Objective: To identify the influence of obesity on mortality, time to weaning from mechanical ventilation and mobility at intensive care unit discharge in patients with COVID-19.
Methods: This retrospective cohort study was carried out between March and August 2020. All adult patients admitted to the intensive care unit in need of ventilatory support and confirmed to have COVID-19 were included. The outcomes included mortality, time on mechanical ventilation, and mobility at intensive care unit discharge.
Results: Four hundred and twenty-nine patients were included, 36.6% of whom were overweight and 43.8% of whom were obese. Compared with normal body mass index patients, overweight and obese patients had lower mortality (p = 0.002) and longer intensive care unit survival (log-rank p < 0.001). Compared with patients with a normal body mass index, overweight patients had a 36% lower risk of death (p = 0.04), while patients with obesity presented a 23% lower risk (p < 0.001). There was no association between obesity and time on mechanical ventilation. The level of mobility at intensive care unit discharge did not differ between groups and showed a moderate inverse correlation with length of stay in the intensive care unit (r = -0.461; p < 0.001).
Conclusion: Overweight and obese patients had lower mortality and higher intensive care unit survival rates. The duration of mechanical ventilation and mobility level at intensive care unit discharge did not differ between the groups.
{"title":"Influence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19.","authors":"Luísa Helena Machado Martinato, Débora Schmidt, Taila Cristina Piva, Gracieli Nadalon Deponti, Maricene Colissi Graboski, Rodrigo Della Méa Plentz, Graciele Sbruzzi","doi":"10.62675/2965-2774.20240253-en","DOIUrl":"10.62675/2965-2774.20240253-en","url":null,"abstract":"<p><strong>Objective: </strong>To identify the influence of obesity on mortality, time to weaning from mechanical ventilation and mobility at intensive care unit discharge in patients with COVID-19.</p><p><strong>Methods: </strong>This retrospective cohort study was carried out between March and August 2020. All adult patients admitted to the intensive care unit in need of ventilatory support and confirmed to have COVID-19 were included. The outcomes included mortality, time on mechanical ventilation, and mobility at intensive care unit discharge.</p><p><strong>Results: </strong>Four hundred and twenty-nine patients were included, 36.6% of whom were overweight and 43.8% of whom were obese. Compared with normal body mass index patients, overweight and obese patients had lower mortality (p = 0.002) and longer intensive care unit survival (log-rank p < 0.001). Compared with patients with a normal body mass index, overweight patients had a 36% lower risk of death (p = 0.04), while patients with obesity presented a 23% lower risk (p < 0.001). There was no association between obesity and time on mechanical ventilation. The level of mobility at intensive care unit discharge did not differ between groups and showed a moderate inverse correlation with length of stay in the intensive care unit (r = -0.461; p < 0.001).</p><p><strong>Conclusion: </strong>Overweight and obese patients had lower mortality and higher intensive care unit survival rates. The duration of mechanical ventilation and mobility level at intensive care unit discharge did not differ between the groups.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11208042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565309","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}
Pub Date : 2024-07-02DOI: 10.62675/2965-2774.20240276-en
J. Finsterer, F. Scorza
Editor We read with interest the article by Monteiro et al. on a retrospective single-center study of the outcomes and mortality of 389 patients with traumatic brain injury (TBI) or subarachnoid bleeding (SAB) depending on the level of neuro-monitoring (standard, advanced) in a neuro-critical care unit (NCCU, Group G1) and a general intensive care unit (ICU) (GICU, Group G2). (1) The severity of the disease was assessed at admission to the emergency department using the simplified acute physiology (SAPS) II score. (1) Advanced multimodal brain monitoring, including autoregulation and NCCU management, was associated with better outcomes than standard neuromonitoring in the GICU. (1) The study is impressive, but some points require discussion. The major limitation of the study is that factors other than ICU monitoring and ICU type were not adequately included in the evaluation. The outcomes of TBI and SAB depend not only on the type and quality of neuro-monitoring in the ICU but also on several other influencing factors. These include the type and severity of TBI and SAB, the treatment of TBI and SAB, comorbidities, comedication, family history, and genetic background. In addition, for patients with SAB, it must be clarified whether the bleeding is aneurysmal or non-aneurysmal. In the case of an aneurysm, it is important to know whether the aneurysm is coiled or resected. The outcome of SAB may also depend on the initial Hunt–Hess score and whether there is blood inside the ventricles as well as age, comorbidities,
