated arterial thrombosis following extracorporeal membrane oxygenation support: a retrospective study.","authors":"Ngan Hoang Kim Trieu,&nbsp;Xuan Thi Phan,&nbsp;Linh Thanh Tran,&nbsp;Huy Minh Pham,&nbsp;Dai Quang Huynh,&nbsp;Tuan Manh Nguyen,&nbsp;Anh Tuan Mai,&nbsp;Quan Quoc Minh Du,&nbsp;Bach Xuan Nguyen,&nbsp;Thao Thi Ngoc Pham","doi":"10.4266/acc.2023.00500","DOIUrl":"https://doi.org/10.4266/acc.2023.00500","url":null,"abstract":"Background Hemostatic dysfunction during extracorporeal membrane oxygenation (ECMO) due to blood-circuit interaction and the consequences of shear stress imposed by flow rates lead to rapid coagulation cascade and thrombus formation in the ECMO system and blood vessels. We aimed to identify the incidence and risk factors for cannula-associated arterial thrombosis (CaAT) post-decannulation. Methods A retrospective study of patients undergoing arterial cannula removal following ECMO was performed. We evaluated the incidence of CaAT and compared the characteristics, ECMO machine parameters, cannula sizes, number of blood products transfused during ECMO, and daily hemostasis parameters in patients with and without CaAT. Multivariate analysis identified the risk factors for CaAT. Results Forty-seven patients requiring venoarterial ECMO (VA-ECMO) or hybrid methods were recruited for thrombosis screening. The median Sequential Organ Failure Assessment score was 11 (interquartile range, 8–13). CaAT occurred in 29 patients (61.7%), with thrombosis in the superficial femoral artery accounting for 51.7% of cases. The rate of limb ischemia complications in the CaAT group was 17.2%. Multivariate analysis determined that the ECMO flow rate–body surface area (BSA) ratio (100 ml/min/m2) was an independent factor for CaAT, with an odds ratio of 0.79 (95% confidence interval, 0.66–0.95; P=0.014). Conclusions We found that the incidence of CaAT was 61.7% following successful decannulation from VA-ECMO or hybrid modes, and the ECMO flow rate–BSA ratio was an independent risk factor for CaAT. We suggest screening for arterial thrombosis following VA-ECMO, and further research is needed to determine the risks and benefits of such screening.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/11/f4/acc-2023-00500.PMC10497893.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10238557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beta-blocker therapy in patients with acute myocardial infarction: not all patients need it.","authors":"Seung-Jae Joo","doi":"10.4266/acc.2023.00955","DOIUrl":"10.4266/acc.2023.00955","url":null,"abstract":"<p><p>Most of the evidences for beneficial effects of beta-blockers in patients with acute myocardial infarction (AMI) were from the clinical studies published in the pre-reperfusion era when anti-platelet drugs, statins or inhibitors of renin-angiotensin-aldosterone system which are known to reduce cardiovascular mortality of patients with AMI were not introduced. In the reperfusion era, beta-blockers' benefit has not been clearly shown except in patients with reduced ejection fraction (EF; ≤40%). In the era of the early reperfusion therapy for AMI, a number of patients with mildly reduced EF (>40%, <50%) or preserved EF (≥50%) become increasing. However, because no randomized clinical trials are available until now, the benefit and the optimal duration of oral treatment with beta-blockers in patients with mildly reduced or preserved EF are questionable. Registry data have not showed the association of oral beta-blocker therapy with decreased mortality in survivors without heart failure or left ventricular systolic dysfunction after AMI. In the Korea Acute Myocardial Infarction Registry-National Institute of Health of in-hospital survivors after AMI, the benefit of beta-blocker therapy at discharge was shown in patients with reduced or mildly reduced EF, but not in those with preserved EF, which provides new information about beta-blocker therapy in patients without reduced EF. However, clinical practice can be changed when the results of appropriate randomized clinical trials are available. Ongoing clinical trials may help to answer the unresolved issues of beta-blocker therapy in patients with AMI.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/54/5a/acc-2023-00955.PMC10497890.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10238550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiomic analysis of abdominal organs during sepsis of digestive origin in a French intensive care unit.","authors":"Louis Boutin,&nbsp;Louis Morisson,&nbsp;Florence Riché,&nbsp;Romain Barthélémy,&nbsp;Alexandre Mebazaa,&nbsp;Philippe Soyer,&nbsp;Benoit Gallix,&nbsp;Anthony Dohan,&nbsp;Benjamin G Chousterman","doi":"10.4266/acc.2023.00136","DOIUrl":"https://doi.org/10.4266/acc.2023.00136","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a severe and common cause of admission to the intensive care unit (ICU). Radiomic analysis (RA) may predict organ failure and patient outcomes. The objective of this study was to assess a model of RA and to evaluate its performance in predicting in-ICU mortality and acute kidney injury (AKI) during abdominal sepsis.