Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2548
S. Lakshman, I. Ahmad, F. Rahaghi, P. Czarnecki
Rationale: Patients with COVID-19 critical illness are at high risk for multiorgan dysfunction, most commonly acute kidney injury (AKI). We sought to characterize the rates of thrombotic and hemorrhagic complications in patients with COVID-19 ARDS as a function of coexisting AKI. Methods: We performed a single-center retrospective analysis of all patients with severe COVID-19 infection, admitted to ICU level of care between 3/1/2020 and 6/1/2020, and we obtained patient data through the Research Patient Data Registry. We excluded patients who did not develop AKI, those who were admitted with a primary medical problem unrelated to coexisting COVID-19 infection, and those with end stage renal disease. We stratified patients into two cohorts: Those with AKI not requiring renal replacement therapy (RRT) and AKI requiring RRT. All data collection was approved by the IRB at Mass General Brigham (IRB #2020P001674). All data was analyzed using Excel and R version 4.0.1 (2020-06-06) when comparing groups-medians and interquartile ranges are reported. Pearson's Chi-squared test was used during statistical analysis. Results: 272 patients were identified, of which 136 patients were excluded from further study due to reasons as above. Of the remaining 136 patients analyzed, all developed AKI as per AKIN criteria, and we identified those who did not require RRT (100), and those who were initiated on RRT (36). Median age was 66 ± 9.75, and 57 ± 7.12, respectively. 38% (38/100) and 27.7% (10/36) were female, respectively. Complications investigated included non-cerebrovascular hemorrhage (17% vs. 38.88%, p 0.014), cerebrovascular hemorrhage (4% vs. 16.66%, p 0.033), thromboembolic phenomena (24% vs 38.8%, p 0.136) and overall ICU Mortality (48% vs 38.8%, p 0.45). Conclusions: Patients with COVID-19 ARDS and associated AKI had a high number of hemorrhagic and thromboembolic complications. There is a higher incidence of hemorrhagic and thromboembolic complications in the AKI-RRT group, with CVA-and non-CVAhemorrhagic complications being statistically significant. Overall ICU mortality was apparently lower in the AKIRRT group, without reaching statistical significance. Our data highlight a clinically most relevant topic, defining COVID-19 patients with AKI as a high-risk population for thromboembolic and hemorrhagic complications, and underlining the importance of careful decisions regarding prophylactic anticoagulant strategies.
{"title":"Hemorrhagic and Thromboembolic Complications in Critically Ill Patients with COVID 19 and Acute Kidney Injury: A Single Center Experience","authors":"S. Lakshman, I. Ahmad, F. Rahaghi, P. Czarnecki","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2548","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2548","url":null,"abstract":"Rationale: Patients with COVID-19 critical illness are at high risk for multiorgan dysfunction, most commonly acute kidney injury (AKI). We sought to characterize the rates of thrombotic and hemorrhagic complications in patients with COVID-19 ARDS as a function of coexisting AKI. Methods: We performed a single-center retrospective analysis of all patients with severe COVID-19 infection, admitted to ICU level of care between 3/1/2020 and 6/1/2020, and we obtained patient data through the Research Patient Data Registry. We excluded patients who did not develop AKI, those who were admitted with a primary medical problem unrelated to coexisting COVID-19 infection, and those with end stage renal disease. We stratified patients into two cohorts: Those with AKI not requiring renal replacement therapy (RRT) and AKI requiring RRT. All data collection was approved by the IRB at Mass General Brigham (IRB #2020P001674). All data was analyzed using Excel and R version 4.0.1 (2020-06-06) when comparing groups-medians and interquartile ranges are reported. Pearson's Chi-squared test was used during statistical analysis. Results: 272 patients were identified, of which 136 patients were excluded from further study due to reasons as above. Of the remaining 136 patients analyzed, all developed AKI as per AKIN criteria, and we identified those who did not require RRT (100), and those who were initiated on RRT (36). Median age was 66 ± 9.75, and 57 ± 7.12, respectively. 38% (38/100) and 27.7% (10/36) were female, respectively. Complications investigated included non-cerebrovascular hemorrhage (17% vs. 38.88%, p 0.014), cerebrovascular hemorrhage (4% vs. 16.66%, p 0.033), thromboembolic phenomena (24% vs 38.8%, p 0.136) and overall ICU Mortality (48% vs 38.8%, p 0.45). Conclusions: Patients with COVID-19 ARDS and associated AKI had a high number of hemorrhagic and thromboembolic complications. There is a higher incidence of hemorrhagic and thromboembolic complications in the AKI-RRT group, with CVA-and non-CVAhemorrhagic complications being statistically significant. Overall ICU mortality was apparently lower in the AKIRRT group, without reaching statistical significance. Our data highlight a clinically most relevant topic, defining COVID-19 patients with AKI as a high-risk population for thromboembolic and hemorrhagic complications, and underlining the importance of careful decisions regarding prophylactic anticoagulant strategies.","PeriodicalId":111156,"journal":{"name":"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125003440","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2527
V. Kerchberger, L. Davis, J. Sealock, P. Straub, J. McNeil, J. Bastarache, L. Ware
RATIONALE: A genetic locus at chromosome-3 was recently identified as a risk factor for respiratory failure during COVID-19, and preliminary in-silico analyses demonstrate a strong association between this locus, elevated serum lactate dehydrogenase (LDH), and respiratory failure. To understand if this locus may affect infection-mediated acute lung injury in other contexts, we tested whether serum LDH and the chromosome-3 locus were associated with ARDS risk and severity in critically ill adults with non-COVID infections. METHODS: We studied 553 critically ill adults with sepsis enrolled in the Validating biomarkers in Acute Lung Injury for Diagnosis (VALID) study. All patients were prospectively phenotyped for ARDS (Berlin Definition) during the first 4 ICU days by two physician investigators. For genetic analyses, we used a convenience sample of 289 septic VALID patients with genomewide genotyping from prior studies. We extracted data on the lead single nucleotide polymorphism in chromosome-3 (rs35081325;wild-type: A;risk variant: T) identified in the COVID-19 Host Genetics Initiative's analysis A2 (COVID-19 with severe respiratory failure). We assessed severity of illness by APACHE-II scores and oxygenation impairment by SpO2:FiO2 ratio. Between-group comparisons were performed using linear regression for continuous outcomes and logistic regression for categorical outcomes. We report effect odds ratios (OR) and 95% confidence intervals (CI). An inverse normal quantile transformation was applied to clinically ascertained LDH values to account for skewness and non-normality;associations are reported per normalized standard deviation (SD) of the transformed LDH value. RESULTS: Serum LDH was higher among patients with ARDS than without ARDS when controlling for age, gender, and APACHE-II (OR=1.20;95%CI: 1.01-1.43;P=0.04). Serum LDH was also associated with oxygenation impairment, particularly among patients with ARDS (FIGURE). Among genotyped patients, the rs35081325 T-allele was associated with higher serum LDH levels (0.62 normalized SD higher LDH;95%CI: 0.16-1.08;P=0.009), and exhibited trends for higher severity of illness (2.10 higher APACHE-II score per T-allele;95%CI:-0.56 to 4.77;P=0.19), increased ARDS risk (OR=1.55 per T-allele;95%CI 0.70-3.44;P=0.28;FIGURE) and increased in-hospital mortality (OR=2.24 per T-allele;95%CI: 1.00-5.05;P=0.05). CONCLUSION: Serum LDH and rs35081325 on chromosome-3 were associated with ARDS risk and oxygenation impairment in a large cohort of septic adults, suggesting a shared host genetic risk for severe respiratory failure among COVID-19 and other etiologies of infection-mediated acute lung injury. As this SNP is near several genes involved in chemokine function, autophagy, and solute transport, further mechanistic investigation is necessary to identify the causative gene(s).
