The coronavirus disease (COVID-19) pandemic caused unprecedented research activity all around the world but publications from Central-Eastern European countries remain scarce. Therefore, our aim was to characterise the features of the pandemic in the intensive care units (ICUs) among members of the SepsEast (Central-Eastern European Sepsis Forum) initiative. We conducted a retrospective, international, multicentre study between March 2020 and February 2021. All adult patients admitted to the ICU with pneumonia caused by COVID-19 were enrolled. Data on baseline and treatment characteristics, organ support and mortality were collected. Eleven centres from six countries provided data from 2139 patients. Patient characteristics were: median 68, [IQR 60-75] years of age; males: 67%; body mass index: 30.1 [27.0-34.7]; and 88% comorbidities. Overall mortality was 55%, which increased from 2020 to 2021 (p = 0.004). The major causes of death were respiratory (37%), cardiovascular (26%) and sepsis with multiorgan failure (21%). 1061 patients received invasive mechanical ventilation (mortality: 66%) without extracorporeal membrane oxygenation (n = 54). The rest of the patients received non-invasive ventilation (n = 129), high flow nasal oxygen (n = 317), conventional oxygen therapy (n = 122), as the highest level of ventilatory support, with mortality of 50%, 39% and 22%, respectively. This is the largest COVID-19 dataset from Central-Eastern European ICUs to date. The high mortality observed especially in those receiving invasive mechanical ventilation renders the need of establishing national-international ICU registries and audits in the region that could provide high quality, transparent data, not only during the pandemic, but also on a regular basis.
- MeSH
- COVID-19 * epidemiologie terapie MeSH
- dospělí MeSH
- jednotky intenzivní péče MeSH
- kyslík MeSH
- lidé MeSH
- registrace MeSH
- respirační insuficience * epidemiologie terapie MeSH
- retrospektivní studie MeSH
- SARS-CoV-2 MeSH
- sepse * epidemiologie MeSH
- syndrom dechové tísně * MeSH
- umělé dýchání MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
OBJECTIVE: Intensive Care Units (ICU) acquired Pneumonia (ICU-AP) is one of the most frequent nosocomial infections in critically ill patients. Our aim was to determine the effects of having an ICU-AP in immunosuppressed patients with acute hypoxemic respiratory failure. DESIGN: Post-hoc analysis of a multinational, prospective cohort study in 16 countries. SETTINGS: ICU. PATIENTS: Immunosuppressed patients with acute hypoxemic respiratory failure. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: The original cohort had 1611 and in this post-hoc analysis a total of 1512 patients with available data on hospital mortality and occurrence of ICU-AP were included. ICU-AP occurred in 158 patients (10.4%). Hospital mortality was higher in patients with ICU-AP (14.8% vs. 7.1% p < 0.001). After adjustment for confounders and centre effect, use of vasopressors (Odds Ratio (OR) 2.22; 95%CI 1.46-3.39) and invasive mechanical ventilation at day 1 (OR 2.12 vs. high flow oxygen; 95%CI 1.07-4.20) were associated with increased risk of ICU-AP while female gender (OR 0.63; 95%CI 0.43-94) and chronic kidney disease (OR 0.43; 95%CI 0.22-0.88) were associated with decreased risk of ICU-AP. After adjustment for confounders and centre effect, ICU-AP was independently associated with mortality (Hazard Ratio 1.48; 95%CI 14.-1.91; P = 0.003). CONCLUSIONS: The attributable mortality of ICU-AP has been repetitively questioned in immunosuppressed patients with acute respiratory failure. This manuscript found that ICU-AP represents an independent risk factor for hospital mortality.
PURPOSE: The characteristics and impact of bacteremia have not been widely investigated in immunocompromised patients with acute respiratory failure (ARF). METHODS: We performed a secondary analysis of a prospective cohort of immunocompromised patients with ARF (EFRAIM study). After exclusion of blood cultures positive for coagulase negative Staphylococci, we compared patients with (n = 236) and without (n = 1127) bacteremia. RESULTS: The incidence of bacteremia was 17%. Bacterial pneumonia and extra-pulmonary ARDS were the main causes of ARF in bacteremic patients. Bacteremia involved gram negative rods (48%), gram positive cocci (40%) or were polymicrobial (10%). Bacteremic patients had more hematological malignancy, higher SOFA scores and increased organ support within 7 days. Bacteremia was associated with higher crude ICU mortality (40% versus 32%, p = 0.02), but neither hospital (49% versus 44%, p = 0.17) nor 90-day mortality (60% versus 56%, p = 0.25) were different from non-bacteremic patients. After propensity score matching based on baseline characteristics, the difference in ICU mortality lost statistical significance (p = 0.06), including in a sensitivity analysis restricted to patients with pneumonia. CONCLUSIONS: We analyzed a large population of immunocompromised patients with ARF and an incidence of bacteremia of 17%. We could not demonstrate an impact of bacteremia on mortality after adjusting for baseline characteristics.
