scholarly journals Delirium Incidence, Duration and Severity in Critically Ill Patients with COVID-19

2020 ◽  
Vol 3 ◽  
Author(s):  
Jessica Hammes ◽  
Sikandar Khan ◽  
Heidi Lindroth ◽  
Babar Khan
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Respiratory Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
Secondary Outcome ◽  
Care Utilization ◽  
Increased Risk ◽  
Brain Behavior

Background:  COVID-19 is associated with severe respiratory failure and high mortality in critically ill patients.2,4,5 Neurologic manifestations of the disease, including delirium and coma, may also be associated with poor clinical outcomes. Delirium is associated with prolonged mechanical ventilation and mortality.3 this study sought to describe the rates, duration, and severity of delirium in patients admitted to the ICU with COVID-19.  Methods:  A retrospective, observational study was conducted from March 1stto April 27th, 2020, at Indiana University Health Methodist and Eskenazi Health Hospitals. The delirium measurements were extracted in the first 14 days of the ICU stay, using the Richmond Agitation and Sedation Scale (RASS) and the CAM-ICU and CAM-ICU7, for those with a positive COVID-19 diagnosis. The primary outcomes were delirium rates and duration; the secondary outcome was delirium severity. Descriptive statistics and median group comparisons were done using SAS v9.4.  Results:   Of 144 patients in the study, 73.6% experienced delirium and 76.4% experienced delirium or coma. The median delirium or coma duration was 7 days (IQR: 3-10), and the median delirium duration was 5 days (IQR: 2-7). The median CAM-ICU-7 score was 6 (IQR: 2-7) signifying severe delirium. Mechanical ventilation was associated increased risk of developing delirium (OR: 22.65, 95% CL: 5.24-97.82). Mortality was also more likely in patients experiencing delirium: 26.4% compared to 15.8% in patients without delirium.   Conclusion:   Of the 144 patients included, 73.6% experienced delirium lasting on average 5 days: the median delirium score being severe. Mechanical ventilation was also associated with greater odds of developing delirium. Because Covid-19 is associated with high rates of delirium, leading to increased rates of functionality disability, more resources and attention are needed to prevent and manage delirium in patients.1      References  Brummel NE, Jackson JC, Pandharipande PP, et al. Delirium in the ICU and subsequent long-term disability among survivors of mechanical ventilation. Critical Care Medicine. 2014;42(2):369-377.  Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA. 2020.   Hayhurst CJ, Pandharipande PP, Hughes CG. Intensive Care Unit Delirium: A Review of Diagnosis, Prevention, and Treatment. Anesthesiology. 2016;125(6):1229-1241.  Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020.  Wu Y, Xu X, Chen Z, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain, behavior, and immunity. 2020:S0889-1591(0820)30357-30353. 

Tracheostomy

2019 ◽  
pp. 850-854
Author(s):  
Saba Ghorab ◽  
David G. Lott
Keyword(s):  
United States ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
The United States ◽  
Critical Care Patients

Tracheostomy is a procedure where a conduit is created between the skin and the trachea. Tracheostomy is one of the most frequent procedures undertaken in critically ill patients. Each year, approximately 10% of critical care patients in the United States require a tracheostomy, most often for prolonged mechanical ventilation.

scholarly journals Surgical tracheostomy in a cohort of COVID-19 patients

HNO ◽  
2021 ◽  
Author(s):  
Patrick J. Schuler ◽  
Jens Greve ◽  
Thomas K. Hoffmann ◽  
Janina Hahn ◽  
Felix Boehm ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Prolonged Mechanical Ventilation ◽  
Tertiary Care ◽  
Lung Compliance ◽  
Hypoxemic Respiratory Failure ◽  
Surgical Tracheostomy ◽  
Increased Risk ◽  
Open Surgical Tracheostomy ◽  
Sedative Drugs

