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Original Article06-14-2024
The respiratory oxygenation index for identifying the risk of orotracheal intubation in COVID-19 patients receiving high-flow nasal cannula oxygen
- Aline Braz Pereira
, - Felipe Dal Pizzol ,
- Viviane Cordeiro Veiga ,
- Leandro Utino Taniguchi ,
- Aline Finoti Misquita , [ ... ],
- Glauco Adrieno Westphal
Abstract
Original ArticleThe respiratory oxygenation index for identifying the risk of orotracheal intubation in COVID-19 patients receiving high-flow nasal cannula oxygen
Critical Care Science. 2024;36:e20240203en
DOI 10.62675/2965-2774.20240203-en
- Aline Braz Pereira ,
- Felipe Dal Pizzol ,
- Viviane Cordeiro Veiga ,
- Leandro Utino Taniguchi ,
- Aline Finoti Misquita ,
- Gustavo Augusto Couto Carvalho ,
- Ligia Maria Coscrato Junqueira Silva ,
- Michelli Marcela Dadam ,
- Ruthy Perotto Fernandes ,
- Israel Silva Maia ,
- Cassio Luis Zandonai ,
- Alexandre Biasi Cavalcanti ,
- Marcelo Luz Pereira Romano ,
- Glauco Adrieno Westphal
Views182ABSTRACT
Objective:
To assess whether the respiratory oxygenation index (ROX index) measured after the start of high-flow nasal cannula oxygen therapy can help identify the need for intubation in patients with acute respiratory failure due to coronavirus disease 2019.
Methods:
This retrospective, observational, multicenter study was conducted at the intensive care units of six Brazilian hospitals from March to December 2020. The primary outcome was the need for intubation up to 7 days after starting the high-flow nasal cannula.
Results:
A total of 444 patients were included in the study, and 261 (58.7%) were subjected to intubation. An analysis of the area under the receiver operating characteristic curve (AUROC) showed that the ability to discriminate between successful and failed high-flow nasal cannula oxygen therapy within 7 days was greater for the ROX index measured at 24 hours (AUROC 0.80; 95%CI 0.76 - 0.84). The median interval between high-flow nasal cannula initiation and intubation was 24 hours (24 - 72), and the most accurate predictor of intubation obtained before 24 hours was the ROX index measured at 12 hours (AUROC 0.75; 95%CI 0.70 - 0.79). Kaplan-Meier curves revealed a greater probability of intubation within 7 days in patients with a ROX index ≤ 5.54 at 12 hours (hazard ratio 3.07; 95%CI 2.24 - 4.20) and ≤ 5.96 at 24 hours (hazard ratio 5.15; 95%CI 3.65 - 7.27).
Conclusion:
The ROX index can aid in the early identification of patients with acute respiratory failure due to COVID-19 who will progress to the failure of high-flow nasal cannula supportive therapy and the need for intubation.
Keywords:CannulaCoronavirus infectionsCOVID-19intubationOxygenRespiratory insufficiencyRespiratory rateSee moreViews182
Abstract
Original ArticleThe respiratory oxygenation index for identifying the risk of orotracheal intubation in COVID-19 patients receiving high-flow nasal cannula oxygen
Critical Care Science. 2024;36:e20240203en
DOI 10.62675/2965-2774.20240203-en
- Aline Braz Pereira ,
- Felipe Dal Pizzol ,
- Viviane Cordeiro Veiga ,
- Leandro Utino Taniguchi ,
- Aline Finoti Misquita ,
- Gustavo Augusto Couto Carvalho ,
- Ligia Maria Coscrato Junqueira Silva ,
- Michelli Marcela Dadam ,
- Ruthy Perotto Fernandes ,
- Israel Silva Maia ,
- Cassio Luis Zandonai ,
- Alexandre Biasi Cavalcanti ,
- Marcelo Luz Pereira Romano ,
- Glauco Adrieno Westphal
Views182ABSTRACT
Objective:
To assess whether the respiratory oxygenation index (ROX index) measured after the start of high-flow nasal cannula oxygen therapy can help identify the need for intubation in patients with acute respiratory failure due to coronavirus disease 2019.
Methods:
This retrospective, observational, multicenter study was conducted at the intensive care units of six Brazilian hospitals from March to December 2020. The primary outcome was the need for intubation up to 7 days after starting the high-flow nasal cannula.
Results:
A total of 444 patients were included in the study, and 261 (58.7%) were subjected to intubation. An analysis of the area under the receiver operating characteristic curve (AUROC) showed that the ability to discriminate between successful and failed high-flow nasal cannula oxygen therapy within 7 days was greater for the ROX index measured at 24 hours (AUROC 0.80; 95%CI 0.76 - 0.84). The median interval between high-flow nasal cannula initiation and intubation was 24 hours (24 - 72), and the most accurate predictor of intubation obtained before 24 hours was the ROX index measured at 12 hours (AUROC 0.75; 95%CI 0.70 - 0.79). Kaplan-Meier curves revealed a greater probability of intubation within 7 days in patients with a ROX index ≤ 5.54 at 12 hours (hazard ratio 3.07; 95%CI 2.24 - 4.20) and ≤ 5.96 at 24 hours (hazard ratio 5.15; 95%CI 3.65 - 7.27).
