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Original Article10-09-2024
Comparison of the effectiveness of awake-prone positioning and high-flow nasal oxygen in patients with COVID-19-related acute respiratory failure between different waves
- Mariano Esperatti
, - Matías Olmos ,
- Marina Busico ,
- Adrian Gallardo ,
- Alejandra Vitali , [ ... ],
Abstract
Original ArticleComparison of the effectiveness of awake-prone positioning and high-flow nasal oxygen in patients with COVID-19-related acute respiratory failure between different waves
Critical Care Science. 2024;36:e20240065en
DOI 10.62675/2965-2774.20240065-en
- Mariano Esperatti ,
- Matías Olmos ,
- Marina Busico ,
- Adrian Gallardo ,
- Alejandra Vitali ,
- Jorgelina Quintana ,
- Hiromi Kakisu ,
- Bruno Leonel Ferreyro ,
- Nora Angélica Fuentes ,
Views64ABSTRACT
Objective:
To compare the effectiveness of the awake-prone position on relevant clinical outcomes in patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen between different waves in Argentina.
Methods:
This multicenter, prospective cohort study included adult patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen. The main exposure position was the awake-prone position (≥ 6 hours/day) compared to the non-prone position. The primary outcome was endotracheal intubation, and the secondary outcome was in-hospital mortality. The inverse probability weighting–propensity score was used to adjust the conditional probability of treatment assignment. We then adjusted for contextual variables that varied over time and compared the effectiveness between the first and second waves.
Results:
A total of 728 patients were included: 360 during the first wave and 368 during the second wave, of whom 195 (54%) and 227 (62%) remained awake-prone for a median (p25 - 75) of 12 (10 - 16) and 14 (8 - 17) hours/day, respectively (Awake-Prone Position Group). The ORs (95%CIs) for endotracheal intubation in the Awake-Prone Position Group were 0.25 (0.13 - 0.46) and 0.19 (0.09 - 0.31) for the first and second waves, respectively (p = 0.41 for comparison between waves). The ORs for in-hospital mortality in the awake-prone position were 0.35 (0.17 - 0.65) and 0.22 (0.12 - 0.43), respectively (p = 0.44 for comparison between waves).
Conclusion:
The awake-prone position was associated with a reduction in the risk of endotracheal intubation and in-hospital mortality. These effects were independent of the context in which the intervention was applied, and no differences were observed between the different waves.
Keywords:Coronavirus infectionsCOVID-19Hospital mortalityIntubation, endotrachealOxygenprone positionRespiratory insufficiencySARS-CoV-2See moreViews64
Abstract
Original ArticleComparison of the effectiveness of awake-prone positioning and high-flow nasal oxygen in patients with COVID-19-related acute respiratory failure between different waves
Critical Care Science. 2024;36:e20240065en
DOI 10.62675/2965-2774.20240065-en
- Mariano Esperatti ,
- Matías Olmos ,
- Marina Busico ,
- Adrian Gallardo ,
- Alejandra Vitali ,
- Jorgelina Quintana ,
- Hiromi Kakisu ,
- Bruno Leonel Ferreyro ,
- Nora Angélica Fuentes ,
Views64ABSTRACT
Objective:
To compare the effectiveness of the awake-prone position on relevant clinical outcomes in patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen between different waves in Argentina.
Methods:
This multicenter, prospective cohort study included adult patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen. The main exposure position was the awake-prone position (≥ 6 hours/day) compared to the non-prone position. The primary outcome was endotracheal intubation, and the secondary outcome was in-hospital mortality. The inverse probability weighting–propensity score was used to adjust the conditional probability of treatment assignment. We then adjusted for contextual variables that varied over time and compared the effectiveness between the first and second waves.
Results:
A total of 728 patients were included: 360 during the first wave and 368 during the second wave, of whom 195 (54%) and 227 (62%) remained awake-prone for a median (p25 - 75) of 12 (10 - 16) and 14 (8 - 17) hours/day, respectively (Awake-Prone Position Group). The ORs (95%CIs) for endotracheal intubation in the Awake-Prone Position Group were 0.25 (0.13 - 0.46) and 0.19 (0.09 - 0.31) for the first and second waves, respectively (p = 0.41 for comparison between waves). The ORs for in-hospital mortality in the awake-prone position were 0.35 (0.17 - 0.65) and 0.22 (0.12 - 0.43), respectively (p = 0.44 for comparison between waves).
