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2.
JAMA Netw Open ; 4(12): e2141328, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1592856

ABSTRACT

Importance: Hospitalized patients with COVID-19 pneumonia have high rates of morbidity and mortality. Objective: To assess the efficacy of colchicine in hospitalized patients with COVID-19 pneumonia. Design, Setting, and Participants: The Estudios Clínicos Latino América (ECLA) Population Health Research Institute (PHRI) COLCOVID trial was a multicenter, open-label, randomized clinical trial performed from April 17, 2020, to March 28, 2021, in adults with confirmed or suspected SARS-CoV-2 infection followed for up to 28 days. Participants received colchicine vs usual care if they were hospitalized with COVID-19 symptoms and had severe acute respiratory syndrome or oxygen desaturation. The main exclusion criteria were clear indications or contraindications for colchicine, chronic kidney disease, and negative results on a reverse transcription-polymerase chain reaction test for SARS-CoV-2 before randomization. Data were analyzed from June 20 to July 25, 2021. Interventions: Patients were assigned in a 1:1 ratio to usual care or usual care plus colchicine. Colchicine was administered orally in a loading dose of 1.5 mg immediately after randomization, followed by 0.5 mg orally within 2 hours of the initial dose and 0.5 mg orally twice a day for 14 days or discharge, whichever occurred first. Main Outcomes and Measures: The first coprimary outcome was the composite of a new requirement for mechanical ventilation or death evaluated at 28 days. The second coprimary outcome was death at 28 days. Results: A total of 1279 hospitalized patients (mean [SD] age, 61.8 [14.6] years; 449 [35.1%] women and 830 [64.9%] men) were randomized, including 639 patients in the usual care group and 640 patients in the colchicine group. Corticosteroids were used in 1171 patients (91.5%). The coprimary outcome of mechanical ventilation or 28-day death occurred in 160 patients (25.0%) in the colchicine group and 184 patients (28.8%) in the usual care group (hazard ratio [HR], 0.83; 95% CI, 0.67-1.02; P = .08). The second coprimary outcome, 28-day death, occurred in 131 patients (20.5%) in the colchicine group and 142 patients (22.2%) in the usual care group (HR, 0.88; 95% CI, 0.70-1.12). Diarrhea was the most frequent adverse effect of colchicine, reported in 68 patients (11.3%). Conclusions and Relevance: This randomized clinical trial found that compared with usual care, colchicine did not significantly reduce mechanical ventilation or 28-day mortality in patients hospitalized with COVID-19 pneumonia. Trial Registration: ClinicalTrials.gov Identifier: NCT04328480.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , COVID-19/therapy , Colchicine/therapeutic use , Hospitalization , Intubation, Intratracheal , Respiration, Artificial , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Anti-Inflammatory Agents/adverse effects , COVID-19/mortality , COVID-19/pathology , Colchicine/adverse effects , Female , Humans , Inflammation/drug therapy , Inflammation/etiology , Male , Middle Aged , SARS-CoV-2 , Standard of Care
5.
J Med Internet Res ; 23(2): e24246, 2021 02 10.
Article in English | MEDLINE | ID: covidwho-1573886

ABSTRACT

BACKGROUND: Predicting early respiratory failure due to COVID-19 can help triage patients to higher levels of care, allocate scarce resources, and reduce morbidity and mortality by appropriately monitoring and treating the patients at greatest risk for deterioration. Given the complexity of COVID-19, machine learning approaches may support clinical decision making for patients with this disease. OBJECTIVE: Our objective is to derive a machine learning model that predicts respiratory failure within 48 hours of admission based on data from the emergency department. METHODS: Data were collected from patients with COVID-19 who were admitted to Northwell Health acute care hospitals and were discharged, died, or spent a minimum of 48 hours in the hospital between March 1 and May 11, 2020. Of 11,525 patients, 933 (8.1%) were placed on invasive mechanical ventilation within 48 hours of admission. Variables used by the models included clinical and laboratory data commonly collected in the emergency department. We trained and validated three predictive models (two based on XGBoost and one that used logistic regression) using cross-hospital validation. We compared model performance among all three models as well as an established early warning score (Modified Early Warning Score) using receiver operating characteristic curves, precision-recall curves, and other metrics. RESULTS: The XGBoost model had the highest mean accuracy (0.919; area under the curve=0.77), outperforming the other two models as well as the Modified Early Warning Score. Important predictor variables included the type of oxygen delivery used in the emergency department, patient age, Emergency Severity Index level, respiratory rate, serum lactate, and demographic characteristics. CONCLUSIONS: The XGBoost model had high predictive accuracy, outperforming other early warning scores. The clinical plausibility and predictive ability of XGBoost suggest that the model could be used to predict 48-hour respiratory failure in admitted patients with COVID-19.