Conclusion:
The ROX index can aid in the early identification of patients with acute respiratory failure due to COVID-19 who will progress to the failure of high-flow nasal cannula supportive therapy and the need for intubation.
Keywords:CannulaCoronavirus infectionsCOVID-19intubationOxygenRespiratory insufficiencyRespiratory rateSee more
- Aline Braz Pereira
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Original Article04-22-2024
Driving pressure, as opposed to tidal volume based on predicted body weight, is associated with mortality: results from a prospective cohort of COVID-19 acute respiratory distress syndrome patients
- Erich Vidal Carvalho ,
- Maycon Moura Reboredo ,
- Edimar Pedrosa Gomes ,
- Pedro Nascimento Martins ,
- Gabriel Paz Souza Mota , [ ... ],
- Bruno Valle Pinheiro
Abstract
Original ArticleDriving pressure, as opposed to tidal volume based on predicted body weight, is associated with mortality: results from a prospective cohort of COVID-19 acute respiratory distress syndrome patients
Critical Care Science. 2024;36:e20240208en
DOI 10.62675/2965-2774.20240208-en
- Erich Vidal Carvalho ,
- Maycon Moura Reboredo ,
- Edimar Pedrosa Gomes ,
- Pedro Nascimento Martins ,
- Gabriel Paz Souza Mota ,
- Giovani Bernardo Costa ,
- Fernando Antonio Basile Colugnati ,
- Bruno Valle Pinheiro
Views150ABSTRACT
Objective:
To evaluate the association between driving pressure and tidal volume based on predicted body weight and mortality in a cohort of patients with acute respiratory distress syndrome caused by COVID-19.
Methods:
This was a prospective, observational study that included patients with acute respiratory distress syndrome due to COVID-19 admitted to two intensive care units. We performed multivariable analyses to determine whether driving pressure and tidal volume/kg predicted body weight on the first day of mechanical ventilation, as independent variables, are associated with hospital mortality.
Results:
We included 231 patients. The mean age was 64 (53 - 74) years, and the mean Simplified Acute and Physiology Score 3 score was 45 (39 - 54). The hospital mortality rate was 51.9%. Driving pressure was independently associated with hospital mortality (odds ratio 1.21, 95%CI 1.04 - 1.41 for each cm H2O increase in driving pressure, p = 0.01). Based on a double stratification analysis, we found that for the same level of tidal volume/kg predicted body weight, the risk of hospital death increased with increasing driving pressure. However, changes in tidal volume/kg predicted body weight were not associated with mortality when they did not lead to an increase in driving pressure.
Conclusion:
In patients with acute respiratory distress syndrome caused by COVID-19, exposure to higher driving pressure, as opposed to higher tidal volume/kg predicted body weight, is associated with greater mortality. These results suggest that driving pressure might be a primary target for lung-protective mechanical ventilation in these patients.
Keywords:acute respiratory distress syndromeCoronavirus infectionsCOVID-19intensive care unitsmortalityRespiration, artificialTidal VolumeSee moreViews150Abstract
Original ArticleDriving pressure, as opposed to tidal volume based on predicted body weight, is associated with mortality: results from a prospective cohort of COVID-19 acute respiratory distress syndrome patients
Critical Care Science. 2024;36:e20240208en
DOI 10.62675/2965-2774.20240208-en
- Erich Vidal Carvalho ,
- Maycon Moura Reboredo ,
- Edimar Pedrosa Gomes ,
- Pedro Nascimento Martins ,
- Gabriel Paz Souza Mota ,
- Giovani Bernardo Costa ,
- Fernando Antonio Basile Colugnati ,
- Bruno Valle Pinheiro
Views150ABSTRACT
Objective:
To evaluate the association between driving pressure and tidal volume based on predicted body weight and mortality in a cohort of patients with acute respiratory distress syndrome caused by COVID-19.
Methods:
This was a prospective, observational study that included patients with acute respiratory distress syndrome due to COVID-19 admitted to two intensive care units. We performed multivariable analyses to determine whether driving pressure and tidal volume/kg predicted body weight on the first day of mechanical ventilation, as independent variables, are associated with hospital mortality.
Results:
We included 231 patients. The mean age was 64 (53 - 74) years, and the mean Simplified Acute and Physiology Score 3 score was 45 (39 - 54). The hospital mortality rate was 51.9%. Driving pressure was independently associated with hospital mortality (odds ratio 1.21, 95%CI 1.04 - 1.41 for each cm H2O increase in driving pressure, p = 0.01). Based on a double stratification analysis, we found that for the same level of tidal volume/kg predicted body weight, the risk of hospital death increased with increasing driving pressure. However, changes in tidal volume/kg predicted body weight were not associated with mortality when they did not lead to an increase in driving pressure.
Conclusion:
In patients with acute respiratory distress syndrome caused by COVID-19, exposure to higher driving pressure, as opposed to higher tidal volume/kg predicted body weight, is associated with greater mortality. These results suggest that driving pressure might be a primary target for lung-protective mechanical ventilation in these patients.
