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1.
Frontiers in Medicine ; 9, 2022.
Article in English | Web of Science | ID: covidwho-2199005

ABSTRACT

BackgroundIt has been demonstrated that surgical patients with COVID-19 are at increased risk for postoperative complications. However, this association has not been tested in asymptomatic elective surgical patients. MethodsA retrospective cohort study among elective gynecological and spine surgery patients at a single tertiary medical center from July 2020 through April 2022 (n = 1,130) was performed. The primary endpoint was prolonged (>75th percentile for the corresponding surgical service) length of stay. Secondary endpoints included postoperative respiratory complications, duration of supplemental oxygen therapy, and other major adverse events. The association between SARS-CoV-2 detection and the above outcomes was investigated with univariate and multivariable analyses. FindingsOf 1,130 patients who met inclusion criteria, 30 (2.7%) experienced intraoperative detection of SARS-CoV-2. Those with intraoperative viral detection did not experience an increased incidence of prolonged length of stay [16.7% vs. 23.2%;RR, 0.72 (95% CI, 0.32-1.61);P = 0.531] nor did they have a longer mean length of stay (4.1 vs. 3.9 days;P = 0.441). Rates of respiratory complications [3.3% vs. 2.9%;RR, 1.15 (95% CI, 0.16-8.11);P = 0.594] and mean duration of supplemental oxygen therapy (9.7 vs. 9.3 h;P = 0.552) were similar as well. All other outcomes were similar in those with and without intraoperative detection of SARS-CoV-2 (all P > 0.05). InterpretationAsymptomatic patients with incidental detection of SARS-CoV-2 on intraoperative testing do not experience disproportionately worse outcomes in the elective spine and gynecologic surgical population.

2.
Front Immunol ; 13:1094346, 2022.
Article in English | PubMed | ID: covidwho-2198923

ABSTRACT

In this paper we aimed to study the characteristics, laboratory data and outcomes of monkeypox virus (MPV) and COVID-19 co-infection. On 2(nd) October 2022, we used the search term "("monkeypox virus" OR "MPV" OR "monkey pox" OR "monkeypox") AND ("COVID-19" OR "COVID 19" OR "novel coronavirus" OR "SARS-CoV-2")" in five databases to collect the relevant articles. We found three male patients, who had sex with men prior to the infection, had multiple comorbid conditions, were diagnosed with PCR, and were admitted to the hospital. The length of hospital stay was 4, 6, and 9 days. On admission, two cases had multiple vesicular lesions on various sites of the body associated with tonsillar inflammation, while the third case had genital ulcers and inguinal lymph node enlargement. All cases were managed in the hospital and recovered well. It might still be too early to establish solid evidence about the exact cause-effect association between SARS-CoV-2 and MPV co-infection and patient's outcomes because of the current low sample size. Accordingly, future relevant investigations, estimating the risk ratio of this association are needed to formulate definite evidence.

3.
Jammi ; 7(4):296-299, 2022.
Article in English | EMBASE | ID: covidwho-2198422
4.
BMC Infectious Diseases ; 22(1):947, 2022.
Article in English | MEDLINE | ID: covidwho-2196082

ABSTRACT

BACKGROUND: This study aims to investigate the clinical characteristics and the length of hospital stay (LOS), as well as risk factors for prolonged LOS in a cohort of asymptomatic and mild COVID-19 patients infected with the Omicron variant.

5.
Nutrition and health ; : 2601060221149088, 2023.
Article in English | EMBASE | ID: covidwho-2194884

ABSTRACT

Low-carbohydrate, high-fat (LCHF) nutrition therapy is characterized by carbohydrates comprising <26% of the daily caloric intake and a higher proportion of fat. LCHF therapies reduce exogenous glucose load, improve glycemic control, decrease inflammation, and improve clinical outcomes such as respiratory function. Given the altered metabolism in critically ill patients, LCHF nutrition therapy may be especially beneficial as it enables the conservation of protein and glucose for metabolic roles beyond energy use. In critical illness, LCHF diets have the potential to reduce hyperglycemia, improve ventilation, decrease hospital length of stay and reduce hospital costs. The purpose of this commentary piece is to describe LCHF nutrition therapy, summarize its impact on health outcomes, and discuss its role in the intensive care unit (ICU). Additional research on the effects of LCHF nutrition therapy on critically ill patients is warranted, including a focus on COVID-19.

