RESUMEN
BACKGROUND: In patients receiving mechanical ventilation, spontaneous awakening trials reduce morbidity and mortality when paired with spontaneous breathing trials. However, spontaneous awakening trials are not performed every day they are indicated and little is known about spontaneous awakening trial protocol use in cardiac intensive care units. LOCAL PROBLEM: Spontaneous awakening trial completion rate at the study institution was low and no trial protocol was regularly used. METHODS: A preintervention-postintervention retrospective cohort study was performed in adult patients with at least 24 hours of invasive mechanical ventilation in Michigan Medicine's cardiac intensive care unit. Patients with SARS-CoV-2 infection were excluded. Data included demographics, sedation, mechanical ventilation duration, and in-hospital mortality. A nurse-driven spontaneous awakening trial protocol modified for the cardiac intensive care unit was implemented in October 2020. RESULTS: Compared with the preintervention cohort (n = 29, May through July 2020), the postintervention cohort (n = 27, October 2020 through February 2021) had a higher ratio of number of trials performed to number of days eligible for trial (0.91 vs 0.52; P < .01). Median continuous sedative infusion duration was shorter after intervention (2.3 vs 3.6 days; P = .02). Median mechanical ventilation duration (3.8 vs 4.7 days; P = .18) and mortality (41% vs 41%; P = .95) were similar between groups. CONCLUSIONS: Spontaneous awakening trial protocol implementation led to a higher trial completion rate and a shorter duration of continuous sedative infusion. Larger studies are needed to assess the impact of protocolized spontaneous awakening trials on cardiac intensive care unit patient outcomes.
Asunto(s)
COVID-19 , Adulto , Humanos , Unidades de Cuidados Intensivos , Estudios Retrospectivos , SARS-CoV-2 , Desconexión del VentiladorAsunto(s)
COVID-19/mortalidad , Insuficiencia Cardíaca/mortalidad , Insuficiencia Multiorgánica/mortalidad , Insuficiencia Respiratoria/mortalidad , Choque Séptico/mortalidad , Cuidado Terminal/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Causas de Muerte , Estudios de Cohortes , Coinfección/epidemiología , Femenino , Insuficiencia Cardíaca/epidemiología , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/epidemiología , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/mortalidad , Planificación de Atención al Paciente , Habitaciones de Pacientes , Insuficiencia Renal/epidemiología , Estudios Retrospectivos , SARS-CoV-2 , Choque Séptico/epidemiología , Estados Unidos/epidemiología , Privación de Tratamiento/estadística & datos numéricosAsunto(s)
Comunicación , Infecciones por Coronavirus/epidemiología , Unidades de Cuidados Intensivos , Política Organizacional , Neumonía Viral/epidemiología , Relaciones Profesional-Familia , Visitas a Pacientes , Betacoronavirus , COVID-19 , Familia , Tamaño de las Instituciones de Salud , Hospitales Rurales , Hospitales Urbanos , Humanos , Michigan , Pandemias , Equipo de Protección Personal , Médicos , SARS-CoV-2 , Encuestas y Cuestionarios , Teléfono , Comunicación por VideoconferenciaRESUMEN
Background Since coronavirus disease 2019 (Covid-19) was first identified in Wuhan, China in December 2019, the number of cases has risen exponentially. Clinical characteristics and outcomes among patients with orthotopic heart transplant (OHT) with Covid-19 remain poorly described. Methods We performed a retrospective case series of patients with OHT with Covid-19 admitted to one of two hospitals in Southeastern Michigan between March 21 and April 22, 2020. Clinical data were obtained through review of the electronic medical record. Final date of follow-up was May 7, 2020. Demographic, clinical, laboratory, radiological, treatment, and mortality data were collected and analyzed. Results We identified 13 patients with OHT admitted with Covid-19. The mean (±SD) age of patients was 61±12 years, 100% were black males, and symptoms began 6±4 days before admission. The most common symptoms included subjective fever (92%), shortness of breath (85%), and cough (77%). Six (46%) required admission to the intensive care unit. Two patients (15%) died during hospitalization. Conclusions Black men may be at increased risk for Covid-19 among patients with OHT. Presenting signs and symptoms in this cohort are similar to those in the general population. Elevated inflammatory markers on presentation appear to be associated with more severe illness.