{"title":"To: Neurocritical care management supported by multimodal brain monitoring after acute brain injury","authors":"J. Finsterer, F. Scorza","doi":"10.62675/2965-2774.20240276-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240276-en","url":null,"abstract":"Editor We read with interest the article by Monteiro et al. on a retrospective single-center study of the outcomes and mortality of 389 patients with traumatic brain injury (TBI) or subarachnoid bleeding (SAB) depending on the level of neuro-monitoring (standard, advanced) in a neuro-critical care unit (NCCU, Group G1) and a general intensive care unit (ICU) (GICU, Group G2). (1) The severity of the disease was assessed at admission to the emergency department using the simplified acute physiology (SAPS) II score. (1) Advanced multimodal brain monitoring, including autoregulation and NCCU management, was associated with better outcomes than standard neuromonitoring in the GICU. (1) The study is impressive, but some points require discussion. The major limitation of the study is that factors other than ICU monitoring and ICU type were not adequately included in the evaluation. The outcomes of TBI and SAB depend not only on the type and quality of neuro-monitoring in the ICU but also on several other influencing factors. These include the type and severity of TBI and SAB, the treatment of TBI and SAB, comorbidities, comedication, family history, and genetic background. In addition, for patients with SAB, it must be clarified whether the bleeding is aneurysmal or non-aneurysmal. In the case of an aneurysm, it is important to know whether the aneurysm is coiled or resected. The outcome of SAB may also depend on the initial Hunt–Hess score and whether there is blood inside the ventricles as well as age, comorbidities,","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141688398","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 : 2024-07-01DOI: 10.62675/2965-2774.20240084-en
S. González-Dambrauskas, J. Salluh, Flávia Ribeiro Machado, Alexandre T Rotta
{"title":"Science over language: a plea to consider language bias in scientific publishing","authors":"S. González-Dambrauskas, J. Salluh, Flávia Ribeiro Machado, Alexandre T Rotta","doi":"10.62675/2965-2774.20240084-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240084-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141703860","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 : 2024-07-01eCollection Date: 2024-01-01DOI: 10.62675/2965-2774.20240040-en
Fulvio Alexandre Scorza, Carla Alessandra Scorza, Josef Finsterer
{"title":"To: Death by community-based methicillin-resistant Staphylococcus aureus: case report.","authors":"Fulvio Alexandre Scorza, Carla Alessandra Scorza, Josef Finsterer","doi":"10.62675/2965-2774.20240040-en","DOIUrl":"10.62675/2965-2774.20240040-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11208040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494450","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}
Pub Date : 2024-07-01DOI: 10.62675/2965-2774.20240058-en
Vanessa Soares Lanziotti, Andrea Ventura, S. Kache, Jaime Fernández-Sarmiento
In Greek mythology, the phoenix bird symbolizes life that overcomes death and the strength that accompanies transformation. Therefore, Phoenix is an appropriate name for the new Pediatric Sepsis Score owing to both the mythological reference and the location where it was first presented (Society of Critical Care Medicine – SCCM - Conference in Phoenix, Arizona). (1) The Phoenix Pediatric Sepsis (PPS) criteria for sepsis and septic shock are intended to identify children (1 month to <18 years) with life-threatening organ dysfunction due to infection, and the score was developed based on more than three million pediatric electronic health encounters, (2) which is a remarkable achievement considering pediatric and adult sepsis studies. The previous pediatric sepsis criteria were published in 2005 by the International Pediatric Sepsis Consensus Conference (IPSCC), and sepsis was defined as a suspected or confirmed infection in the presence of systemic inflammatory response syndrome (SIRS) (Figure 1). (3) Although these criteria are broadly used in daily practice, limitations to this definition have been identified since its inception. (4) Specific limitations of concern include a lack of consideration of a global context, leading to challenges in the applicabiblity of these criteria in limited-resource settings where the highest sepsis burden lies; variability in application at the bedside, which leads to delay in patient diagnosis; and the inability to