{"title":"Chromosome 3 rs35081325 and Serum Lactate Dehydrogenase as Shared Host Determinants of Infection-Mediated Acute Respiratory Distress Syndrome (ARDS) in Both COVID-19 and Sepsis","authors":"V. Kerchberger, L. Davis, J. Sealock, P. Straub, J. McNeil, J. Bastarache, L. Ware","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2527","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2527","url":null,"abstract":"RATIONALE: A genetic locus at chromosome-3 was recently identified as a risk factor for respiratory failure during COVID-19, and preliminary in-silico analyses demonstrate a strong association between this locus, elevated serum lactate dehydrogenase (LDH), and respiratory failure. To understand if this locus may affect infection-mediated acute lung injury in other contexts, we tested whether serum LDH and the chromosome-3 locus were associated with ARDS risk and severity in critically ill adults with non-COVID infections. METHODS: We studied 553 critically ill adults with sepsis enrolled in the Validating biomarkers in Acute Lung Injury for Diagnosis (VALID) study. All patients were prospectively phenotyped for ARDS (Berlin Definition) during the first 4 ICU days by two physician investigators. For genetic analyses, we used a convenience sample of 289 septic VALID patients with genomewide genotyping from prior studies. We extracted data on the lead single nucleotide polymorphism in chromosome-3 (rs35081325;wild-type: A;risk variant: T) identified in the COVID-19 Host Genetics Initiative's analysis A2 (COVID-19 with severe respiratory failure). We assessed severity of illness by APACHE-II scores and oxygenation impairment by SpO2:FiO2 ratio. Between-group comparisons were performed using linear regression for continuous outcomes and logistic regression for categorical outcomes. We report effect odds ratios (OR) and 95% confidence intervals (CI). An inverse normal quantile transformation was applied to clinically ascertained LDH values to account for skewness and non-normality;associations are reported per normalized standard deviation (SD) of the transformed LDH value. RESULTS: Serum LDH was higher among patients with ARDS than without ARDS when controlling for age, gender, and APACHE-II (OR=1.20;95%CI: 1.01-1.43;P=0.04). Serum LDH was also associated with oxygenation impairment, particularly among patients with ARDS (FIGURE). Among genotyped patients, the rs35081325 T-allele was associated with higher serum LDH levels (0.62 normalized SD higher LDH;95%CI: 0.16-1.08;P=0.009), and exhibited trends for higher severity of illness (2.10 higher APACHE-II score per T-allele;95%CI:-0.56 to 4.77;P=0.19), increased ARDS risk (OR=1.55 per T-allele;95%CI 0.70-3.44;P=0.28;FIGURE) and increased in-hospital mortality (OR=2.24 per T-allele;95%CI: 1.00-5.05;P=0.05). CONCLUSION: Serum LDH and rs35081325 on chromosome-3 were associated with ARDS risk and oxygenation impairment in a large cohort of septic adults, suggesting a shared host genetic risk for severe respiratory failure among COVID-19 and other etiologies of infection-mediated acute lung injury. As this SNP is near several genes involved in chemokine function, autophagy, and solute transport, further mechanistic investigation is necessary to identify the causative gene(s).","PeriodicalId":111156,"journal":{"name":"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127139938","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2546
A. Bavishi, R. Mylvaganam, R. Agrawal, R. Avery, M. Cuttica
Introduction: As the management of COVID-19 has continued to evolve, the question as to whether delaying intubation is beneficial or harmful for patients with COVID-19 induced hypoxic respiratory failure has yet to be answered. Early reports suggested that patients may benefit from early intubation during a period of severe hypoxia;later management shifted towards delaying intubation as much as possible using non-invasive ventilation. Additionally, the pathophysiologic implications of timing of intubation are poorly understood, including the potential for pulmonary vascular thrombosis and intussusceptive angiogenesis. This study examines the differences in outcomes and respiratory mechanics between subjects who are intubated earlier versus later in their COVID-19 disease course. Study Design and Methods: Retrospective single-center cohort study of subjects intubated for COVID-19 ARDS between March and June 2020. Patients were stratified by time to intubation: 30 subjects were intubated 4-24 hours after presentation and 24 subjects were intubated 5-10 days after presentation. Data regarding baseline characteristics, hospitalization, ventilator mechanics and outcomes were extracted and analyzed. 10 clinically available CT scans for these patients were manually reviewed to identify evidence of pulmonary vascular thrombosis and intussusceptive angiogenesis. Results: Median time from symptom onset to intubation was significantly different between the Early and Late Intubation Cohorts, with the latter being intubated later in the course of their illness (7.9 days vs 11.8 days;p=0.04). The Early Intubation Cohort had a lower mortality rate than the Late Intubation Cohort (6% vs 30%, p < 0.001) without significantly different ventilator mechanics at the time of intubation. However, the Late Intubation Cohort was noted to have higher dead space ratio (0.40 vs 0.52;p = 0.03). On review of CT scans, the Late Intubation Cohort also had more segments with dilated and tortuous peripheral vessels on imaging (2 segments vs 5 segments). Interpretation: As our approaches to treatment of COVID-19 continue to evolve, the decision of timing of intubation remains paramount. While non-invasive ventilation may allow for delaying intubation, it is possible that there are downstream effects of delayed intubation that should be considered.
