Critical Care Research and Practice最新文献

{"title":"Early Tracheostomy May Reduce the Length of Hospital Stay.","authors":"Fernanda Kazmierski Morakami,&nbsp;Ana Luiza Mezzaroba,&nbsp;Alexandre Sanches Larangeira,&nbsp;Lucienne Tibery Queiroz Cardoso,&nbsp;Carlos Augusto Marçal Camillo,&nbsp;Cintia Magalhães Carvalho Grion","doi":"10.1155/2023/8456673","DOIUrl":"https://doi.org/10.1155/2023/8456673","url":null,"abstract":"<p><strong>Introduction: </strong>There is evidence that prolonged invasive mechanical ventilation has negative consequences for critically ill patients and that performing tracheostomy (TQT) could help to reduce these consequences. The ideal period for performing TQT is still not clear in the literature since few studies have compared clinical aspects between patients undergoing early or late TQT.</p><p><strong>Objective: </strong>To compare the mortality rate, length of stay in the intensive care unit, length of hospital stay, and number of days free of mechanical ventilation in patients undergoing TQT before or after ten days of orotracheal intubation.</p><p><strong>Methods: </strong>A retrospective cohort study carried out by collecting data from patients admitted to an intensive care unit between January 2008 and December 2017. Patients who underwent TQT were divided into an early TQT group (i.e., time to TQT ≤ 10 days) or late TQT (i.e., time to TQT > 10 days) and the clinical outcomes of the two groups were compared.</p><p><strong>Results: </strong>Patients in the early TQT group had a shorter ICU stay than the late TQT group (19 ± 16 vs. 32 ± 22 days, <i>p</i> < 0.001), a shorter stay in the hospital (42 ± 32 vs. 52 ± 50 days, <i>p</i> < 0.001), a shorter duration of mechanical ventilation (17 ± 14 vs. 30 ± 18 days, <i>p</i> < 0.001), and a higher proportion of survivors in the ICU outcome (57% vs. 46%, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Tracheostomy performed within 10 days of mechanical ventilation provides several benefits to the patient and should be considered by the multidisciplinary team as a part of their clinical practice.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"8456673"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10457168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101251","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":"Developing a Preliminary Clinical Prediction Model for Prognosis of Pneumonia Complicated with Heart Failure Based on Metagenomic Sequencing.","authors":"Rongyuan Yang,&nbsp;Yong Duan,&nbsp;Dawei Wang,&nbsp;Qing Liu","doi":"10.1155/2023/5930742","DOIUrl":"https://doi.org/10.1155/2023/5930742","url":null,"abstract":"<p><strong>Background: </strong>The predictive factors of prognosis in patients with pneumonia complicated with heart failure (HF) have not been fully investigated yet, especially with the use of next-generation sequencing (NGS) of metagenome.</p><p><strong>Methods: </strong>Patients diagnosed with pneumonia complicated with HF were collected and divided into control group and NGS group. Univariate and multivariate logistic regression and LASSO regression analysis were conducted to screen the predictive factors for the prognosis, followed by nomogram construction, ROC curve plot, and internal validation. Data analysis was conducted in SPSS and R software.</p><p><strong>Results: </strong>The NGS of metagenome detected more microbial species. Univariate and multivariate logistic regression and LASSO regression analysis revealed that Enterococcus (<i>χ</i>² = 7.449, <i>P</i> = 0.006), Hb (Wals = 6.289, <i>P</i> = 0.012), and ProBNP (Wals = 4.037, <i>P</i> = 0.045) were screened out as potential predictive factors for the prognosis. Nomogram was constructed with these 3 parameters, and the performance of nomogram was checked in ROC curves (AUC = 0.772). The specificity and sensitivity of this model were calculated as 0.579 and 0.851, respectively, with the threshold of 0.630 in ROC curve. Further internal verification indicated that the predictive value of our constructed model was efficient.</p><p><strong>Conclusion: </strong>This study developed a preliminary clinical prediction model for the prognosis of pneumonia complicated with HF based on NGS of metagenome. More objects will be collected and tested to improve the predictive model in the near future.