Conclusion:
The awake-prone position was associated with a reduction in the risk of endotracheal intubation and in-hospital mortality. These effects were independent of the context in which the intervention was applied, and no differences were observed between the different waves.
Keywords:Coronavirus infectionsCOVID-19Hospital mortalityIntubation, endotrachealOxygenprone positionRespiratory insufficiencySARS-CoV-2See more
- Mariano Esperatti
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Original Article09-18-2024
Advancing insights in critical COVID-19: unraveling lymphopenia through propensity score matching – Findings from the Multicenter LYMPH-COVID Study
- José Pedro Cidade ,
- Vicente Cês Souza-Dantas ,
- Rafaela Braga Mamfrim,
- Renata Carnevale Miranda,
- Henrique Tommasi Caroli, [ ... ],
- Pedro Póvoa
Abstract
Original ArticleAdvancing insights in critical COVID-19: unraveling lymphopenia through propensity score matching – Findings from the Multicenter LYMPH-COVID Study
Critical Care Science. 2024;36:e20240236en
DOI 10.62675/2965-2774.20240236-en
- José Pedro Cidade ,
- Vicente Cês Souza-Dantas ,
- Rafaela Braga Mamfrim,
- Renata Carnevale Miranda,
- Henrique Tommasi Caroli,
- Natália Almeida Oliveira,
- Alessandra e Figueiredo Thompson ,
- Gabriela E. Oliveira,
- Pedro Póvoa
Views85ABSTRACT
Objective
To elucidate the impact of lymphopenia on critical COVID-19 patient outcomes.
Methods
We conducted a multicenter prospective cohort study across five hospitals in Portugal and Brazil from 2020 to 2021. The study included adult patients admitted to the intensive care unit with SARS-CoV-2 pneumonia. Patients were categorized into two groups based on their lymphocyte counts within 48 hours of intensive care unit admission: the Lymphopenia Group (lymphocyte serum count < 1 × 109/L) and the Nonlymphopenia Group. Multivariate logistic regression, propensity score matching, Kaplan‒Meier survival curve analysis and Cox proportional hazards regression analysis were used.
Results
A total of 912 patients were enrolled, with 191 (20.9%) in the Nonlymphopenia Group and 721 (79.1%) in the Lymphopenia Group. Lymphopenia patients displayed significantly elevated disease severity indices, including Sequential Organ Failure Assessment and Simplified Acute Physiology Score 3 scores, at intensive care unit admission (p = 0.001 and p < 0.001, respectively). Additionally, they presented heightened requirements for vasopressor support (p = 0.045) and prolonged intensive care unit and in-hospital stays (both p < 0.001). Multivariate logistic regression analysis after propensity score matching revealed a significant contribution of lymphopenia to mortality, with an odds ratio of 1,621 (95%CI: 1,275 - 2,048; p < 0.001). Interaction models revealed an increase of 8% in mortality for each decade of longevity in patients with concomitant lymphopenia. In the subanalysis utilizing three-group stratification, the Severe Lymphopenia Group had the highest mortality rate, not only in direct comparisons but also in Kaplan‒Meier survival analysis (log-rank test p = 0.0048).
Conclusion
Lymphopenia in COVID-19 patients is associated with increased disease severity and an increased risk of mortality, underscoring the need for prompt support for critically ill high-risk patients. These findings offer important insights into improving patient care strategies for COVID-19 patients.
Keywords:Coronavirus infectionsCOVID-19critical careintensive care unitsLymphopeniamortalitySARS-CoV-2See moreViews85Abstract
Original ArticleAdvancing insights in critical COVID-19: unraveling lymphopenia through propensity score matching – Findings from the Multicenter LYMPH-COVID Study
Critical Care Science. 2024;36:e20240236en
DOI 10.62675/2965-2774.20240236-en
- José Pedro Cidade ,
- Vicente Cês Souza-Dantas ,
- Rafaela Braga Mamfrim,
- Renata Carnevale Miranda,
- Henrique Tommasi Caroli,
- Natália Almeida Oliveira,
- Alessandra e Figueiredo Thompson ,
- Gabriela E. Oliveira,
- Pedro Póvoa
Views85ABSTRACT
Objective
To elucidate the impact of lymphopenia on critical COVID-19 patient outcomes.