Abstract Background One of the main symptoms of severe infection with the new coronavirus‑2 (SARS-CoV-2) is hypoxemic respiratory failure because of viral pneumonia with the need for mechanical ventilation. Prolonged mechanical ventilation may require a tracheostomy, but the increased risk for contamination is a matter of considerable debate. Objective Evaluation of safety and effects of surgical tracheostomy on ventilation parameters and outcome in patients with COVID-19. Study design Retrospective observational study between March 27 and May 18, 2020, in a single-center coronavirus disease-designated ICU at a tertiary care German hospital. Patients Patients with COVID-19 were treated with open surgical tracheostomy due to severe hypoxemic respiratory failure requiring mechanical ventilation. Measurements Clinical and ventilation data were obtained from medical records in a retrospective manner. Results A total of 18 patients with confirmed SARS-CoV‑2 infection and surgical tracheostomy were analyzed. The age range was 42–87 years. All patients received open tracheostomy between 2–16 days after admission. Ventilation after tracheostomy was less invasive (reduction in PEAK and positive end-expiratory pressure [PEEP]) and lung compliance increased over time after tracheostomy. Also, sedative drugs could be reduced, and patients had a reduced need of norepinephrine to maintain hemodynamic stability. Six of 18 patients died. All surgical staff were equipped with N99-masks and facial shields or with powered air-purifying respirators (PAPR). Conclusion Our data suggest that open surgical tracheostomy can be performed without severe complications in patients with COVID-19. Tracheostomy may reduce invasiveness of mechanical ventilation and the need for sedative drugs and norepinehprine. Recommendations for personal protective equipment (PPE) for surgical staff should be followed when PPE is available to avoid contamination of the personnel.

ANEMIA AND TRANSFUSIONS AMONG CRITICALLY ILL PATIENTS ON PROLONGED MECHANICAL VENTILATION

CHEST Journal ◽  
2006 ◽  
Vol 130 (4) ◽  
pp. 212S
Author(s):  
Andrew F. Shorr ◽  
Lee S. Stern ◽  
Monika K. Raut ◽  
Lisa R. Rosenblatt ◽  
Samir Mody ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation

Soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) is Highly Associated With Mortality and Persistent Organ Dysfunction in the Critically Ill: a Cohort Study

2020 ◽  
Author(s):  
Neha Alhad Sathe ◽  
Pavan K. Bhatraju ◽  
Carmen Mikacenic ◽  
Eric D. Morrell ◽  
W. Conrad Liles ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Academic Medical Center ◽  
Myeloid Cells ◽  
Soluble Form ◽  
Hypoxemic Respiratory Failure ◽  
Study Enrollment

Abstract Background. The triggering receptor expressed on myeloid cells-1 (TREM-1) mediates fatal septic shock in murine models, but studies linking the soluble form of TREM-1 (sTREM-1) to mortality in clinical sepsis are inconclusive, and few have examined its relationship to organ dysfunction. We sought to identify associations between circulating sTREM-1 and both mortality and organ dysfunction among a broad cohort of critically ill medical, post-surgical and trauma patients. Methods. We enrolled a prospective cohort of patients who met two or more criteria for the systemic inflammatory response syndrome (SIRS) within 24 hours of intensive care unit (ICU) admission at a large academic medical center. sTREM-1 concentrations were measured at study enrollment. We used relative risk regression, adjusted for age, sex, and Charlson comorbidity index, to determine associations between sTREM-1 and the primary outcome of 28-day mortality. We also examined secondary outcomes of prevalent organ dysfunction on enrollment, and composites of persistent organ dysfunction or death at day 7. Results. Among 231 critically ill patients, non-survivors (n=19, 8%) had a higher proportion of pre-existing comorbidities, mechanical ventilation (79% vs. 44%) and shock (58% vs. 28%) compared to survivors. At study enrollment, increasing sTREM-1 was associated with a higher risk of severe acute kidney injury (AKI), shock, and acute hypoxemic respiratory failure requiring mechanical ventilation. sTREM-1 was higher among non-survivors than survivors (885 vs 336 pg/mL); each doubling of sTREM-1 concentration was associated with a 2.41-fold higher risk of 28-day mortality (95% CI 1.57, 3.72). Among 92 patients with shock on enrollment, doubling of sTREM-1 was associated with a 3.89-fold higher risk of persistent shock or death by day 7 (95% CI 1.85, 8.17). Higher sTREM-1 was also associated with a higher risk of both persistent AKI and persistent hypoxemic respiratory failure or death. Conclusions. Elevated plasma sTREM-1 is highly associated with 28-day mortality and organ dysfunction across a diverse critically ill population. These data support that early activation of the innate immune system plays a role in the development of organ dysfunction and death. Further studies should address whether modulation of the TREM-1 pathway might be beneficial in critically ill patients.

scholarly journals Prolonged Mechanical Ventilation Assistance Interacts Synergistically with Carbapenem for Clostridium difficile Infection in Critically Ill Patients