在希腊神话中，凤凰鸟象征着战胜死亡的生命和伴随转变的力量。因此，凤凰城是新的儿科脓毒症评分标准的恰当名称，这既与神话有关，也与该评分标准首次发布的地点有关（美国亚利桑那州凤凰城召开的重症医学会（Society of Critical Care Medicine - SCCM））。(1）凤凰城儿科败血症（PPS）败血症和脓毒性休克标准旨在识别因感染导致器官功能障碍而危及生命的儿童（1 个月至小于 18 岁），该评分是基于 300 多万次儿科电子健康会诊制定的，（2）考虑到儿科和成人败血症研究，这是一项了不起的成就。之前的儿科败血症标准由国际儿科败血症共识会议（IPSCC）于 2005 年发布，败血症被定义为存在全身炎症反应综合征（SIRS）的疑似或确诊感染（图 1）。(3）尽管这些标准在日常实践中得到了广泛应用，但自该定义提出以来，已发现了其局限性。(4)值得关注的具体局限性包括：缺乏对全球背景的考虑，导致这些标准在资源有限的环境中的适用性面临挑战，而这些环境正是败血症负担最重的地方；床旁应用的可变性，导致患者诊断的延迟；以及无法在全球范围内使用这些标准。
{"title":"New Phoenix criteria for pediatric sepsis and septic shock: the strengths and the future of a comprehensive perspective","authors":"Vanessa Soares Lanziotti, Andrea Ventura, S. Kache, Jaime Fernández-Sarmiento","doi":"10.62675/2965-2774.20240058-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240058-en","url":null,"abstract":"In Greek mythology, the phoenix bird symbolizes life that overcomes death and the strength that accompanies transformation. Therefore, Phoenix is an appropriate name for the new Pediatric Sepsis Score owing to both the mythological reference and the location where it was first presented (Society of Critical Care Medicine – SCCM - Conference in Phoenix, Arizona). (1) The Phoenix Pediatric Sepsis (PPS) criteria for sepsis and septic shock are intended to identify children (1 month to <18 years) with life-threatening organ dysfunction due to infection, and the score was developed based on more than three million pediatric electronic health encounters, (2) which is a remarkable achievement considering pediatric and adult sepsis studies. The previous pediatric sepsis criteria were published in 2005 by the International Pediatric Sepsis Consensus Conference (IPSCC), and sepsis was defined as a suspected or confirmed infection in the presence of systemic inflammatory response syndrome (SIRS) (Figure 1). (3) Although these criteria are broadly used in daily practice, limitations to this definition have been identified since its inception. (4) Specific limitations of concern include a lack of consideration of a global context, leading to challenges in the applicabiblity of these criteria in limited-resource settings where the highest sepsis burden lies; variability in application at the bedside, which leads to delay in patient diagnosis; and the inability to","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695738","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 : 2024-07-01DOI: 10.62675/2965-2774.20240068-en
L. C. L. Damascena, Aline Roseane Queiroz de Paiva Faria, Nyellisonn Nando Nóbrega de Lucena, Ana Hermínia Andrade e Silva, Talita Tavares Alves de Almeida, Diana de Fátima Alves Pinto, H. F. Coêlho, Ana Maria Gondim Valença
ABSTRACT Objective To identify factors associated with hospitalization in the intensive care unit in children and adolescents with COVID-19. Methods This was a retrospective cohort study using secondary data of hospitalized children and adolescents (zero to 18 years old) with COVID-19 reported in Paraíba from April 2020 to July 2021, totaling 486 records. Descriptive analysis, logistic regression and multilevel regression were performed, utilizing a significance level of 5%. Results According to logistic regression without hierarchical levels, there was an increased chance of admission to the intensive care unit for male patients (OR = 1.98; 95%CI 1.18 - 3.32), patients with respiratory distress (OR = 2.43; 95%CI 1.29 - 4.56), patients with dyspnea (OR = 3.57; 95%CI 1.77 - 7.18) and patients living in large cities (OR = 2.70; 95%CI 1.07 - 6.77). The likelihood of requiring intensive care was observed to decrease with increasing age (OR = 0.94; 95%CI = 0.90 - 0.97), the presence of cough (OR = 0.32; 95%CI 0.18 - 0.59) or fever (OR = 0.42; 95%CI 0.23 - 0.74) and increasing Gini index (OR = 0.003; 95%CI 0.000 - 0.243). According to the multilevel analysis, the odds of admission to the intensive care unit increased in male patients (OR = 1.70; 95%CI = 1.68-1.71) and with increasing population size of the municipality per 100,000 inhabitants (OR = 1.01; 95%CI 1.01-1.03); additionally, the odds of admission to the intensive care unit decreased for mixed-race versus non-brown-skinned patients (OR = 0.981; 95%CI 0.97 - 0.99) and increasing Gini index (OR = 0.02; 95%CI 0.02 - 0.02). Conclusion The effects of patient characteristics and social context on the need for intensive care in children and adolescents with SARS-CoV-2 infection were better estimated with the inclusion of a multilevel regression model.