6.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194394

ABSTRACT

Introduction: According to recent global estimates there are nearly 530 million cases and 6.3 million deaths due to novel coronavirus disease 2019 (COVID-19) pandemic. Studies have shown that COVID-19 disproportionately affects males than females. In this study we looked at differences in in-hospital outcomes of COVID-19 based on sex using a larger administrative database. Hypothesis: The adverse in-hospital outcomes of COVID-19 will be significantly higher among males. Method(s): This was a retrospective analysis of the California State Inpatient Database 2020. All COVID-19 hospitalizations with age 18 years and above were included for the analysis. These hospitalizations were classified into males and females. The main outcomes of the study were inhospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission. Any length of stay >=75th percentile value for the entire cohort was considered as prolonged length of stay. Logistic regression analyses after adjusting for covariates were used to compare COVID-19 related outcomes between males and females. Result(s): A total of 95,180 primary COVID-19 hospitalizations were included for the analysis. Of these 52465 (55.1%) were males and 42715 (44.9%) were females. Among these hospitalizations, mortality (12.4% versus 10.1%, P<0.001), prolonged length of stay (30.6% versus 25.8%, P<0.001), vasopressor use (2.6% versus 1.6%, P<0.001), mechanical ventilation (11.8% versus 8.0%, P<0.001), and ICU admission (11.4% versus 7.8%, P<0.001) were significantly higher among males. Logistics regression analysis showed that males had significantly greater odds for mortality (aOR, 1.38, 95% CI: 1.32-1.44), prolonged length of stay (aOR, 1.35, 95% CI: 1.31-1.39), vasopressor use (aOR, 1.59, 95% CI: 1.51-1.66), mechanical ventilation (aOR, 1.62, 95% CI: 1.47- 1.78), and ICU admission (aOR, 1.58, 95% CI: 1.51-1.66). Conclusion(s): Adverse outcomes such as mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission were independently associated with male sex. These findings could be due differences to both biological and social factors between the sexes. Future studies should explore these factors to efficiently control COVID-19.

7.
Colorectal Disease ; 23(Supplement 2):154, 2021.
Article in English | EMBASE | ID: covidwho-2192487

ABSTRACT

Aim: The SARS-Cov- 2 pandemic has been undoubtedly overwhelming for elective colorectal cancer resections. However, early establishment of a green pathway has enabled our trust to operate in a clean, covid-19 free environment and this project aims to demonstrate this pathway. Method(s): Elective colorectal cancer resections have been included in this cohort from January until July 2020. Emergency and benign resections have been excluded from this study. The main procedures that have been performed were laparoscopic right hemicolectomies and high anterior resections. Complication rate was classified using the Clavien-Dindo scale. Patients from March 2020 onwards were operated and nursed post-operatively on a green covid-19 pathway. Result(s): A total of 62 patients were included in this study. Resections were mainly performed laparoscopically (85%) and these were mainly right hemicolectomies (41%) and high anterior resections (31%). There has been a single Covid19 positive resection and that was before the pathway has been established. The median length of stay was 5 days for all resections. The main post-operative complication was ileus and there were no anastomotic leaks. Conclusion(s): Elective colorectal resections during a respiratory pandemic are safe and feasible with appropriately established pathways.

8.
Colorectal Disease ; 23(Supplement 2):139, 2021.
Article in English | EMBASE | ID: covidwho-2192465

ABSTRACT

Aim: A comparative analysis of short term outcome of colorectal resections undertaken before and during COVID-19 pandemic. Method(s): A retrospective analysis of prospective database of colorectal cancer resections pre and post COVID-19 (2019 vs 2020) in a DGH. The cohort had 106 patients (60 in 2019;46 in 2020). Outcome parameters analysed were, Length of stay (LOS), stoma formation, resection margin, Clavien-dindo classification of complications, 30 day re-admission rate and 30 day mortality. Demographic data included age, gender and type of resection Results: A total of 60 resections were performed in 2019, 53% being female and median age 68 years In 2020 there were 46 resections, median age 70.5yrs and 43% female. In 2019 15/60 (25%) of resections were performed as an emergency and in 2020 10/46 (22%) (P = 0.65). Median LOS was 8 days in 2019 and 7 in 2020 (P = 0.25). 5/60 patients were readmitted within 30days in 2019 and 9/46 in 2020 (P = 0.045*). In both arms 30 day mortality was 0. In 2019 8 patients suffered Clavien-dindo complications rated at 2 or greater and 11 in 2020 (P = 0.08). Stomas were formed in 26/60 in 2019 and 28/46 in 2020 (P = 0.037*). Finally in 2019 7/60 resections had R1 resection and 4/46 in 2020 (P = 0.62). Conclusion(s): The analysis found no signifcant difference in short term outcome of the two periods including length of stay or days in ICU. Comparatively little statistical difference was found between the two years despite COVID-19. The only parameters notably different were the stoma rate rising from 43% to 61%, and 30 day readmission rate increasing from 8% to 20%. This data-set is too small to infer if problems related to stoma care were responsible. This analysis would suggest that there was not a significant difference in occupancy of ICU beds despite increasing stoma formation at a local level. Many of these patients will need reversal and the pandemic is likely to continue, therefore should stomas be formed as readily? Larger multicentre audit may validate such observations.