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"5930742"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10368513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10258877","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":"Occurrence, Risk Factors, and Outcomes of Pulmonary Barotrauma in Critically Ill COVID-19 Patients: A Retrospective Cohort Study.","authors":"Hasan M Al-Dorzi,&nbsp;Haifa Al Mejedea,&nbsp;Reema Nazer,&nbsp;Yara Alhusaini,&nbsp;Aminah Alhamdan,&nbsp;Ajyad Al Jawad","doi":"10.1155/2023/4675910","DOIUrl":"https://doi.org/10.1155/2023/4675910","url":null,"abstract":"<p><strong>Objective: </strong>Pulmonary barotrauma has been frequently observed in patients with COVID-19 who present with acute hypoxemic respiratory failure. This study evaluated the prevalence, risk factors, and outcomes of barotrauma in patients with COVID-19 requiring ICU admission.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with confirmed COVID-19 who were admitted to an adult ICU between March and December 2020. We compared patients who had barotrauma with those who did not. A multivariable logistic regression analysis was performed to determine the predictors of barotrauma and hospital mortality.</p><p><strong>Results: </strong>Of 481 patients in the study cohort, 49 (10.2%, 95% confidence interval: 7.6-13.2%) developed barotrauma on a median of 4 days after ICU admission. Barotrauma manifested as pneumothorax (<i>N</i> = 21), pneumomediastinum (<i>N</i> = 25), and subcutaneous emphysema (<i>N</i> = 25) with frequent overlap. Chronic comorbidities and inflammatory markers were similar in both patient groups. Barotrauma occurred in 4/132 patients (3.0%) who received noninvasive ventilation without intubation, and in 43/280 patients (15.4%) who received invasive mechanical ventilation. Invasive mechanical ventilation was the only risk factor for barotrauma (odds ratio: 14.558, 95% confidence interval: 1.833-115.601). Patients with barotrauma had higher hospital mortality (69.4% versus 37.0%; <i>p</i> < 0.0001) and longer duration of mechanical ventilation and ICU stay. Barotrauma was an independent predictor of hospital mortality (odds ratio: 2.784, 95% confidence interval: 1.310-5.918).</p><p><strong>Conclusion: </strong>s. Barotrauma was common in critical COVID-19, with invasive mechanical ventilation being the most prominent risk factor. Barotrauma was associated with poorer clinical outcomes and was an independent predictor of hospital mortality.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"4675910"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9977517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10849455","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":"MRI and the Critical Care Patient: Clinical, Operational, and Financial Challenges.","authors":"Barbara McLean,&nbsp;Douglas Thompson","doi":"10.1155/2023/2772181","DOIUrl":"https://doi.org/10.1155/2023/2772181","url":null,"abstract":"<p><p>Neuroimaging in conjunction with a neurologic examination has become a valuable resource for today's intensive care unit (ICU) physicians. Imaging provides critical information during the assessment and ongoing neuromonitoring of patients for toxic-metabolic or structural injury of the brain. A patient's condition can change rapidly, and interventions may require imaging. When making this determination, the benefit must be weighed against possible risks associated with intrahospital transport. The patient's condition is assessed to decide if they are stable enough to leave the ICU for an extended period. Intrahospital transport risks include adverse events related to the physical nature of the transport, the change in the environment, or relocating equipment used to monitor the patient. Adverse events can be categorized as minor (e.g., clinical decompensation) or major (e.g., requiring immediate intervention) and may occur in preparation or during transport. Regardless of the type of event experienced, any intervention during transport impacts the patient and may lead to delayed treatment and disruption of critical care. This review summarizes the commentary