Keywords:acute respiratory distress syndromeCoronavirus infectionsCOVID-19intensive care unitsmortalityRespiration, artificialTidal VolumeSee more
- Erich Vidal Carvalho
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Original Article04-16-2024
A comprehensive physical functional assessment of survivors of critical care unit stay due to COVID-19
- Marcia Souza Volpe ,
- Ana Carolina Cardoso dos Santos ,
- Sílvia Gaspar ,
- Jade Lara de Melo ,
- Gabriela Harada , [ ... ],
- Carlos Roberto Ribeiro de Carvalho
Abstract
Original ArticleA comprehensive physical functional assessment of survivors of critical care unit stay due to COVID-19
Critical Care Science. 2024;36:e20240284en
DOI 10.62675/2965-2774.20240284-en
- Marcia Souza Volpe ,
- Ana Carolina Cardoso dos Santos ,
- Sílvia Gaspar ,
- Jade Lara de Melo ,
- Gabriela Harada ,
- Patrícia Rocha Alves Ferreira ,
- Karina Ramiceli Soares da Silva ,
- Natália Tiemi Simokomaki Souza ,
- Carlos Toufen Junior ,
- Luciana Dias Chiavegato ,
- Marcelo Britto Passos Amato ,
- Maria Ignez Zanetti Feltrim ,
- Carlos Roberto Ribeiro de Carvalho
Views119See moreABSTRACT
Objective:
To examine the physical function and respiratory muscle strength of patients - who recovered from critical COVID-19 – after intensive care unit discharge to the ward on Days one (D1) and seven (D7), and to investigate variables associated with functional impairment.
Methods:
This was a prospective cohort study of adult patients with COVID-19 who needed invasive mechanical ventilation, non-invasive ventilation or high-flow nasal cannula and were discharged from the intensive care unit to the ward. Participants were submitted to Medical Research Council sum-score, handgrip strength, maximal inspiratory pressure, maximal expiratory pressure, and short physical performance battery tests. Participants were grouped into two groups according to their need for invasive ventilation: the Invasive Mechanical Ventilation Group (IMV Group) and the Non-Invasive Mechanical Ventilation Group (Non-IMV Group).
Results:
Patients in the IMV Group (n = 31) were younger and had higher Sequential Organ Failure Assessment scores than those in the Non-IMV Group (n = 33). The short physical performance battery scores (range 0 - 12) on D1 and D7 were 6.1 ± 4.3 and 7.3 ± 3.8, respectively for the Non-Invasive Mechanical Ventilation Group, and 1.3 ± 2.5 and 2.6 ± 3.7, respectively for the IMV Group. The prevalence of intensive care unit-acquired weakness on D7 was 13% for the Non-IMV Group and 72% for the IMV Group. The maximal inspiratory pressure, maximal expiratory pressure, and handgrip strength increased on D7 in both groups, but the maximal expiratory pressure and handgrip strength were still weak. Only maximal inspiratory pressure was recovered (i.e., > 80% of the predicted value) in the Non-IMV Group. Female sex, and the need and duration of invasive mechanical were independently and negatively associated with the short physical performance battery score and handgrip strength.
Conclusion:
Patients who recovered from critical COVID-19 and who received invasive mechanical ventilation presented greater disability than those who were not invasively ventilated. However, they both showed marginal functional improvement during early recovery, regardless of the need for invasive mechanical ventilation. This might highlight the severity of disability caused by SARS-CoV-2.
Views119Abstract
Original ArticleA comprehensive physical functional assessment of survivors of critical care unit stay due to COVID-19
Critical Care Science. 2024;36:e20240284en
DOI 10.62675/2965-2774.20240284-en
- Marcia Souza Volpe ,
- Ana Carolina Cardoso dos Santos ,
- Sílvia Gaspar ,
- Jade Lara de Melo ,
- Gabriela Harada ,
- Patrícia Rocha Alves Ferreira ,
- Karina Ramiceli Soares da Silva ,
- Natália Tiemi Simokomaki Souza ,
- Carlos Toufen Junior ,
- Luciana Dias Chiavegato ,
- Marcelo Britto Passos Amato ,
- Maria Ignez Zanetti Feltrim ,
- Carlos Roberto Ribeiro de Carvalho
Views119See moreABSTRACT
Objective:
To examine the physical function and respiratory muscle strength of patients - who recovered from critical COVID-19 – after intensive care unit discharge to the ward on Days one (D1) and seven (D7), and to investigate variables associated with functional impairment.
Methods:
This was a prospective cohort study of adult patients with COVID-19 who needed invasive mechanical ventilation, non-invasive ventilation or high-flow nasal cannula and were discharged from the intensive care unit to the ward. Participants were submitted to Medical Research Council sum-score, handgrip strength, maximal inspiratory pressure, maximal expiratory pressure, and short physical performance battery tests. Participants were grouped into two groups according to their need for invasive ventilation: the Invasive Mechanical Ventilation Group (IMV Group) and the Non-Invasive Mechanical Ventilation Group (Non-IMV Group).