9.
Pediatric Critical Care Medicine Conference: 11th Congress of the World Federation of Pediatric Intensive and Critical Care Societies, WFPICCS ; 23(11 Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2190781

ABSTRACT

BACKGROUND AND AIM: Children are increasingly being dischared directly home from the pediatric intensive care unit (PICU). Transitions out of critical care have been recognized as a period of increased patient and caregiver stress, as well as increased risk for adverse events. In children, there is little evidence evaluating patient/caregiver outcomes after being discharged directly home from the PICU. The aim of this study is to explore families experience with discharge directly home from the PICU. METHOD(S): This prospective mixed methods study was conducted in the PICU of CHU Sainte-Justine from January to July 2021. We included families of children expected to be discharged home in the following 12 hours. Qualitative data was obtained through semi-structured discharge interviews, then with telephone interviews 7 and 28 days post-PICU discharge. We measured comfort on a Likert scale, and screened for caregiver anxiety. RESULT(S): The families of 25 patients were interviewed. Median patient age was 1.5 years (0.6-8.6), and median length of stay was 3 days (IQR 2-4). Thematic analysis of the interviews on discharge day revealed several themes, such as feeling stress and anxiety, feeling confident, avoiding Covid-19, anticipating family and friends, knowing when to consult a physician and being supported by social media. Median comfort level on a 5-point Likert was 4 (comfortable) (IQR 4-5). CONCLUSION(S): Despite feelings of anxiety, many families felt comfortable with discharge directly home from the PICU. Increasing our understanding of the family experience of discharge from the PICU, will help to better support these patients/families during their transition from PICU to home.

10.
Pediatric Critical Care Medicine Conference: 11th Congress of the World Federation of Pediatric Intensive and Critical Care Societies, WFPICCS ; 23(11 Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2190760

ABSTRACT

BACKGROUND AND AIM: Evidence for therapies for pediatric COVID-19 is limited. Primary aim was to study the effect of steroid administration within 2 days of admission for pediatric non-MIS-C-COVID-19 on hospital and ICU length of stay (LOS). The secondary aim was to study its effect on inflammation and fever defervescence. METHOD(S): A retrospective study of 1163 children hospitalized with non-MISC-COVID-19, from 03/20 to 09/21, from 58 hospitals (7 countries, 92% US), in the Viral Infection and Respiratory Illness Universal Study (VIRUS) registry. Effect of steroid administration <= 2 days of admission on hospital and ICU LOS was studied using intention to treat analysis, adjusted for confounders by multivariable mixed linear regression. RESULT(S): Median age was 7(IQR 0.9,14.3) years. 184(15.8%) children who received steroids within <= 2 days were compared to 979 (84.1%) children who did not. 56.5% (n=658) required respiratory support. Patients in the steroid group were older, with higher severity of illness. A greater proportion required respiratory and vasoactive support. On multivariable linear regression with random intercept for site (Table), there was no significant difference in hospital LOS (exponentiated [exp] co-efficient 0.92, 95%CI = 0.77, 1.10, p=0.374) or ICU LOS (exp co-efficient 1.02, 95%CI = 0.78, 1.34, p=0.864) between the groups. There was no significant difference in time to fever defervescence and normalization of inflammatory mediators by Day 3. CONCLUSION(S): In pediatric non-MIS-C COVID-19, steroid treatment <= 2 days of hospital admission did not show a statistically significant effect on hospital or ICU LOS. (Table Presented).

