ABSTRACT
Background. Prior to the COVID-19 pandemic, the incidence of infection related ventilator associated complications plus possible ventilator associated pneumonias (IVAC+) was decreasing;however, as the number of COVID-19 hospitalizations increased, so did the number of IVAC+. Our goal was to investigate if there was a relationship between these two occurrences. Methods. This was a retrospective study at the Audie Murphy VA Hospital (ALMVA) from October 2017 to December 2021. ALMVA is a level 1A facility with 232 beds and an active bone marrow transplant program in San Antonio, Texas. This study included acute care COVID-19 hospitalizations per 10,000 bed days of care and IVAC+ per 1000 ventilator days. Monthly acute and intensive care COVID-19 hospitalization rates were correlated with IVAC+ rates using Pearson correlation for the overall study period and in the subgroup of COVID pandemic months (Mar 2020-December 2021). Results. During the overall study period, COVID-19 hospitalization rates were significantly associated with IVAC+ rates: acute care correlation 0.86 (p< 0.01) and intensive care correlation 0.33 (p=0.04). During the COVID-19 pandemic months, acute care COVID-19 hospitalizations but not intensive care COVID-19 hospitalizations, were correlated with IVAC+ (correlation 0.90, p< 0.01 and correlation 0.21, p=0.53, respectively). There were 0 IVAC+ before the pandemic months and this rose to 14 during (0 per 1000 ventilator days and 3.05 per 1000 ventilator days, respectively). All but 2 cases of IVAC+ had COVID-19. COVID-19 Hospitalizations and IVAC Plus, October 2017 to December 2021 A sharp increase in COVID-19 hospitalizations correlated with a rise in patients meeting criteria for IVAC Plus. Conclusion. The natural history of COVID-19 disease has presented challenges for IVAC+ monitoring. COVID-19 can cause persistent fevers and worsening oxygenation, and antibiotic use is common during periods of clinical deterioration. These factors can fulfill criteria for IVAC+. In this study, each IVAC+ case was traced for safety bundle compliance. These bundles were followed, along with conservative fluid management, low tidal volume ventilation, and sedation breaks. Patients met NHSN criteria for IVAC+ despite these measures and most had COVID-19. Given the common occurrence of IVAC+ in COVID-19 patients, futures studies are needed to define if IVAC+ are preventable in this population and whether IVAC+ surveillance has any value among COVID-19 patients. (Figure Presented).
ABSTRACT
Background. After COVID-19 vaccinations, breakthrough infections appear to be of public health concern. There is limited data regarding clinical effectiveness of COVID-19 vaccination. Our aim was to determine the differences in clinical outcomes among COVID-19 unvaccinated versus vaccinated patients who required hospitalization. Methods. This was a retrospective cohort study of COVID-19 hospitalized patients between 7/25/21 and 9/6/2021. Previously infected COVID-19 patients were excluded. The patients were classified as fully vaccinated vs. unvaccinated (CDC guidelines). The primary outcome included the need for advance oxygen therapy (high flow nasal cannula, non-invasive ventilation, mechanical ventilation), ICU admission, or 28-day all-cause mortality. We performed a subgroup analysis according to the immunocompetent status and older age (>=65 years). Results. We enrolled 207 patients, stratified as unvaccinated (n=147 [71%]) vs. fully vaccinated (n=60 [29%]). Unvaccinated patients were younger (median age 58 vs. 71 years old, p< 0.001) and more likely to require oxygen (n=105[71%] vs. n=35[58%], p=0.07) compared to vaccinated patients. Unvaccinated patients were more likely to reach the primary outcome (n=59 [40%] vs. n=16 [26%], p=0.08) when compared to vaccinated patients. The subgroup analyses revealed that unvaccinated patients had higher rates of the primary outcome when >=65 years old ( n=27/46 [58.7%] vs. n=13/37 [35.1%], p=0.047), immunocompetent (n=57/139 [41%] vs. 13/53 [24.5%]) and both groups combined (n=22/39 [56%] vs. 11/38 [28.9%], p=0.021), respectively. Conclusion. Unvaccinated patients represented the largest proportion of hospitalized patients. Unvaccinated patients were younger and required oxygen therapy. Unvaccinated immunocompetent patients aged >= 65 had worse outcomes compared to vaccinated patients. Further studies are needed to identify unmeasured characteristics that may be associated with poor clinical outcomes.
ABSTRACT
Introduction: Recent studies have demonstrated that behavioral sleep extension can increase sleep duration among short sleepers. However, little is known about the contribution of the intervention components. The goal of this study is to examine the effects of a fitbit and coaching on sleep extension in a behavioral sleep extension intervention. Methods: Participants included adults aged 25 to 65 years with sleep duration <7 hours who were randomized into one of four groups: self-management, Fitbit, coaching, or Fitbit + coaching. The self-management group did not receive any intervention materials. The other three groups received sleep educational materials emailed weekly. The coaching intervention (5-min telephone call) was delivered weekly for 6 weeks to the coaching and Fitbit+coaching groups to enhance motivation. Assessments were completed at baseline, post intervention (6 weeks), and 12-week follow- up. Participants completed self-report questionnaires and actigraphy at study visits. Results were analyzed using mixed models. Results: Enrollment and data collection were ended prematurely due to the COVID-19 pandemic. Participants included 32 adults (self-management n=8, coaching n=11, Fitbit n=11, and Fitbit+coaching n=8). Fitbit+coaching group increased hours of sleep by 0.62 h hours more (95% CI: 0.04, 1.20;p=0.047) than the self-management group between their first and second visit. Coaching and the Fitbit groups showed estimated improvements over the self-management group as well: 0.54 h and 0.39 h, respectively, though their differences were not found to be statistically significant (p=0.081 and p=0.20, respectively). At the 12-week follow-up visit, there were no statistically significant differences between groups but the Fitbit+coaching group did maintain their sleep improvement. Conclusion: These results suggest that sleep extension intervention components may affect the pattern of sleep changes, but more research is needed to refine and explore changes in sleep with behavioral interventions.