Results:
Patients in the IMV Group (n = 31) were younger and had higher Sequential Organ Failure Assessment scores than those in the Non-IMV Group (n = 33). The short physical performance battery scores (range 0 - 12) on D1 and D7 were 6.1 ± 4.3 and 7.3 ± 3.8, respectively for the Non-Invasive Mechanical Ventilation Group, and 1.3 ± 2.5 and 2.6 ± 3.7, respectively for the IMV Group. The prevalence of intensive care unit-acquired weakness on D7 was 13% for the Non-IMV Group and 72% for the IMV Group. The maximal inspiratory pressure, maximal expiratory pressure, and handgrip strength increased on D7 in both groups, but the maximal expiratory pressure and handgrip strength were still weak. Only maximal inspiratory pressure was recovered (i.e., > 80% of the predicted value) in the Non-IMV Group. Female sex, and the need and duration of invasive mechanical were independently and negatively associated with the short physical performance battery score and handgrip strength.
Conclusion:
Patients who recovered from critical COVID-19 and who received invasive mechanical ventilation presented greater disability than those who were not invasively ventilated. However, they both showed marginal functional improvement during early recovery, regardless of the need for invasive mechanical ventilation. This might highlight the severity of disability caused by SARS-CoV-2.
- Marcia Souza Volpe
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Original Article03-25-2024
Association of biomarkers with successful ventilatory weaning in COVID-19 patients: an observational study
Critical Care Science. 2024;36:e20240158en
Abstract
Original ArticleAssociation of biomarkers with successful ventilatory weaning in COVID-19 patients: an observational study
Critical Care Science. 2024;36:e20240158en
DOI 10.62675/2965-2774.20240158-en
Views126ABSTRACT
Objective:
To evaluate the association of biomarkers with successful ventilatory weaning in COVID-19 patients.
Methods:
An observational, retrospective, and single-center study was conducted between March 2020 and April 2021. C-reactive protein, total lymphocytes, and the neutrophil/lymphocyte ratio were evaluated during attrition and extubation, and the variation in these biomarker values was measured. The primary outcome was successful extubation. ROC curves were drawn to find the best cutoff points for the biomarkers based on sensitivity and specificity. Statistical analysis was performed using logistic regression.
Results:
Of the 2,377 patients admitted to the intensive care unit, 458 were included in the analysis, 356 in the Successful Weaning Group and 102 in the Failure Group. The cutoff points found from the ROC curves were −62.4% for C-reactive protein, +45.7% for total lymphocytes, and −32.9% for neutrophil/lymphocyte ratio. These points were significantly associated with greater extubation success. In the multivariate analysis, only C-reactive protein variation remained statistically significant (OR 2.6; 95%CI 1.51 – 4.5; p < 0.001).
Conclusion:
In this study, a decrease in C-reactive protein levels was associated with successful extubation in COVID-19 patients. Total lymphocytes and the neutrophil/lymphocyte ratio did not maintain the association after multivariate analysis. However, a decrease in C-reactive protein levels should not be used as a sole variable to identify COVID-19 patients suitable for weaning; as in our study, the area under the ROC curve demonstrated poor accuracy in discriminating extubation outcomes, with low sensitivity and specificity.
Keywords:Airway extubationartificialBiomarkersCoronavirus infectionsCOVID-19intensive care unitsintratrachealintubationRespirationVentilator weaningSee moreViews126Abstract
Original ArticleAssociation of biomarkers with successful ventilatory weaning in COVID-19 patients: an observational study
Critical Care Science. 2024;36:e20240158en
DOI 10.62675/2965-2774.20240158-en
Views126ABSTRACT
Objective:
To evaluate the association of biomarkers with successful ventilatory weaning in COVID-19 patients.
Methods:
An observational, retrospective, and single-center study was conducted between March 2020 and April 2021. C-reactive protein, total lymphocytes, and the neutrophil/lymphocyte ratio were evaluated during attrition and extubation, and the variation in these biomarker values was measured. The primary outcome was successful extubation. ROC curves were drawn to find the best cutoff points for the biomarkers based on sensitivity and specificity. Statistical analysis was performed using logistic regression.
Results:
Of the 2,377 patients admitted to the intensive care unit, 458 were included in the analysis, 356 in the Successful Weaning Group and 102 in the Failure Group. The cutoff points found from the ROC curves were −62.4% for C-reactive protein, +45.7% for total lymphocytes, and −32.9% for neutrophil/lymphocyte ratio. These points were significantly associated with greater extubation success. In the multivariate analysis, only C-reactive protein variation remained statistically significant (OR 2.6; 95%CI 1.51 – 4.5; p < 0.001).
Conclusion:
In this study, a decrease in C-reactive protein levels was associated with successful extubation in COVID-19 patients. Total lymphocytes and the neutrophil/lymphocyte ratio did not maintain the association after multivariate analysis. However, a decrease in C-reactive protein levels should not be used as a sole variable to identify COVID-19 patients suitable for weaning; as in our study, the area under the ROC curve demonstrated poor accuracy in discriminating extubation outcomes, with low sensitivity and specificity.