Methods
We conducted a multicenter prospective cohort study across five hospitals in Portugal and Brazil from 2020 to 2021. The study included adult patients admitted to the intensive care unit with SARS-CoV-2 pneumonia. Patients were categorized into two groups based on their lymphocyte counts within 48 hours of intensive care unit admission: the Lymphopenia Group (lymphocyte serum count < 1 × 109/L) and the Nonlymphopenia Group. Multivariate logistic regression, propensity score matching, Kaplan‒Meier survival curve analysis and Cox proportional hazards regression analysis were used.
Results
A total of 912 patients were enrolled, with 191 (20.9%) in the Nonlymphopenia Group and 721 (79.1%) in the Lymphopenia Group. Lymphopenia patients displayed significantly elevated disease severity indices, including Sequential Organ Failure Assessment and Simplified Acute Physiology Score 3 scores, at intensive care unit admission (p = 0.001 and p < 0.001, respectively). Additionally, they presented heightened requirements for vasopressor support (p = 0.045) and prolonged intensive care unit and in-hospital stays (both p < 0.001). Multivariate logistic regression analysis after propensity score matching revealed a significant contribution of lymphopenia to mortality, with an odds ratio of 1,621 (95%CI: 1,275 - 2,048; p < 0.001). Interaction models revealed an increase of 8% in mortality for each decade of longevity in patients with concomitant lymphopenia. In the subanalysis utilizing three-group stratification, the Severe Lymphopenia Group had the highest mortality rate, not only in direct comparisons but also in Kaplan‒Meier survival analysis (log-rank test p = 0.0048).
Conclusion
Lymphopenia in COVID-19 patients is associated with increased disease severity and an increased risk of mortality, underscoring the need for prompt support for critically ill high-risk patients. These findings offer important insights into improving patient care strategies for COVID-19 patients.
Keywords:Coronavirus infectionsCOVID-19critical careintensive care unitsLymphopeniamortalitySARS-CoV-2See more
- José Pedro Cidade
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Original Article09-18-2024
Long-term mortality of Dutch COVID-19 patients admitted to the intensive care medicine: a retrospective analysis from a national quality registry
- Safira A. Wortel ,
- Ferishta Bakhshi-Raiez ,
- Ameen Abu-Hanna ,
- Dave A. Dongelmans ,
- Nicolette F. de Keizer , [ ... ],
Abstract
Original ArticleLong-term mortality of Dutch COVID-19 patients admitted to the intensive care medicine: a retrospective analysis from a national quality registry
Critical Care Science. 2024;36:e202400251en
DOI 10.62675/2965-2774.20240251-en
- Safira A. Wortel ,
- Ferishta Bakhshi-Raiez ,
- Ameen Abu-Hanna ,
- Dave A. Dongelmans ,
- Nicolette F. de Keizer ,
Views99ABSTRACT
Objective:
To describe the 12-month mortality of Dutch COVID-19 intensive care unit patients, the total COVID-19 population and various subgroups on the basis of the number of comorbidities, age, sex, mechanical ventilation, and vasoactive medication use.
Methods:
We included all patients admitted with COVID-19 between March 1, 2020, and March 29, 2022, from the Dutch National Intensive Care (NICE) database. The crude 12-month mortality rate is presented via Kaplan-Meier survival curves for each patient subgroup. We used Cox regression models to analyze the effects of patient characteristics on 12-month mortality after hospital discharge.
Results:
We included 16,605 COVID-19 patients. The in-hospital mortality rate was 28.1%, and the 12-month mortality rate after intensive care unit admission was 29.8%. Among hospital survivors, 12-month mortality after hospital discharge was 2.5% (300/11,931). The hazard of death at 12 months after hospital discharge was greater in patients between 60 and 79 years (HR 4.74; 95%CI 2.23 - 10.06) and ≥ 80 years (HR 22.77; 95%CI 9.91 - 52.28) than in patients < 40 years of age; in male patients than in female patients (HR 1.38; 95%CI 1.07 - 1.78); and in patients with one (adjusted HR 1.95; 95%CI 1.5 - 2.53), two (adjusted HR 4.49; 95%CI 3.27 - 6.16) or more than two comorbidities (adjusted HR 4.99; 95%CI 2.62 - 9.5) than in patients with no comorbidities. Neither vasoactive medication use nor mechanical ventilation resulted in statistically significant results.
