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1.
Crit Care ; 26(1): 94, 2022 04 04.
Article in English | MEDLINE | ID: covidwho-1775327

ABSTRACT

OBJECTIVE: To compare old patients hospitalized in ICU for respiratory distress due to COVID-19 with old patients hospitalized in ICU for a non-COVID-19-related reason in terms of autonomy and quality of life. DESIGN: Comparison of two prospective multi-centric studies. SETTING: This study was based on two prospective multi-centric studies, the Senior-COVID-Rea cohort (COVID-19-diagnosed ICU-admitted patients aged over 60) and the FRAGIREA cohort (ICU-admitted patients aged over 70). PATIENTS: We included herein the patients from both cohorts who had been evaluated at day 180 after admission (ADL score and quality of life). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 93 COVID-19 patients and 185 control-ICU patients were included. Both groups were not balanced on age, body mass index, mechanical ventilation, length of ICU stay, and ADL and SAPS II scores. We modeled with ordered logistic regression the influence of COVID-19 on the quality of life and the ADL score. After adjustment on these factors, we observed COVID-19 patients were less likely to have a loss of usual activities (aOR [95% CI] 0.47 [0.23; 0.94]), a loss of mobility (aOR [95% CI] 0.30 [0.14; 0.63]), and a loss of ADL score (aOR [95% CI] 0.30 [0.14; 0.63]). On day 180, 52 (56%) COVID-19 patients presented signs of dyspnea, 37 (40%) still used analgesics, 17 (18%) used anxiolytics, and 14 (13%) used antidepressant. CONCLUSIONS: COVID-19-related ICU stay was not associated with a lower quality of life or lower autonomy compared to non-COVID-19-related ICU stay.


Subject(s)
COVID-19 , Quality of Life , Aftercare , Aged , Critical Care , Humans , Intensive Care Units , Outcome Assessment, Health Care , Patient Discharge , Prospective Studies
2.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-331574

ABSTRACT

Background: Lung ultrasound (LUS) is a validated tool for the management of coronavirus disease 2019 (COVID-19)-related pneumonia. An awake prone positioning (PP) improves oxygenation and outcomes in COVID-19 non-intubated patients, but its tolerance remains an issue. A chair positioning (CP) may have beneficial effects on oxygenation and lung aeration. Thus, CP could be an easier alternative to PP. This study assessed the effects of a CP session on oxygenation (using SpO 2 FiO 2 ratio) and lung aeration (using lung reaeration score) changes in non-intubated COVID-19 patients. Methods: An observational multicenter study was conducted in three university hospital intensive care units (ICUs). We retrospectively analyzed prospectively collected data from LUS exams performed before and after a CP session in non-intubated COVID-19 patients. Patients were divided into groups of responders or non-responders in terms of oxygenation and lung aeration. Results: Of the 33 patients included in the study, 14 (44%) were oxygenation non-responders and 18 (56%) were oxygenation responders, and 13 (40.6%) and 19 (59.4%) patients were classified as lung aeration non-responders and responders, respectively. Changes in oxygenation and lung aeration before and after a CP session were not correlated (Pearson’s r = -0.19, p = 0.3, 95% CI: -0.5–0.17). The reaeration scores did not differ between oxygenation responders and non-responders (1 [-0.75–3.75] vs. 4, [-1–6], p = 0.41). The LUS score was significantly correlated with SpO 2 FiO 2 ratio before a CP session (Pearson’s r = 0.37, p = 0.04, 95% CI: 0.03–0.64) but not after (Pearson’s r = 0.17, p = 0.35, 95% CI: -0.19–0.50). Conclusion: A CP session was associated with improved oxygenation and lung aeration in more than half of the non-intubated COVID-19 patients. However, oxygenation and lung aeration changes were not associated, suggesting that a CP session induces a ventilation:perfusion matching alteration.