ABSTRACT Objective To identify factors associated with hospitalization in the intensive care unit in children and adolescents with COVID-19。方法 这是一项回顾性队列研究，使用的是 2020 年 4 月至 2021 年 7 月期间帕拉伊巴州报告的 COVID-19 住院儿童和青少年（0 至 18 岁）的二手数据，共计 486 条记录。研究采用描述性分析、逻辑回归和多层次回归，显著性水平为 5%。结果 根据无层次的逻辑回归，男性患者（OR = 1.98；95%CI 1.18 - 3.32）、呼吸困难患者（OR = 2.43；95%CI 1.29 - 4.56）、呼吸困难患者（OR = 3.57；95%CI 1.77 - 7.18）和居住在大城市的患者（OR = 2.70；95%CI 1.07 - 6.77）入住重症监护室的几率增加。据观察，随着年龄的增加（OR = 0.94；95%CI = 0.90 - 0.97）、出现咳嗽（OR = 0.32；95%CI 0.18 - 0.59）或发烧（OR = 0.42；95%CI 0.23 - 0.74）以及基尼指数的增加（OR = 0.003；95%CI 0.000 - 0.243），需要重症监护的可能性降低。根据多层次分析，男性患者入住重症监护室的几率增加（OR = 1.70；95%CI = 1.68-1.71），且随着每 10 万居民中城市人口数量的增加而增加（OR = 1.01；95%CI=1.01-1.03）；此外，混血儿相对于非棕色皮肤患者（OR=0.981；95%CI=0.97-0.99）和基尼指数增加（OR=0.02；95%CI=0.02-0.02）时，入住重症监护室的几率降低。结论 采用多层次回归模型可以更好地估计患者特征和社会环境对感染 SARS-CoV-2 的儿童和青少年重症监护需求的影响。
{"title":"Analysis of factors associated with admission to the intensive care unit of children and adolescents with COVID-19: application of a multilevel model","authors":"L. C. L. Damascena, Aline Roseane Queiroz de Paiva Faria, Nyellisonn Nando Nóbrega de Lucena, Ana Hermínia Andrade e Silva, Talita Tavares Alves de Almeida, Diana de Fátima Alves Pinto, H. F. Coêlho, Ana Maria Gondim Valença","doi":"10.62675/2965-2774.20240068-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240068-en","url":null,"abstract":"ABSTRACT Objective To identify factors associated with hospitalization in the intensive care unit in children and adolescents with COVID-19. Methods This was a retrospective cohort study using secondary data of hospitalized children and adolescents (zero to 18 years old) with COVID-19 reported in Paraíba from April 2020 to July 2021, totaling 486 records. Descriptive analysis, logistic regression and multilevel regression were performed, utilizing a significance level of 5%. Results According to logistic regression without hierarchical levels, there was an increased chance of admission to the intensive care unit for male patients (OR = 1.98; 95%CI 1.18 - 3.32), patients with respiratory distress (OR = 2.43; 95%CI 1.29 - 4.56), patients with dyspnea (OR = 3.57; 95%CI 1.77 - 7.18) and patients living in large cities (OR = 2.70; 95%CI 1.07 - 6.77). The likelihood of requiring intensive care was observed to decrease with increasing age (OR = 0.94; 95%CI = 0.90 - 0.97), the presence of cough (OR = 0.32; 95%CI 0.18 - 0.59) or fever (OR = 0.42; 95%CI 0.23 - 0.74) and increasing Gini index (OR = 0.003; 95%CI 0.000 - 0.243). According to the multilevel analysis, the odds of admission to the intensive care unit increased in male patients (OR = 1.70; 95%CI = 1.68-1.71) and with increasing population size of the municipality per 100,000 inhabitants (OR = 1.01; 95%CI 1.01-1.03); additionally, the odds of admission to the intensive care unit decreased for mixed-race versus non-brown-skinned patients (OR = 0.981; 95%CI 0.97 - 0.99) and increasing Gini index (OR = 0.02; 95%CI 0.02 - 0.02). Conclusion The effects of patient characteristics and social context on the need for intensive care in children and adolescents with SARS-CoV-2 infection were better estimated with the inclusion of a multilevel regression model.","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692665","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 : 2024-07-01DOI: 10.62675/2965-2774.20240118-en