Conclusion:
For Dutch COVID-19 intensive care unit patients, most deaths occurred during their hospital stay. For hospital survivors, the crude 12-month mortality rate was low. Patient age (older than 60), sex and the number of comorbidities were associated with a greater hazard of death at 12 months after hospital discharge, whereas mechanical ventilation and vasoactive medication were not.
Keywords:Coronavirus infectionsCOVID-19critical careDatabases, factualHospital mortalityintensive care unitsLength of stayOutcome assessment (Health Care)Patient dischargeRespiration, artificialSARS-CoV-2SurvivorsSee moreViews99Abstract
Original ArticleLong-term mortality of Dutch COVID-19 patients admitted to the intensive care medicine: a retrospective analysis from a national quality registry
Critical Care Science. 2024;36:e202400251en
DOI 10.62675/2965-2774.20240251-en
- Safira A. Wortel ,
- Ferishta Bakhshi-Raiez ,
- Ameen Abu-Hanna ,
- Dave A. Dongelmans ,
- Nicolette F. de Keizer ,
Views99ABSTRACT
Objective:
To describe the 12-month mortality of Dutch COVID-19 intensive care unit patients, the total COVID-19 population and various subgroups on the basis of the number of comorbidities, age, sex, mechanical ventilation, and vasoactive medication use.
Methods:
We included all patients admitted with COVID-19 between March 1, 2020, and March 29, 2022, from the Dutch National Intensive Care (NICE) database. The crude 12-month mortality rate is presented via Kaplan-Meier survival curves for each patient subgroup. We used Cox regression models to analyze the effects of patient characteristics on 12-month mortality after hospital discharge.
Results:
We included 16,605 COVID-19 patients. The in-hospital mortality rate was 28.1%, and the 12-month mortality rate after intensive care unit admission was 29.8%. Among hospital survivors, 12-month mortality after hospital discharge was 2.5% (300/11,931). The hazard of death at 12 months after hospital discharge was greater in patients between 60 and 79 years (HR 4.74; 95%CI 2.23 - 10.06) and ≥ 80 years (HR 22.77; 95%CI 9.91 - 52.28) than in patients < 40 years of age; in male patients than in female patients (HR 1.38; 95%CI 1.07 - 1.78); and in patients with one (adjusted HR 1.95; 95%CI 1.5 - 2.53), two (adjusted HR 4.49; 95%CI 3.27 - 6.16) or more than two comorbidities (adjusted HR 4.99; 95%CI 2.62 - 9.5) than in patients with no comorbidities. Neither vasoactive medication use nor mechanical ventilation resulted in statistically significant results.
Conclusion:
For Dutch COVID-19 intensive care unit patients, most deaths occurred during their hospital stay. For hospital survivors, the crude 12-month mortality rate was low. Patient age (older than 60), sex and the number of comorbidities were associated with a greater hazard of death at 12 months after hospital discharge, whereas mechanical ventilation and vasoactive medication were not.
Keywords:Coronavirus infectionsCOVID-19critical careDatabases, factualHospital mortalityintensive care unitsLength of stayOutcome assessment (Health Care)Patient dischargeRespiration, artificialSARS-CoV-2SurvivorsSee more
- Safira A. Wortel
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Original Article06-19-2024
Influence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19
- Luísa Helena Machado Martinato ,
- Débora Schmidt ,
- Taila Cristina Piva ,
- Gracieli Nadalon Deponti ,
- Maricene Colissi Graboski , [ ... ],
- Graciele Sbruzzi
Abstract
Original ArticleInfluence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19
Critical Care Science. 2024;36:e20240253en
DOI 10.62675/2965-2774.20240253-en
- Luísa Helena Machado Martinato ,
- Débora Schmidt ,
- Taila Cristina Piva ,
- Gracieli Nadalon Deponti ,
- Maricene Colissi Graboski ,
- Rodrigo Della Méa Plentz ,
- Graciele Sbruzzi
Views92ABSTRACT
Objective
To identify the influence of obesity on mortality, time to weaning from mechanical ventilation and mobility at intensive care unit discharge in patients with COVID-19.
Methods
This retrospective cohort study was carried out between March and August 2020. All adult patients admitted to the intensive care unit in need of ventilatory support and confirmed to have COVID-19 were included. The outcomes included mortality, time on mechanical ventilation, and mobility at intensive care unit discharge.
