scholarly journals Therapeutic efficacy, mechanical ventilation, length of hospital stay, and mortality rate in severe COVID‐19 patients treated with tocilizumab

2021 ◽  
Author(s):  
Rania M Sarhan ◽  
Yasmin M. Madney ◽  
Ahmed E. Abou Warda ◽  
Marian S. Boshra
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Hospital Stay ◽  
Therapeutic Efficacy ◽  
Length Of Hospital Stay

scholarly journals MO850OUTCOMES OF COVID-19 INFECTION IN DIALYSIS PATIENTS IN QATAR: A NATIONWIDE COHORT STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Tarek Abdellatif ◽  
Abdullah Hamad ◽  
Mohamad Alkadi ◽  
Essa Abuhelaiqa ◽  
Muftah Othman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Mortality Rate ◽  
General Population ◽  
Hospital Stay ◽  
Laboratory Tests ◽  
Length Of Hospital Stay ◽  
Dialysis Patients ◽  
Risk Of Death

Abstract Background and Aims Patients on maintenance dialysis are more susceptible to COVID-19 and its severe complications. We studied outcomes of COVID-19 infection in dialysis patients in the state of Qatar. Our primary outcome was to determine the mortality rate of dialysis patients with COVID-19 infection and associated risk factors. Our secondary outcomes were to assess the severity of COVID-19 in dialysis patients and its related complications such as the incidence of hypoxia, critical care unit admission, need for mechanical ventilation or inotropes, incidence of acute respiratory distress syndrome (ARDS), and length of hospital stay. Method This was an observational, analytical, retrospective, nationwide study. We included all adult patients on dialysis who tested positive for COVID-19 (PCR assay of nasopharyngeal swab) during the period from February 1, 2020 to July 19, 2020. Patient demographics and clinical features were collected from a national electronic medical record. Laboratory tests were evaluated upon diagnosis and on day 7. Results There were 76 out of 1068 dialysis patients who were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). Eleven patients (15%) died during study period. Mortality due to COVID-19 among our dialysis cohort was 100 times higher than that in the general population for the same period (15% vs. 0.15%; OR 114.2 [95% CI: 1.53 to 2.44]; p<0.001). Univariate analysis for risk factors associated with COVID-19-related death in dialysis patients showed minor but statistically significant increases in risks with age (OR 1.07), peak WBC peak level (OR 1.189), AST level at day 7 (OR 1.04), fibrinogen level at day 7 (OR 1.4), D-dimer level on day 7 (OR 1.94), and peak CRP level (OR 1.01). A major increase in the risk of death was noted with atrial fibrillation (OR, 8.7; p=0.008) and hypoxia (OR: 28; p=0.001). High severity of COVID-19 illness in dialysis manifested as 25% of patients required admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes for intractable hypotension or shock. The mean length of hospital stay was 19.2±10.4 days. Laboratory tests were remarkable for severely elevated ferritin, fibrinogen, CRP, and peak IL-6 levels and decreased albumin levels on day 7. Conclusion This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high mortality rate of COVID-19 infection compared to the general population. Dialysis patients had severe COVID-19 course complicated by prolonged hospitalization and high need for critical care, mechanical ventilation and inotropes. Special care should be done to prevent COVID-19 in dialysis patients to avoid severe complications and mortality.

scholarly journals Remdesivir Efficacy in COVID-19 Treatment: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Sherief Abd-Elsalam ◽  
Ossama Ashraf Ahmed ◽  
Noha O. Mansour ◽  
Doaa H. Abdelaziz ◽  
Marwa Salama ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Hospital Stay ◽  
Standard Care ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Final Analysis ◽  
Secondary Outcome ◽  
Control Group ◽  
Egyptian Patients

