Detecting Patient Deterioration Early Using Continuous Heart rate and Respiratory rate Measurements in Hospitalized COVID-19 Patients.

BACKGROUND: Presenting symptoms of COVID-19 patients are unusual compared with many other illnesses. Blood pressure, heart rate, and respiratory rate may stay within acceptable ranges as the disease progresses. Consequently, intermittent monitoring does not detect deterioration as it is happening. We investigated whether continuously monitoring heart rate and respiratory rate enables earlier detection of deterioration compared with intermittent monitoring, or introduces any risks. METHODS: When available, patients admitted to a COVID-19 ward received a wireless wearable sensor which continuously measured heart rate and respiratory rate. Two intensive care unit (ICU) physicians independently assessed sensor data, indicating when an intervention might be necessary (alarms). A third ICU physician independently extracted clinical events from the electronic medical record (EMR events). The primary outcome was the number of true alarms. Secondary outcomes included the time difference between true alarms and EMR events, interrater agreement for the alarms, and severity of EMR events that were not detected. RESULTS: In clinical practice, 48 (EMR) events occurred. None of the 4 ICU admissions were detected with the sensor. Of the 62 sensor events, 13 were true alarms (also EMR events). Of these, two were related to rapid response team calls. The true alarms were detected 39 min (SD = 113) before EMR events, on average. Interrater agreement was 10%. Severity of the 38 non-detected events was similar to the severity of 10 detected events. CONCLUSION: Continuously monitoring heart rate and respiratory rate does not reliably detect deterioration in COVID-19 patients when assessed by ICU physicians.

Renal replacement therapy in critically ill patients with COVID-19: A retrospective study investigating mortality, renal recovery and filter lifetime.

PURPOSE: This study aims to investigate mortality and renal recovery in patients with Acute Kidney Injury (AKI) and Renal Replacement Therapy (RRT) due to COVID-19. A secondary aim is to investigate the filter life time in Continuous VenoVenous Hemofiltration (CVVH) and the effect of different methods of anticoagulation. METHODS: All patients with COVID-19 infection admitted to the ICU between March 16th 2020 to May 10th 2020 were retrospectively studied. Patients were categorized in a AKI-group and a non-AKI-group. RESULTS: Thirty-seven patients were included. Twenty-two (60%) patients developed AKI. Mortality in the AKI-group was 41% compared to 20% in the non-AKI group, p = 0.275. Comparable mortality was seen in the RRT (39%) and the non-RRT group (44%), p = 1.000. Renal function recovered to a KDIGO-stage 1 in 64% of the patients with AKI when discharged from the ICU. Life time for the CVVH filters (n = 53) was 27 h (14-63)[2-78]. No difference was found with various methods of anticoagulation. CONCLUSION: The need for RRT in critically ill patients with COVID-19 was reversible in our cohort and RRT was not associated with an increased mortality compared to AKI without the need for RRT. Higher levels of anticoagulation were not associated with prolonged filter life.