2018 ◽  
Vol 7 (8) ◽  
pp. 224 ◽  
Author(s):  
Shyh-Ren Chiang ◽  
Chih-Cheng Lai ◽  
Chung-Han Ho ◽  
Chin-Ming Chen ◽  
Chien-Ming Chao ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clostridium Difficile ◽  
Critically Ill ◽  
Clostridium Difficile Infection ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
Comorbidity Scores ◽  
Independent Risk Factors ◽  
High Comorbidity

Objectives: Interactions between mechanical ventilation (MV) and carbapenem interventions were investigated for the risk of Clostridium difficile infection (CDI) in critically ill patients undergoing concurrent carbapenem therapy. Methods: Taiwan’s National Intensive Care Unit Database (NICUD) was used in this analytical, observational, and retrospective study. We analyzed 267,871 intubated patients in subgroups based on the duration of MV support: 7–14 days (n = 97,525), 15–21 days (n = 52,068), 22–28 days (n = 35,264), and 29–60 days (n = 70,021). The primary outcome was CDI. Results: Age (>75 years old), prolonged MV assistance (>21 days), carbapenem therapy (>15 days), and high comorbidity scores were identified as independent risk factors for developing CDI. CDI risk increased with longer MV support. The highest rate of CDI was in the MV 29–60 days subgroup (adjusted hazard ratio (AHR) = 2.85; 95% confidence interval (CI) = 1.46–5.58; p < 0.02). Moreover, higher CDI rates correlated with the interaction between MV and carbapenem interventions; these CDI risks were increased in the MV 15–21 days (AHR = 2.58; 95% CI = 1.12–5.91) and MV 29–60 days (AHR = 4.63; 95% CI = 1.14–10.03) subgroups than in the non-MV and non-carbapenem subgroups. Conclusions: Both MV support and carbapenem interventions significantly increase the risk that critically ill patients will develop CDI. Moreover, prolonged MV support and carbapenem therapy synergistically induce CDI. These findings provide new insights into the role of MV support in the development of CDI.

IMPACT OF TRANSFUSION ON OUTCOMES IN CRITICALLY ILL PATIENTS REQUIRING PROLONGED MECHANICAL VENTILATION.

2006 ◽  
Vol 34 ◽  
pp. A136
Author(s):  
A F Shorr ◽  
L S Stern ◽  
L C Rosenblatt ◽  
S K Hendlish ◽  
J J Doyle ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation

scholarly journals Effect of sedatives on in-hospital and long-term mortality of critically ill patients requiring extended mechanical ventilation for more than 48 hours

2020 ◽  
Author(s):  
Hannah Lee ◽  
Seongmi Choi ◽  
Eun Jin Jang ◽  
Juhee Lee ◽  
Dalho Kim ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Significant Risk ◽  
Population Based ◽  
Case Volume ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Comorbidity Index ◽  
One Year

Abstract Background The purpose of this study was to assess the correlation between sedatives and mortality in critically ill patients who required mechanical ventilation (MV) for ≥48 hours from 2007 to 2016.Methods We conducted a nationwide retrospective cohort study using population-based healthcare reimbursement claims database. : Data from adult patients (aged ≥18) who underwent MV for ≥48 hours between 2008 and 2016 were identified and extracted from the National Health Insurance Service database. The benzodiazepine group consisted of patients who were administered benzodiazepines for sedation during MV. All other patients were assigned to the non-benzodiazepine group.Results A total of 158,712 patients requiring MV for ≥48 hours were admitted in 55 centers in Korea from 2007 to 2016. The benzodiazepine group had significantly higher in-hospital and one-year mortality compared to the non-benzodiazepine group (37.0% vs. 34.3%, 55.0% vs. 54.4%, respectively). Benzodiazepine use decreased from 2008 to 2016, after adjusting for age, sex, and mean Elixhauser comorbidity index in the Poisson regression analysis (incidence rate ratio, 0.968; 95% CI 0.954–0.983; p < 0.001) whereas dexmedetomidine sales have continuously increased since the second half of 2010. Benzodiazepine use, older age, lower case volume (≤500 cases/year), chronic kidney disease, and higher Elixhauser comorbidity index were common significant risk factors for in-hospital and one-year mortality.Conclusion In critically ill patients undergoing MV for >48 hours, the use of benzodiazepines for sedation was associated with an increased risk of in-hospital mortality and one-year mortality.

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