To date, no antiviral therapy has shown proven clinical effectiveness in treating patients with COVID-19. We assessed the efficacy of remdesivir in hospitalized Egyptian patients with COVID-19. Patients were randomly assigned at a 1:1 ratio to receive either remdesivir (200 mg on the first day followed by 100 mg daily for the next 9 days intravenously infused over 30–60 minutes) in addition to standard care or standard care alone. The primary outcomes were the length of hospital stay and mortality rate. The need for mechanical ventilation was assessed as a secondary outcome. Two hundred patients (100 in each group) completed the study and were included in the final analysis. The remdesivir group showed a significantly lower median duration of hospital stay (10 days) than the control group (16 days; P < 0.001). Eleven of the patients in the remdesivir group needed mechanical ventilation compared with eight patients in the control group (P = 0.469). The mortality rate was comparable between the two groups (P = 0.602). Mortality was significantly associated with older age, elevated C-reactive protein levels, elevated D-dimer, and the need for mechanical ventilation (P = 0.039, 0.003, 0.001, and < 0.001 respectively). Remdesivir had a positive influence on length of hospital stay, but it had no mortality benefit in Egyptian patients with COVID-19. Its use, in addition to standard care including dexamethasone, should be considered, particularly in low- and middle-income countries when other effective options are scarce.

scholarly journals Timing of Tracheostomy and Outcomes in Adults with Moderate and Severe Tetanus

2019 ◽  
Vol 34 (2) ◽  
pp. 20-23
Author(s):  
Wenrol Espinosa ◽  
Von Vinco
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Morbidity And Mortality ◽  
P Value ◽  
Early Tracheostomy ◽  
Severe Stage ◽  
Significant Difference ◽  
Severe Tetanus

Objective: This study aimed to evaluate the timing of tracheostomy and relationship to outcomes (length of hospital stay, length of mechanical ventilation, morbidity and mortality rate) in adults with moderate and severe tetanus.  Methods:             Design:           Cross-Sectional Study             Setting:           Tertiary Government Training Hospital             Patients:         All adult patients (19 years old and above) diagnosed with moderate and    severe stage tetanus from January 2015 to January 2018 were considered for inclusion. Results: There were 109 patients included in this study, majority were males (n=95) with a male to female ratio of 7:1. Most belonged to the 51-60 years age group (mean: 53.7 SD: +/-16.1). Based on Cole Tetanus staging, the majority presented with severe stage tetanus (67.9%; n=74). Only 35.8% (n=39) were admitted at the Intensive Care Unit. Early tracheostomy was performed in 56.0% (n=61) of the patients (mean 6.3 hours SD: +/- 4.61). Mortality rate was noted to be 52.3% (n=57). Overall, early tracheostomy among moderate to severe stage tetanus patients showed shorter length of hospital stay and length of mechanical ventilation than  late tracheostomy (tracheostomy >24 hours) (p-value < .05). However, no significant difference was noted for timing of tracheostomy in terms of morbidity and mortality rate (p-value > .05). Conclusion: Early tracheostomy within less than 24 hours from time of admission for moderate and severe tetanus is associated with shorter length of hospital stay and mechanical ventilation than late tracheostomy, and may play a role in tetanus management. Keywords: tracheostomy; tetanus; hospital stay; mechanical ventilation; morbidity; mortality

scholarly journals RELATIONSHIP BETWEEN ICU WAITING AND MORTALITY RATE IN PATIENTS UNDER MECHANICAL VENTILATION ADMITTED IN EMERGENCY ROOM

2020 ◽  
Author(s):  
Layanna Alves da Silva Andrade ◽  
Monica Lucia Soares Borges ◽  
Geovane Rossone Reis ◽  
Aktor Hugo Teixeira ◽  
Rebeca Oliveira Crispim da Silva ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Hospital Stay ◽  
Average Length ◽  
Total Mortality ◽  
Length Of Hospital Stay ◽  
Field Research ◽  
Average Hospital ◽  
Number Of Patients ◽  
Using Data

Background: The number of patients who remain on prolonged mechanical ventilatory assistance has recently increased. The average length of hospital stay intervenes directly with the number of beds essential for assistance to a given population and is weighted as an indicator of service efficiency. Objective: To investigate the average time in which patients on mechanical ventilation admitted to the emergency department of a hospital remain waiting for a place in the ICU. Materials and Methods: Quantitative field research, where data collection was performed using data from medical records, admission books, death books / outcome of hospitalized patients and in line with pre-established criteria under mechanical ventilation. Mechanical ventilation patients admitted to the ER and the ICU, over 18 years old, were recruited. Results: The research comprises a sample of 67 patients. The average hospital stay was 334 hours and 36 minutes. The general ratio was for every 03 patients who entered for treatment, 01 was discharged and 02 died. The total mortality rate of the sample was 68.65%. Conclusion: The length of stay in ER and ICU in patients on mechanical ventilation is related to the high mortality rate.