Keywords:Airway extubationartificialBiomarkersCoronavirus infectionsCOVID-19intensive care unitsintratrachealintubationRespirationVentilator weaningSee more
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Original Article03-25-2024
Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis
- Gustavo Adolfo Vásquez-Tirado ,
- Edinson Dante Meregildo-Rodríguez ,
- Martha Genara Asmat-Rubio ,
- María José Salazar-Castillo ,
- Claudia Vanessa Quispe-Castañeda , [ ... ],
- María del Carmen Cuadra-Campos
Abstract
Original ArticleConscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis
Critical Care Science. 2024;36:e20240176en
DOI 10.62675/2965-2774.20240176-en
- Gustavo Adolfo Vásquez-Tirado ,
- Edinson Dante Meregildo-Rodríguez ,
- Martha Genara Asmat-Rubio ,
- María José Salazar-Castillo ,
- Claudia Vanessa Quispe-Castañeda ,
- María del Carmen Cuadra-Campos
Views196See moreABSTRACT
Objective:
To systematically review the effect of the prone position on endotracheal intubation and mortality in nonintubated COVID-19 patients with acute respiratory distress syndrome.
Methods:
We registered the protocol (CRD42021286711) and searched for four databases and gray literature from inception to December 31, 2022. We included observational studies and clinical trials. There was no limit by date or the language of publication. We excluded case reports, case series, studies not available in full text, and those studies that included children < 18-years-old.
Results:
We included ten observational studies, eight clinical trials, 3,969 patients, 1,120 endotracheal intubation events, and 843 deaths. All of the studies had a low risk of bias (Newcastle-Ottawa Scale and Risk of Bias 2 tools). We found that the conscious prone position decreased the odds of endotracheal intubation by 44% (OR 0.56; 95%CI 0.40 - 0.78) and mortality by 43% (OR 0.57; 95%CI 0.39 - 0.84) in nonintubated COVID-19 patients with acute respiratory distress syndrome. This protective effect on endotracheal intubation and mortality was more robust in those who spent > 8 hours/day in the conscious prone position (OR 0.43; 95%CI 0.26 - 0.72 and OR 0.38; 95%CI 0.24 - 0.60, respectively). The certainty of the evidence according to the GRADE criteria was moderate.
Conclusion:
The conscious prone position decreased the odds of endotracheal intubation and mortality, especially when patients spent over 8 hours/day in the conscious prone position and treatment in the intensive care unit. However, our results should be cautiously interpreted due to limitations in evaluating randomized clinical trials, nonrandomized clinical trials and observational studies. However, despite systematic reviews with meta-analyses of randomized clinical trials, we must keep in mind that these studies remain heterogeneous from a clinical and methodological point of view.
Views196Abstract
Original ArticleConscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis
Critical Care Science. 2024;36:e20240176en
DOI 10.62675/2965-2774.20240176-en
- Gustavo Adolfo Vásquez-Tirado ,
- Edinson Dante Meregildo-Rodríguez ,
- Martha Genara Asmat-Rubio ,
- María José Salazar-Castillo ,
- Claudia Vanessa Quispe-Castañeda ,
- María del Carmen Cuadra-Campos
Views196See moreABSTRACT
Objective:
To systematically review the effect of the prone position on endotracheal intubation and mortality in nonintubated COVID-19 patients with acute respiratory distress syndrome.
Methods:
We registered the protocol (CRD42021286711) and searched for four databases and gray literature from inception to December 31, 2022. We included observational studies and clinical trials. There was no limit by date or the language of publication. We excluded case reports, case series, studies not available in full text, and those studies that included children < 18-years-old.
Results:
We included ten observational studies, eight clinical trials, 3,969 patients, 1,120 endotracheal intubation events, and 843 deaths. All of the studies had a low risk of bias (Newcastle-Ottawa Scale and Risk of Bias 2 tools). We found that the conscious prone position decreased the odds of endotracheal intubation by 44% (OR 0.56; 95%CI 0.40 - 0.78) and mortality by 43% (OR 0.57; 95%CI 0.39 - 0.84) in nonintubated COVID-19 patients with acute respiratory distress syndrome. This protective effect on endotracheal intubation and mortality was more robust in those who spent > 8 hours/day in the conscious prone position (OR 0.43; 95%CI 0.26 - 0.72 and OR 0.38; 95%CI 0.24 - 0.60, respectively). The certainty of the evidence according to the GRADE criteria was moderate.
Conclusion:
The conscious prone position decreased the odds of endotracheal intubation and mortality, especially when patients spent over 8 hours/day in the conscious prone position and treatment in the intensive care unit. However, our results should be cautiously interpreted due to limitations in evaluating randomized clinical trials, nonrandomized clinical trials and observational studies. However, despite systematic reviews with meta-analyses of randomized clinical trials, we must keep in mind that these studies remain heterogeneous from a clinical and methodological point of view.
- Gustavo Adolfo Vásquez-Tirado
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Original Article01-17-2023
Delirium severity and outcomes of critically ill COVID-19 patients
- Luciana Leal do Rego ,
- Jorge Ibrain Figueira Salluh ,
- Vicente Cés de Souza-Dantas ,
- José Roberto Lapa e Silva ,
- Pedro Póvoa , [ ... ],
- Rodrigo Bernardo Serafim
Abstract
Original ArticleDelirium severity and outcomes of critically ill COVID-19 patients
Critical Care Science. 2023;35(4):394-401
DOI 10.5935/2965-2774.20230170-en
- Luciana Leal do Rego ,
- Jorge Ibrain Figueira Salluh ,
- Vicente Cés de Souza-Dantas ,
- José Roberto Lapa e Silva ,
- Pedro Póvoa ,
- Rodrigo Bernardo Serafim
Views111ABSTRACT
Objective:
To investigate the impact of delirium severity in critically ill COVID-19 patients and its association with outcomes.