Marcio Soares, J. Salluh, Fernando G Zampieri, F. A. Bozza, Pedro Martins Pereira Kurtz
{"title":"A decade of the ORCHESTRA study: organizational characteristics, patient outcomes, performance and efficiency in critical care","authors":"Marcio Soares, J. Salluh, Fernando G Zampieri, F. A. Bozza, Pedro Martins Pereira Kurtz","doi":"10.62675/2965-2774.20240118-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240118-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695818","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 : 2024-07-01eCollection Date: 2024-01-01DOI: 10.62675/2965-2774.20240203-en
Aline Braz Pereira, Felipe Dal Pizzol, Viviane Cordeiro Veiga, Leandro Utino Taniguchi, Aline Finoti Misquita, Gustavo Augusto Couto Carvalho, Ligia Maria Coscrato Junqueira Silva, Michelli Marcela Dadam, Ruthy Perotto Fernandes, Israel Silva Maia, Cassio Luis Zandonai, Alexandre Biasi Cavalcanti, Marcelo Luz Pereira Romano, Glauco Adrieno Westphal
Objective: To assess whether the respiratory oxygenation index (ROX index) measured after the start of high-flow nasal cannula oxygen therapy can help identify the need for intubation in patients with acute respiratory failure due to coronavirus disease 2019.
Methods: This retrospective, observational, multicenter study was conducted at the intensive care units of six Brazilian hospitals from March to December 2020. The primary outcome was the need for intubation up to 7 days after starting the high-flow nasal cannula.
Results: A total of 444 patients were included in the study, and 261 (58.7%) were subjected to intubation. An analysis of the area under the receiver operating characteristic curve (AUROC) showed that the ability to discriminate between successful and failed high-flow nasal cannula oxygen therapy within 7 days was greater for the ROX index measured at 24 hours (AUROC 0.80; 95%CI 0.76 - 0.84). The median interval between high-flow nasal cannula initiation and intubation was 24 hours (24 - 72), and the most accurate predictor of intubation obtained before 24 hours was the ROX index measured at 12 hours (AUROC 0.75; 95%CI 0.70 - 0.79). Kaplan-Meier curves revealed a greater probability of intubation within 7 days in patients with a ROX index ≤ 5.54 at 12 hours (hazard ratio 3.07; 95%CI 2.24 - 4.20) and ≤ 5.96 at 24 hours (hazard ratio 5.15; 95%CI 3.65 - 7.27).
Conclusion: The ROX index can aid in the early identification of patients with acute respiratory failure due to COVID-19 who will progress to the failure of high-flow nasal cannula supportive therapy and the need for intubation.