Results
Four hundred and twenty-nine patients were included, 36.6% of whom were overweight and 43.8% of whom were obese. Compared with normal body mass index patients, overweight and obese patients had lower mortality (p = 0.002) and longer intensive care unit survival (log-rank p < 0.001). Compared with patients with a normal body mass index, overweight patients had a 36% lower risk of death (p = 0.04), while patients with obesity presented a 23% lower risk (p < 0.001). There was no association between obesity and time on mechanical ventilation. The level of mobility at intensive care unit discharge did not differ between groups and showed a moderate inverse correlation with length of stay in the intensive care unit (r = -0.461; p < 0.001).
Conclusion
Overweight and obese patients had lower mortality and higher intensive care unit survival rates. The duration of mechanical ventilation and mobility level at intensive care unit discharge did not differ between the groups.
Keywords:Coronavirus infectionsCOVID-19intensive care unitsmortalityObesityRehabilitationRespiration, artificialSARS-CoV-2See moreViews92Abstract
Original ArticleInfluence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19
Critical Care Science. 2024;36:e20240253en
DOI 10.62675/2965-2774.20240253-en
- Luísa Helena Machado Martinato ,
- Débora Schmidt ,
- Taila Cristina Piva ,
- Gracieli Nadalon Deponti ,
- Maricene Colissi Graboski ,
- Rodrigo Della Méa Plentz ,
- Graciele Sbruzzi
Views92ABSTRACT
Objective
To identify the influence of obesity on mortality, time to weaning from mechanical ventilation and mobility at intensive care unit discharge in patients with COVID-19.
Methods
This retrospective cohort study was carried out between March and August 2020. All adult patients admitted to the intensive care unit in need of ventilatory support and confirmed to have COVID-19 were included. The outcomes included mortality, time on mechanical ventilation, and mobility at intensive care unit discharge.
Results
Four hundred and twenty-nine patients were included, 36.6% of whom were overweight and 43.8% of whom were obese. Compared with normal body mass index patients, overweight and obese patients had lower mortality (p = 0.002) and longer intensive care unit survival (log-rank p < 0.001). Compared with patients with a normal body mass index, overweight patients had a 36% lower risk of death (p = 0.04), while patients with obesity presented a 23% lower risk (p < 0.001). There was no association between obesity and time on mechanical ventilation. The level of mobility at intensive care unit discharge did not differ between groups and showed a moderate inverse correlation with length of stay in the intensive care unit (r = -0.461; p < 0.001).
Conclusion
Overweight and obese patients had lower mortality and higher intensive care unit survival rates. The duration of mechanical ventilation and mobility level at intensive care unit discharge did not differ between the groups.
Keywords:Coronavirus infectionsCOVID-19intensive care unitsmortalityObesityRehabilitationRespiration, artificialSARS-CoV-2See more
- Luísa Helena Machado Martinato
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Case Report06-04-2024
Impact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study
- Fernando Luís Scolari ,
- Marciane Maria Rover ,
- Geraldine Trott ,
- Mariana Motta Dias da Silva ,
- Denise de Souza, [ ... ],
- Regis Goulart Rosa
Abstract
Case ReportImpact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study
Critical Care Science. 2024;36:e20240258en
DOI 10.62675/2965-2774.20240258-en
- Fernando Luís Scolari ,
- Marciane Maria Rover ,
- Geraldine Trott ,
- Mariana Motta Dias da Silva ,
- Denise de Souza,
- Raine Fogliati de Carli Schardosim ,
- Rosa da Rosa Minho dos Santos ,
- Emelyn de Souza Roldão ,
- Duane Mocellin ,
- Jennifer Menna Barreto de Souza ,
- Aline Paula Miozzo ,
- Gabriela Soares Rech ,
- Carolina Rothmann Itaqui ,
- Juliana de Mesquita Neto,
- Gabriel Pozza Muller Estivalete ,
- Hellen Jordan Martins Freitas,
- Catherine Vitória Pereira dos Santos,
- Lucas Gobetti da Luz ,
- Marcelo Kern,
- Milena Soriano Marcolino ,
- Bruna Brandão Barreto ,
- Paulo R. Schwartzman ,
- Ana Carolina Peçanha Antonio ,
- Maicon Falavigna ,
- Caroline Cabral Robinson,
- Carisi Anne Polanczy ,
- Regis Goulart Rosa
Views122ABSTRACT
Rationale:
Evidence about long-term sequelae after hospitalization for acute respiratory distress syndrome due to COVID-19 is still scarce.
