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1.
Neurology ; 93(23 Supplement 2):S34, 2022.
Article in English | EMBASE | ID: covidwho-2196705

ABSTRACT

Objective To determine cumulative incidence and point prevalence of neuromyelitis optica spectrum disorder (NMOSD), multiple sclerosis (MS), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in Thailand using population-based data of Chumphon province. Background CNS inflammatory demyelinating diseases (CNSIDDs) have a great interracial heterogeneity. The epidemiology of CNSIDDs in Thailand, a Mainland Southeast Asian country, is unknown. Design/Methods Searching for CNSIDD patients at a public secondary care hospital in Chumphon from January 2016 to December 2021 was performed using relevant ICD-10-CM codes. All neurology patients were systematically referred to this hospital as it was the only hospital in the province with a neurologist. Diagnoses were individually ascertained by retrospective chart review. Cumulative incidence over 2016-2021, point prevalence on December 31st, 2021, attack rate, mortality rate, and disabilityadjusted life years (DALYs) were calculated. Population data were obtained from the National Statistical Office of Thailand. As of December 31st, 2021, the population census of Chumphon was 509,479. Results NMOSD was the most prevalent CNSIDD in adult Thai population at 3.33 per 100,000 persons (crude prevalence 2.55). The age-adjusted prevalence of aquaporin-4 antibody-positive NMOSD alone was 3.08 per 100,000 persons. Age-adjusted incidence rate of NMOSD was 1.65 per 100,000 persons/year (crude incidence rate 0.20). Age-adjusted prevalence of MS followed at 0.77 and MOGAD at 0.51 per 100,000 persons (crude prevalence 0.59 and 0.39, respectively). Although most had a fair recovery, disability was worst amongNMOSD with a DALY of 3.47 years per 100,000 persons. Mortality and attack rates were highest in NMOSD as well. No increase in incidence or attack rate were observed during the COVID-19 pandemic. Conclusions CNSIDDs are rare diseases in Thailand. The prevalence is comparable to that of East Asian countries. NMOSD caused the highest DALYs among CNSIDDs.

2.
Pharmaceutical Journal ; 309(7966), 2022.
Article in English | EMBASE | ID: covidwho-2196685
3.
Pharmaceutical Journal ; 309(7965), 2022.
Article in English | EMBASE | ID: covidwho-2196674
4.
Vascular Medicine ; 27(6):650-651, 2022.
Article in English | EMBASE | ID: covidwho-2194539

ABSTRACT

Background: Underutilization of proven therapies in peripheral artery disease (PAD) remains a critical problem. Implementation science aims to improve this, but few trials exist. We describe a randomized trial designed with pragmatic elements in PAD patients. Method(s): OPTIMIZE PAD-1 was designed to evaluate the efficacy of a multidisciplinary vascular care team using an intensive lipid reduction program in PAD patients versus usual care. The primary endpoint is low density lipoprotein-cholesterol (LDL-C) reduction at 12 months. A second objective is to assess the impact of a structured quality assurance program (EQuIP) on variability in 6-minute walk test (6MWT) distance. Due to COVID-19, pragmatic aspects were introduced, including virtual consent/recruitment, home-based subject conducted lab testing, and virtually monitored homebased 6MWT. Result(s): A total of 114 subjects with PAD were recruited over ~18 months at the University of Colorado and randomized to algorithm-driven lipid management by a multidisciplinary vascular care team with pharmacist support or to usual care (Figure). Subjects were also randomized to 6MWT conducted by site versus EQuIP staff. Potential participants and clinical events during follow up were identified via electronic medical records. Adjustments to enable remote study conduct were successfully implemented. Conclusion(s): Pragmatic randomized trials in PAD patients are feasible to strengthen implementation science.