Subject(s)
COVID-19/physiopathology , Hospitalization , Intubation, Intratracheal/statistics & numerical data , Machine Learning , Respiration, Artificial/statistics & numerical data , Respiratory Insufficiency/epidemiology , Aged , COVID-19/complications , Clinical Decision Rules , Early Warning Score , Emergency Service, Hospital , Female , Hospitals , Humans , Logistic Models , Male , Middle Aged , Patient Admission , ROC Curve , Respiratory Insufficiency/etiology , Retrospective Studies , SARS-CoV-2 , Triage
7.
Turk J Med Sci ; 51(4): 1665-1674, 2021 08 30.
Article in English | MEDLINE | ID: covidwho-1526879

ABSTRACT

Background/aim: Coronavirus disease 2019 (COVID-19) is a disease with a high rate of progression to critical illness. However, the predictors of mortality in critically ill patients admitted to the intensive care unit (ICU) are not yet well understood. In this study, we aimed to investigate the risk factors associated with ICU mortality in our hospital. Materials and methods: In this single-centered retrospective study, we enrolled 86 critically ill adult patients with COVID-19 admitted to ICU of Dokuz Eylül University Hospital (Izmir, Turkey) between 18 March 2020 and 31 October 2020. Data on demographic information, preexisting comorbidities, treatments, the laboratory findings at ICU admission, and clinical outcomes were collected. The chest computerized tomography (CT) of the patients were evaluated specifically for COVID-19 and CT score was calculated. Data of the survivors and nonsurvivors were compared with survival analysis to identify risk factors of mortality in the ICU. Results: The mean age of the patients was 71.1 ± 14.1 years. The patients were predominantly male. The most common comorbidity in patients was hypertension. ICU mortality was 62.8%. Being over 60 years old, CT score > 15, acute physiology and chronic health evaluation (APACHE) II score ≥ 15, having dementia, treatment without favipiravir, base excess in blood gas analysis ≤ ­2.0, WBC > 10,000/mm3, D-dimer > 1.6 µg/mL, troponin > 24 ng/L, Na ≥ 145 mmol/L were considered to link with ICU mortality according to Kaplan­Meier curves (log-rank test, p < 0.05). The APACHE II score (HR: 1.055, 95% CI: 1.021­1.090) and chest CT score (HR: 2.411, 95% CI:1.193­4.875) were associated with ICU mortality in the cox proportional-hazard regression model adjusted for age, dementia, favipiravir treatment and troponin. Howewer, no difference was found between survivors and nonsurvivors in terms of intubation timing. Conclusions: COVID-19 patients have a high ICU admission and mortality rate. Studies in the ICU are also crucial in this respect. In our study, we investigated the ICU mortality risk factors of COVID-19 patients. We determined a predictive mortality model consisting of APACHE II score and chest CT score. It was thought that this feasible and practical model would assist in making clinical decisions.


Subject(s)
COVID-19/diagnostic imaging , COVID-19/mortality , Critical Care/methods , Hospital Mortality , Intubation, Intratracheal/methods , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Intensive Care Units , Intubation, Intratracheal/statistics & numerical data , Lung/diagnostic imaging , Male , Middle Aged , Retrospective Studies , Risk Factors , SARS-CoV-2 , Survival Analysis , Time Factors , Turkey/epidemiology , Young Adult
9.
Air Med J ; 40(6): 395-398, 2021.
Article in English | MEDLINE | ID: covidwho-1525663

