RESUMEN
Introduction: The aim of our study is to evaluate the relationship between dexmedetomidine (DEX) use as a sedative agent in mechanical ventilated ICU patients and 28-day mortality. DEX, a selective alfa-2 adrenergic receptor agonist, widely used for its sedative and analgesic properties, has been linked to increasing parasympathetic tone, reducing the inflammatory response and oxidative stress [1]. Since severe COVID-19 is associated with an hyperinflammatory state, it is hypothesized that DEX might improve outcomes in these patients. Method(s): This is a retrospective observational study of mechanically ventilated patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. Logistic regression analysis was performed to evaluate the association of DEX use and 28-day mortality from time of intubation. Result(s): A total of 277 patients were analyzed, 151 in the DEX group and 126 in the no DEX group. Patients in the DEX group were younger (53.3 vs. 63.3 years, p < 0.001), had less comorbidities (2.8 vs. 3.5, p = 0.01), lower SOFA at admission (6.2 vs. 7.1, p = 0.01) but had a prolonged ICU stay (21.4 vs. 15.9, p < 0.001). Male gender (65.6 vs. 69.0, p = 0.54), incidence of obesity (56.3 vs. 46.8, p = 0.12), coronary artery disease (4.0 vs. 7.9, p = 0.16) and atrial fibrillation (4.0 vs. 7.1, p = 0.25) were similar between groups. PaO2/ FiO2 ratio at admission (111.1 vs. 108.1, p = 0.61), days spent in RASS < 3 (13.7 vs. 12.4, p = 0.31) and opioid use (14.8 vs. 13.1, p = 0.16) were also similar. From time of intubation, 28-day mortality in the cohort receiving DEX was 14.7% compared to 59.5% in the no DEX group (OR 0.12;95% CI 0.07-0.21;p = 0.01). Conclusion(s): Use of DEX was associated with lower 28-day mortality in COVID-19 critically ill patients requiring invasive mechanical ventilation in our study analysis. Considering the limitations of a retrospective observational study, RCTs are needed to confirm the results.
RESUMEN
Introduction: The aim of this study is to identify the factors associated with an increased risk of developing nosocomial infections (NI) in COVID-19 patients admitted with pulmonary involvement in the ICU. NI in COVID-19 ICU population are an important cause of morbidity and mortality worldwide and its prompt identification might lead to its prevention and better outcomes. Method(s): This is a retrospective observational study of patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. We considered NI as any infection acquired > 48 h post ICU admission. Clinical, analytical and baseline patient data were evaluated. Logistic regression analysis was performed to correlate patient related variables with the development of NI. Result(s): A total of 338 patients were enrolled, from which 167 (47.9%) presented with NI. Baseline characteristics are described in Table 1. In the logistic regression analysis, older age (OR 1.13;95% CI 1.03-1.25;p = 0.013), coronary artery disease (CAD) (OR 28.7;95% CI 1.92-429;p = 0.02), obesity (OR 3.14;95% CI 0.86-11.42;p = 0.008), chronic liver disease (CLD) (OR 104.33;95% CI 1,.04-1008.49;p = 0.04), use of dexamethasone (OR 21.89;95% CI 3.04-157.85;p = 0.002) and days in RASS < 3 (OR 1.4;95% CI 1.05-1.86;p = 0.02) were associated with an increased risk of developing NI in the ICU. Surprisingly, SOFA at admission, days of invasive mechanical ventilation, days of sedation and PaO2/ FiO2 ratio at admission, although statistically significantly different between groups, did not correlate with the risk of infection. Conclusion(s): We identified prolonged deep sedation, corticosteroid use, and patient characteristics (CAD, obesity, CLD, older age) as independent risk factors for NI development in COVID-19 critically ill patients. It is also noteworthy to point out for the presence of confounding variables, including the excessive workload in the ICU during this period, leading to an increase in NI numbers.
RESUMEN
Introduction: Our goal is to describe outcomes of critically ill COVID-19 patients submitted to renal replacement therapy (RRT), in particular the association of RRT with mortality. Multi-system organ failure or direct kidney injury caused by SARS-CoV-2 is associated with the development of acute kidney injury (AKI) which subsequently increases the need for RRT and may affect the outcomes. Method(s): This is a retrospective observational study of 338 critically ill patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. Clinical, analytical and baseline patient characteristics were evaluated. Logistic regression analysis was performed to correlate patient data with the need for RRT and ICU mortality. Result(s): From a total of 338 patients, 5% required RRT (n = 16), 25% of which received intermittent hemodialysis (n = 4) and 87,5% continuous veno-venous hemofiltration (n = 14). Baseline characteristics are described in Table 1. In our sample, 61 patients (18%) presented with acute AKI, from whom 14 (23%) were submitted to RRT. From all the patients receiving RRT, 10 (62.5%) did not have pre-existing chronic kidney disease. In the logistic regression analysis, AKI (OR 45.4;95% CI 7.7-269.5;p < 0.001), higher SOFA (OR 1.24;95% CI 103-1.51;p = 0,03), creatinine (OR 2.01;95% CI 1.4-3.0;p < 0.001) and C-reactive protein (OR 1.09;95% CI 1.02-1.16;p = 0,01) on admission were associated with the need for RRT. Additionally, ICU mortality associated with RRT was 75% compared to 28.3% in the group not submitted to RRT (OR 7.6;2.4-24.2;p = 0.001). Conclusion(s): The need for RRT in critically ill COVID-19 patients is associated with an increased mortality rate in our study. We were also able to identify AKI, higher SOFA, creatinine and C-reactive protein at admission as risk factors for RRT. However, due to the retrospective nature of our analysis and our small sample size, more studies on this topic are needed to confirm these results.