on the current literature on the associated risks and provides insight into the costs as well as provider experiences. Approximately, one-third of patients who are transported from the ICU to an imaging suite may experience an adverse event. This creates an additional risk for extending a patient's stay in the ICU. The delay in obtaining imaging can negatively impact the patient's treatment plan and affect long-term outcomes as increased disability or mortality. Disruption of ICU therapy can decrease respiratory function after the patient returns from transport. Because of the complex care team needed for patient transport, the staff time alone can cost $200 or more. New technologies and advancements are needed to reduce patient risk and improve safety.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"2772181"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10264715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9654505","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":"Extracorporeal Membrane Oxygenation to Support COVID-19 Patients: A Propensity-Matched Cohort Study.","authors":"Björn Stessel,&nbsp;Maayeen Bin Saad,&nbsp;Lotte Ullrick,&nbsp;Laurien Geebelen,&nbsp;Jeroen Lehaen,&nbsp;Philippe Jr Timmermans,&nbsp;Michiel Van Tornout,&nbsp;Ina Callebaut,&nbsp;Jeroen Vandenbrande,&nbsp;Jasperina Dubois","doi":"10.1155/2023/5101456","DOIUrl":"https://doi.org/10.1155/2023/5101456","url":null,"abstract":"<p><strong>Background: </strong>In patients with severe respiratory failure from COVID-19, extracorporeal membrane oxygenation (ECMO) treatment can facilitate lung-protective ventilation and may improve outcome and survival if conventional therapy fails to assure adequate oxygenation and ventilation. We aimed to perform a confirmatory propensity-matched cohort study comparing the impact of ECMO and maximum invasive mechanical ventilation alone (MVA) on mortality and complications in severe COVID-19 pneumonia.</p><p><strong>Materials and methods: </strong>All 295 consecutive adult patients with confirmed COVID-19 pneumonia admitted to the intensive care unit (ICU) from March 13^th, 2020, to July 31^st, 2021 were included. At admission, all patients were classified into 3 categories: (1) full code including the initiation of ECMO therapy (AAA code), (2) full code excluding ECMO (AA code), and (3) do-not-intubate (A code). For the 271 non-ECMO patients, match eligibility was determined for all patients with the AAA code treated with MVA. Propensity score matching was performed using a logistic regression model including the following variables: gender, P/F ratio, SOFA score at admission, and date of ICU admission. The primary endpoint was ICU mortality.</p><p><strong>Results: </strong>A total of 24 ECMO patients were propensity matched to an equal number of MVA patients. ICU mortality was significantly higher in the ECMO arm (45.8%) compared with the MVA cohort (16.67%) (OR 4.23 (1.11, 16.17); <i>p</i>=0.02). Three-month mortality was 50% with ECMO compared to 16.67% after MVA (OR 5.91 (1.55, 22.58); <i>p</i> < 0.01). Applied peak inspiratory pressures (33.42 ± 8.52 vs. 24.74 ± 4.86 mmHg; <i>p</i> < 0.01) and maximal PEEP levels (14.47 ± 3.22 vs. 13.52 ± 3.86 mmHg; <i>p</i>=0.01) were higher with MVA. ICU length of stay (LOS) and hospital LOS were comparable in both groups.</p><p><strong>Conclusion: </strong>ECMO therapy may be associated with an up to a three-fold increase in ICU mortality and 3-month mortality compared to MVA despite the facilitation of lung-protective ventilation settings in mechanically ventilated COVID-19 patients. We cannot confirm the positive results of the first propensity-matched cohort study on this topic. This trial is registered with NCT05158816.