导言:随着COVID-19的管理不断发展，延迟插管对COVID-19诱导的低氧呼吸衰竭患者是有益还是有害的问题尚未得到回答。早期报告表明，患者在严重缺氧期间早期插管可能会受益;后来的管理转向尽可能延迟插管，使用无创通气。此外，插管时机的病理生理学意义尚不清楚，包括肺血管血栓形成和肠套敏感性血管生成的可能性。本研究探讨了在COVID-19疾病过程中早期和晚期插管的受试者在结果和呼吸力学方面的差异。研究设计和方法:对2020年3月至6月期间因COVID-19 ARDS插管的受试者进行回顾性单中心队列研究。根据插管时间对患者进行分层:30例患者在就诊后4-24小时插管，24例患者在就诊后5-10天插管。提取并分析有关基线特征、住院、呼吸机力学和结局的数据。这些患者的10个临床可用的CT扫描被人工审查，以确定肺血管血栓形成和肠套敏感性血管生成的证据。结果:从症状出现到插管的中位时间在早期和晚期插管组之间有显著差异，后者在病程中插管较晚(7.9天vs 11.8天;p=0.04)。早期插管组的死亡率低于晚期插管组(6% vs 30%， p <0.001)，插管时呼吸机力学无显著差异。然而，晚期插管组的死亡空间比较高(0.40 vs 0.52;p = 0.03)。回顾CT扫描，晚期插管队列在影像学上也有更多的节段扩张和弯曲的周围血管(2节段对5节段)。解释:随着我们治疗COVID-19的方法不断发展，插管时机的决定仍然至关重要。虽然无创通气可能允许延迟插管，但可能存在延迟插管的下游影响，应该考虑。
{"title":"Early vs Late Intubation in COVID-19 Acute Respiratory Distress Syndrome: A Retrospective Study of Ventilator Mechanics, Computed Tomography Findings, and Outcomes","authors":"A. Bavishi, R. Mylvaganam, R. Agrawal, R. Avery, M. Cuttica","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2546","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2546","url":null,"abstract":"Introduction: As the management of COVID-19 has continued to evolve, the question as to whether delaying intubation is beneficial or harmful for patients with COVID-19 induced hypoxic respiratory failure has yet to be answered. Early reports suggested that patients may benefit from early intubation during a period of severe hypoxia;later management shifted towards delaying intubation as much as possible using non-invasive ventilation. Additionally, the pathophysiologic implications of timing of intubation are poorly understood, including the potential for pulmonary vascular thrombosis and intussusceptive angiogenesis. This study examines the differences in outcomes and respiratory mechanics between subjects who are intubated earlier versus later in their COVID-19 disease course. Study Design and Methods: Retrospective single-center cohort study of subjects intubated for COVID-19 ARDS between March and June 2020. Patients were stratified by time to intubation: 30 subjects were intubated 4-24 hours after presentation and 24 subjects were intubated 5-10 days after presentation. Data regarding baseline characteristics, hospitalization, ventilator mechanics and outcomes were extracted and analyzed. 10 clinically available CT scans for these patients were manually reviewed to identify evidence of pulmonary vascular thrombosis and intussusceptive angiogenesis. Results: Median time from symptom onset to intubation was significantly different between the Early and Late Intubation Cohorts, with the latter being intubated later in the course of their illness (7.9 days vs 11.8 days;p=0.04). The Early Intubation Cohort had a lower mortality rate than the Late Intubation Cohort (6% vs 30%, p < 0.001) without significantly different ventilator mechanics at the time of intubation. However, the Late Intubation Cohort was noted to have higher dead space ratio (0.40 vs 0.52;p = 0.03). On review of CT scans, the Late Intubation Cohort also had more segments with dilated and tortuous peripheral vessels on imaging (2 segments vs 5 segments). Interpretation: As our approaches to treatment of COVID-19 continue to evolve, the decision of timing of intubation remains paramount. While non-invasive ventilation may allow for delaying intubation, it is possible that there are downstream effects of delayed intubation that should be considered.","PeriodicalId":111156,"journal":{"name":"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT","volume":"282 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122945817","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2550
A. Anwar, N. Ramos-Bascon, A. Crerar-Gilbert, N. Barnes, B. Madden
Introduction:During the Corona-virus pandemic, our intensive care units and staff were overwhelmed by both patient numbers and the complexities of their clinical presentation. We believed that a specialist dedicated team would assist our medical and nursing colleagues and help identify and treat the various cardio-pulmonary pathologies contributing to the critical illness of our patients. To support our colleagues and to assist with diagnosis and treatment, we developed a specialist team. We named this team the Acute Respiratory Disease Support (ARDS) team. The purpose of our team was to provide specialist input for severely unwell patients with COVID-19 early in their disease and to assess for conditions that may respond to specific therapies including advanced pulmonary vasodilator therapy and steroids. Methods:The Acute Respiratory Disease Support team reviewed 44 consecutive patients referred from the intensive care units from mid-April to end of May 2020 on a daily basis and coordinated therapies for pulmonary hypertension, pulmonary thrombosis and evolving fibrosis. A follow-up post hospital discharge clinic was set up. Results:The mortality for this group was significantly lower (34%) than the total group admitted to critical care as a whole (51%) and for those not reviewed by the team (55%;p=0.012). Mortality among Asian and African-Caribbean patients was higher than Caucasians (p=0.035). Twenty-three patients (52%) were diagnosed with pulmonary thrombosis. Pulmonary hypertension was present in 84% of the patients. Thirty-two patients received sildenafil therapy and this was associated with improvement in right heart function in all survivors. Short time on mechanical ventilation was associated with a poorer outcome (p=0.0003). Ten patients with evolving pulmonary fibrosis and no evidence of sepsis received high dose steroid therapy in the form of intravenous pulsed methylprednisolone early in their disease. Repeat thoracic computerised tomographic (CT) scans were performed which showed excellent effect (Figure 1). Conclusion:Our experience has reinforced the concept that there are many contributing factors to impaired cardio-pulmonary function in COVID-19 patients and that many of these may be co-contributory to the patient's clinical presentation. It suggests that a coordinated specialised cardio-pulmonary team approach contributes significantly to successful management and outcome of severely unwell patients with COVID-19 and offers an important platform for continuity of patient care, education and staff well-being.