11.
Critical Care Medicine ; 51(1 Supplement):647, 2023.
Article in English | EMBASE | ID: covidwho-2190691

ABSTRACT

INTRODUCTION: The COVID-19 mandated lockdown created unintended outcomes in traumatic injury patterns and psychosocial behaviors compared to previous years during the same timeframe. The aim of this research is to describe a population of trauma patients during the past five years to determine particular trends in ETOH levels. METHOD(S): A retrospective cohort study on prospectively collected trauma registry data of all adult (>=18 years) trauma patients admitted to this ACS verified Level I trauma center in South Carolina, inclusive years 2017 to 2021. The data was grouped based upon the COVID-19 lockdown period, which included a time between March 15 to May 22. The five groups were compared based upon ETOH levels, patient demographics, injury patterns, morbidity, mortality, and comorbidity. Continuous variables were compared using the Kruska-Wallis test, whereas categorical variables were compared using Pearson's chi-square test of proportions, as appropriate in R software. RESULT(S): A total of 3281 adult trauma patients were included in the analysis during the lockdown periodacross five years. The ETOH mg/dL trend was in decline with a mean 138 mg/dL in 2019;however, began to significantly climb during 2020 (Mean = 164 mg/dL) and 2021 (Mean = 169 mg/dL;p < 0.01). The trauma population during the 2020 group was likely full activations (p < 0.01) with penetrating injuries (p < 0.01) who received a massive transfusion (p < 0.01). The 2020 group typically had a longer ICU length of stay (Mean = 1.77 days;p < 0.01), and longer ventilation days (Mean 0.72;p = 0.02). CONCLUSION(S): Excess alcohol consumption particularly during a pandemic year and beyond may lead to a higher incidence in trauma severity, such as penetrating injuries needing massive transfusions. The psychosocial impacts of government-mandated lockdowns may lead to increased alcohol consumption leading to a higher degree of severity and morbidity markers in the trauma population in South Carolina.

12.
Critical Care Medicine ; 51(1 Supplement):608, 2023.
Article in English | EMBASE | ID: covidwho-2190687

ABSTRACT

INTRODUCTION: Thiamine (TH) is a co-factor for pyruvate dehydrogenase, an enzyme necessary for pyruvate entry into the Krebs cycle, and without this enzyme, pyruvate would be converted to lactate. Elevated lactate, which is often used as a marker of perfusion, is proportionally associated with increased mortality in septic shock. The few publications on TH in septic shock are inconclusive. This study aims to ascertain if there is benefit to adding TH to standard of care (SOC) in the management of septic shock. METHOD(S): IRB-approved, multicenter, retrospective review from 2016 to 2021. Adult patients admitted to the ICU for septic shock and receiving >= 400 mg a day of IV TH (in divided doses) were included. Patients < 18, pregnant, admitted for SARS-COV-2, or whom received < 400 mg of TH daily were excluded. Two matched cohorts were evaluated, SOC plus TH versus SOC alone. The primary endpoint is time to shock reversal, defined as off vasopressors for at least 12 hrs and alive. Secondary endpoints include time to lactate clearance (< 2 mmol/L), lactate trends at 6, 12, 24, 48 hrs, and end of therapy, hospital and ICU lengths of stay, new end organ dysfunction, and in-hospital mortality. RESULT(S): Data from 50 patients were analyzed: 25 in the SOC plus TH and 25 in the SOC arm. The TH arm had greater number of vasopressors (2 vs. 1, p=.019), and greater utilization of stress-dose steroids (72% vs. 8%, p<.001), however there was no difference in cumulative vasopressor dose in norepinephrine equivalents at baseline (BL) (30.1 vs. 25.8 mcg/min, p=.248). There was no difference in SOFA score at ICU admission (10 vs. 8.5, p=.106) or lactate level at ICU admission (5.9 vs. 3.9 mmol/L, p=.055). There was a longer time to shock reversal from vasopressor initiation time in the TH arm (93 vs. 37.1 hrs, p=.023). Lactate clearance was slower in the TH arm (44.75 vs. 15.8 hrs, p=.027), and there was increased in-hospital mortality in the TH arm (13 vs. 5, p=.018). CONCLUSION(S): Compared to SOC alone, TH treated patients had longer times to shock reversal. However, this outcome may have been confounded by differences at BL with regard to number of vasopressors, and stress-dose steroid utilization, which indicate these patients were sicker at BL. Larger, prospective studies are required to confirm these findings.