ABSTRACT

OBJECTIVE: Prehospital emergency anesthesia in the form of rapid sequence intubation (RSI) is a critical intervention delivered by advanced prehospital critical care teams. Our previous simulation study determined the feasibility of in-aircraft RSI. We now examine whether this feasibility is preserved in a simulated setting when clinicians wear personal protective equipment (PPE) for aerosol-generating procedures (AGPs) for in-aircraft, on-the-ground RSI. METHODS: Air Ambulance Kent Surrey Sussex is a helicopter emergency medical service that uses an AW169 cabin simulator. Wearing full AGP PPE (eye protection, FFP3 mask, gown, and gloves), 10 doctor-paramedic teams performed RSI in a standard "can intubate, can ventilate" scenario and a "can't intubate, can't oxygenate" (CICO) scenario. Prespecified timings were reported, and participant feedback was sought by questionnaire. RESULTS: RSI was most commonly performed by direct laryngoscopy and was successfully achieved in all scenarios. The time to completed endotracheal intubation (ETI) was fastest (287 seconds) in the standard scenario and slower (370 seconds, P = .01) in the CICO scenario. The time to ETI was not significantly delayed by wearing PPE in the standard (P = .19) or CICO variant (P = .97). Communication challenges, equipment complications, and PPE difficulties were reported, but ways to mitigate these were also reported. CONCLUSION: In-aircraft RSI (aircraft on the ground) while wearing PPE for AGPs had no significant impact on the time to successful completion of ETI in a simulated setting. Patient safety is paramount in civilian helicopter emergency medical services, but the adoption of in-aircraft RSI could confer significant patient benefit in terms of prehospital time savings, and further research is warranted.


Subject(s)
Anesthesia , COVID-19 , Emergency Medical Services , Aircraft , Feasibility Studies , Humans , Intubation, Intratracheal , Personal Protective Equipment , SARS-CoV-2
10.
Minerva Cardiol Angiol ; 69(5): 596-605, 2021 10.
Article in English | MEDLINE | ID: covidwho-1524826

ABSTRACT

The best timing of orotracheal intubation and invasive ventilation in COVID-19 patients with acute respiratory distress syndrome is unknown. The use of non-invasive ventilation, a life-saving technique in many medical conditions, is debated in patients with ARDS since prolonged NIV and delayed intubation may be harmful. Shortage of intensive care beds and ventilators during a respiratory pandemic can trigger a widespread use of early non-invasive ventilation in many hospitals but which is the best way to ventilate patients with severe bilateral pneumonia and severely increased spontaneous ventilation is controversial. Moreover, viral spreading to health-care workers and other hospitalized patients is an issue for any device used to administer oxygen. Even if protective mechanical ventilation is currently the gold standard for the management of acute respiratory distress syndrome, tracheal intubation is not without risks and is associated with delirium, hemodynamic instability, immobilization and post intensive care syndrome. Both invasive and non-invasive ventilation are associated with advantages and limitations that should be carefully considered when patients with COVID-19-ARDS need our attention. In the absence of strong evidence, in this review we highlight all the pro and con of these two different approaches.


Subject(s)
COVID-19 , Humans , Intubation, Intratracheal , Lung , Pandemics , SARS-CoV-2
15.
Stud Health Technol Inform ; 286: 84-88, 2021 Nov 08.
Article in English | MEDLINE | ID: covidwho-1512003

ABSTRACT

Concerns over high transmission risk of SARS-CoV-2 have led to innovation and usage of an aerosol box to protect healthcare workers during airway intubation in patients with COVID-19. However, only a few studies have examined the impact of these aerosol boxes on the dispersion of droplets and aerosols, which are both thought to be significant contributors to the spread of COVID-19. In addition, to our knowledge, only a few studies have included in the concerned testbeds elements of the work context, which nevertheless have an impact on the use of the device.


Subject(s)
COVID-19 , Infectious Disease Transmission, Patient-to-Professional , Aerosols , Humans , Intubation, Intratracheal , SARS-CoV-2
18.
Sci Rep ; 11(1): 21124, 2021 10 26.
Article in English | MEDLINE | ID: covidwho-1493211

ABSTRACT

Patients with coronavirus disease 2019 (COVID-19) can have increased risk of mortality shortly after intubation. The aim of this study is to develop a model using predictors of early mortality after intubation from COVID-19. A retrospective study of 1945 intubated patients with COVID-19 admitted to 12 Northwell hospitals in the greater New York City area was performed. Logistic regression model using backward selection was applied. This study evaluated predictors of 14-day mortality after intubation for COVID-19 patients. The predictors of mortality within 14 days after intubation included older age, history of chronic kidney disease, lower mean arterial pressure or increased dose of required vasopressors, higher urea nitrogen level, higher ferritin, higher oxygen index, and abnormal pH levels. We developed and externally validated an intubated COVID-19 predictive score (ICOP). The area under the receiver operating characteristic curve was 0.75 (95% CI 0.73-0.78) in the derivation cohort and 0.71 (95% CI 0.67-0.75) in the validation cohort; both were significantly greater than corresponding values for sequential organ failure assessment (SOFA) or CURB-65 scores. The externally validated predictive score may help clinicians estimate early mortality risk after intubation and provide guidance for deciding the most effective patient therapies.