Methods:
This prospective cohort study was performed in two tertiary intensive care units in Rio de Janeiro, Brazil. COVID-19 patients were evaluated daily during the first 7 days of intensive care unit stay using the Richmond Agitation Sedation Scale, Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Confusion Method Assessment for Intensive Care Unit-7 (CAM-ICU-7). Delirium severity was correlated with outcomes and one-year mortality.
Results:
Among the 277 COVID-19 patients included, delirium occurred in 101 (36.5%) during the first 7 days of intensive care unit stay, and it was associated with a higher length of intensive care unit stay in days (IQR 13 [7 - 25] versus 6 [4 - 12]; p < 0.001), higher hospital mortality (25.74% versus 5.11%; p < 0.001) and additional higher one-year mortality (5.3% versus 0.6%, p < 0.001). Delirium was classified by CAM-ICU-7 in terms of severity, and higher scores were associated with higher in-hospital mortality (17.86% versus 34.38% versus 38.46%, 95%CI, p value < 0.001). Severe delirium was associated with a higher risk of progression to coma (OR 7.1; 95%CI 1.9 - 31.0; p = 0.005) and to mechanical ventilation (OR 11.09; 95%CI 2.8 - 58.5; p = 0.002) in the multivariate analysis, adjusted by severity and frailty.
Conclusion:
In patients admitted with COVID-19 in the intensive care unit, delirium was an independent risk factor for the worst prognosis, including mortality. The delirium severity assessed by the CAM-ICU-7 during the first week in the intensive care unit was associated with poor outcomes, including progression to coma and to mechanical ventilation.
Keywords:Coronavirus infectionsCOVID-19Critical care outcomescritical illnessdeliriumintensive care unitsprognosisPsychiatric status rating scalesrisk factorsSurveys and questionnairesSee moreViews111Abstract
Original ArticleDelirium severity and outcomes of critically ill COVID-19 patients
Critical Care Science. 2023;35(4):394-401
DOI 10.5935/2965-2774.20230170-en
- Luciana Leal do Rego ,
- Jorge Ibrain Figueira Salluh ,
- Vicente Cés de Souza-Dantas ,
- José Roberto Lapa e Silva ,
- Pedro Póvoa ,
- Rodrigo Bernardo Serafim
Views111ABSTRACT
Objective:
To investigate the impact of delirium severity in critically ill COVID-19 patients and its association with outcomes.
Methods:
This prospective cohort study was performed in two tertiary intensive care units in Rio de Janeiro, Brazil. COVID-19 patients were evaluated daily during the first 7 days of intensive care unit stay using the Richmond Agitation Sedation Scale, Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Confusion Method Assessment for Intensive Care Unit-7 (CAM-ICU-7). Delirium severity was correlated with outcomes and one-year mortality.
Results:
Among the 277 COVID-19 patients included, delirium occurred in 101 (36.5%) during the first 7 days of intensive care unit stay, and it was associated with a higher length of intensive care unit stay in days (IQR 13 [7 - 25] versus 6 [4 - 12]; p < 0.001), higher hospital mortality (25.74% versus 5.11%; p < 0.001) and additional higher one-year mortality (5.3% versus 0.6%, p < 0.001). Delirium was classified by CAM-ICU-7 in terms of severity, and higher scores were associated with higher in-hospital mortality (17.86% versus 34.38% versus 38.46%, 95%CI, p value < 0.001). Severe delirium was associated with a higher risk of progression to coma (OR 7.1; 95%CI 1.9 - 31.0; p = 0.005) and to mechanical ventilation (OR 11.09; 95%CI 2.8 - 58.5; p = 0.002) in the multivariate analysis, adjusted by severity and frailty.
Conclusion:
In patients admitted with COVID-19 in the intensive care unit, delirium was an independent risk factor for the worst prognosis, including mortality. The delirium severity assessed by the CAM-ICU-7 during the first week in the intensive care unit was associated with poor outcomes, including progression to coma and to mechanical ventilation.
Keywords:Coronavirus infectionsCOVID-19Critical care outcomescritical illnessdeliriumintensive care unitsprognosisPsychiatric status rating scalesrisk factorsSurveys and questionnairesSee more
- Luciana Leal do Rego
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Original Article01-17-2023
Typical phenotypes of patients with acute respiratory failure with and without COVID-19 and their relationship with outcomes: a cohort study
- Mirella Cristine de Oliveira ,
- Rafaella Stradiotto Bernardelli ,
- Amanda Christina Kozesinski-Nakatani ,
- Joelle Turnes ,
- Fernanda Baeumle Reese , [ ... ],
- Álvaro Réa-Neto
Abstract
Original ArticleTypical phenotypes of patients with acute respiratory failure with and without COVID-19 and their relationship with outcomes: a cohort study
Critical Care Science. 2023;35(4):355-366
DOI 10.5935/2965-2774.20230015-en
- Mirella Cristine de Oliveira ,
- Rafaella Stradiotto Bernardelli ,
- Amanda Christina Kozesinski-Nakatani ,
- Joelle Turnes ,
- Fernanda Baeumle Reese ,
- Leandro Caramuru Pozzo ,
- Rafael Alexandre de Oliveira Deucher ,
- Caroline Uliana Rossi ,
- Luana Alves Tannous ,
- Álvaro Réa-Neto
Views164See moreABSTRACT
Objective:
To compare, within a cohort of patients with acute respiratory failure, the phenotypes of patients with and without COVID-19 in the context of the pandemic and evaluate whether COVID-19 is an independent predictor of intensive care unit mortality.