5.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194373

ABSTRACT

Introduction: Risk of congenital heart disease (CHD) for in vitro fertilization (IVF) pregnancies is higher than the general population, though other factors may be involved. IVF is an indication for fetal echocardiogram (FE), however there is center variation to perform FE without a secondary indication if the anatomy ultrasound (AU) is normal. We aim to assess the number of new CHD diagnoses following normal AU in IVF-only pregnancies. Hypothesis: We hypothesize that there is minimal benefit to a FE in IVF-only pregnancies with a normal AU and may result in overutilization of resources. Method(s): Retrospective chart review from 2016-2021 of all IVF pregnancies with and without a secondary indication for FE at our center. Those without FE during the COVID-19 pandemic were included to assess postnatal CHD detection. Patients were classified as IVF-only if they had a normal AU and no secondary indication for FE;all others classified as IVF+other. Maternal and fetal demographics, AU, FE, and postnatal echo (post-echo) data was obtained. Result(s): A total of 556 maternal and 628 fetal patients from IVF pregnancies were included;401 fetuses were IVF-only with a FE, 116 were IVF-only with no FE, the remaining were IVF+other. There was no complex CHD (CCHD) in either IVF-only groups, the FE group detected several minor findings, and the no FE group detected three small septal defects on post-echo (Table 1). The probability of a normal postnatal evaluation in IVF-only with a normal FE was 94% and with no FE was 96%. Minor variations found on FE triggered additional testing (71 total FE in 43 fetuses) and detected a few minor CHD, none requiring intervention. Conclusion(s): Given low-risk for CCHD in IVF-only pregnancies, there is minimal benefit to a FE in the setting of a normal comprehensive AU and raises questions of cost vs. benefit of FE. This may impact future recommendations for indications for FE in the setting of IVF-only without added risk factors for CHD.

6.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194364

ABSTRACT

Introduction: COVID-19 significantly affected outpatient cardiac rehabilitation which is a central resource for patients recovering from cardiovascular disease. The aim of the study was to examine the impact of COVID-19 on Cardiac Rehabilitation (CR) Phase II clinical outcomes. Method(s): A single-site retrospective chart review of CR Phase II patients who completed 12 or more visits during 2019 (pre-COVID) and 2020 (COVID) was performed. Depression was measured using the PHQ-9, functional capacity was measured by the 6-minute walk in distance (ft) and metabolic equivalents (METs), and quality of life (QOL) was measured by the Ferrans and Powers Index. Descriptive and linear mixed methods were used to analyze the data. Result(s): A total of 212 patients who were predominately male 67% and 66.5 (SD=10.8) years old were included. PHQ-9 results showed a significant interaction COVID*pre-post scores F(1, 119.66) = 4.66, p = 0.03. For the remaining scores, all results showed significant improvements in pre-post: distance F(1, 151.90) = 226.92, p <.001;METs F(1, 180.13) = 138.7, p <.001;and QOL F(1, 145.32) = 5.89, p =0.02. Interactions were not significant for the three variables. QOL results showed significant differences in the COVID group with F(1, 239.12) = 6.13, p = 0.01. Conclusion(s): All four outcomes improved significantly in the pre-COVID and COVID sample. COVID significantly impacted depression PHQ-9 score change, with a pre-post improvement of 0.62 points in the pre-COVID group and 2.08 points during COVID. Finally, the mean overall QOL score was significantly lower in the COVID group than the pre-COVID group.

7.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194358

ABSTRACT

Introduction: Recent data shows that when adults are discharged after hospitalization for acute heart failure (HF), a clinic follow up with either cardiology or general medicine within 7 days results in significantly lower chances of 30 day readmissions. We sought to analyze the trends of clinic follow up after acute HF hospitalization and the associated barriers and facilitators at our safety net hospital. Method(s): Data was extracted from the electronic medical records using ICD 9,10 codes for acute HF admissions between Jan 2019 and Dec 2021. Quarterly trends of rates of clinic follow up were analyzed over the past 3 years;t-test was used to assess for statistical significance. Multivariable logistic regression models were constructed to test the association between patient level factors and clinic follow up after adjusting for sociodemographic factors. A p value < 0.05 was used to establish significance. Result(s): Of 1,037 patients admitted for acute HF between 2019-2021, 29.5% were 65 years or older, 64.7% were males, 48.7% were Black and 16.6% were uninsured. Only 8% and 23.1% had a 7 and 14 day clinic follow up respectively. Of those with scheduled follow up 65% and 56% showed up to their appointments at 7 and 14 days respectively. Overtime we noted an increase in the proportion of encounters with a 7 day follow up although the effective follow up (after accounting for no-shows) remained unchanged. Patients that had an inpatient cardiology consult had higher odds of getting a 7 day follow up (OR=1.42, p value = 0.001) after adjusting for age, gender, insurance status and race (black > white, OR = 1.34, p<0.001). Conclusion(s): Our study showed that the effective 7 day follow up did not improve from 2019 to 2021 likely due to COVID19 pandemic. However, a significantly higher proportion of patients obtained 7 day appointments in the last quarter with room for improvement. Steps to increase follow up rates include intervening on the highlighted modifiable factors to achieve better results. (Figure Presented).