Purpose:
To evaluate changes in pulmonary, cardiac, and renal function and in quality of life after hospitalization for acute respiratory distress syndrome secondary to COVID-19.
Methods:
This will be a multicenter case–control study of 220 participants. Eligible are patients who are hospitalized for acute respiratory distress syndrome due to COVID-19. In the control group, individuals with no history of hospitalization in the last 12 months or long-term symptoms of COVID-19 will be selected. All individuals will be subjected to pulmonary spirometry with a carbon monoxide diffusion test, chest tomography, cardiac and renal magnetic resonance imaging with gadolinium, ergospirometry, serum and urinary creatinine, total protein, and urinary microalbuminuria, in addition to quality-of-life questionnaires. Patients will be evaluated 12 months after hospital discharge, and controls will be evaluated within 90 days of inclusion in the study. For all the statistical analyses, p < 0.05 is the threshold for significance.
Results:
The primary outcome of the study will be the pulmonary diffusing capacity for carbon monoxide measured after 12 months. The other parameters of pulmonary, cardiac, and renal function and quality of life are secondary outcomes.
Conclusion:
This study aims to determine the long-term sequelae of pulmonary, cardiac, and renal function and the quality of life of patients hospitalized for acute respiratory distress syndrome due to COVID-19 in the Brazilian population.
Keywords:BrazilCoronavirusCOVID-19intensive care unitsQuality of lifeRespiratory distress syndromeSARS-CoV-2See moreViews122Abstract
Case ReportImpact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study
Critical Care Science. 2024;36:e20240258en
DOI 10.62675/2965-2774.20240258-en
- Fernando Luís Scolari ,
- Marciane Maria Rover ,
- Geraldine Trott ,
- Mariana Motta Dias da Silva ,
- Denise de Souza,
- Raine Fogliati de Carli Schardosim ,
- Rosa da Rosa Minho dos Santos ,
- Emelyn de Souza Roldão ,
- Duane Mocellin ,
- Jennifer Menna Barreto de Souza ,
- Aline Paula Miozzo ,
- Gabriela Soares Rech ,
- Carolina Rothmann Itaqui ,
- Juliana de Mesquita Neto,
- Gabriel Pozza Muller Estivalete ,
- Hellen Jordan Martins Freitas,
- Catherine Vitória Pereira dos Santos,
- Lucas Gobetti da Luz ,
- Marcelo Kern,
- Milena Soriano Marcolino ,
- Bruna Brandão Barreto ,
- Paulo R. Schwartzman ,
- Ana Carolina Peçanha Antonio ,
- Maicon Falavigna ,
- Caroline Cabral Robinson,
- Carisi Anne Polanczy ,
- Regis Goulart Rosa
Views122ABSTRACT
Rationale:
Evidence about long-term sequelae after hospitalization for acute respiratory distress syndrome due to COVID-19 is still scarce.
Purpose:
To evaluate changes in pulmonary, cardiac, and renal function and in quality of life after hospitalization for acute respiratory distress syndrome secondary to COVID-19.
Methods:
This will be a multicenter case–control study of 220 participants. Eligible are patients who are hospitalized for acute respiratory distress syndrome due to COVID-19. In the control group, individuals with no history of hospitalization in the last 12 months or long-term symptoms of COVID-19 will be selected. All individuals will be subjected to pulmonary spirometry with a carbon monoxide diffusion test, chest tomography, cardiac and renal magnetic resonance imaging with gadolinium, ergospirometry, serum and urinary creatinine, total protein, and urinary microalbuminuria, in addition to quality-of-life questionnaires. Patients will be evaluated 12 months after hospital discharge, and controls will be evaluated within 90 days of inclusion in the study. For all the statistical analyses, p < 0.05 is the threshold for significance.
Results:
The primary outcome of the study will be the pulmonary diffusing capacity for carbon monoxide measured after 12 months. The other parameters of pulmonary, cardiac, and renal function and quality of life are secondary outcomes.
Conclusion:
This study aims to determine the long-term sequelae of pulmonary, cardiac, and renal function and the quality of life of patients hospitalized for acute respiratory distress syndrome due to COVID-19 in the Brazilian population.