scholarly journals Trends in the incidence and outcome of sepsis using data from a Japanese nationwide medical claims database-the Japan Sepsis Alliance (JaSA) study group-

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Taro Imaeda ◽  
Taka-aki Nakada ◽  
Nozomi Takahashi ◽  
Yasuo Yamao ◽  
Satoshi Nakagawa ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Organ Dysfunction ◽  
Length Of Hospital Stay ◽  
Annual Incidence ◽  
Claim Database ◽  
Antibiotic Administration ◽  
Electronic Health Record Data ◽  
Acute Organ Dysfunction

Abstract Background Trends in the incidence and outcomes of sepsis using a Japanese nationwide database were investigated. Methods This was a retrospective cohort study. Adult patients, who had both presumed serious infections and acute organ dysfunction, between 2010 and 2017 were extracted using a combined method of administrative and electronic health record data from the Japanese nationwide medical claim database, which covered 71.5% of all acute care hospitals in 2017. Presumed serious infection was defined using blood culture test records and antibiotic administration. Acute organ dysfunction was defined using records of diagnosis according to the international statistical classification of diseases and related health problems, 10th revision, and records of organ support. The primary outcomes were the annual incidence of sepsis and death in sepsis per 1000 inpatients. The secondary outcomes were in-hospital mortality rate and length of hospital stay in patients with sepsis. Results The analyzed dataset included 50,490,128 adult inpatients admitted between 2010 and 2017. Of these, 2,043,073 (4.0%) patients had sepsis. During the 8-year period, the annual proportion of patients with sepsis across inpatients significantly increased (slope = + 0.30%/year, P < 0.0001), accounting for 4.9% of the total inpatients in 2017. The annual death rate of sepsis per 1000 inpatients significantly increased (slope = + 1.8/1000 inpatients year, P = 0.0001), accounting for 7.8 deaths per 1000 inpatients in 2017. The in-hospital mortality rate and median (interquartile range) length of hospital stay significantly decreased (P < 0.001) over the study period and were 18.3% and 27 (15–50) days in 2017, respectively. Conclusions The Japanese nationwide data indicate that the annual incidence of sepsis and death in inpatients with sepsis significantly increased; however, the annual mortality rates and length of hospital stay in patients with sepsis significantly decreased. The increasing incidence of sepsis and death in sepsis appear to be a significant and ongoing issue.

scholarly journals Severity of hyperoxia as a risk factor in patients undergoing on-pump cardiac surgery

2017 ◽  
Vol 24 (3) ◽  
pp. 153-158
Author(s):  
Gabrielius Jakutis ◽  
Ieva Norkienė ◽  
Donata Ringaitienė ◽  
Tomas Jovaiša
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Prolonged Mechanical Ventilation ◽  
Length Of Hospital Stay ◽  
Infectious Complications ◽  
Research Database ◽  
Elective Cardiac Surgery ◽  
The Impact

Background. Hyperoxia has long been perceived as a desirable or at least an inevitable part of cardiopulmonary bypass. Recent evidence suggest that it might have multiple detrimental effects on patient homeostasis. The aim of the study was to identify the determinants of supra-physiological values of partial oxygen pressure during on-pump cardiac surgery and to assess the impact of hyperoxia on clinical outcomes. Materials and methods. Retrospective data analysis of the institutional research database was performed to evaluate the effects of hyperoxia in patients undergoing elective cardiac surgery with cardiopulmonary bypass, 246 patients were included in the final analysis. Patients were divided in three groups: mild hyperoxia (MHO, PaO2 100–199 mmHg), moderate hyperoxia (MdHO, PaO2 200–299 mmHg), and severe hyperoxia (SHO, PaO2 >300 mmHg). Postoperative complications and outcomes were defined according to standardised criteria of the Society of Thoracic Surgeons. Results. The extent of hyperoxia was more immense in patients with a lower body mass index (p = 0.001) and of female sex (p = 0.005). A significant link between severe hyperoxia and a higher incidence of infectious complications (p – 0.044), an increased length of hospital stay (p – 0.044) and extended duration of mechanical ventilation (p < 0.001) was confirmed. Conclusions. Severe hyperoxia is associated with an increased incidence of postoperative infectious complications, prolonged mechanical ventilation, and increased hospital stay.

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