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"5101456"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10279486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9713040","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":"In-ICU Outcomes of Critically Ill Patients in a Reference Cameroonian Intensive Care Unit: A Retrospective Cohort Study.","authors":"Edgar Mandeng Ma Linwa,&nbsp;Charles Binam Bikoi,&nbsp;Joel Tochie Noutakdie,&nbsp;Emmanuel Ndoye Ndo,&nbsp;Jean Moise Bikoy,&nbsp;Charlotte Eposse Ekoube,&nbsp;Raissa Fogue Mogoung,&nbsp;Igor Simo Ghomsi,&nbsp;Michael Ngenge Budzi,&nbsp;Esther Eleonore Ngo Linwa,&nbsp;Martin Geh Meh,&nbsp;David Mekolo","doi":"10.1155/2023/6074700","DOIUrl":"https://doi.org/10.1155/2023/6074700","url":null,"abstract":"<p><strong>Introduction: </strong>Mortality rate amongst critically ill patients admitted to the intensive care unit (ICU) is disproportionately high in sub-Saharan African countries such as Cameroon. Identifying factors associated with higher in-ICU mortality guides more aggressive resuscitative measures to curb mortality, but the dearth of data on predictors of in-ICU mortality precludes this action. We aimed to determine predictors of in-ICU mortality in a major referral ICU in Cameroon. <i>Methodology</i>. This was a retrospective cohort study of all patients admitted to the ICU of Douala Laquintinie Hospital from 1st of March 2021 to 28th February 2022. We performed a multivariable analysis of sociodemographic, vital signs on admission, and other clinical and laboratory variables of patients discharged alive and dead from the ICU to control for confounding factors. Significance level was set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Overall, the in-ICU mortality rate was 59.4% out of 662 ICU admissions. Factors independently associated with in-ICU mortality were deep coma (aOR = 0.48 (0.23-0.96), 95% CI, <i>p</i> = 0.043), and hypernatremia (>145 meq/L) (aOR = 0.39 (0.17-0.84) 95% CI, <i>p</i> = 0.022).</p><p><strong>Conclusion: </strong>The in-ICU mortality rate in this major referral Cameroonian ICU is high. Six in 10 patients admitted to the ICU die. Patients were more likely to die if admitted with deep coma and high sodium levels in the blood.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"6074700"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10185429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9541330","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":"Change in Antimicrobial Therapy Based on Bronchoalveolar Lavage Data Improves Outcomes in ICU Patients with Suspected Pneumonia.","authors":"Bharti Chogtu,&nbsp;Vrinda Mariya Elenjickal,&nbsp;Dharma U Shetty,&nbsp;Mahsheeba Asbin,&nbsp;Vasudeva Guddattu,&nbsp;Rahul Magazine","doi":"10.1155/2023/6928319","DOIUrl":"https://doi.org/10.1155/2023/6928319","url":null,"abstract":"<p><p>Flexible bronchoscopy (FB) is often performed in critically ill patients with suspected pneumonia. It is assumed that there will be an association with improved outcomes when bronchoalveolar lavage (BAL) data lead to a change in antimicrobial therapy. <i>Methods.</i> This study included a retrospective cohort of intensive care unit (ICU) patients who underwent FB for a diagnosis of suspected pneumonia. The study compared the outcome of patients in whom antimicrobial modification was carried out based on BAL reports versus those in whom it was not carried out. Cases where the procedure could not be completed or had incomplete records were excluded. The FB reports were accessed from the register maintained in the Department of Respiratory Medicine. The demographic details, clinical symptoms, laboratory investigations, and microbiological and radiology reports were recorded. Data on the antmicrobial therapy that the patients received during treatment and the outcome of the treatment were obtained from the case records and noted in the data collection form. <i>Results.</i> Data from a total of 150 patients admitted to the ICU, who underwent FB, were analyzed. The outcomes in the group where antimicrobial modification based on bronchoalveolar lavage (BAL) fluid reports was carried out versus the no-change group were as follows: expired 23, improved 82, unchanged 8 versus expired 12, improved 18, and unchanged 7 (<i>p</i> = 0.018); total duration of ICU stay 13.12 ± 10.61 versus 19.43 ± 13.4 days (<i>p</i> = 0.012); and duration from FB to discharge from ICU 6.33 ± 3.76 days versus 8.46 ± 5.99 (<i>p</i> = 0.047). The median total duration of ICU stay and clinical outcomes were significantly better in the nonintubated patients in whom BAL-directed antimicrobial modification was implemented. Distribution of microorganisms based on BAL reports was as follows: <i>Acinetobacter baumanii</i> 45 (30%), <i>Klebsiella pneumoniae</i> 37 (24.66%), <i>Escherichia coli</i> 9 (6%), and <i>Pseudomonas aeruginosa</i> 9 (6%). <i>Conclusion.