{"title":"Experience of a Novel Specialised Cardio-Pulmonary Approach in the Management of Severely Ill Patients with COVID-19 in Intensive Care Settings","authors":"A. Anwar, N. Ramos-Bascon, A. Crerar-Gilbert, N. Barnes, B. Madden","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2550","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2550","url":null,"abstract":"Introduction:During the Corona-virus pandemic, our intensive care units and staff were overwhelmed by both patient numbers and the complexities of their clinical presentation. We believed that a specialist dedicated team would assist our medical and nursing colleagues and help identify and treat the various cardio-pulmonary pathologies contributing to the critical illness of our patients. To support our colleagues and to assist with diagnosis and treatment, we developed a specialist team. We named this team the Acute Respiratory Disease Support (ARDS) team. The purpose of our team was to provide specialist input for severely unwell patients with COVID-19 early in their disease and to assess for conditions that may respond to specific therapies including advanced pulmonary vasodilator therapy and steroids. Methods:The Acute Respiratory Disease Support team reviewed 44 consecutive patients referred from the intensive care units from mid-April to end of May 2020 on a daily basis and coordinated therapies for pulmonary hypertension, pulmonary thrombosis and evolving fibrosis. A follow-up post hospital discharge clinic was set up. Results:The mortality for this group was significantly lower (34%) than the total group admitted to critical care as a whole (51%) and for those not reviewed by the team (55%;p=0.012). Mortality among Asian and African-Caribbean patients was higher than Caucasians (p=0.035). Twenty-three patients (52%) were diagnosed with pulmonary thrombosis. Pulmonary hypertension was present in 84% of the patients. Thirty-two patients received sildenafil therapy and this was associated with improvement in right heart function in all survivors. Short time on mechanical ventilation was associated with a poorer outcome (p=0.0003). Ten patients with evolving pulmonary fibrosis and no evidence of sepsis received high dose steroid therapy in the form of intravenous pulsed methylprednisolone early in their disease. Repeat thoracic computerised tomographic (CT) scans were performed which showed excellent effect (Figure 1). Conclusion:Our experience has reinforced the concept that there are many contributing factors to impaired cardio-pulmonary function in COVID-19 patients and that many of these may be co-contributory to the patient's clinical presentation. It suggests that a coordinated specialised cardio-pulmonary team approach contributes significantly to successful management and outcome of severely unwell patients with COVID-19 and offers an important platform for continuity of patient care, education and staff well-being.","PeriodicalId":111156,"journal":{"name":"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122565852","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2569
J. Tringali, K. Sarigiannis, C. Herbert, D. Banana, S. Basapur, C. Glover, R. Shah, James I. Gerhart, J. Greenberg
RATIONALE: Clinicians typically encourage family presence in the Intensive Care Unit (ICU) as a way to improve both patient and family outcomes. To limit the spread of the disease, families were typically prohibited from visiting the ICU during the COVID-19 pandemic. Little is known about the approach clinicians should take when engaging with families in times when they cannot visit the hospital. METHODS: Surrogates of critically ill patients with COVID-19 who participated in a clinical trial at a single academic center were contacted after ICU discharge to participate in a follow up study dealing with their ICU experience. Upon enrollment in this post-ICU discharge study, the subject (surrogate of the ICU patient) completed the Critical Care Family Needs Inventory (CCFNI) questionnaire and participated in a semi-structured telephone interview. The CCFNI questionnaire includes 14 questions dealing with aspects of the ICU experience that are important to family members. The answers to each question range from 1 (almost all the time) to 4 (none of the time), with lower scores indicating a better experience. Telephone interviews were transcribed and coded using thematic content analysis. RESULTS: Of the 58 subjects enrolled from September 2020 to December 2020, 23 (40%) respective patients were deceased. Subjects of deceased patients had higher median CCFNI scores than subjects of surviving patients, reflecting greater dissatisfaction with the ICU experience (1.82 [1.45-2.00] vs 1.45 [1.27-1.72], respectively, p=0.009). Subjects recollected that they typically received at least one medical update from the patient's ICU team each day. While many subjects felt that telephone communication with the ICU team was adequate, some believed they were unable to fully understand the patient's condition. In addition, some subjects feared the patient was clinically worsening when they did not receive frequent updates, which had a negative impact on their experience. Nearly all subjects reported that visitor restrictions made the ICU experience more difficult. Some subjects believed that the medical decisions that were made and the care the patient received were negatively impacted by not having family present at the bedside. CONCLUSION: During the COVID-19 pandemic, families of critically ill patients typically received medical updates by phone daily because they were unable to visit. These aspects of ICU care delivery had differential effects on the ICU experience of families, with more negative experiences among families of deceased patients. These data suggest that more individualized approach to family engagement is needed during times of visitor restrictions.