3.
Eur J Anaesthesiol ; 39(5): 427-435, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1707427

ABSTRACT

BACKGROUND: SARS-Cov-2 (COVID-19) has become a major worldwide health concern since its appearance in China at the end of 2019. OBJECTIVE: To evaluate the intrinsic mortality and burden of COVID-19 and seasonal influenza pneumonia in ICUs in the city of Lyon, France. DESIGN: A retrospective study. SETTING: Six ICUs in a single institution in Lyon, France. PATIENTS: Consecutive patients admitted to an ICU with SARS-CoV-2 pneumonia from 27 February to 4 April 2020 (COVID-19 group) and seasonal influenza pneumonia from 1 November 2015 to 30 April 2019 (influenza group). A total of 350 patients were included in the COVID-19 group (18 refused to consent) and 325 in the influenza group (one refused to consent). Diagnosis was confirmed by RT-PCR. Follow-up was completed on 1 April 2021. MAIN OUTCOMES AND MEASURES: Differences in 90-day adjusted-mortality between the COVID-19 and influenza groups were evaluated using a multivariable Cox proportional hazards model. RESULTS: COVID-19 patients were younger, mostly men and had a higher median BMI, and comorbidities, including immunosuppressive condition or respiratory history were less frequent. In univariate analysis, no significant differences were observed between the two groups regarding in-ICU mortality, 30, 60 and 90-day mortality. After Cox modelling adjusted on age, sex, BMI, cancer, sepsis-related organ failure assessment (SOFA) score, simplified acute physiology score SAPS II score, chronic obstructive pulmonary disease and myocardial infarction, the probability of death associated with COVID-19 was significantly higher in comparison to seasonal influenza [hazard ratio 1.57, 95% CI (1.14 to 2.17); P = 0.006]. The clinical course and morbidity profile of both groups was markedly different; COVID-19 patients had less severe illness at admission (SAPS II score, 37 [28 to 48] vs. 48 [39 to 61], P < 0.001 and SOFA score, 4 [2 to 8] vs. 8 [5 to 11], P < 0.001), but the disease was more severe considering ICU length of stay, duration of mechanical ventilation, PEEP level and prone positioning requirement. CONCLUSION: After ICU admission, COVID-19 was associated with an increased risk of death compared with seasonal influenza. Patient characteristics, clinical course and morbidity profile of these diseases is markedly different.


Subject(s)
COVID-19 , Influenza, Human , Pneumonia , Female , Hospital Mortality , Hospitals , Humans , Influenza, Human/diagnosis , Influenza, Human/epidemiology , Intensive Care Units , Male , Retrospective Studies , SARS-CoV-2 , Seasons
4.
Anaesth Crit Care Pain Med ; 40(4): 100931, 2021 08.
Article in English | MEDLINE | ID: covidwho-1306763

ABSTRACT

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, Artificial
5.
Prat Anesth Reanim ; 25(2): 103-109, 2021 Apr.
Article in French | MEDLINE | ID: covidwho-1298754

ABSTRACT

The COVID-19 pandemic has turned hospital under tension. Front-line staff, those most heavily exposed to the virus, are also those most at risk of developing psychological disorders. The aim of this national survey was to determine the prevalence of psychological disorders among the nurses working in intensive care unit during the pandemic. We developed an electronic questionnaire distributed by email between June 17th and July 17th, 2020. The responders were 381 health care professionals (nurses, anaesthetists nurse, operating room nurses and health managers). The Hospital Anxiety and Depression Scale and the Impact Event Scale Revisited were used to assess the prevalence of anxiety, depression and post-traumatic stress disorder. Operating Room Nurses were those who suffered the most from psychological disorders: anxiety disorder (64%) (P = 0.055), depression (45%) (P = 0.004) and post-traumatic stress disorder (45%) (P = 0.008). Nurses usually working in intensive care were the least affected by psychological disorders: anxiety disorder (30%), depressive disorder (11%) and post-traumatic stress (20%). The risk factors for developing a psychological disorder are the low level of training in intensive care unit (ICU), not being volunteer for working in ICU and having a burnout history. This study describes a profile of professionals at risk of developing psychological disorders in this setting. Prevention should be based on staff training and psychological support.

7.
Adv Ther ; 38(5): 2599-2612, 2021 05.
Article in English | MEDLINE | ID: covidwho-1182322

ABSTRACT

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks have led to massive admissions to intensive care units (ICUs). An ultrasound examination of the thorax is widely performed on admission in these patients. The primary objective of our study was to assess the performance of the lung ultrasound score (LUS) on ICU admission to predict the 28-day mortality rate in patients with SARS-CoV-2. The secondary objective was to asses the performance of thoracic ultrasound and biological markers of cardiac injury to predict mortality. METHODS: This multicentre, retrospective, observational study was conducted in six ICUs of four university hospitals in France from 15 March to 3 May 2020. Patients admitted to ICUs because of SARS-CoV-2-related acute respiratory failure and those who received an LUS examination at admission were included. The area under the receiver-operating characteristics (ROC) curve was determined for the LUS score to predict the 28-day mortality rate. The same analysis was performed for the Simplified Acute Physiology Score, left ventricular ejection fraction, cardiac output, brain natriuretic peptide and ultra-sensitive troponin levels at admission. RESULTS: In 57 patients, the 28-day mortality rate was 21%. The area under the ROC curve of the LUS score value on ICU admission was 0.68 [95% CI 0.54-0.82; p = 0.05]. In non-intubated patients on ICU admission (n = 40), the area under the ROC curves was 0.84 [95% CI 0.70-0.97; p = 0.005]. The best cut-off of 22 corresponded to 85% specificity and 83% sensitivity. CONCLUSIONS: LUS scores on ICU admission for SARS-CoV-2 did not efficiently predict the 28-day mortality rate. Performance was better for non-intubated patients at admission. Performance of biological cardiac markers may be equivalent to the LUS score.