8.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194347

ABSTRACT

Introduction: The HEART score is an effective method of risk stratifying emergency department (ED) patients with chest pain. The low rate of major adverse cardiovascular events (MACE) in patients with a moderate risk HEART score referred from an urgent care (UC) center for an expedited outpatient cardiology evaluation was first described by this group in 2020. This is a follow up study with a total of 446 patient over a 36 month period. Hypothesis: Patients with a moderate risk HEART score who present to the ED are usually hospitalized for further evaluation. The safety of outpatient evaluation of these patients is not well studied. We assessed the hypothesis that there is a low rate of MACE when patients with a moderate risk HEART score were referred from an UC for an expedited outpatient cardiology follow up. Method(s): A cross sectional study was performed from 2/14/2019 through 3/30/2022 in 5 UC centers of 446 patients who presented with chest pain or anginal equivalent and a HEART score of 4 to 6 in Las Vegas, Nevada. A streamlined disposition protocol was adopted by all UC providers for an expedited outpatient cardiology instead of ED referral. The population was followed for 6 weeks with a primary endpoint of MACE (death, myocardial infarction (MI), revascularization) determined by electronic medical records review and direct phone contact with patients. Outcomes were confirmed in 93% of patients. Result(s): The average age was 65 years with 52% female and 48% male. 395 patients (89%) were seen by a cardiology provider, 346 patients (88%) were seen within 3 days. 265 stress tests (67%), 42 coronary CT angiograms (11%) and 19 invasive coronary angiograms (5%) were ordered. 8 patients (2%) were found to have MACE: 2 had routine surgical revascularization, 4 had non-fatal MI followed by revascularization, 2 patients died: 1 was urgently referred for mitral valve replacement and died after surgery from renal failure and COVID, the other patient died from COVID pneumonia. There were no ischemic cardiac deaths. Conclusion(s): In conclusion, patients with a moderate risk HEART score referred from UC for an expedited outpatient cardiology evaluation had a low rate of MACE and no ischemic cardiac deaths due to delay of care.

9.
Emergency medicine Australasia : EMA ; 05, 2023.
Article in English | EMBASE | ID: covidwho-2192189

ABSTRACT

OBJECTIVE: Supported by the state government, three health networks partnered to initiate a virtual ED (VED), as part of a broader roll-out of emergency telehealth services in Victoria. The aim of the present study (Southeast Region Virtual Emergency Department-1 [SERVED-1]) was to report the initial 5-month experience and included all patients assessed through the service over the first 5 months (1 February 2022 to 30 June 2022). METHOD(S): VED consults occurred after referral from paramedics in the pre-hospital setting. Electronic medical records were retrospectively reviewed for demographic, presenting complaint and outcome data. The primary outcome was the count of VED consultations. The secondary outcome was the proportion of patients where physical ED attendance was avoided within 72h. The proportion of physical ED attendances avoided sub-grouped by primary presenting complaints were reported. RESULT(S): There were 1748 patients who had a VED consultation, of which 1261 (72.1%;95% confidence interval [CI] 70.0-74.2) patients had physical presentation to an ED avoided in the 72h following the consult. There was a significant increase in consultations over the 5-month period (incidence rate ratio 1.27;95% CI 1.23-1.31, P<0.001) that was consistent in the three health services. The most common presenting complaints were COVID-19 and shortness of breath, and physical presentation was avoided most often among younger patients and those with COVID-19. CONCLUSION(S): Initial experience demonstrated a significant increase in adoption of the service and an overall avoidance of physical ED attendance by a majority of patients. These results support ongoing VED consultations, complemented by follow up and health economic evaluations. Copyright © 2023 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.