{"title":"Recollections of the Intensive Care Unit Experience Among Families of Patients with COVID-19","authors":"J. Tringali, K. Sarigiannis, C. Herbert, D. Banana, S. Basapur, C. Glover, R. Shah, James I. Gerhart, J. Greenberg","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2569","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2569","url":null,"abstract":"RATIONALE: Clinicians typically encourage family presence in the Intensive Care Unit (ICU) as a way to improve both patient and family outcomes. To limit the spread of the disease, families were typically prohibited from visiting the ICU during the COVID-19 pandemic. Little is known about the approach clinicians should take when engaging with families in times when they cannot visit the hospital. METHODS: Surrogates of critically ill patients with COVID-19 who participated in a clinical trial at a single academic center were contacted after ICU discharge to participate in a follow up study dealing with their ICU experience. Upon enrollment in this post-ICU discharge study, the subject (surrogate of the ICU patient) completed the Critical Care Family Needs Inventory (CCFNI) questionnaire and participated in a semi-structured telephone interview. The CCFNI questionnaire includes 14 questions dealing with aspects of the ICU experience that are important to family members. The answers to each question range from 1 (almost all the time) to 4 (none of the time), with lower scores indicating a better experience. Telephone interviews were transcribed and coded using thematic content analysis. RESULTS: Of the 58 subjects enrolled from September 2020 to December 2020, 23 (40%) respective patients were deceased. Subjects of deceased patients had higher median CCFNI scores than subjects of surviving patients, reflecting greater dissatisfaction with the ICU experience (1.82 [1.45-2.00] vs 1.45 [1.27-1.72], respectively, p=0.009). Subjects recollected that they typically received at least one medical update from the patient's ICU team each day. While many subjects felt that telephone communication with the ICU team was adequate, some believed they were unable to fully understand the patient's condition. In addition, some subjects feared the patient was clinically worsening when they did not receive frequent updates, which had a negative impact on their experience. Nearly all subjects reported that visitor restrictions made the ICU experience more difficult. Some subjects believed that the medical decisions that were made and the care the patient received were negatively impacted by not having family present at the bedside. CONCLUSION: During the COVID-19 pandemic, families of critically ill patients typically received medical updates by phone daily because they were unable to visit. These aspects of ICU care delivery had differential effects on the ICU experience of families, with more negative experiences among families of deceased patients. These data suggest that more individualized approach to family engagement is needed during times of visitor restrictions.","PeriodicalId":111156,"journal":{"name":"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117149692","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2555
B. Berg, A. Pająk, P. Gandhi, S. Thakur, J. Liou, T. Al-Mohamad, I. Slabý, H. Arsenault, D. Valentino, A. Deitchman
RATIONALE: Severity of some infections has been correlated to ABO blood type. We sought to determine if ABO blood type correlated with outcome or other measures of disease severity in critically ill patients with COVID-19 requiring ICU level of care. METHODS: We conducted a retrospective, dual-hospital, single-institution cohort analysis of adult patients (>18 yo) with confirmed diagnosed SARS-CoV-19 infection admitted to our medical intensive care unit between 3/11/2020 and 8/19/2020. The primary outcome of our study was in-hospital mortality when comparing various blood types;A-, A+, B-, B+, O-, O+, AB+, AB-. Secondary outcomes were ICU length of stay, need for mechanical ventilation (MV), and oxygenation requirement at discharge. RESULTS: Of the total 270 patients 48 were excluded for absence of blood type data and 11 were excluded due to Covid-19 being incidental to another major medical condition. Blood type distribution and outcome among the 211 patients with COVID-19 admitted to our ICU are given in the table: Statistical analysis using chi square for categories with a substantial number of cases (A+, B+, O+) analyzed for death, MV, or discharge need for O2 revealed no significant differences (p=0.11). Similarly, the ICU length of stay (LOS) was not significantly different among groups. CONCLUSION: Unlike some recent literature has suggested, in our population, blood type did not correlate with death or markers of disease severity in patients with COVID-19 that required ICU level of care.
{"title":"Correlation of ABO Blood Type with Survival in Critically Ill COVID19 Patients Requiring ICU Level of Care","authors":"B. Berg, A. Pająk, P. Gandhi, S. Thakur, J. Liou, T. Al-Mohamad, I. Slabý, H. Arsenault, D. Valentino, A. Deitchman","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2555","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2555","url":null,"abstract":"RATIONALE: Severity of some infections has been correlated to ABO blood type. We sought to determine if ABO blood type correlated with outcome or other measures of disease severity in critically ill patients with COVID-19 requiring ICU level of care. METHODS: We conducted a retrospective, dual-hospital, single-institution cohort analysis of adult patients (>18 yo) with confirmed diagnosed SARS-CoV-19 infection admitted to our medical intensive care unit between 3/11/2020 and 8/19/2020. The primary outcome of our study was in-hospital mortality when comparing various blood types;A-, A+, B-, B+, O-, O+, AB+, AB-. Secondary outcomes were ICU length of stay, need for mechanical ventilation (MV), and oxygenation requirement at discharge. RESULTS: Of the total 270 patients 48 were excluded for absence of blood type data and 11 were excluded due to Covid-19 being incidental to another major medical condition. Blood type distribution and outcome among the 211 patients with COVID-19 admitted to our ICU are given in the table: Statistical analysis using chi square for categories with a substantial number of cases (A+, B+, O+) analyzed for death, MV, or discharge need for O2 revealed no significant differences (p=0.11). Similarly, the ICU length of stay (LOS) was not significantly different among groups. CONCLUSION: Unlike some recent literature has suggested, in our population, blood type did not correlate with death or markers of disease severity in patients with COVID-19 that required ICU level of care.","PeriodicalId":111156,"journal":{"name":"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122123192","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2545
L. Rougui, K. Weze, S. Donaldson, A. Mehari
