Dysphagia in intensive care, a real problem: analysis of risk factors.

AIMS: To identify risk factors present in patients with dysphagia in a population of critically ill patients. METHODS: Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. OUTCOMES: 103 patients were recruited from 401 possible. The mean age was 59,33 ± 13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74 ± 6,17) and Charlson (2,98 ± 3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p < 0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65; 95% CI:1,31-16,47; p = 0,014) and a hospital stay (OR: 8,50; 95%CI: 2,20-32,83; p < 0,001) On discharge from the ICU, 37,9% of the population still had dysphagia; 12,6% maintained this problem at hospital discharge. CONCLUSIONS: Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.

Dysphagia in intensive care, a real problem: analysis of risk factors

Aims: To identify risk factors present in patients with dysphagia in a population of critically ill patients. Methods: Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. Outcomes: 103 patients were recruited from 401 possible. The mean age was 59,33±13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74±6,17) and Charlson (2,98±3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p<0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65;95% CI:1,31-16,47;p=0,014) and a hospital stay (OR: 8,50;95%CI: 2,20-32,83;p<0,001). On discharge from the ICU, 37,9% of the population still had dysphagia;12,6% maintained this problem at hospital discharge. Conclusions: Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization. © 2022 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC)

La disfagia en cuidados intensivos, un problema real: análisis de factores de riesgo

Resumen Objetivos Determinar los factores de riesgo presentes en los pacientes con disfagia en relación con una población de pacientes críticos. Método Serie de casos de una cohorte de pacientes reclutados en la unidad de cuidados intensivos (UCI) hasta el alta hospitalaria. Se reclutaron a aquellos pacientes que dieron su consentimiento y cumplían los criterios de inclusión. El método de exploración clínica Volumen-Viscosidad fue utilizado para la detección de la disfagia. Se realizó un análisis estadístico uni- y bivariante, a través del odds ratio (OR) para detectar los factores de riesgo en la disfagia. Resultados 103 pacientes fueron reclutados de 401 posibles. La media de edad fue de 59,33±13,23;los hombres representaban el 76,7%. La gravedad media fue: APACHE II (12,74±6,17) y Charlson (2,98±3,31). Un 45,6% de los pacientes desarrollaron disfagia, obteniendo valores significativos de OR (p<0,050) para el desarrollo de disfagia: la mayor edad, los antecedentes neurológicos, COVID19, la alta estancia en UCI y hospitalización y la presencia de traqueotomía. Los pacientes COVID19 representaban el 46,6%, por lo que se realizó un análisis de este subgrupo observando resultados similares, con un riesgo de Charlson (OR:4,65;IC95%: 1,31-16,47;p=0,014) y una estancia hospitalaria (OR: 8,50;IC95%: 2,20-32,83;p<0,001). Al alta de UCI, el 37,9% de la población presentaba todavía disfagia, y mantenía este problema al alta hospitalaria el 12,6%. Conclusiones Casi la mitad de nuestros pacientes presentaron disfagia. Fueron factores de riesgo la gravedad clínica y la presencia de traqueotomía. Se observó en estos pacientes una mayor estancia tanto en UCI como en hospitalización. Aims To identify risk factors present in patients with dysphagia in a population of critically ill patients. Methods Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. Outcomes 103 patients were recruited from 401 possible. The mean age was 59,33±13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74±6,17) and Charlson (2,98±3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p<0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65;95% CI:1,31-16,47;p=0,014) and a hospital stay (OR: 8,50;95%CI: 2,20-32,83;p<0,001). On discharge from the ICU, 37,9% of the population still had dysphagia;12,6% maintained this problem at hospital discharge. Conclusions Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.

Relationship between the abo blood group and the coronavirus disease 2019 (COVID-19) severity: a population-based cohort study in the Valencian community (Spain)

Background: It has already been published the existence of an association between ABO blood groups and COVID-19 severity. These studies have reported that the ABO blood group is statistically associated with the acquisition of SARS-CoV-2 and survival after the virus infection. Researchers have found that blood group A was associated with a higher risk for COVID-19 infection and severity compared with others blood groups, whereas blood group O was associated with a significantly lower risk compared with non-O blood groups. Aims: This study aimed to demonstrate, in a population-based cohort study in the Valencian Community (Spain), the relationship between the ABO blood group and COVID-19 severity. Methods: A total of 567 regular blood donors from the Valencian Community (Spain) who had been infected by SARS-CoV-2 were recruited. They were divided into three different cohorts based on their symptoms and their requirements during the infection: asymptomatic donors, mild donors, and severe donors. Demographic data were also included. Asymptomatic donors did not have any symptoms;mild donors had the most common symptoms associated with COVID-19 without the need for hospitalization and severe donors needed hospitalization due to severity. For the statistical analysis, we compared the three cohorts with regular blood donors who donated blood in the last 3 years (256,203 donors) in the Valencian Community. Data were analysed using Chi-Square tests. p-values <0.05 were considered significant, standardized residuals were calculated to assess the contribution of each cell to the significance of the test. GraphPad Prism v.7.0 software was used. Results: Our results show that 63.33% of blood donors who had passed COVID-19 disease and required hospitalization (severe donors) were from blood group A while only 26.67% were from blood group O (p-value = 0.0002). The same results were observed in the established cohort for mild donors, with 47.01% and 39.08% from blood groups A and O (p-value<0.0001), respectively (Table 1). These data suggest that blood group A could be a risk factor for COVID-19 infection and group. Regarding asymptomatic donors, only 38.52% were donors from blood group A while 13.12% were donors from blood group B (Table 1). This data indicate that blood group B could be protective against COVID-19 severity (pvalue< 0.0001). Summary/Conclusions: Blood group A and blood group O donors showed a significantly higher and lower risk (p-value = 0.0002), respectively, to require hospitalization after the infection of COVID- 19. However, belonging to blood group B seemed to be associated with low-risk SARS-CoV-2 infection (p-value<0.0001).