10.
19th IEEE International Multi-Conference on Systems, Signals and Devices, SSD 2022 ; : 698-702, 2022.
Article in English | Scopus | ID: covidwho-2192070

ABSTRACT

The medical record is a crucial element in the follow-up of a patient. It includes the opinions of healthcare specialists, analyses, prescriptions, and all information concerning the patient. In fact, several actors such as the patient, the doctor, the pharmacist participate in the process of sharing and managing this file. But after the Covid-19 virus pandemic, the use and exchange of paper became dangerous. This need has pushed researchers to find solutions to minimize contact and save medical data in a secure and accessible way. For this purpose, we propose to investigate blockchain distributed ledger technology to manage electronic medical record. Blockchain technology provides just such a solution in the form of a distributed and secure registry that allows patients not only to have visibility over their data, but also to control access to it. In this article, we present a smart electronic medical record based on smart contract. We discuss relevant requirements to guarantee the security of patient data and then propose the system communication process. © 2022 IEEE.

11.
Plastic and reconstructive surgery ; 02, 2023.
Article in English | EMBASE | ID: covidwho-2191185

ABSTRACT

BACKGROUND: Following the reopening of elective surgery, our division transitioned from inpatient admission to same-day discharge for immediate prosthetic breast reconstruction in an effort to decrease the hospital's clinical burden and minimize potential COVID-19 exposure. This study aims to compare complication rates following this acute transition for patients who had inpatient and outpatient mastectomy with immediate alloplastic reconstruction. METHOD(S): A retrospective chart review was performed on patients who underwent mastectomy with immediate prosthetic reconstruction. The outcome of interest was 30-day morbidity. Descriptive statistics were compared for patients with outpatient and inpatient surgeries. Odds ratios were calculated to determine whether any pre-operative factors increased odds of 30-day complications. RESULT(S): A total of 115 patients were included in this study. Twenty-six patients had outpatient surgery and 89 stayed inpatient postoperatively. Same-day discharge did not significantly impact the odds of having one or more 30-day complications (OR: 0.275, 95% CI: 0.047-1.618, p = 0.153). Patients with complications had significantly longer median operating times (5.0, IQR 4.0 - 6.0 vs. 4.0, IQR 3.0 - 5.0, p = 0.05), and there was a statistically significant association between length of surgery and odds of complication (OR: 1.596, 95% CI: 1.039-2.451, p = 0.033). Age was independently associated with increased risk of 30-day complication (OR: 1.062, 95% CI: 1.010-1.117, p = 0.020). CONCLUSION(S): Our findings support a continuation of same-day discharge strategy which could decrease costs for patients and hospitals without increasing complications. Copyright © 2022 by the American Society of Plastic Surgeons.

12.
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-2190745

ABSTRACT

BACKGROUND AND AIM: During the COVID period, reduced exposure to common viral infections is suggested to produce an immune debt in children leading to severe infections with complications. We planned to compare the clinical outcomes of non-covid viral respiratory tract infections (RTI) in children between the pre-COVID and COVID era. METHOD(S): Data from medical records of children admitted with RTI in pre-COVID (2018 - 2019) & COVID era (2021) were analyzed. Patient demographics, virology profile & outcomes were compared. Primary objective was to compare the need for invasive ventilation between the two groups and the secondary objective was to compare the length of ICU stay. RESULT(S): Total number of children admitted with RTI needing oxygen during pre-COVID and COVID era were 140 & 70 respectively. Out of this, 116 and 49 were virology positive. RSV was the commonest virus in both groups. During the pre-COVID period,12 out of 116 children (10.3%) needed invasive ventilation and in the COVID era, 7 out of 49 (14%) were ventilated (Relative risk: 1.38, 95% CI: 0.57 - 3.2). 9 out of 116 children (7%) in the pre- COVID period & 10 out of 49 children (18%) in the COVID era needed prolonged ICU stay (more than 14 days) (Relative risk: 2.63, 95% CI: 1.13 - 6.07). CONCLUSION(S): Children with viral respiratory infection in the COVID era required prolonged ICU stay compared to children in the pre-COVID period.