INTRODUCTION:Coronavirus-2 disease 2019 (COVID-19) is a novelty virus that caused a worldwide pandemic. It can cause mild to critical illness requiring intensive care unit (ICU) admission. In the United States, Black and Hispanic individuals comprise a disproportionately high number of infections and deaths due to COVID-19, likely related to underlying social and healthcare disparities.1,2 There are limited studies identifying predictors of outcome among COVID-19,3 in minority patients. The aim of this study was to identify the predictors of mortality among laboratory confirmed COVID-19 minority patients with severe clinical disease admitted to the ICU. METHODS:Clinical data at the time of ICU admission was extracted from electronic records for a total of 95 sequentially admitted patients to the medical ICU with confirmed COVID-19 diagnoses. Demographics, comorbidities, laboratory values that included inflammatory markers, ICU course, mortality and discharge status data were collected. The primary outcome was ICU mortality treated as a binary outcome. Summary characteristics were described based on survival status with a test of significance using ANOVA, kwallis and chisquare as appropriate. A univariate logistic regression was used to identify mortality predictor variables of statistical significance which were then included in a final multivariate regression model. Inflammatory markers were added individually to this finalized model to avoid collinearity. Findings were summarized using odds ratios and confidence intervals. RESULTS:The mean (SD) age was 61.54(14) years, 34(36%) were men, 67(71%) were African Americans and 20 (16%) were Hispanic. Most common comorbidities were hypertension 55 (58%) and diabetes 46 (48%). Fifty-three (56%) were intubated, 23 (25%) required pressor support, and 15 (16%) patients had their initial blood culture positive. Inflammatory markers were elevated in most all patients which was associated with mortality. ICU mortality was 48% (45 patients). Univariate analysis identified age ≥ 65yrs (odds ratio [OR]=1.25;95% CI,1.02-1.52;p= 0.032), higher SOFA scores of 2 and 3{ (OR=1.74, 95% CI ,1.05-2.89,p=0.035) and (OR=1.90,95%CI,1.1-3.29;p=0.024 respectively)}, vasopressor use ( OR=1.77;95%CI,1.44-2.18;p<0.001), severe ARDS (OR=;1.45;95%CI,1.05-2.01;p=0.027), mechanical ventilation use (OR=1.46;95%CI,1.22-1.79;p<0.001), procalcitonin>2.5ng/ml (OR=1.84;95% CI, 95%CI,1.03-3.29;p=0.042), ferritin>2000ng/ml (OR=1.45;95% CI,1.12-1.89;p=0.007), CRP>20mg/dl (OR=1.67 OR=;95CI,1.3-2.13;p<0.001) and LDH>400 (OR=1.68;95%C,1.26-2.23;p<0.001) as predictors of ICU morality. Of these, only age ≥ 65yrs, mechanical ventilation and vasopressor use remained statistically significant independent predictors of mortality in multivariable regression model. CONCLUSIONAmong predominantly minority patients with severe COVID-19 admitted to the ICU, older patients who become intubated, requiring vasopressor support and/or had elevated biomarkers o
{"title":"Predictors of Mortality in Minority Patients Admitted to the ICU with COVID-19 Infection","authors":"L. Rougui, K. Weze, S. Donaldson, A. Mehari","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2545","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2545","url":null,"abstract":"INTRODUCTION:Coronavirus-2 disease 2019 (COVID-19) is a novelty virus that caused a worldwide pandemic. It can cause mild to critical illness requiring intensive care unit (ICU) admission. In the United States, Black and Hispanic individuals comprise a disproportionately high number of infections and deaths due to COVID-19, likely related to underlying social and healthcare disparities.1,2 There are limited studies identifying predictors of outcome among COVID-19,3 in minority patients. The aim of this study was to identify the predictors of mortality among laboratory confirmed COVID-19 minority patients with severe clinical disease admitted to the ICU. METHODS:Clinical data at the time of ICU admission was extracted from electronic records for a total of 95 sequentially admitted patients to the medical ICU with confirmed COVID-19 diagnoses. Demographics, comorbidities, laboratory values that included inflammatory markers, ICU course, mortality and discharge status data were collected. The primary outcome was ICU mortality treated as a binary outcome. Summary characteristics were described based on survival status with a test of significance using ANOVA, kwallis and chisquare as appropriate. A univariate logistic regression was used to identify mortality predictor variables of statistical significance which were then included in a final multivariate regression model. Inflammatory markers were added individually to this finalized model to avoid collinearity. Findings were summarized using odds ratios and confidence intervals. RESULTS:The mean (SD) age was 61.54(14) years, 34(36%) were men, 67(71%) were African Americans and 20 (16%) were Hispanic. Most common comorbidities were hypertension 55 (58%) and diabetes 46 (48%). Fifty-three (56%) were intubated, 23 (25%) required pressor support, and 15 (16%) patients had their initial blood culture positive. Inflammatory markers were elevated in most all patients which was associated with mortality. ICU mortality was 48% (45 patients). Univariate analysis identified age ≥ 65yrs (odds ratio [OR]=1.25;95% CI,1.02-1.52;p= 0.032), higher SOFA scores of 2 and 3{ (OR=1.74, 95% CI ,1.05-2.89,p=0.035) and (OR=1.90,95%CI,1.1-3.29;p=0.024 respectively)}, vasopressor use ( OR=1.77;95%CI,1.44-2.18;p<0.001), severe ARDS (OR=;1.45;95%CI,1.05-2.01;p=0.027), mechanical ventilation use (OR=1.46;95%CI,1.22-1.79;p<0.001), procalcitonin>2.5ng/ml (OR=1.84;95% CI, 95%CI,1.03-3.29;p=0.042), ferritin>2000ng/ml (OR=1.45;95% CI,1.12-1.89;p=0.007), CRP>20mg/dl (OR=1.67 OR=;95CI,1.3-2.13;p<0.001) and LDH>400 (OR=1.68;95%C,1.26-2.23;p<0.001) as predictors of ICU morality. Of these, only age ≥ 65yrs, mechanical ventilation and vasopressor use remained statistically significant independent predictors of mortality in multivariable regression model. CONCLUSIONAmong predominantly minority patients with severe COVID-19 admitted to the ICU, older patients who become intubated, requiring vasopressor support and/or had elevated biomarkers o","PeriodicalId":111156,"journal":{"name":"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124960836","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2537
A. L. F. Baldarrago, A. Patel, J. Silva, A. Moshensky, S. Perera, L. J. Ma, J. Pham, M. Lam, M. Odish, N. Coufal, A. Meier, L. Alexander
Background: Neutrophils are key players in the immune and aid in the defense against microorganisms. Neutrophil extracellular traps (NETs) are extracellular DNA complexes, which are released during NETosis, a programmed form of cell death. Although NETs are crucial in the fight against infectious agents, an overabundance of neutrophils has been implicated in many inflammatory lung conditions. Our aim is to determine whether an overabundance of NETosis is associated with clinical deterioration of patients with COVID-19. Methods: Circulating polymorphonuclear cells (neutrophils) were isolated from human peripheral blood of 20 human subjects with COVID-19. Neutrophils were seeded in 96-well plates and treated with 0, 2.5 nM, 25 nM, and 250 nM of phorbol 12-myrisate 13-acetate (PMA) or 12 uM nigericin for 2 hours to stimulate NET production via canonical and noncanonical pathways, respectively. Following incubation, wells were treated with micrococcal nuclease, supernatants were collected from each well, and extracellular DNA content to quantify NETosis was detected by fluorescent plate reader. We calculated acute physiology and chronic health evaluation (APACHE-II) scores for every human subject. These were calculated at the same time point at which the neutrophils were collected. They were then compared to the degree of NETosis and absolute neutrophil count (ANC). These were analyzed using a simple linear regression model. We also categorized participants based on APACHE-II scores (APACHE-II <15, APACHE-II>15) and compared them to rates of NETosis using a bar graph. Results: APACHE II is a widely used ICU mortality prediction score that is used to risk-stratify patients. We found that participants with higher APACHE-II scores had higher rates of NETosis, both at 0 nM PMA and when stimulated with nigericin (figure 1a-b). This suggests that higher rates of NETosis correlate with increased disease severity. Additionally, we found a positive correlation between ANC and NETosis (Figure 1c-1d), suggesting that ANC itself is a reliable marker of NETosis and disease severity. Conclusion: NETosis is an important player in immune system defense but has also been implicated in various inflammatory lung conditions. We found that in patients with COVID-19, there was a positive correlation between worsening disease state, measure by APACHE II scores, and increased NETosis. This suggests that over-activation of neutrophils may play a role in disease progression. We also found a positive correlation between NETosis and ANC, indicating that the degree of circulating neutrophils is a reliable marker of the functional state of neutrophils, as well as disease severity.