</i> A change in antimicrobial therapy based on BAL data was associated with improved outcomes. The commonest bacterial isolate in the BAL fluid was <i>Acinetobacter baumanii</i>.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"6928319"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10442184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10114853","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":"Early Neuromuscular Electrical Stimulation Preserves Muscle Size and Quality and Maintains Systemic Levels of Signaling Mediators of Muscle Growth and Inflammation in Patients with Traumatic Brain Injury: A Randomized Clinical Trial.","authors":"Luciana Vieira,&nbsp;Paulo Eugênio Silva,&nbsp;Priscilla Flavia de Melo,&nbsp;Vinicius Maldaner,&nbsp;Joao Q Durigan,&nbsp;Rita de Cassia Marqueti,&nbsp;Otavio Nobrega,&nbsp;Sunita Mathur,&nbsp;Chris Burtin,&nbsp;Fabrício Barin,&nbsp;Wilcelly Machado-Silva,&nbsp;Sergio Ramalho,&nbsp;Gaspar R Chiappa,&nbsp;Nadia Oliveira Gomes,&nbsp;Celso R F Carvalho,&nbsp;Graziella F B Cipriano,&nbsp;Gerson Cipriano","doi":"10.1155/2023/9335379","DOIUrl":"https://doi.org/10.1155/2023/9335379","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of an early neuromuscular electrical stimulation (NMES) protocol on muscle quality and size as well as signaling mediators of muscle growth and systemic inflammation in patients with traumatic brain injury (TBI).</p><p><strong>Design: </strong>Two-arm, single-blinded, parallel-group, randomized, controlled trial with a blinded assessment. <i>Setting</i>. Trauma intensive care unit at a university hospital. <i>Participants</i>. Forty consecutive patients on mechanical ventilation (MV) secondary to TBI were prospectively recruited within the first 24 hours following admission. <i>Interventions</i>. The intervention group (NMES; <i>n</i> = 20) received a daily session of NMES on the rectus femoris muscle for five consecutive days (55 min/each session). The control group (<i>n</i> = 20) received usual care. <i>Main Outcome Measures</i>. Muscle echogenicity and thickness were evaluated by ultrasonography. A daily blood sample was collected to assess circulating levels of insulin-like growth factor I (IGF-I), inflammatory cytokines, and matrix metalloproteinases (MMP).</p><p><strong>Results: </strong>Both groups were similar at baseline. A smaller change in muscle echogenicity and thickness (difference between Day 1 and Day 7) was found in the control group compared to the NMES group (29.9 ± 2.1 vs. 3.0 ± 1.2, <i>p</i> < 0.001; -0.79 ± 0.12 vs. -0.01 ± 0.06, <i>p</i> < 0.001, respectively). Circulating levels of IGF-I, pro-inflammatory cytokines (IFN-y), and MMP were similar between groups.</p><p><strong>Conclusion: </strong>An early NMES protocol can preserve muscle size and quality and maintain systemic levels of signaling mediators of muscle growth and inflammation in patients with TBI. This trial is registered with https://www.ensaiosclinicos.gov.br under number RBR-2db.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"9335379"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10397495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9944374","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":"Association of Lower Antispike Antibody Levels with Mortality in ICU Patients with COVID-19 Disease.","authors":"Sangeeta Yelle,&nbsp;Rahul Amte,&nbsp;Vishwanath Gella,&nbsp;Sasikala Mitnala,&nbsp;Deepika Gujjarlapudi,&nbsp;Mohammed Ismail,&nbsp;Ledo Thankachan,&nbsp;Sandhyarani Adla,&nbsp;Fatima Unnisa,&nbsp;Sivakumar Reddy,&nbsp;Duvvur Nageshwar Reddy","doi":"10.1155/2023/4174241","DOIUrl":"https://doi.org/10.1155/2023/4174241","url":null,"abstract":"<p><strong>Background: </strong>Though vaccines have been reported as highly efficacious in preventing severe COVID-19 disease, there is emerging data of severe infections, albeit a small number, in vaccinated individuals. We have conducted a retrospective observational study to assess the clinical characteristics, immunological response, and disease outcomes among the vaccinated and unvaccinated patients admitted to the ICU with severe COVID-19 disease.