Subject(s)
COVID-19 , SARS-CoV-2 , Critical Illness , France , Humans , Intensive Care Units , ROC Curve , Retrospective Studies , Stroke Volume , Ventricular Function, Left
10.
Anaesth Crit Care Pain Med ; 39(6): 717-722, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-812445

ABSTRACT

SUBJECT AND PURPOSE: Just as every pandemic, COVID-19 could lead to emotional and psychological disturbances among caregivers, especially in the Intensive Care Unit (ICU), where significant stress related to the influx of patients, exposure to the virus and the lack of documentation on this new SARS occurred. The present study aimed at assessing the psychological impact of COVID-19 on the caregivers at the peak of the "crisis period". MATERIALS AND METHODS: A survey using the Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale - Revised (IES-R) was proposed to the persons working in 5 ICUs of a French teaching hospital (8th of April to the 21st of April 2020). Logistic regression was performed to find independent risk factors for anxiety and post-traumatic stress disorder (PTSD). A value of p < 0.05 was considered significant. RESULTS: The incidence of anxiety and depression were 48% and 16%, respectively. PTSD symptoms were present in 27% of respondents. The independent risk factors for developing anxiety syndrome were being assigned in COVID-19 + ICU (OR = 2.081 [95% confident interval (CI), 1.035-4.184)], and not be trained in intensive care medicine, OR = 2.570 [95% CI, 1.344-4.901]. The independent risk factors for PTSD are having a history of burn-out (OR = 4.591 [95% CI, 1.464-14.397] and not being trained in ICU, (OR = 2.155 [95% CI, 1.047-4.440]). CONCLUSION: COVID-19 could have a strong impact on ICU workers. These findings should lead to prevention procedures (ICU training sessions) in persons at risk.


Subject(s)
Anxiety/epidemiology , COVID-19/psychology , Critical Care/psychology , Personnel, Hospital/psychology , SARS-CoV-2 , Stress, Psychological/epidemiology , Adult , Anxiety/etiology , Burnout, Professional/epidemiology , COVID-19/epidemiology , Caregivers/psychology , Female , France/epidemiology , Humans , Incidence , Intensive Care Units , Logistic Models , Male , Middle Aged , Pandemics , Risk Factors , Stress Disorders, Post-Traumatic/etiology , Stress, Psychological/etiology , Test Anxiety Scale
11.
Intensive Care Med ; 46(9): 1707-1713, 2020 09.
Article in English | MEDLINE | ID: covidwho-684759

ABSTRACT

PURPOSE: The relationship between lung ultrasound (LUS) and chest computed tomography (CT) scans in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is not clearly defined. The primary objective of our study was to assess the performance of LUS in determining severity of SARS-CoV-2 pneumonia compared with chest CT scan. Secondary objectives were to test the association between LUS score and location of the patient, use of mechanical ventilation, and the pulse oximetry (SpO2)/fractional inspired oxygen (FiO2) ratio. METHODS: A multicentre observational study was performed between 15 March and 20 April 2020. Patients in the Emergency Department (ED) or Intensive Care Unit (ICU) with acute dyspnoea who were PCR positive for SARS-CoV-2, and who had LUS and chest CT performed within a 24-h period, were included. RESULTS: One hundred patients were included. LUS score was significantly associated with pneumonia severity assessed by chest CT and clinical features. The AUC of the ROC curve of the relationship of LUS versus chest CT for the assessment of severe SARS-CoV-2 pneumonia was 0.78 (CI 95% 0.68-0.87; p < 0.0001). A high LUS score was associated with the use of mechanical ventilation, and with a SpO2/FiO2 ratio below 357. CONCLUSION: In known SARS-CoV-2 pneumonia patients, the LUS score was predictive of pneumonia severity as assessed by a chest CT scan and clinical features. Within the limitations inherent to our study design, LUS can be used to assess SARS-CoV-2 pneumonia severity.


Subject(s)
Coronavirus Infections/diagnostic imaging , Lung/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Aged , Betacoronavirus , COVID-19 , Comorbidity , Emergency Service, Hospital , Female , Hospitals, University , Humans , Intensive Care Units , Male , Middle Aged , Oximetry , Pandemics , SARS-CoV-2 , Severity of Illness Index , Tomography, X-Ray Computed , Ultrasonography
12.
Anaesth Crit Care Pain Med ; 39(3): 385, 2020 06.
Article in English | MEDLINE | ID: covidwho-324652
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