Methods:
This historical cohort study evaluated 1001 acute respiratory failure patients with suspected COVID-19 admitted to the intensive care unit of 8 hospitals. Patients were classified as COVID-19 cases and non-COVID-19 cases according to real-time polymerase chain reaction results. Data on clinical and demographic characteristics were collected on intensive care unit admission, as well as daily clinical and laboratory data and intensive care unit outcomes.
Results:
Although the groups did not differ in terms of APACHE II or SOFA scores at admission, the COVID-19 group had more initial symptoms of fever, myalgia and diarrhea, had a longer duration of symptoms, and had a higher prevalence of obesity. They also had a lower PaO2/FiO2 ratio, lower platelet levels than non-COVID-19 patients, and more metabolic changes, such as higher levels of blood glucose, C-reactive protein, and lactic dehydrogenase. Patients with non-COVID-19 acute respiratory failure had a higher prevalence of chronic obstructive pulmonary disease/asthma and cardiopathy. Patients with COVID-19 stayed in the hospital longer and had more complications, such as acute kidney failure, severe acute respiratory distress syndrome and severe infection. The all-cause mortality rate was also higher in this group (43.7% in the COVID-19 group versus 27.4% in the non-COVID-19 group). The diagnosis of COVID-19 was a predictor of intensive care unit mortality (odds ratio, 2.77; 95%CI, 1.89 - 4.07; p < 0.001), regardless of age or Charlson Comorbidity Index score.
Conclusion:
In a prospective cohort of patients admitted with acute respiratory failure, patients with COVID-19 had a clearly different phenotype and a higher mortality than non-COVID-19 patients. This may help to outline more accurate screening and appropriate and timely treatment for these patients.
Views164Abstract
Original ArticleTypical phenotypes of patients with acute respiratory failure with and without COVID-19 and their relationship with outcomes: a cohort study
Critical Care Science. 2023;35(4):355-366
DOI 10.5935/2965-2774.20230015-en
- Mirella Cristine de Oliveira ,
- Rafaella Stradiotto Bernardelli ,
- Amanda Christina Kozesinski-Nakatani ,
- Joelle Turnes ,
- Fernanda Baeumle Reese ,
- Leandro Caramuru Pozzo ,
- Rafael Alexandre de Oliveira Deucher ,
- Caroline Uliana Rossi ,
- Luana Alves Tannous ,
- Álvaro Réa-Neto
Views164See moreABSTRACT
Objective:
To compare, within a cohort of patients with acute respiratory failure, the phenotypes of patients with and without COVID-19 in the context of the pandemic and evaluate whether COVID-19 is an independent predictor of intensive care unit mortality.
Methods:
This historical cohort study evaluated 1001 acute respiratory failure patients with suspected COVID-19 admitted to the intensive care unit of 8 hospitals. Patients were classified as COVID-19 cases and non-COVID-19 cases according to real-time polymerase chain reaction results. Data on clinical and demographic characteristics were collected on intensive care unit admission, as well as daily clinical and laboratory data and intensive care unit outcomes.
Results:
Although the groups did not differ in terms of APACHE II or SOFA scores at admission, the COVID-19 group had more initial symptoms of fever, myalgia and diarrhea, had a longer duration of symptoms, and had a higher prevalence of obesity. They also had a lower PaO2/FiO2 ratio, lower platelet levels than non-COVID-19 patients, and more metabolic changes, such as higher levels of blood glucose, C-reactive protein, and lactic dehydrogenase. Patients with non-COVID-19 acute respiratory failure had a higher prevalence of chronic obstructive pulmonary disease/asthma and cardiopathy. Patients with COVID-19 stayed in the hospital longer and had more complications, such as acute kidney failure, severe acute respiratory distress syndrome and severe infection. The all-cause mortality rate was also higher in this group (43.7% in the COVID-19 group versus 27.4% in the non-COVID-19 group). The diagnosis of COVID-19 was a predictor of intensive care unit mortality (odds ratio, 2.77; 95%CI, 1.89 - 4.07; p < 0.001), regardless of age or Charlson Comorbidity Index score.
Conclusion:
In a prospective cohort of patients admitted with acute respiratory failure, patients with COVID-19 had a clearly different phenotype and a higher mortality than non-COVID-19 patients. This may help to outline more accurate screening and appropriate and timely treatment for these patients.