13.
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-2190727

ABSTRACT

BACKGROUND AND AIM: Air Leak syndromes (ALS), such as pneumothorax, pneumomediastinum, pneumopericardium, subcutaneous emphysema, and pneumoperitoneum, have been observed in adult patients with respiratory failure secondary to severe acute respiratory syndrome coronavirus-2 SARS-CoV-2 pneumonia with an incidence of approximately ~ 1%. Our aim is to describe the incidence of ALS in children with SARS-CoV-2 pneumonia admitted with respiratory failure to the pediatric intensive care unit (PICU) at 2 large Pediatric Children's Hospitals. METHOD(S): IRB exempted retrospective search of electronic medical record data from patients admitted to the PICUs (Wolfson Children's Hospital and UF Health Shands Children's Hospital) with a diagnosis of SARS-CoV-2 pneumonia with respiratory failure from March 1st, 2020, to December 31, 2021. Diagnosis of SARS-CoV-2 was done with real-time reverse transcriptase PCR performed on nasopharyngeal swab. RESULT(S): 104 patients met criteria for inclusion. The age of the patients ranged from 1 month to 18 years old. Twelve patients (11.5%) presented with or developed ALS including pneumothorax, pneumomediastinum, pneumopericardium, subcutaneous emphysema, and pneumoperitoneum. Of the twelve patients with ALS, three required a chest tube, two were placed on extracorporeal membrane oxygenation (ECMO) and three died. CONCLUSION(S): ALS, with an incidence of 11.5%, are not uncommon in patients with SARS-CoV-2 pneumonia and respiratory failure. ALS contribute to morbidity and was associated with a mortality rate of 25%. To understand if SARS-CoV-2 pneumonia has an intrinsic pathobiology that predispose to ALS, we will perform a propensity score matching with a cohort group considering age-severity of illness and intensity of interventions.

14.
Critical Care Medicine ; 51(1 Supplement):554, 2023.
Article in English | EMBASE | ID: covidwho-2190671

ABSTRACT

INTRODUCTION: There is a wide range in the reported incidence of pneumothorax (PTX) and pneumomediastinum (PMN) in patients with coronavirus disease 2019 (COVID-19). PTX alone and PTX/PMN combined has also been associated with higher mortality in patients with COVID-19 related acute respiratory distress syndrome (ARDS), however, current data regarding outcomes or predictors of PTX and PMN in COVID-19 ARDS is limited. The purpose of this study was to determine if the incidence of PTX/PMN in a large cohort with COVID-19 related respiratory failure was associated with mortality. Further, we looked to determine which clinical factors or ventilator management strategies may have impacted mortality in underserved patient population with PTX. METHOD(S): We conducted a retrospective analysis of data from a single center COVID-19 intensive care unit of an urban tertiary safety net hospital including all adult patients admitted with COVID-19 associated ARDS requiring mechanical ventilation between March 2020 and January 2021. Following identification of a cohort with radiographic evidence of PTX and/or PMN, demographics, ventilator data, radiographic data, position, information regarding chest tube and sedation management and outcome data were obtained from the electronic medical record. RESULT(S): Among 502 patients admitted to the ICU with COVID-19 related ARDS, PTX was identified in 103/ 502 (20.5%), predominantly affecting Hispanic (88%) and male (66%) patients. Thirty-four patients had PMN (18.7%) alone. Of patients with documented PTX, 60 (50.8%) had preceding or co-morbid PMN. PTX with/without PMN was associated with increased mortality (OR 2.19, p=0.0027) even after adjustment for ventilator days. There was no significant association between PMN alone and mortality (OR 0.82, p=0.60). Conservative management without tube thoracostomy was rarely possible (18.4% of PTX). Time to development of PTX was not associated with mortality, but PTX was associated with longer survival times (HR 2.10;p< 0.001). CONCLUSION(S): There is a high incidence of PTX/PMN in critically ill patients with COVID-19. PTX, but not PMN alone, is associated with higher mortality in ICU patients.

