Effects of Etomidate on Postintubation Hypotension, Inflammatory Markers, and Mortality in Critically Ill Patients with COVID-19: An International, Multicenter, Retrospective Study.

OBJECTIVE: To evaluate the association of etomidate with postintubation hypotension, inflammation, and mortality in critically ill patients with COVID-19. DESIGN: International, multicenter, retrospective study. PARTICIPANTS: Critically ill patients hospitalized specifically for COVID-19 from three major academic institutions in the US and Europe. MAIN OUTCOME AND MEASURES: Patients were allocated into the etomidate (ET) group or another induction agent (OA) group. The primary outcome was postintubation hypotension. Secondary outcomes included postintubation inflammatory status, in-hospital mortality, and mortality at 30 days. RESULTS: 171 patients with a median age of 68 (IQR 58-73) years were included (ET, n = 98; OA, n = 73). Etomidate was associated with lower postintubation mean arterial pressure [74.33 (64-85) mm Hg versus 81.84 (69.75-94.25) mm Hg, p = 0.005] compared to other agents. No statistically significant differences were generally observed in inflammatory markers between the two groups at 7- and 14-days after admission to the intensive care unit. In-hospital mortality [77 (79%) versus 41 (56%), p = 0.003] and mortality at 30-days [78 (80%) versus 43 (59%), p = 0.006] were higher in the ET group. In multivariate logistic regression analysis, only etomidate (p = 0.009) and postintubation mean arterial pressure (p < 0.001) had a statistically significant effect on mortality, in contrast to stress-dose steroids (p = 0.301), after adjusting for creatinine (p = 0.695), blood urea nitrogen (p = 0.153), age (p = 0.055), oxygen saturation of hemoglobin (SpO2) (p = 0.941), and fraction of inspired oxygen (FiO2) (p = 0.712). CONCLUSIONS: Administration of a single-bolus dose of etomidate in critically ill patients with COVID-19 is associated with lower postintubation mean arterial pressure and higher in-hospital and 30-day mortality compared to other induction agents.

Making connections after brain injury: development and evaluation of a social peer-mentoring program for persons with traumatic brain injury.

OBJECTIVE: To describe the development and implementation of a social peer-mentoring program for persons with traumatic brain injury (TBI) and to explore whether this program yielded increased social functioning outcomes compared with wait-list (WL)controls. DESIGN: Pilot randomized controlled study. PARTICIPANTS: Community-dwelling individuals with TBI(12 matched with social peer mentors and 18 completing the WL condition). INTERVENTION: Trained social peer mentors (SPMs)were matched to partners with TBI (peer partners (PP)) to foster skill-building in planning of social activities and improving social communication abilities through phone contacts and joint participation in social events within the community over a 3-month period. MEASURES: Social Activity Interview, Center for Epidemiological Studies Depression Scale, UCLA Loneliness Scale, Satisfaction with Life Scale, 6-Item Interpersonal Support Evaluation List (baseline and postmentoring); weekly social activity data(1-month baseline, continuously collected during 3-month mentoring or WL period); satisfaction survey. RESULTS: Both SPM and PP participants reported high satisfaction with the mentoring program. Statistically significant improvements in perceived social support after mentoring were observed for the mentored group than for WL participants; however, an increase in depressive symptoms was also observed. While significant improvements in social activity level and social network size were not found, a trend toward increased satisfaction with social life was present for mentored participants. CONCLUSIONS: Satisfaction ratings for the SPM program were uniformly high and selected positive findings encourage further investigation of social mentoring as an intervention to effect improvements in social integration. Small sample size and reduced "dosage" of mentor interactions were limitations of this pilot study. Benefits of and challenges to implementation of an SPM program are outlined.

Exploring experiences of intimacy from the viewpoint of individuals with traumatic brain injury and their partners.