- Mirella Cristine de Oliveira
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Original Article12-22-2023
Accuracy of the persistent AKI risk index in predicting acute kidney injury in patients admitted to the intensive care unit for acute respiratory failure
- João Raphael Zanlorensi Glir ,
- Rafaella Stradiotto Bernardelli ,
- Amanda Christina Kozesinski-Nakatani ,
- Rafael Alexandre de Oliveira Deucher ,
- Mirella Cristine de Oliveira , [ ... ],
- Álvaro Réa-Neto
Abstract
Original ArticleAccuracy of the persistent AKI risk index in predicting acute kidney injury in patients admitted to the intensive care unit for acute respiratory failure
Critical Care Science. 2023;35(3):302-310
DOI 10.5935/2965-2774.20230141-en
- João Raphael Zanlorensi Glir ,
- Rafaella Stradiotto Bernardelli ,
- Amanda Christina Kozesinski-Nakatani ,
- Rafael Alexandre de Oliveira Deucher ,
- Mirella Cristine de Oliveira ,
- Álvaro Réa-Neto
Views115ABSTRACT
Objective:
To evaluate the accuracy of the persistent AKI risk index (PARI) in predicting acute kidney injury within 72 hours after admission to the intensive care unit, persistent acute kidney injury, renal replacement therapy, and death within 7 days in patients hospitalized due to acute respiratory failure.
Methods:
This study was done in a cohort of diagnoses of consecutive adult patients admitted to the intensive care unit of eight hospitals in Curitiba, Brazil, between March and September 2020 due to acute respiratory failure secondary to suspected COVID-19. The COVID-19 diagnosis was confirmed or refuted by RT-PCR for the detection of SARS-CoV-2. The ability of PARI to predict acute kidney injury at 72 hours, persistent acute kidney injury, renal replacement therapy, and death within 7 days was analyzed by ROC curves in comparison to delta creatinine, SOFA, and APACHE II.
Results:
Of the 1,001 patients in the cohort, 538 were included in the analysis. The mean age was 62 ± 17 years, 54.8% were men, and the median APACHE II score was 12. At admission, the median SOFA score was 3, and 83.3% had no renal dysfunction. After admission to the intensive care unit, 17.1% had acute kidney injury within 72 hours, and through 7 days, 19.5% had persistent acute kidney injury, 5% underwent renal replacement therapy, and 17.1% died. The PARI had an area under the ROC curve of 0.75 (0.696 - 0.807) for the prediction of acute kidney injury at 72 hours, 0.71 (0.613 - 0.807) for renal replacement therapy, and 0.64 (0.565 - 0.710) for death.
Conclusion:
The PARI has acceptable accuracy in predicting acute kidney injury within 72 hours and renal replacement therapy within 7 days of admission to the intensive care unit, but it is not significantly better than the other scores.
Keywords:Acute Kidney InjuryCoronavirus infectionsCOVID-19deathintensive care unitsmortalityprognosisRenal replacement therapyRespiratory insufficiencySARS-CoV-2See moreViews115Abstract
Original ArticleAccuracy of the persistent AKI risk index in predicting acute kidney injury in patients admitted to the intensive care unit for acute respiratory failure
Critical Care Science. 2023;35(3):302-310
DOI 10.5935/2965-2774.20230141-en
- João Raphael Zanlorensi Glir ,
- Rafaella Stradiotto Bernardelli ,
- Amanda Christina Kozesinski-Nakatani ,
- Rafael Alexandre de Oliveira Deucher ,
- Mirella Cristine de Oliveira ,
- Álvaro Réa-Neto
Views115ABSTRACT
Objective:
To evaluate the accuracy of the persistent AKI risk index (PARI) in predicting acute kidney injury within 72 hours after admission to the intensive care unit, persistent acute kidney injury, renal replacement therapy, and death within 7 days in patients hospitalized due to acute respiratory failure.
Methods:
This study was done in a cohort of diagnoses of consecutive adult patients admitted to the intensive care unit of eight hospitals in Curitiba, Brazil, between March and September 2020 due to acute respiratory failure secondary to suspected COVID-19. The COVID-19 diagnosis was confirmed or refuted by RT-PCR for the detection of SARS-CoV-2. The ability of PARI to predict acute kidney injury at 72 hours, persistent acute kidney injury, renal replacement therapy, and death within 7 days was analyzed by ROC curves in comparison to delta creatinine, SOFA, and APACHE II.
Results:
Of the 1,001 patients in the cohort, 538 were included in the analysis. The mean age was 62 ± 17 years, 54.8% were men, and the median APACHE II score was 12. At admission, the median SOFA score was 3, and 83.3% had no renal dysfunction. After admission to the intensive care unit, 17.1% had acute kidney injury within 72 hours, and through 7 days, 19.5% had persistent acute kidney injury, 5% underwent renal replacement therapy, and 17.1% died. The PARI had an area under the ROC curve of 0.75 (0.696 - 0.807) for the prediction of acute kidney injury at 72 hours, 0.71 (0.613 - 0.807) for renal replacement therapy, and 0.64 (0.565 - 0.710) for death.
Conclusion:
The PARI has acceptable accuracy in predicting acute kidney injury within 72 hours and renal replacement therapy within 7 days of admission to the intensive care unit, but it is not significantly better than the other scores.
Keywords:Acute Kidney InjuryCoronavirus infectionsCOVID-19deathintensive care unitsmortalityprognosisRenal replacement therapyRespiratory insufficiencySARS-CoV-2See more
- João Raphael Zanlorensi Glir
Coronavirus infections Archives - Critical Care Science (CCS)