15.
Critical Care Medicine ; 51(1 Supplement):461, 2023.
Article in English | EMBASE | ID: covidwho-2190638

ABSTRACT

INTRODUCTION: ARDS net trial recommends keeping low tidal volumes (6-8 cc/IBW) and plateau pressures less than 30 cm H20. However, it is not well studied if sporadic elevation or continuous elevation of plateau pressures results in poor outcomes. We hypothesize that persistent elevation of p plat for >24 hrs. or > 6 times (measured 4 hrs. apart) continuously is associated with increased mortality. METHOD(S): Retrospective chart review of patients admitted with COVID-19 during the surge of August to September 2021 at Houston Methodist Baytown hospital. Inclusion Criteria- COVID-19 patients with respiratory failure, ards and intubated. Plateau pressures are recorded every 4 hrs. Data obtained from EPIC ICU flowsheet. Persistent elevation was defined as all the plateau pressures measured for > 24 hrs. and are continuously elevated. Exclusion criteria - patients admitted to ICU with cardiac arrest, patients who are covid negative and covid positive, but no ARDS are excluded. Tidal volume recorded is when the first highest p plateau pressure was documented. Descriptive statistics and t-tests were used to interpret the results. RESULT(S): Out of a total of 48 patients, only 12 patients survived, and 36 patients died. Mortality rate- 75%. Survivors vs. non survivors average Age(y) 42 vs.55 (p< 0.05), Tidal volume 5.98 ml/PBW vs.6.03 ml/PBW (p=0.105), Normal elastance 4.06 vs. 4.07(p=0.44), Delta P 22 vs.23(p=0.27) and ventilatory ratio 84 vs. 98(p< 0.05) were calculated during maximum plateau pressures. In patients with continuous p plat >30, 29 (85%) patients died and 5 (15%) survived. OR- 5.8 (P< 0.05). Out of the 5 patients that survived 2 went on ECMO. Intermittent p plat elevation was noted in 11 out of 14 patients who did not have continuous p plat elevation. CONCLUSION(S): Ventilatory ratio, a simple index of impaired ventilation and physiological dead space was higher in nonsurvivors compared with survivors. Continuous p plat elevation for more than 24 hrs. that is resistant to intervention might be an indirect indicator of worsening lung ventilation and increasing mortality. Rather than a single-time daily measurement of variables like delta P or p plateau pressure multiple measurements and trends might be helpful to prognosticate patients that might have poor outcomes and indicate worsening lung function.

16.
Critical Care Medicine ; 51(1 Supplement):414, 2023.
Article in English | EMBASE | ID: covidwho-2190610

ABSTRACT

INTRODUCTION: As an infection control measure for COVID-19, our PICU transitioned to near universal video laryngoscopy (VL). In 2019, 24% of intubations used VL;this increased to 96% in 2021. Comparing these two cohorts elucidates the effect of transitioning from direct laryngoscopy (DL) to VL on first time success rate (FTSR), Cormack-Lehane (C-L) grade view and successful trainee intubation. First time intubation success is associated with fewer complications and is therefore an important marker of intubation safety. METHOD(S): Single Center retrospective case control. Data for 2019 were identified via chart review. Data from 2021 were obtained through a dedicated form introduced in the Fall of 2020. Each comparison group was limited to a full calendar year (Jan-Dec) to account for progression in trainee skill. A comparison was made between all patients in cohort groups with additional stratification of patients above and below the age of one. Included intubations were those in the PICU as well as those in the pediatric floor or ED performed by PICU staff. Statistics via Fischer Exact test. RESULT(S): 75 patients met criteria for 2019 and 73 in 2021. The age range in both groups was 2 days to 23 years. C-L view was documented in 72 of 75 patients in 2019 and all patients in 2021. 2019 had a 69.4% grade 1 C-L view rate, while 2021 had a 79.5% grade 1 C-L view rate (p=0.19). The overall FTSR in 2019 was 57.3% vs 65.7% in 2021 (p=0.31). 26 children under the age of one were intubated in both years, with a FTSR of 53.8% and 50% respectively. The FTSR in children above one year was 59.2% and 74.5% respectively (p=0.13). Additionally, an airway provider was documented in all but two cases in 2019. Of these, 75.3% were managed successfully by pediatric subspecialty fellows (PICU or rotating PEM). In 2021 this number increased to 84.9% (p=0.21). CONCLUSION(S): FTSR did not improve with transition to VL. In the 2021 cohort, children above age one had a 15.3% increased FTSR and trainees had a 9.6% increase in completed intubations. While not significant, these findings would benefit from reanalysis with a larger sample. First time success is an important marker for safe intubation practice, however there may be other benefits to either approach such as set up time and assistance from a second viewer.