13.
Critical Care Medicine ; 51(1 Supplement):602, 2023.
Article in English | EMBASE | ID: covidwho-2190683

ABSTRACT

INTRODUCTION: The Surviving Sepsis Campaign guidelines recommend prompt intravenous antibiotic administration within one hour for patients with septic shock or a high likelihood of sepsis. To improve timeliness of antibiotic administration, piperacillin-tazobactam and cefepime were stocked in the automated dispensing cabinets (ADCs) in five intensive care units (ICU).The aim of this study was to evaluate the time from order entry of piperacillintazobactam or cefepime to administration in ICU patients before and after addition to the ADC. METHOD(S): This was a retrospective study of adult, presumed septic patients who received their first dose of piperacillin-tazobactam or cefepime in an ICU. Patients included from March 23, 2019 - March 23, 2020 received antibiotics from the inpatient pharmacy (Pre-ADC) and those from March 25, 2020 - March 25, 2021 received piperacillintazobactam and cefepime from the ICU ADCs (Post-ADC). The primary outcome was time from antibiotic order entry to administration. Secondary outcomes included time from order entry to pharmacy verification, in-hospital mortality, and hospital length of stay. RESULT(S): One thousand eight hundred and three patients were included with 903 patients in the Pre-ADC group and 900 in the Post-ADC group. Baseline characteristics were similar, and respiratory infection was the most common antibiotic indication (37% Pre-ADC vs. 36% Post-ADC). Additionally, more Post-ADC patients had isolation precautions at the time of antibiotic administration (15% Pre-ADC vs. 19% Post-ADC, p=0.04). The median (IQR) time (minutes) from order of antibiotics to administration was shorter in the Pre-ADC group at 57 (32-97) vs. 75 (43-126) Post-ADC (p < 0.001). Median (IQR) time (minutes) from pharmacy verification to nursing administration was 51 (28- 91) Pre-ADC vs. 75 (43-126) Post-ADC, p< 0.001. Hospital length of stay and mortality were similar between the groups. CONCLUSION(S): Adding piperacillin-tazobactam and cefepime to the ICU ADCs did not result in earlier antibiotic administration in presumed septic patients. Due to the timing of this study, the COVID-19 pandemic and isolation precautions likely confounded the results. Further investigation of antibiotic administration barriers is needed to optimize patient care and meet Surviving Sepsis Campaign recommendations.

14.
Critical Care Medicine ; 51(1 Supplement):600, 2023.
Article in English | EMBASE | ID: covidwho-2190681

ABSTRACT

INTRODUCTION: The COVID-19 pandemic disrupted access and delivery of routine continuing care for sepsis recovery, including provision of postacute services like skilled nursing facility (SNF) discharge, home healthcare (HH), and outpatient follow up. We hypothesized pandemic-related precautions and care disturbances would disparately impact postacute care for adults with sepsis due to COVID-19 vs non-COVID-19 pneumonia. METHOD(S): ENCOMPASS is an ongoing hybrid trial to test implementation of a multidisciplinary postsepsis transitional care program at 8 diverse hospitals (NCT04495946). In the current study, we analyzed community-dwelling trial participants (i.e., adults with clinically defined sepsis) enrolled July 2020-Nov 2021 with discharge diagnoses of COVID-19 (ICD10 U07.1) or non-COVID-19 pneumonia (ICD10 J13-18). Using EHR data, we examined discharge care setting (SNF or inpatient rehab, HH, or home with self care) and outpatient follow up within 14 days (in-person, virtual, or none) as primary and secondary outcomes. For each outcome, we fit multinomial regression models adjusted for patient (age, insurance), clinical (comorbidity burden, organ failure, length of stay) and community factors (rurality by zip code). RESULT(S): Among 410 participants with COVID-19 (n=151) or non-COVID-19 (n=259) pneumonia (median, at enrollment: age=70, CCI=5, SOFA score=4), 52 (13%) died in hospital and 18 (4%) discharged to hospice. of remaining patients, 134 (39%) were discharged to home with self care, 118 (35%) to HH, and 88 (26%) to SNF or inpatient rehab. Survivors with vs without COVID-19 had similar adjusted odds of discharge to HH (OR=1.17 95%CI=0.65-2.10) and SNF or inpatient rehab (OR=1.60 95%CI=0.81-3.14) compared to home. Outpatient visit completion was similar for COVID-19 and non-COVID-19 survivors (26% vs 30%, p=0.43), but patients with vs without COVID-19 had higher odds of virtual (OR=4.76 95%CI=2.11-10.75) compared to no completed follow-up. CONCLUSION(S): In an ongoing postsepsis care trial, COVID-19 and non-COVID-19 survivors had similar provision of postacute services. COVID-19 was associated with increased virtual outpatient follow up, highlighting the value of telehealth to reduce exposure risk while maintaining close follow up of patients recovering from serious illness during the pandemic.