</p><p><strong>Methods: </strong><i>Study Design and Participants</i>. We conducted a retrospective observational study in COVID ICU of a tertiary care hospital. Data were collected from the month of 1 April 2021 to 31 November 2021. All adult patients admitted to the ICU having severe COVID-19 disease were included in the study. Data were collected from the medical records database which included demographics, a clinical course in the ICU, laboratory and radiological parameters, and disease outcomes. In a subset of patients, cell-mediated immunity and S1S2-neutralising antibody assessment was done.</p><p><strong>Results: </strong>A total of 419 patients with severe COVID-19 were included in the study. Of the 419 patients, 90 (21.5%) were vaccinated, and 329 (78.5%) were unvaccinated. There was a significantly higher mortality in unvaccinated severe COVID 19 patients as compared to vaccinated severe COVID patients (46.2% vs 34.4%; <i>P</i> < 0.0455). The neutralizing antibody titre was significantly higher in survivors as compared to nonsurvivors (2139.8, SE ± 713.3 vs 471, SE ± 154.4); <i>P</i> < 0.026.</p><p><strong>Conclusion: </strong>Our study suggests the association of lower neutralizing antibody levels with mortality in ICU patients admitted with COVID-19 breakthrough infections.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"4174241"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9904915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10679269","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":"Mechanical Power in Prone Position Intubated Patients with COVID-19-Related ARDS: A Cohort Study.","authors":"Roberto Stalla Alves da Fonseca,&nbsp;Viviane Martins Correa Boniatti,&nbsp;Michelle Carneiro Teixeira,&nbsp;Alessandra Preisig Werlang,&nbsp;Francielle Martins,&nbsp;Pedro Henrique Rigotti Soares,&nbsp;Leonardo da Silva Marques,&nbsp;Wagner Luis Nedel","doi":"10.1155/2023/6604313","DOIUrl":"https://doi.org/10.1155/2023/6604313","url":null,"abstract":"<p><strong>Background: </strong>Respiratory monitoring of mechanical ventilation (MV) is relevant and challenging in COVID-19. Mechanical power (MP) is a novel and promising monitoring tool in acute distress respiratory syndrome (ARDS), representing the amount of energy transferred from the ventilator to the patient. It encompasses several setting parameters and patient-dependent variables that could cause lung injury. MP can therefore be an additional tool in the assessment of these patients.</p><p><strong>Objective: </strong>This study aims to evaluate respiratory monitoring through MP and its relationship with mortality in patients with COVID-19-related ARDS (CARDS) under mechanical ventilation (MV) and prone position (PP) strategies.</p><p><strong>Methods: </strong>Retrospective, unicentric, and cohort studies. We included patients with CARDS under invasive MV and PP strategies. Information regarding MP, ventilation, and gas exchange was collected at 3 moments: (1) prior to the first PP, (2) during the first PP, and (3) during the last PP. We tested the relationship between MP and VR with in-hospital mortality.</p><p><strong>Results: </strong>We included 91 patients. There was a statistically significant difference in MP measurements between survivors and nonsurvivors only in the last prone position (<i>p</i> < 0.001). This is due to the significant increase in MP measurements in nonsurvivors (difference from the baseline: 3.63 J/min; 95% CI: 0.31 to 6.94), which was not observed in the group that survived (difference from the baseline: 0.02 J/min; 95% CI: -2.66 to 2.70). In multivariate analysis, MP (<i>p</i>=0.009) was associated with hospital death when corrected for confounder variables (SAPS 3 score, mechanical ventilation time, age, and number of prone sessions).</p><p><strong>Conclusions: </strong>MP is an independent predictor of mortality in PP patients with CARDS.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"6604313"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9995186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9104703","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}