{"title":"Neutrophil Extracellular Trap Formation (NETosis) Increases with Severity of Disease in COVID-19 Patients","authors":"A. L. F. Baldarrago, A. Patel, J. Silva, A. Moshensky, S. Perera, L. J. Ma, J. Pham, M. Lam, M. Odish, N. Coufal, A. Meier, L. Alexander","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2537","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2537","url":null,"abstract":"Background: Neutrophils are key players in the immune and aid in the defense against microorganisms. Neutrophil extracellular traps (NETs) are extracellular DNA complexes, which are released during NETosis, a programmed form of cell death. Although NETs are crucial in the fight against infectious agents, an overabundance of neutrophils has been implicated in many inflammatory lung conditions. Our aim is to determine whether an overabundance of NETosis is associated with clinical deterioration of patients with COVID-19. Methods: Circulating polymorphonuclear cells (neutrophils) were isolated from human peripheral blood of 20 human subjects with COVID-19. Neutrophils were seeded in 96-well plates and treated with 0, 2.5 nM, 25 nM, and 250 nM of phorbol 12-myrisate 13-acetate (PMA) or 12 uM nigericin for 2 hours to stimulate NET production via canonical and noncanonical pathways, respectively. Following incubation, wells were treated with micrococcal nuclease, supernatants were collected from each well, and extracellular DNA content to quantify NETosis was detected by fluorescent plate reader. We calculated acute physiology and chronic health evaluation (APACHE-II) scores for every human subject. These were calculated at the same time point at which the neutrophils were collected. They were then compared to the degree of NETosis and absolute neutrophil count (ANC). These were analyzed using a simple linear regression model. We also categorized participants based on APACHE-II scores (APACHE-II <15, APACHE-II>15) and compared them to rates of NETosis using a bar graph. Results: APACHE II is a widely used ICU mortality prediction score that is used to risk-stratify patients. We found that participants with higher APACHE-II scores had higher rates of NETosis, both at 0 nM PMA and when stimulated with nigericin (figure 1a-b). This suggests that higher rates of NETosis correlate with increased disease severity. Additionally, we found a positive correlation between ANC and NETosis (Figure 1c-1d), suggesting that ANC itself is a reliable marker of NETosis and disease severity. Conclusion: NETosis is an important player in immune system defense but has also been implicated in various inflammatory lung conditions. We found that in patients with COVID-19, there was a positive correlation between worsening disease state, measure by APACHE II scores, and increased NETosis. This suggests that over-activation of neutrophils may play a role in disease progression. We also found a positive correlation between NETosis and ANC, indicating that the degree of circulating neutrophils is a reliable marker of the functional state of neutrophils, as well as disease severity.","PeriodicalId":111156,"journal":{"name":"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT","volume":"206 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115185390","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2566
B. Park, A. Kannappan, A. N. Rizzo, Y. Jin, R. Peterson, M. Moss, S. Jolley
RATIONALE: The COVID-19 pandemic has rapidly become the most significant worldwide public health crisis in the modern era. Like other states around the country, the state of Colorado instituted a statewide lockdown to combat increasing case and hospitalization rates for COVID-19 throughout the state. The impact of this mandate on the ICU admission rates and outcomes of other medical problems has never been investigated. Our study aimed to determine the effects of stay-at-home orders on outcomes for other diagnoses by analyzing ICU admission rates and outcomes of patients presenting to the ICU for non-COVID related issues before, during, and after the statewide mandate. METHODS: We performed a retrospective analysis of all ICU admissions in three phases: before (2 months prior), during, and 1.5 months after the statewide lockdown (March 26 to April 27, 2020). We included all patients admitted to the University of Colorado Health System hospitals ICUs within this defined time period. A time-to-event analysis was performed with the date of index ICU stay set as time zero. Baseline characteristics were obtained. Primary outcome measures were 28-day mortality and all-time mortality. Kaplan-Meier curves were used to estimate survival probabilities, while Cox regression and multivariable logistic regression were utilized to model phase-specific mortality controlling for comorbidities, demographics, and admission diagnoses. Counts of typical ICU admission diagnoses were also analyzed to determine any changes across lockdown periods. RESULTS: 9201 total ICU admissions occurred, of which 8154 (88.6%) were non-COVID-19 related. Approximately 57.4% were male with a mean age of 60.4 years. 28-day mortality rates for non-COVID-19 ICU admissions were 475 (11.0%), 127 (13.8%), and 306 (10.5%) before, during, and after the lockdown, respectively. The increased mortality during lockdown persisted after adjustment for comorbidities and demographics (HR=1.23, 95% CI, 1.007 to 1.512, p = 0.043). Acute respiratory failure was the most common diagnosis in each time period, and increased during lockdown (p<0.001). Admissions for sepsis increased during lockdown and decreased after (p = 0.001);myocardial infarction (MI) admission decreased during lockdown but increased after (p = 0.014);and alcohol withdrawal (AW) admission increased both during and after lockdown (p < 0.001). CONCLUSIONS: For non-COVID-19 related ICU admissions, the mortality rate increased during the state-wide shutdown but decreased after shutdown, although this difference became insignificant after controlling for patient admission diagnoses. Admission diagnoses also differed with more admissions for sepsis and AW during lockdown and more admissions for MI and AW after lockdown.