15.
Critical Care Medicine ; 51(1 Supplement):550, 2023.
Article in English | EMBASE | ID: covidwho-2190665

ABSTRACT

INTRODUCTION: Tracheostomy is the most frequent surgical procedure performed in critically ill patients, mostly in patients requiring prolonged mechanical ventilation. We aimed to describe the outcomes associated with tracheostomies in critically ill COVID-19 patients admitted to our ICU. METHOD(S): We studied a cohort of adult patients admitted with the diagnosis of COVID-19 to a mixed ICU between 03/2020 and 06/2021. We collected patients' demographics, severity of illness, ICU resource utilization, and outcomes. Descriptive statistics were reported. RESULT(S): A total of 275 patients with confirmed COVID-19 were admitted to our ICU during the study period. Among them, 26 patients (9.45%) underwent tracheostomy. There were 10 females (38.4%) with an average age of 60 years (range 53-67). Median body mass index was 31 (range 26-41). Patients identified themselves as African American (39%), Caucasian (27%), and the remaining as other or declined to answer. Median Sequential Organ Failure Assessment (SOFA) score on admission was 10 (range 8-12) and max SOFA score was 13 (range 11-17). Mean mechanical ventilation-days was 19 days (range 12-23). Median ICU length of stay (LOS) was 41 days (range 31-48) and hospital LOS was 46 days (range 32-60). The ICU and hospital mortality rates were 23% and 27% respectively. There were no procedural causes of death. CONCLUSION(S): Although the mortality of the patients that underwent tracheostomies was relatively high, these patients were less than 3% of the total cohort of COVID-19 patients admitted to the ICU and had lower mortality than expected adjusted for their severity of illness based on the SOFA score.

16.
Critical Care Medicine ; 51(1 Supplement):547, 2023.
Article in English | EMBASE | ID: covidwho-2190664

ABSTRACT

INTRODUCTION: An impacted population of the COVID-19 pandemic is those with limited English proficiency (LEP). Due to visitor restrictions, caregivers were unable to facilitate communication with hospital staff, and those with LEP were more susceptible to poor communication with their healthcare providers. METHOD(S): Data was ed from the BIDMC site of the SCCM VIRUS Discovery Database, a de-identified, HIPAA-compliant database containing clinical information for COVID-19 patients admitted to BIDMC. Patients were placed into two groups, either requiring translator services for any language or not. Statistical analyses were performed in R Version 3.0 to calculate test statistics such as ANOVA and Chi-Square p-values. The primary outcome assessed length of stay (LOS). Secondary outcomes included complications, discharge status of alive or deceased, discharge location of either home or another care facility, and number of symptomatic days before hospital admission. The association between non-White, non-Hispanic demographics and need for translation services was also examined. RESULT(S): 1522 patients were included with 91 excluded due to unknown use of translator services. The relationship between the requirement of an interpreter and LOS, complications, and symptomatic days was not statistically significant. However, statistically significant findings include patients who required translational services were more likely discharged alive (OR 1.53, 95% CI 1.07-2.24), and discharged to their homes (OR 1.42, 95% CI 1.07-1.91). Use of translator services was strongly associated with minority status (OR 5.20, 95% CI 3.81-7.21). A limitation of this dataset is that deceased status is only recorded if the patient dies during the index visit, potentially missing those who expire from COVID-related complications post-discharge. CONCLUSION(S): The requirement of a translator was not correlated with longer hospital stays, more complications, or days symptomatic prior to admission in comparison to the patients' English-speaking counterparts. However, the use of a translator was positively correlated with survival, discharge home, and minority status. The increased odds of discharge home could be due to the cultural values of minorities providing care in a familial setting.