Impact of the COVID-19 pandemic on the activity of the Radiological Emergency Department: the experience of the Maggiore della Carità Hospital in Novara.

PURPOSE: During the first peak of the COVID-19 pandemic, the activity of Emergency Departments worldwide changed dramatically, focusing on diagnosis and care of the Sars-Cov-2 associated disease. These major changes also involved the activity of the Emergency Radiology Department (ERD). This study aimed to analyse the impact of the COVID-19 pandemic on imaging studies, both in terms of the amount, frequency and subspecialty of different imaging modalities requested to the ERD of the Maggiore della Carità Hospital in Novara (Italy). METHODS: To this end, our observational study took into account the imaging studies requested by the emergency department during three-time spans. These were defined as phase 0 (pre-pandemic), phase 1 (pandemic peak with complete lockdown) and phase 2 (post-pandemic peak with partial lifting of restrictive measures), as derived from Italian urgent decrees by the President of the Council of Ministers (DPCM) which established the duration and entity of the lockdown measures throughout the pandemic. The dataset was processed and then compared with Pearson's chi-squared test. RESULTS: During the pandemic peak, our data showed a significant drop in the total number of studies requested and a significant rise in computed tomography (CT) studies. In particular, a statistically significant increase in chest CT studies was found, probably due to the high sensitivity of this imaging method in identifying pulmonary involvement during respiratory tract infection of possible viral etiology (SARS-Cov-2). Moreover, we observed a statistically significant decrease of X-ray (XR) and ultrasound (US) studies during phase 1 compared to phase 0 and phase 2 probably due to a reduction in the numbers of ER visits for minor traumas given the mobility restrictions and people hesitancy in visiting the ER due to fear of contagion. CONCLUSIONS: We can conclude that the activity of the ERD was heavily impacted by the SARS-Cov-2 pandemic. Further studies will be needed to estimate the impact of the pandemic on public health in terms of excess mortality related to delayed diagnosis and care of non-COVID diseases.

Demographic and clinical characteristics of patients with CKD and SARS-COV2 undergoing hemodialysis treatment

Background: Patients on HD or PD are likely to be at increased risk of COVID-19 and its complications because they have multiple comorbid conditions. There is a lack of evidence about the optimal management and even clinical manifestations because clinical presentation is highly variable. The delayed diagnosis is because it's not recognized by the treating centers and the confusion with patients with fluid overload or uremic syndrome can be fatal in this population. Methods: Retrospective, observational, single-center study in Mexico. We analyzed the clinical manifestations and outcomes of all maintenance HD patients hospitalized with COVID-19 from April 9th to May 31st, 2020 as confirmed by real-time polymerase chain reaction Results: 20 patients followed in our hospital with median age of 45.2±13.8 years, 50% were men. All the patients have HTA (100%), DM (50%), the most common symptoms at admission were asthenia (75%), dyspnea (65%), cough (55%) followed by myalgias (50%) and fever (45%). Poor oxygen saturation (<95%) breathing room air was observed in 18 patients (90%) with mean oxygen saturation of 77± 9%. Lung abnormalities on initial chest X-ray were observed in all patients. Peripheral ground-glassopacities, the typical radiologic pattern, were bilateral in 13 patients and unilateral in 7. Laboratory studies with lymphopenia in 85% of patients with a mean of 0.7+0.38. There were no differences baseline leukocyte or lymphocyte from patients who survived vs from those who died. The mortality rate (40%) was much higher than that observed in the general population (8%). Mortality was higher in women. Conclusions: The impact of this virus on patients with CKD is poorly understood. The evaluation of the nephrologist must be very detailed, most of the patients had mild dyspnea, however on physical examination, desaturation and radiological images were suggestive of infection by SARS-CoV2. The current situation provides a unique opportunity to gather vital information to process and learn from the experience worldwide. These results will allow us to treat them in a timely manner and reduce lethality in dialysis patients.

Respiratory function in patients post-infection by COVID-19: a systematic review and meta-analysis.

BACKGROUND: Evidence suggests lungs as the organ most affected by coronavirus disease 2019 (COVID-19). The literature on previous coronavirus infections reports that patients may experience persistent impairment in respiratory function after being discharged. Our objective was to determine the prevalence of restrictive pattern, obstructive pattern and altered diffusion in patients post-COVID-19 infection and to describe the different evaluations of respiratory function used with these patients. METHODS: A systematic review was conducted in five databases. Studies that used lung function testing to assess post-infection COVID-19 patients were included for review. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence. RESULTS: Of the 1973 reports returned by the initial search, seven articles reporting on 380 patients were included in the data synthesis. In the sensitivity analysis, we found a prevalence of 0.39 (CI 0.24-0.56, p < 0.01, I2 = 86%), 0.15 (CI 0.09-0.22, p = 0.03, I2 = 59%), and 0.07 (CI 0.04-0.11, p = 0.31, I2 = 16%) for altered diffusion capacity of the lungs for carbon monoxide (DLCO), restrictive pattern and obstructive pattern, respectively. CONCLUSION: Post-infection COVID-19 patients showed impaired lung function; the most important of the pulmonary function tests affected was the diffusion capacity.