17.
Critical Care Medicine ; 51(1 Supplement):345, 2023.
Article in English | EMBASE | ID: covidwho-2190591

ABSTRACT

INTRODUCTION: Adults with COVID-19 pneumonia have well-documented decline in physical function and mobility, yet little is known regarding pediatric patients' rehabilitation needs during and after inpatient treatment for COVID-19 pneumonia. We sought to characterize the rehabilitation needs noted in children who were admitted with COVID-19 pneumonia. METHOD(S): This small cohort study took place at a standalone academic children's hospital. Subjects were identified by reviewing the physical and occupational therapy consult list and the infectious disease surveillance list for patients with a primary diagnosis of COVID-19 pneumonia, acute respiratory failure due to COVID-19, or acute respiratory distress syndrome secondary to COVID-19 during a 6-week period from September 1, 2021- October 13, 2021. Data were extracted from the electronic medical record. RESULT(S): The entire cohort included 29 patients, 20 of which had rehabilitation (rehab) consults and nine who did not. When comparing groups, the rehab cohort was older (median age 16 years, IQR: 13-17, vs. median age 0 years, IQR 0-1.5) and more likely to be obese (12 [60%] vs. none). Fifteen (75%) of the rehab cohort and four (44%) of the norehab cohort required the intensive care unit (ICU), with five (25%) requiring invasive mechanical ventilation compared to none in the no-rehab group. The rehab cohort had a longer ICU length of stay (median 5 days [IQR 3-17] vs. 2.5 days [IQR 2-3]) and hospital length of stay (median 7 days [IQR 4-8.75] vs. 4 days [IQR 3.5-4.5]. In the rehabilitation cohort, on initial evaluation 19/20 (95%) were recommended physical and occupational therapy while inpatient, and on discharge 17/20 (85%) were recommended outpatient rehabilitation. CONCLUSION(S): In this small cohort of children requiring hospitalization for COVID-19 pneumonia, rehabilitation needs during admission and post discharge were prevalent. It is unknown if the cohort of children not evaluated by the rehabilitation team may have had unrecognized needs and benefited from therapy. Further larger scale prospective studies are needed to ascertain the true burden of rehabilitation needs in this patient population and help guide screening and treatment recommendations.

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):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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Critical Care Medicine ; 51(1 Supplement):177, 2023.
Article in English | EMBASE | ID: covidwho-2190522

ABSTRACT

INTRODUCTION: Although Staphylococcus aureus is known to be a poor prognostic factor in coronavirus disease of 2019 (SARS-CoV-2 or COVID-19), it is unclear if COVID-19 increases the risk of S. aureus infections. The purpose of this study is to give healthcare providers a better understanding of the pharmacological risk factors that may predispose patients to a S. aureus co-infection in COVID-19 positive patients. METHOD(S): This retrospective chart review included adult patients treated at a Spectrum Health medical or cardiothoracic ICU between October 2020 and November 2021. To be included in the exposure arm of the analysis, patients had to have a positive culture for S. aureus. A chi-square analysis was utilized for the primary outcome while a logistic regression was used to uncover possible risk factors for S. aureus in COVID-19 patients. Overall, S. aureus infections were compared between patients with and without COVID-19 with a secondary analysis that was done for patients who had been treated with tocilizumab or dexamethasone. RESULT(S): A total of 406 patients were included;96 patients were positive for S. aureus, and 310 patients remained negative throughout their admission. COVID-19 patients were more likely to acquire a S. aureus infection than their COVID-19 negative counterparts (p < 0.0001). Neither tocilizumab nor dexamethasone use were statistically significant in increasing risk of S. aureus co-infection. CONCLUSION(S): COVID-19 patients are more likely to acquire S. aureus infections than their COVID-19 negative counterparts. Dexamethasone and tocilizumab use were not associated with increased incidence of S. aureus infections in COVID-19 patients.

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