17.
Critical Care Medicine ; 51(1 Supplement):437, 2023.
Article in English | EMBASE | ID: covidwho-2190616

ABSTRACT

INTRODUCTION: Increased sedation and analgesia requirements have been described in patients with acute respiratory distress syndrome (ARDS) on veno-venous (VV) extracorporeal membrane oxygenation (ECMO) support due to unique pharmacokinetic challenges. The primary objective of this study was to compare analgesia and sedation requirements in adult patients with SARS-CoV-2 ARDS versus other etiologies of ARDS requiring VV-ECMO support. METHOD(S): This was a retrospective cohort study of adult patients requiring VV-ECMO for ARDS between May 2016 and July 2021. Patients were excluded if cannulated at an outside hospital for greater than 24 hours, expired within 48 hours of ECMO cannulation, or received neuromuscular blocking agents for greater than 7 consecutive days. The primary outcome of the study was the daily median dose for continuous infusion analgosedation for 7 days following ECMO cannulation. Secondary outcomes included the daily median analgosedation requirements utilizing the highest daily rate, ICU length of stay and mortality, and incidence of adjunct sedation, analgesia, and anxiolytic use while on VVECMO. RESULT(S): Of 108 patients evaluated on VV-ECMO support, 44 had non-SARS-CoV-2 ARDS and 64 had SARS-CoV-2 ARDS. The median daily dexmedetomidine requirements were significantly higher in the SARS-CoV-2 cohort (16.7 vs. 13.4 mcg/kg/day, p=0.03), while the median propofol daily requirements were significantly higher in the non- SARS-CoV-2 cohort (40.3 vs. 53.5 mg/kg/day, p < 0.01). There was no difference in daily requirements of opioids, benzodiazepines, and ketamine between groups. Patients in the SARS-CoV-2 cohort remained on greater than 2 continuous infusion agents significantly longer than the non-SARS-CoV-2 cohort (3.0 vs. 2.0 days, p=0.04). Use of non-parenteral adjunct agents was significantly higher in the SARS-CoV-2 cohort (78.1% vs. 43.2%, p< 0.01). CONCLUSION(S): Patients with ARDS on VV-ECMO support require multiple analgesic and sedative agents with higher utilization of non-parenteral adjunct agents in the SARSCoV- 2 ARDS cohort. To circumvent these challenges, ECMO centers should consider implementation of ECMO-specific analgosedation protocols to optimize patient outcomes.

18.
Critical Care Medicine ; 51(1 Supplement):279, 2023.
Article in English | EMBASE | ID: covidwho-2190576

ABSTRACT

INTRODUCTION: Families are often not present at the bedside during their child's pediatric intensive care unit (PICU) admission. Family presence is important for participation in family-centered care (FCC), promoted by the American Academy of Pediatrics to improve health outcomes. It is unknown if demographic characteristics are associated with family presence during peak illness severity, the first 72 hours of admission. We describe associations between demographic characteristics and family presence during peak illness severity. METHOD(S): We performed a retrospective observational study of PICU admissions > 72 hours from July 2012-June 2021 at a single tertiary care children's hospital to determine associations with our primary outcome of bedside family presence percentage in the first 72 hours of admission. Predictor variables included patient and family demographic characteristics obtained from the electronic medical record. We completed descriptive bivariate analyses of the predictor variables and family presence percentage (Spearman Rho for continuous variables and Kruskal Wallis for categorical variables). RESULT(S): 3006 unique patients were included. Family members were present a mean of 81% and a median of 97% of the first 72 hours. Family presence percentage was weakly positively correlated with age (rs=0.108, p< 0.001) and weakly negatively correlated with length of stay (rs=-0.253, p< 0.001) and PELOD-2 score (rs=-0.217, p< 0.001). Decreased median family presence percentage was associated with Black race (81.1 v 97.2-98.1 all other races, p=< 0.001), non-Hispanic ethnicity (95.8 v 97.2 Hispanic ethnicity, p< 0.001), public insurance (94.8 v private 98.4, p< 0.001), and admissions after COVID (94.2 v 96.6 pre- COVID, p< 0.001). Increased family presence percentage was associated with Spanish speaking families (97.9 v 96.2 English, p = 0.01). Family presence percentage was not associated with distance from hospital, complex care conditions, or siblings. CONCLUSION(S): Family presence percentage during peak illness severity is associated with patient demographic characteristics. Families of racially and ethnically diverse patients and with public insurance may benefit from interventions to increase their ability to be present at the bedside.