{"title":"The Impact of the Colorado State-Wide Lockdown on Non-COVID-19 Related ICU Admissions and Mortality","authors":"B. Park, A. Kannappan, A. N. Rizzo, Y. Jin, R. Peterson, M. Moss, S. Jolley","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2566","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2566","url":null,"abstract":"RATIONALE: The COVID-19 pandemic has rapidly become the most significant worldwide public health crisis in the modern era. Like other states around the country, the state of Colorado instituted a statewide lockdown to combat increasing case and hospitalization rates for COVID-19 throughout the state. The impact of this mandate on the ICU admission rates and outcomes of other medical problems has never been investigated. Our study aimed to determine the effects of stay-at-home orders on outcomes for other diagnoses by analyzing ICU admission rates and outcomes of patients presenting to the ICU for non-COVID related issues before, during, and after the statewide mandate. METHODS: We performed a retrospective analysis of all ICU admissions in three phases: before (2 months prior), during, and 1.5 months after the statewide lockdown (March 26 to April 27, 2020). We included all patients admitted to the University of Colorado Health System hospitals ICUs within this defined time period. A time-to-event analysis was performed with the date of index ICU stay set as time zero. Baseline characteristics were obtained. Primary outcome measures were 28-day mortality and all-time mortality. Kaplan-Meier curves were used to estimate survival probabilities, while Cox regression and multivariable logistic regression were utilized to model phase-specific mortality controlling for comorbidities, demographics, and admission diagnoses. Counts of typical ICU admission diagnoses were also analyzed to determine any changes across lockdown periods. RESULTS: 9201 total ICU admissions occurred, of which 8154 (88.6%) were non-COVID-19 related. Approximately 57.4% were male with a mean age of 60.4 years. 28-day mortality rates for non-COVID-19 ICU admissions were 475 (11.0%), 127 (13.8%), and 306 (10.5%) before, during, and after the lockdown, respectively. The increased mortality during lockdown persisted after adjustment for comorbidities and demographics (HR=1.23, 95% CI, 1.007 to 1.512, p = 0.043). Acute respiratory failure was the most common diagnosis in each time period, and increased during lockdown (p<0.001). Admissions for sepsis increased during lockdown and decreased after (p = 0.001);myocardial infarction (MI) admission decreased during lockdown but increased after (p = 0.014);and alcohol withdrawal (AW) admission increased both during and after lockdown (p < 0.001). CONCLUSIONS: For non-COVID-19 related ICU admissions, the mortality rate increased during the state-wide shutdown but decreased after shutdown, although this difference became insignificant after controlling for patient admission diagnoses. Admission diagnoses also differed with more admissions for sepsis and AW during lockdown and more admissions for MI and AW after lockdown.","PeriodicalId":111156,"journal":{"name":"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT","volume":"407 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115913102","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2547
Patrick Leonardo Nogueira da Silva, F. Cruz, L. Ball, J. Herrmann, S. Gerard, Y. Xin, P. Pelosi, P. Rocco
RATIONALE: Chest computed tomography (CT) has a potential role in the diagnosis, detection of complications, and prognosis of coronavirus disease 2019 (COVID-19). The value of chest CT can be further amplified when associated to physiological variables. Some studies have done efforts to correlate chest CT findings with overall oxygenation and respiratory mechanics, which although they are easily obtained may not be specifically related to COVID-19. Very few studies have tried to correlate chest CT findings with specific biomarkers related to COVID-19. For this purpose, temporal changes of chest CT were evaluated and then correlated with laboratory data in multicenter randomized clinical trial. METHODS: Adult patients who presented chest CT scan features compatible with viral pneumonia were admitted in the hospital and followed during 7 days (NCT: 04561219). CT scans and laboratory data [D-dimer, ferritin, and lactate dehydrogenase (LDH)] in blood were obtained at the moment of admission (Baseline) and on day 7 (Final). Qualitative and quantitative chest CT scan parameters were evaluated in ventral, middle and dorsal regions of interest (ROI) and classified as: hyper-, normal-, poor-, and non-aerated. RESULTS: In this study involving 45 COVID-19 patients no statistically significant differences in the overall Hounsfield Units (HU) ranges and percent of whole lung mass were found overtime. Normally aerated lung tissue reduced from Baseline to Final (p=0.004), mainly associated with a decrease in ventral (p=0.001) and middle (p=0.026) ROIs. At dorsal ROI, a reduction in CT lung mass in poorly aerated areas was observed from Baseline to Final. Poorly aerated and non-aerated lung areas were well correlated only with D-dimer blood levels (r=0.55, p<0.001;and r=0.52, p=0.001, respectively). CONCLUSION: In patients with COVID-19 pneumonia, changes in poor-and non-aerated were associated to changes in D-dimer blood levels, which may be a specific biomarker to be follow in facilities without CT as a way to infer radiologic changes.
{"title":"Time Course of Chest Computed Tomography Findings and Biomarkers in COVID-19 Pneumonia Patients","authors":"Patrick Leonardo Nogueira da Silva, F. Cruz, L. Ball, J. Herrmann, S. Gerard, Y. Xin, P. Pelosi, P. Rocco","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2547","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2547","url":null,"abstract":"RATIONALE: Chest computed tomography (CT) has a potential role in the diagnosis, detection of complications, and prognosis of coronavirus disease 2019 (COVID-19). The value of chest CT can be further amplified when associated to physiological variables. Some studies have done efforts to correlate chest CT findings with overall oxygenation and respiratory mechanics, which although they are easily obtained may not be specifically related to COVID-19. Very few studies have tried to correlate chest CT findings with specific biomarkers related to COVID-19. For this purpose, temporal changes of chest CT were evaluated and then correlated with laboratory data in multicenter randomized clinical trial. METHODS: Adult patients who presented chest CT scan features compatible with viral pneumonia were admitted in the hospital and followed during 7 days (NCT: 04561219). CT scans and laboratory data [D-dimer, ferritin, and lactate dehydrogenase (LDH)] in blood were obtained at the moment of admission (Baseline) and on day 7 (Final). Qualitative and quantitative chest CT scan parameters were evaluated in ventral, middle and dorsal regions of interest (ROI) and classified as: hyper-, normal-, poor-, and non-aerated. RESULTS: In this study involving 45 COVID-19 patients no statistically significant differences in the overall Hounsfield Units (HU) ranges and percent of whole lung mass were found overtime. Normally aerated lung tissue reduced from Baseline to Final (p=0.004), mainly associated with a decrease in ventral (p=0.001) and middle (p=0.026) ROIs. At dorsal ROI, a reduction in CT lung mass in poorly aerated areas was observed from Baseline to Final. Poorly aerated and non-aerated lung areas were well correlated only with D-dimer blood levels (r=0.55, p<0.001;and r=0.52, p=0.001, respectively). CONCLUSION: In patients with COVID-19 pneumonia, changes in poor-and non-aerated were associated to changes in D-dimer blood levels, which may be a specific biomarker to be follow in facilities without CT as a way to infer radiologic changes.","PeriodicalId":111156,"journal":{"name":"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122569300","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}
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