Subject(s)
COVID-19/diagnosis , COVID-19/mortality , Intubation, Intratracheal/methods , Severity of Illness Index , Adolescent , Adult , Age Factors , Aged , Arterial Pressure , COVID-19/therapy , Female , Ferritins/blood , Humans , Hydrogen-Ion Concentration , Male , Middle Aged , New York , Nitrogen/metabolism , Oxygen/metabolism , Predictive Value of Tests , ROC Curve , Regression Analysis , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Vasoconstrictor Agents/pharmacology , Young Adult
19.
J Int Med Res ; 49(9): 3000605211043245, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1486544

ABSTRACT

OBJECTIVE: Pulmonary complication is common in older patients after surgery. We analyzed risk factors of lower respiratory tract infection after general anesthesia among older patients. METHODS: In this retrospective investigation, we included older patients who underwent surgery with general anesthesia. Logistic regression analyses were performed to determine risk factors of lower respiratory tract infection. RESULTS: A total 418 postoperative patients with general anesthesia were included; the incidence of lower respiratory tract infection was 9.33%. Ten cases were caused by gram-positive bacteria, 26 cases by gram-negative bacteria, and 2 cases by fungus. We found significant differences in age, smoking, diabetes, oral/nasal tracheal intubation, and surgery duration. Logistic regression analysis indicated that age ≥70 years (odds ratio [OR] 2.028, 95% confidence interval [CI] 1.115-3.646), smoking (OR 2.314, 95% CI 1.073-4.229), diabetes (OR 2.185, 95% CI 1.166-4.435), nasotracheal intubation (OR 3.528, 95% CI 1.104-5.074), and duration of surgery ≥180 minutes (OR 1.334, 95% CI 1.015-1.923) were independent risk factors of lower respiratory tract infections. CONCLUSIONS: Older patients undergoing general anesthesia after tracheal intubation have a high risk of lower respiratory tract infections. Clinical interventions should be provided to prevent pulmonary infections in patients with relevant risk factors.


Subject(s)
Anesthesia, General , Respiratory Tract Infections , Aged , Anesthesia, General/adverse effects , Humans , Intubation, Intratracheal , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/etiology , Retrospective Studies , Risk Factors
20.
In Vivo ; 35(6): 3305-3313, 2021.
Article in English | MEDLINE | ID: covidwho-1485627

ABSTRACT

BACKGROUND: The study provides a novel prediction model for COVID-19 progression and outcome by the combination of the CD8+: B-cells ratio with neutrophil-to-lymphocyte ratio (NLR). PATIENTS AND METHODS: Immune phenotyping was performed in 120 COVID-19 patients. RESULTS: A decrease in CD8+:B-cell (p<0.0001) and in lymphocyte-to-CRP (LCR) ratio (p<0.0001) was observed in intubated patients versus non-intubated with an increase for CD4+:CD8+ (p<0.01), NLR (p<0.0001) and CRP: Albumin (p<0.001). Receiving operating curve (ROC) analysis predicting requirement for mechanical ventilation revealed the highest AUC for CD8+:B-cells, (AUC=0.795, p<0.001) versus NLR (AUC=0.783, p<0.001), LCR (AUC=0.779, p<0.001), Albumin:CRP (AUC=0.750, p<0.001) and CD4+:CD8+ (AUC=0.779, p<0.001). Combination of the CD8+: B-cell ratio with the NLR increased the AUC (AUC=0.845, p<0.001). The combined ratios correlated with outcome defined as duration of hospital (r=0.435, p<0.001) or ICU stay (r=0.596, p<0.001). CONCLUSION: Combination of the CD8+: B-cell ratio and NLR serves as a useful prognostic tool for COVID-19 patient progression.


Subject(s)
COVID-19 , Neutrophils , B-Lymphocytes , CD8-Positive T-Lymphocytes , Humans , Intubation, Intratracheal , Lymphocytes , Prognosis , ROC Curve , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index
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