19.
Critical Care Medicine ; 51(1 Supplement):271, 2023.
Article in English | EMBASE | ID: covidwho-2190572

ABSTRACT

INTRODUCTION: Medical complications among pregnant peripartum patients are not common. However, certain disease such as obstetric hemorrhage or respiratory failure could be associated with poor outcome among obstetric patients whose biological systems are already stretched. When a peripartum patients encounter a severe medical condition, they are frequently transferred to a tertiary center for management of these patients' complex conditions. Our study investigated the outcomes of the peripartum patients who were transferred from other hospitals (Interhospital transfer [IHT]) to the Intensive Care Unit at an academic quaternary center. METHOD(S): We retrospectively analyzed all adult IHT peripartum patients to our institution's ICU between Jan. 2017 to Dec. 2021. We presented descriptive analysis for our patients and used multivariable ordinal regressions for association between demographic, clinical factors, and patients' length of stay (LOS) in the ICU (ICULOS), hospital (HLOS). RESULT(S): Among 1794 IHT peripartum patients, 59 patients were transferred directly to an ICU, 8 (13.6%) to Medical ICU, 2 (3.4%) Neuro ICU, 2 (3.4%) Surgical ICU and 47 (79.7%) to our Critical Care Resuscitation Unit. Patients' mean (Standard Deviation) age was 32 (6) years, SOFA score 3 (3), APACHE II 8 (4), median Respiratory Oxygenation (ROx) index was 13 [Interquartile Range 4-22], and serum lactate 11 [9-15] mmol/L. Respiratory failure occurred in 19 (32%), postpartum hemorrhage 9 (15%), sepsis 8 (14%) patients. 16 (27%) patients were infected with COVID-19. 24 (41%) needed intubation, 13 (22%) vasopressor, 4 (7%) Extracorporeal Membrane Oxygenation. Median ICULOS and HLOS was 5 [2-12], 8 [5-17] days. Only 1 (1.7%) died, while 45 (76.3%) were discharged home directly. Having COVID-19 infection was associated with both ICULOS (Correlation Coefficient -2,23, OR 0.06, 95%CI 0.02-0.65, P = 0.016) and HLOS (Corr. Coeff. -2.75, OR 0.06, 95%CI 0.01-0.37, P = 0.002). CONCLUSION(S): Although severe medical conditions were uncommon among interhospital transferred peripartum patients, they could be severe, especially during the COVID-19 pandemic. Fortunately, the mortality rate for peripartum patients in our study was very low. Further studies with larger sample sizes are needed to confirm our observation.

20.
Critical Care Medicine ; 51(1 Supplement):232, 2023.
Article in English | EMBASE | ID: covidwho-2190565

ABSTRACT

INTRODUCTION: Neurological prognostication is an important part of caring for critically ill patients and can help guide goals of care. This has become a challenge when caring for patients with severe COVID-19 pneumonia, as they have been shown to often have prolonged periods of coma followed by meaningful neurological recovery. However, this has not been studied in patients who require venovenous extracorporeal membrane oxygenation (VV-ECMO) support. We hypothesize that patients with COVID-19 pneumonia on VV-ECMO will have a more prolonged period of unconsciousness when compared to their COVID-negative counterparts. METHOD(S): We conducted a retrospective chart review of all patients who received VV-ECMO support at our institution from March 2020 to January 2022. This timeframe was selected to limit the effect of any changes in sedation practices that were brought about by the COVID-19 pandemic. We compared the daily Glascow Coma Scale (GCS) of patients with COVID-19 pneumonia to those who were cannulated for other etiologies. Our outcomes were duration of unconsciousness, which was defined as time from intubation to GCS motor score=6 for 48 hours, as well as changes in GCS over time. RESULT(S): Our preliminary analysis included 84 patients, 57 (68%) of whom were COVID-19 positive. There were no significant differences in the baseline characteristics of the groups, including initial Sequential Organ Failure Assessment score and need for renal replacement therapy. Patients with COVID-19 pneumonia had a significantly longer duration on ECMO in hours (952 vs 312, p< 0.001) and hospital length of stay in days (42 vs 30, p=0.01). There was no significant difference in the duration of unconsciousness (days) between the two groups (11 vs 9, p=0.21). However, the trend in GCS over time was notable as we found that patients with COVID-19 spent more days unresponsive, defined as a GCS=3 (8 vs 5, p=0.04). CONCLUSION(S): Our preliminary analysis found that in patients on VV-ECMO, those with COVID-19 pneumonia spent a longer time on ECMO and in the hospital. While there was no difference in the duration of unconsciousness, patients with COVID-19 spent more of that period unresponsive prior to recovery. While additional analysis is needed, this finding may assist providers when prognosticating neurological recovery.

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