</p><p><strong>Methods: </strong>This single-center, retrospective study included patients admitted to the ICU for abdominal sepsis. To predict in-ICU mortality or AKI, elastic net regularized logistic regression and the random forest algorithm were used in a five-fold cross-validation set repeated 10 times.</p><p><strong>Results: </strong>Fifty-five patients were included. In-ICU mortality was 25.5%, and 76.4% of patients developed AKI. To predict in-ICU mortality, elastic net and random forest models, respectively, achieved areas under the curve (AUCs) of 0.48 (95% confidence interval [CI], 0.43-0.54) and 0.51 (95% CI, 0.46-0.57) and were not improved combined with Simplified Acute Physiology Score (SAPS) II. To predict AKI with RA, the AUC was 0.71 (95% CI, 0.66-0.77) for elastic net and 0.69 (95% CI, 0.64-0.74) for random forest, and these were improved combined with SAPS II, respectively; AUC of 0.94 (95% CI, 0.91-0.96) and 0.75 (95% CI, 0.70-0.80) for elastic net and random forest, respectively.</p><p><strong>Conclusions: </strong>This study suggests that RA has poor predictive performance for in-ICU mortality but good predictive performance for AKI in patients with abdominal sepsis. A secondary validation cohort is needed to confirm these results and the assessed model.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1f/cf/acc-2023-00136.PMC10497895.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10604260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 pandemic on diabetic ketoacidosis management in the pediatric intensive care unit.","authors":"Fevzi Kahveci,&nbsp;Buse Önen Ocak,&nbsp;Emrah Gün,&nbsp;Anar Gurbanov,&nbsp;Hacer Uçmak,&nbsp;Ayşen Durak Aslan,&nbsp;Ayşegül Ceran,&nbsp;Hasan Özen,&nbsp;Burak Balaban,&nbsp;Edin Botan,&nbsp;Zeynep Şıklar,&nbsp;Merih Berberoğlu,&nbsp;Tanıl Kendirli","doi":"10.4266/acc.2023.00038","DOIUrl":"https://doi.org/10.4266/acc.2023.00038","url":null,"abstract":"<p><strong>Background: </strong>Diabetic ketoacidosis (DKA) is a common endocrine emergency in pediatric patients. Early presentation to health facilities, diagnosis, and good management in the pediatric intensive care unit (PICU) are crucial for better outcomes in children with DKA.</p><p><strong>Methods: </strong>This was a single-center, retrospective cohort study conducted between February 2015 and January 2022. Patients with DKA were divided into two groups according to pandemic status and diabetes diagnosis.</p><p><strong>Results: </strong>The study enrolled 59 patients, and their mean age was 11±5 years. Forty (68%) had newly diagnosed type 1 diabetes mellitus (T1DM), and 61% received follow-up in the pre-pandemic period. Blood glucose, blood ketone, potassium, phosphorus, and creatinine levels were significantly higher in the new-onset T1DM group compared with the previously diagnosed group (P=0.01, P=0.02, P<0.001, P=0.01, and P=0.08, respectively). In patients with newly diagnosed T1DM, length of PICU stays were longer than in those with previously diagnosed T1DM (28.5±8.9 vs. 17.3±6.7 hours, P<0.001). The pandemic group was compared with pre-pandemic group, there was a statistically significant difference in laboratory parameters of pH, HCO3, and lactate and also Pediatric Risk of Mortality (PRISM) III score. All patients survived, and there were no neurologic sequelae.</p><p><strong>Conclusions: </strong>Patients admitted during the pandemic period were admitted with more severe DKA and had higher PRISM III scores. During the pandemic period, there was an increase in the incidence of DKA in the participating center compared to that before the pandemic.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/31/acc-2023-00038.PMC10497885.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10604264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing sleep quality in the intensive care unit: a descriptive pilot study in Korea.","authors":"Yoon Hae Ahn,&nbsp;Hong Yeul Lee,&nbsp;Sang-Min Lee,&nbsp;Jinwoo Lee","doi":"10.4266/acc.2023.00514","DOIUrl":"https://doi.org/10.4266/acc.2023.00514","url":null,"abstract":"<p><strong>Background: </strong>As sleep disturbances are common in the intensive care unit (ICU), this study assessed the sleep quality in the ICU and identified barriers to sleep.</p><p><strong>Methods: </strong>Patients admitted to the ICUs of a tertiary hospital between June 2022 and December 2022 who were not mechanically ventilated at enrollment were included. The quality of sleep (QoS) at home was assessed on a visual analog scale as part of an eight-item survey, while the QoS in the ICU was evaluated using the Korean version of the Richards-Campbell Sleep Questionnaire (K-RCSQ). Good QoS was defined by a score of ≥50.