Keywords:BrazilCoronavirusCOVID-19intensive care unitsQuality of lifeRespiratory distress syndromeSARS-CoV-2See more
- Fernando Luís Scolari
-
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
Views64See 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.
Views64Abstract
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
Views64See 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
-
Special Article12-22-2023
The II Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19 Joint Guidelines of the Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia and Sociedade Brasileira de Reumatologia
- Maicon Falavigna ,
- Cintia Laura Pereira de Araujo ,
- Alexandre Naime Barbosa ,
- Karlyse Claudino Belli ,
- Verônica Colpani , [ ... ],
- Carlos Roberto Ribeiro de Carvalho
Abstract
Special ArticleThe II Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19 Joint Guidelines of the Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia and Sociedade Brasileira de Reumatologia
Critical Care Science. 2023;35(3):243-255
DOI 10.5935/2965-2774.20230136-en
- Maicon Falavigna ,
- Cintia Laura Pereira de Araujo ,
- Alexandre Naime Barbosa ,
- Karlyse Claudino Belli ,
- Verônica Colpani ,
- Felipe Dal-Pizzol ,
- Rosemeri Maurici da Silva ,
- Luciano César Pontes de Azevedo ,
- Maria Beatriz Souza Dias,
- José Luiz Gomes do Amaral ,
- Gilson Pires Dorneles ,
- Juliana Carvalho Ferreira ,
- Ana Paula da Rocha Freitas,
- Débora Dalmas Gräf ,
- Hélio Penna Guimarães ,
- Suzana Margareth Ajeje Lobo ,
- Flávia Ribeiro Machado ,
- Michelle Silva Nunes ,
- Maura Salaroli de Oliveira ,
- Suena Medeiros Parahiba ,
- Regis Goulart Rosa ,
- Vania Cristina Canuto Santos ,
- Marcone Lima Sobreira ,
- Viviane Cordeiro Veiga ,
- Ricardo Machado Xavier ,
- Alexandre Prehn Zavascki ,
- Cinara Stein ,
- Carlos Roberto Ribeiro de Carvalho
Views144ABSTRACT
Objective:
To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil.
Methods:
Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method.
Results:
Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made.
Conclusion:
New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy.
Keywords:BrazilCoronavirus infectionsCOVID-19COVID-19/ drug therapyHealth planning guidelinesSARS-CoV-2See moreViews144Abstract
Special ArticleThe II Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19 Joint Guidelines of the Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia and Sociedade Brasileira de Reumatologia
Critical Care Science. 2023;35(3):243-255
DOI 10.5935/2965-2774.20230136-en
- Maicon Falavigna ,
- Cintia Laura Pereira de Araujo ,
- Alexandre Naime Barbosa ,
- Karlyse Claudino Belli ,
- Verônica Colpani ,
- Felipe Dal-Pizzol ,
- Rosemeri Maurici da Silva ,
- Luciano César Pontes de Azevedo ,
- Maria Beatriz Souza Dias,
- José Luiz Gomes do Amaral ,
- Gilson Pires Dorneles ,
- Juliana Carvalho Ferreira ,
- Ana Paula da Rocha Freitas,
- Débora Dalmas Gräf ,
- Hélio Penna Guimarães ,
- Suzana Margareth Ajeje Lobo ,
- Flávia Ribeiro Machado ,
- Michelle Silva Nunes ,
- Maura Salaroli de Oliveira ,
- Suena Medeiros Parahiba ,
- Regis Goulart Rosa ,
- Vania Cristina Canuto Santos ,
- Marcone Lima Sobreira ,
- Viviane Cordeiro Veiga ,
- Ricardo Machado Xavier ,
- Alexandre Prehn Zavascki ,
- Cinara Stein ,
- Carlos Roberto Ribeiro de Carvalho
Views144ABSTRACT
Objective:
To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil.
Methods:
Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method.
Results:
Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made.
Conclusion:
New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy.
Keywords:BrazilCoronavirus infectionsCOVID-19COVID-19/ drug therapyHealth planning guidelinesSARS-CoV-2See more
- Maicon Falavigna
-
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
Views71ABSTRACT
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 moreViews71Abstract
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
Views71ABSTRACT
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
SARS-CoV-2 Archives - Critical Care Science (CCS)
