Subject(s)
Anti-Bacterial Agents/therapeutic use , Antibiotic Prophylaxis , Betacoronavirus , Coronavirus Infections/therapy , Critical Illness/therapy , Cross Infection/prevention & control , Pandemics , Pneumonia, Ventilator-Associated/prevention & control , Pneumonia, Viral/therapy , Sepsis/prevention & control , beta-Lactams/therapeutic use , Aged , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/blood , Anti-Bacterial Agents/pharmacokinetics , Antibiotic Prophylaxis/adverse effects , COVID-19 , Cefepime/adverse effects , Cefepime/blood , Coinfection/prevention & control , Confusion/chemically induced , Confusion/etiology , Coronavirus Infections/complications , Deep Sedation , Delirium/chemically induced , Delirium/etiology , Drug Monitoring , Female , Humans , Hypnotics and Sedatives/therapeutic use , Male , Middle Aged , Pneumonia, Viral/complications , Respiration, Artificial/adverse effects , SARS-CoV-2 , beta-Lactams/adverse effects , beta-Lactams/blood , beta-Lactams/pharmacokineticsABSTRACT
The FilmArray Pneumonia Panel has proven to be an effective tool for rapid detection of main respiratory pathogens. However, its rational use needs appropriate knowledge and formation regarding its indication and interpretation. Herein, we provide some advices to help with success of its daily routine use, particularly in critically ill ventilated COVID-19 patients. Clinical Trial registration number: NCT04453540.
Subject(s)
COVID-19/complications , Critical Illness , Molecular Diagnostic Techniques/methods , Pneumonia, Bacterial/complications , Respiration, Artificial , SARS-CoV-2 , Algorithms , Coinfection/diagnosis , Humans , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/microbiologyABSTRACT
AIM: Describing acute respiratory distress syndrome patterns, therapeutics management, and outcomes of ICU COVID-19 patients and indentifying risk factors of 28-day mortality. METHODS: Prospective multicentre, cohort study conducted in 29 French ICUs. Baseline characteristics, comorbidities, adjunctive therapies, ventilatory support at ICU admission and survival data were collected. RESULTS: From March to July 2020, 966 patients were enrolled with a median age of 66 (interquartile range 58-73) years and a median SAPS II of 37 (29-48). During the first 24 h of ICU admission, COVID-19 patients received one of the following respiratory supports: mechanical ventilation for 559 (58%), standard oxygen therapy for 228 (24%) and high-flow nasal cannula (HFNC) for 179 (19%) patients. Overall, 721 (75%) patients were mechanically ventilated during their ICU stay. Prone positioning and neuromuscular blocking agents were used in 494 (51%) and 460 (48%) patients, respectively. Bacterial co-infections and ventilator-associated pneumonia were diagnosed in 79 (3%) and 411 (43%) patients, respectively. The overall 28-day mortality was 18%. Age, pre-existing comorbidities, severity of respiratory failure and the absence of antiviral therapy on admission were identified as independent predictors of 28-day outcome. CONCLUSION: Severity of hypoxaemia on admission, older age (> 70 years), cardiovascular and renal comorbidities were associated with worse outcome in COVID-19 patients. Antiviral treatment on admission was identified as a protective factor for 28-day mortality. Ascertaining the outcomes of critically ill COVID-19 patients is crucial to optimise hospital and ICU resources and provide the appropriate intensity level of care.
Subject(s)
COVID-19 , SARS-CoV-2 , Aged , Cohort Studies , Critical Care , Humans , Intensive Care Units , Middle Aged , Prospective Studies , Respiration, ArtificialABSTRACT
BACKGROUND: Prone positioning (PP) is a standard of care for patients with moderate-severe acute respiratory distress syndrome (ARDS). While adverse events associated with PP are well-documented in the literature, research examining the effect of PP on the risk of infectious complications of intravascular catheters is lacking. METHOD: All consecutive ARDS patients treated with PP were recruited retrospectively over a two-year period and formed the exposed group. Intensive care unit (ICU) patients during the same period without ARDS for whom PP was not conducted but who had an equivalent disease severity were matched 1:1 to the exposed group based on age, sex, centre, length of ICU stay and SAPS II (unexposed group). Infection-related catheter complications were defined by a composite criterion, including catheter tip colonization or intravascular catheter-related infection. RESULTS: A total of 101 exposed patients were included in the study. Most had direct ARDS (pneumonia). The median [Q1-Q3] PP session number was 2 [1-4]. These patients were matched with 101 unexposed patients. The mortality rates of the exposed and unexposed groups were 31 and 30%, respectively. The incidence of the composite criterion was 14.2/1000 in the exposed group compared with 8.2/1000 days in the control group (p = 0.09). Multivariate analysis identified PP as a factor related to catheter colonization or infection (p = 0.04). CONCLUSION: Our data suggest that PP is associated with a higher risk of CVC infectious complications.