OBJECTIVE: To explore qualitatively the experience of intimacy from the viewpoint of persons with traumatic brain injury (TBI) and their intimate partners. DESIGN: Qualitative interview study. SETTING: Outpatient community. PARTICIPANTS: Eighteen persons with TBI and their intimate partners at a mean length of 4.78 years postinjury. MAIN MEASURES: Open-ended, semistructured, in-depth interviews regarding participants' experience of intimacy, factors impacting intimacy, and need for services. RESULTS: Factors that were perceived as helping relationships remain strong included unconditional commitment, spending time together, open communication, a strong preinjury relationship, bonding through surviving the injury together, social support, family bonds, spirituality, experience with overcoming hardship, and coping skills. Factors that were perceived as barriers to intimacy included injury-related changes, emotional reactions to changes, sexual difficulties, role conflict and strain, family issues, social isolation, and communication issues. CONCLUSIONS AND IMPLICATIONS: Education regarding the impact of TBI on intimacy should be integrated into rehabilitation. Health professionals should be sensitized as to the needs that persons with TBI and their partners have regarding intimacy and how to make appropriate referrals to assist them.

Relationship of race/ethnicity and income to community integration following traumatic brain injury: investigation in a non-rehabilitation trauma sample.

The purpose of the current study was to determine the contribution of race/ethnicity and income to community integration at approximately 6 months following traumatic brain injury (TBI). Participants were 151 persons with mild to severe TBI (38% Black; 38% Hispanic; 24% White) recruited from consecutive admissions to the Neurosurgery service of a county Level I trauma center. A large number of participants had low income and low education. Community integration was assessed using the Community Integration Questionnaire (CIQ), Craig Handicap Assessment and Reporting Technique - Short Form (CHART-SF), and Community Integration Measure (CIM). Results of analysis of covariance (ANCOVA) indicated that, after accounting for injury severity, age, education, and income, race/ethnicity contributed significantly to the variance in CIQ Total score, Home Integration Scale, and Productive Activity Scale scores. Blacks had lower CIQ Total scores compared to Whites. Black and Hispanic participants had lower scores than Whites on the Home Integration Scale, and Blacks had lower scores than Whites and Hispanics on the CIQ Productive Activity Scale. Low income ( < or = $20,000) was related to lower scores on the CIQ and CHART-SF Social Integration Scales, and scores on the CIM Total, Belonging, and Independent Participation scales. These results indicate that racial/ethnic differences in community integration exist, even after accounting for income. However, income was more predictive than race/ethnicity for certain aspects of community integration, indicating that it should be accounted for in all studies investigating racial/ethnic differences in outcomes.

Perceptions of communication abilities for persons with traumatic brain injury: validity of the La Trobe Communication Questionnaire.

PRIMARY OBJECTIVE: To further evaluate the construct validity of the La Trobe Communication Questionnaire (LCQ) and to investigate the extent to which self-ratings of adults with traumatic brain injury compared to ratings made by close others and self-ratings made by non-injured matched controls. RESEARCH DESIGN: Prospective cohort study. METHODS AND PROCEDURES: Two hundred and seventy-six adults with TBI (121 of which are >1-year post-injury and previously enrolled in TBI Model Systems and 155 of which were consecutively admitted to a Level 1 trauma centre and were at least 6-months post-injury) completed the La Trobe Communication Questionnaire. In addition, for the TBI Model systems sample, 88 friends/family members and 80 non-injured matched controls participated. MAIN OUTCOMES AND RESULTS: Principle components analysis with varimax rotation yielded four factors: Initiation/Conversational Flow, Disinhibition/Impulsivity, Conversational Effectiveness and Partner Sensitivity, which were found to have adequate internal consistency. Adequate discriminative validity was obtained in comparing adults with TBI to non-injured matched controls, while no significant differences were found between self-ratings of communication abilities by adults with TBI and those made by close others. CONCLUSIONS: Additional support for the LCQ as a useful measure of perceived social communication abilities was obtained. Confirmatory factor analysis with a larger sample of adults with TBI will be a useful step in further development of this tool.