{"title":"The respiratory oxygenation index for identifying the risk of orotracheal intubation in COVID-19 patients receiving high-flow nasal cannula oxygen.","authors":"Aline Braz Pereira, Felipe Dal Pizzol, Viviane Cordeiro Veiga, Leandro Utino Taniguchi, Aline Finoti Misquita, Gustavo Augusto Couto Carvalho, Ligia Maria Coscrato Junqueira Silva, Michelli Marcela Dadam, Ruthy Perotto Fernandes, Israel Silva Maia, Cassio Luis Zandonai, Alexandre Biasi Cavalcanti, Marcelo Luz Pereira Romano, Glauco Adrieno Westphal","doi":"10.62675/2965-2774.20240203-en","DOIUrl":"10.62675/2965-2774.20240203-en","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether the respiratory oxygenation index (ROX index) measured after the start of high-flow nasal cannula oxygen therapy can help identify the need for intubation in patients with acute respiratory failure due to coronavirus disease 2019.</p><p><strong>Methods: </strong>This retrospective, observational, multicenter study was conducted at the intensive care units of six Brazilian hospitals from March to December 2020. The primary outcome was the need for intubation up to 7 days after starting the high-flow nasal cannula.</p><p><strong>Results: </strong>A total of 444 patients were included in the study, and 261 (58.7%) were subjected to intubation. An analysis of the area under the receiver operating characteristic curve (AUROC) showed that the ability to discriminate between successful and failed high-flow nasal cannula oxygen therapy within 7 days was greater for the ROX index measured at 24 hours (AUROC 0.80; 95%CI 0.76 - 0.84). The median interval between high-flow nasal cannula initiation and intubation was 24 hours (24 - 72), and the most accurate predictor of intubation obtained before 24 hours was the ROX index measured at 12 hours (AUROC 0.75; 95%CI 0.70 - 0.79). Kaplan-Meier curves revealed a greater probability of intubation within 7 days in patients with a ROX index ≤ 5.54 at 12 hours (hazard ratio 3.07; 95%CI 2.24 - 4.20) and ≤ 5.96 at 24 hours (hazard ratio 5.15; 95%CI 3.65 - 7.27).</p><p><strong>Conclusion: </strong>The ROX index can aid in the early identification of patients with acute respiratory failure due to COVID-19 who will progress to the failure of high-flow nasal cannula supportive therapy and the need for intubation.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11208043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494449","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}
Pub Date : 2024-06-24eCollection Date: 2024-01-01DOI: 10.62675/2965-2774.20240049-en
Josef Finsterer
Boswellia serrata is an herbal extract from the Boswellia serrata tree that has anti-inflammatory and analgesic properties and alleviates pain caused by rheumatoid arthritis, gout, osteoarthritis, and sciatica. Syndrome of inappropriate antidiuretic hormone secretion accompanied by hyponatremia, seizures, and rhabdomyolysis as a manifestation of Boswellia serrata intoxication has not been reported previously. A 38-year-old female suffered clinically isolated syndrome and has since been regularly taking B. serrata capsules (200mg/d) to strengthen her immune system. She experienced hypersensitivity to light, ocular pain, nausea, dizziness, and lower limb weakness four days after receiving her first BNT162b2 vaccine dose, and she increased the dosage of B. serrata to five capsules (1000mg/d) one week after vaccination. After taking B. serrata at a dosage of 1000mg/d for 3 weeks, she was admitted to the intensive care unit because of a first, unprovoked generalized tonic-clonic seizure. The patient's workup revealed syndrome of inappropriate antidiuretic hormone secretion, which resolved completely upon treatment and discontinuation of B. serrata. In summary, B. serrata potentially causes syndrome of inappropriate antidiuretic hormone secretion when it is taken at high doses. Patients should not self-medicate.
血清乳香是从血清乳香树中提取的一种草药提取物，具有消炎和镇痛特性，可减轻类风湿性关节炎、痛风、骨关节炎和坐骨神经痛引起的疼痛。作为乳香中毒的一种表现形式，抗利尿激素分泌失调综合征伴有低钠血症、癫痫发作和横纹肌溶解症，此前尚未见报道。一名 38 岁的女性患有临床孤立综合征，此后一直定期服用蛇床子乳香胶囊（200 毫克/天）以增强免疫系统。在接种第一剂 BNT162b2 疫苗四天后，她出现了对光过敏、眼痛、恶心、头晕和下肢无力等症状，接种疫苗一周后，她将血清 B. 的剂量增加到五粒（1000 毫克/天）。在以 1000 毫克/天的剂量服用血清乙型肝炎片 3 周后，她因首次无诱因全身强直-阵挛发作而被送入重症监护室。患者的检查结果显示其患有抗利尿激素分泌失调综合征，经治疗并停用血清双氢萘后，该综合征完全消失。总之，大剂量服用 B. serrata 有可能导致抗利尿激素分泌失调综合征。患者不应自行用药。
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Pub Date : 2024-06-17eCollection Date: 2024-01-01DOI: 10.62675/2965-2774.20240291-en
Roberto A Villa
{"title":"To: Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens.","authors":"Roberto A Villa","doi":"10.62675/2965-2774.20240291-en","DOIUrl":"10.62675/2965-2774.20240291-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428457","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}
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