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1.
Dongelmans, Dave A.; Termorshuizen, Fabian, Brinkman, Sylvia, Bakhshi-Raiez, Ferishta, Sesmu, Arbous M.; de Lange Dylan, W.; van Bussel Bas, C. T.; de Keizer Nicolette, F.; Verbiest, Dirk P.; te Velde Leo, F.; van Driel Erik, M.; Rijpstra, Tom, Elbers, Paul W. G.; Georgieva, Lyuba, Verweij, Eva, de Jong Remko, M.; van Iersel Freya, M.; Koning Dick, T. J. J.; Rengers, Els, Kusadasi, Nuray, Erkamp, Michiel L.; van den Berg, Roy, Jacobs Cretièn, J. M. G.; Epker, Jelle L.; Rijkeboer, Annemiek A.; de Bruin Martha, T.; Spronk, Peter, Draisma, Annelies, Versluis, Dirk Jan, van den Berg Lettie, A. E.; Mos Marissa, Vrolijk-de, Lens, Judith A.; Jannet, Mehagnoul-Schipper D.; Gommers, Diederik, Lutisan, Johan G.; Hoeksema, Martijn, Pruijsten, Ralph V.; Kieft, Hans, Rozendaal, Jan, Nooteboom, Fleur, Boer, Dirk P.; Janssen Inge, T. A.; van Gulik, Laura, Peter, Koetsier M.; Silderhuis, Vera M.; Schnabel, Ronny M.; Drogt, Ioana, de Ruijter, Wouter, Bosman, Rob J.; Frenzel, Tim, Urlings-Strop Louise, C.; Allard, Dijkhuizen, Hené, Ilanit Z.; de Meijer Arthur, R.; Holtkamp Jessica, W. M.; Postma, Nynke, Bindels Alexander, J. G. H.; Wesselink Ronald, M. J.; van Slobbe-Bijlsma Eline, R.; van der Voort Peter, H. J.; Eikemans Bob, J. W.; Barnas Michel, G. W.; Festen-Spanjer, Barbara, van Lieshout, Maarten, Gritters, Niels C.; van Tellingen, Martijn, Brunnekreef, Gert B.; Vandeputte, Joyce, Dormans Tom, P. J.; Hoogendoorn, Marga E.; de Graaff, Mart, Moolenaar, David, Reidinga, Auke C.; Spijkstra Jan, Jaap, de Waal, Ruud.
Annals of Intensive Care ; 12(1), 2022.
Article in English | ProQuest Central | ID: covidwho-1837260

ABSTRACT

BackgroundTo assess trends in the quality of care for COVID-19 patients at the ICU over the course of time in the Netherlands.MethodsData from the National Intensive Care Evaluation (NICE)-registry of all COVID-19 patients admitted to an ICU in the Netherlands were used. Patient characteristics and indicators of quality of care during the first two upsurges (N = 4215: October 5, 2020–January 31, 2021) and the final upsurge of the second wave, called the ‘third wave’ (N = 4602: February 1, 2021–June 30, 2021) were compared with those during the first wave (N = 2733, February–May 24, 2020).ResultsDuring the second and third wave, there were less patients treated with mechanical ventilation (58.1 and 58.2%) and vasoactive drugs (48.0 and 44.7%) compared to the first wave (79.1% and 67.2%, respectively). The occupancy rates as fraction of occupancy in 2019 (1.68 and 1.55 vs. 1.83), the numbers of ICU relocations (23.8 and 27.6 vs. 32.3%) and the mean length of stay at the ICU (HRs of ICU discharge = 1.26 and 1.42) were lower during the second and third wave. No difference in adjusted hospital mortality between the second wave and the first wave was found, whereas the mortality during the third wave was considerably lower (OR = 0.80, 95% CI [0.71–0.90]).ConclusionsThese data show favorable shifts in the treatment of COVID-19 patients at the ICU over time. The adjusted mortality decreased in the third wave. The high ICU occupancy rate early in the pandemic does probably not explain the high mortality associated with COVID-19.

2.
J Clin Med ; 10(6)2021 03 11.
Article in English | MEDLINE | ID: covidwho-1125931

ABSTRACT

We describe the practice of ventilation and mortality rates in invasively ventilated normal-weight (18.5 ≤ BMI ≤ 24.9 kg/m2), overweight (25.0 ≤ BMI ≤ 29.9 kg/m2), and obese (BMI > 30 kg/m2) COVID-19 ARDS patients in a national, multicenter observational study, performed at 22 intensive care units in the Netherlands. The primary outcome was a combination of ventilation variables and parameters over the first four calendar days of ventilation, including tidal volume, positive end-expiratory pressure (PEEP), respiratory system compliance, and driving pressure in normal-weight, overweight, and obese patients. Secondary outcomes included the use of adjunctive treatments for refractory hypoxaemia and mortality rates. Between 1 March 2020 and 1 June 2020, 1122 patients were included in the study: 244 (21.3%) normal-weight patients, 531 (47.3%) overweight patients, and 324 (28.8%) obese patients. Most patients received a tidal volume < 8 mL/kg PBW; only on the first day was the tidal volume higher in obese patients. PEEP and driving pressure were higher, and compliance of the respiratory system was lower in obese patients on all four days. Adjunctive therapies for refractory hypoxemia were used equally in the three BMI groups. Adjusted mortality rates were not different between BMI categories. The findings of this study suggest that lung-protective ventilation with a lower tidal volume and prone positioning is similarly feasible in normal-weight, overweight, and obese patients with ARDS related to COVID-19. A patient's BMI should not be used in decisions to forgo or proceed with invasive ventilation.

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