</p><p><strong>Results: </strong>Of the 30 patients in the study, 19 reported a QoS score <50. The Spearman correlation coefficient showed no meaningful relationship between the QoS at home and the overall K-RCSQ QoS score in the ICU (r=0.16, P=0.40). The most common barriers to sleep were physical discomfort (43%), being awoken for procedures (43%), and feeling unwell (37%); environmental factors including noise (30%) and light (13%) were also identified sources of sleep disruption. Physical discomfort (median [interquartile range]: 32 [28.0-38.0] vs. 69 [42.0-80.0], P=0.004), being awoken for procedures (36 [20.0-48.0] vs. 54 [36.0-80.0], P=0.04), and feeling unwell (31 [18.0-42.0] vs. 54 [40.0-76.0], P=0.01) were associated with lower K-RCSQ scores.</p><p><strong>Conclusions: </strong>In the ICU, physical discomfort, patient care interactions, and feeling unwell were identified as barriers to sleep.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2a/fa/acc-2023-00514.PMC10497899.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mobilization phases in traumatic brain injury.","authors":"Tommy Alfandy Nazwar,&nbsp;Ivan Triangto,&nbsp;Gutama Arya Pringga,&nbsp;Farhad Bal'afif,&nbsp;Donny Wisnu Wardana","doi":"10.4266/acc.2023.00640","DOIUrl":"https://doi.org/10.4266/acc.2023.00640","url":null,"abstract":"<p><p>Mobilization in traumatic brain injury (TBI) have shown the improvement of length of stay, infection, long term weakness, and disability. Primary damage as a result of trauma's direct effect (skull fracture, hematoma, contusion, laceration, and nerve damage) and secondary damage caused by trauma's indirect effect (microvasculature damage and pro-inflammatory cytokine) result in reduced tissue perfusion & edema. These can be facilitated through mobilization, but several precautions must be recognized as mobilization itself may further deteriorate patient's condition. Very few studies have discussed in detail regarding mobilizing patients in TBI cases. Therefore, the scope of this review covers the detail of physiological effects, guideline, precautions, and technique of mobilization in patients with TBI.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f6/14/acc-2023-00640.PMC10497896.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10238549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awake prone positioning for COVID-19 acute hypoxemic respiratory failure in Tunisia.","authors":"Khaoula Ben Ismail,&nbsp;Fatma Essafi,&nbsp;Imen Talik,&nbsp;Najla Ben Slimene,&nbsp;Ines Sdiri,&nbsp;Boudour Ben Dhia,&nbsp;Takoua Merhbene","doi":"10.4266/acc.2023.00591","DOIUrl":"https://doi.org/10.4266/acc.2023.00591","url":null,"abstract":"<p><strong>Background: </strong>In this study, we explored whether awake prone position (PP) can impact prognosis of severe hypoxemia coronavirus disease 2019 (COVID-19) patients.</p><p><strong>Methods: </strong>This was a prospective observational study of severe, critically ill adult COVID-19 patients admitted to the intensive care unit. Patients were divided into two groups: group G1, patients who benefited from a vigilant and effective PP (>4 hours minimum/24) and group G2, control group. We compared demographic, clinical, paraclinical and evolutionary data.</p><p><strong>Results: </strong>Three hundred forty-nine patients were hospitalized during the study period, 273 met the inclusion criteria. PP was performed in 192 patients (70.3%). The two groups were comparable in terms of demographic characteristics, clinical severity and modalities of oxygenation at intensive care unit (ICU) admission. The mean PaO2/ FIO2 ratios were 141 and 128 mm Hg, respectively (P=0.07). The computed tomography scan was comparable with a critical >75% in 48.5% (G1) versus 54.2% (G2). The median duration of the daily PP session was 13±7 hours per day. The average duration of spontaneous PP days was 7 days (4-19). Use of invasive ventilation was lower in the G1 group (27% vs. 56%, P=0.002). Healthcare-associated infections were significantly lower in G1 (42.1% vs. 82%, P=0.01). Duration of total mechanical ventilation and length of ICU stay were comparable between the two groups. Mortality was significantly higher in G2 (64% vs. 28%, P=0.02).</p><p><strong>Conclusions: </strong>Our study confirmed that awake PP can improve prognosis in COVID-19 patients. Randomized controlled trials are needed to confirm this result.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b1/97/acc-2023-00591.PMC10497894.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10229945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}