- MeSH
- bakteriemie * epidemiologie MeSH
- hostitel s imunodeficiencí MeSH
- jednotky intenzivní péče MeSH
- kritický stav MeSH
- lidé MeSH
- prospektivní studie MeSH
- respirační insuficience * epidemiologie MeSH
- syndrom dechové tísně * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a fatal interstitial lung disease characterized by irreversible loss of lung function and an unpredictable course of disease progression. METHODS: The safety data for patients with IPF who received placebo in 6 clinical trials were pooled to examine the categories and frequencies of serious adverse events (SAEs) in this population. RESULTS: In 1082 patients with IPF who received placebo, 673 SAEs were reported. Of these, 93 SAEs resulted in death (8.6% of patients). Respiratory-related conditions were the most frequently reported SAE (225 events, 16.33 per 100 patient-exposure years [PEY]), followed by infections and infestations (136 events, 9.87 per 100 PEY) and cardiac disorders (79 events, 5.73 per 100 PEY); these categories also had the most fatal outcomes (60, 10, and 10 deaths, respectively). The most frequently reported fatal respiratory-related SAEs were IPF and respiratory failure (38 and 11 patients, respectively), and the most frequently reported fatal infections and infestations and cardiac disorders were pneumonia (5 patients) and myocardial infarction (3 patients), respectively. CONCLUSIONS: This pooled analysis has value as a comparator for safety in future studies of IPF and provides insights in the natural evolution of both IPF and common comorbidities.
- MeSH
- bezpečnost statistika a číselné údaje MeSH
- idiopatická plicní fibróza farmakoterapie epidemiologie mortalita patofyziologie MeSH
- infarkt myokardu epidemiologie MeSH
- infekce epidemiologie MeSH
- intersticiální plicní nemoci epidemiologie mortalita MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci srdce epidemiologie MeSH
- placeba aplikace a dávkování škodlivé účinky MeSH
- pneumonie epidemiologie MeSH
- progrese nemoci MeSH
- respirační funkční testy metody MeSH
- respirační insuficience epidemiologie MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze II MeSH
- klinické zkoušky, fáze III MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
- MeSH
- lidé MeSH
- respirační insuficience diagnóza epidemiologie etiologie klasifikace patologie terapie MeSH
- Check Tag
- lidé MeSH
Úvod: Chronickú obštrukčnú chorobu pľúc (CHOCHP) charakterizuje porucha prietoku vzduchu prieduškami. Tieto zmeny sú ireverzibilné a zvyčajne progredujú. CHOCHP sa delí na základe funkčných parametrov a fenotypu. Exacerbácia CHOCHP akceleruje chorobu s negatívnymi dopadmi pre pacienta, priebeh a prognózu choroby. Rozvoj akútnej dychovej nedostatočnosti je častou príčinou ich hospitalizácie. Tretina pacientov hospitalizovaných pre respiračnú insuficienciu si vyžaduje ventilačnú podporu. Pre vysokú mortalitu invazívne ventilovaných pacientov sa v dnešnej dobe preferujú konzervatívne liečebné postupy a neinvazívna ventilačná podpora. Cieľ práce bol retrospektívny prehľad priebehu, komplikácií a mortality pacientov vo vyšších štádiách CHOCHP s ťažkým respiračným zlyhaním a nutnosťou ventilačnej podpory. Naše skúsenosti: Behom ročného obdobia na jednotke intenzívnej starostlivosti pľúcnej kliniky sme zaznamenali až 69% úspešnosť zvládnutia ťažkého respiračného zlyhania za pomoci neinvazívnej ventilačnej podpory. Takto sme sa mohli vyhnúť nutnosti intubácie. Priemerná doba neinvazívnej ventilácie bola 93 hodín. Preferovaný bol tlakovo podporný režim. Ventilácia bola vykonávaná intermitentne s prestávkami po zlepšení klinického stavu a úprave alebo stabilizácii krvných plynov. Najčastejšou komplikáciou bola nespolupráca pacienta. Druhú skupinu tvorili pacienti s CHOCHP na oddelení intenzívnej medicíny (za ročné obdobie), ktorých bolo nutné invazívne ventilovať pre ťažké respiračné zlyhanie, u väčšiny pacientov bola prítomná aj cirkulačná instabilita. Vyvolávajúcim faktorom exacerbácie bola u väčšiny pacientov infekcia. Všetci pacienti mali realizovanú tracheostómiu pre predpokladanú dlhšiu dobu ventilácie a za účelom jednoduchšieho odpájania od umelej pľúcnej ventilácie. Priemerná doba UPV bola 12 dní a priemerná doba odpájania 4 dni. Diskusia: Rozvoj akútnej dychovej nedostatočnosti je častou príčinou hospitalizácie pacientov s CHOCHP. Tretina hospitalizovaných pacientov si vyžaduje ventilačnú podporu. Ventilačná podpora pacientov s CHOCHP s invazívnym zaistením dýchacích ciest, je vzhľadom na vysokú až 30% mortalitu vyhradená pre pacientov, u ktorých zlyhali menej invazívne postupy. Hlavným cieľom ventilačnej mechanickej podpory u pacientov s exacerbovanou CHOCHP je zmiernenie problémov, zníženie mortality a morbidity. Vo viacerých štúdiách bolo dokázané, že neinvazívna ventilačná podpora v krvných plynoch zvyšuje pH a znižuje PaCO2, znižuje dychovú prácu, zmierňuje dýchavicu, skracuje dobu hospitalizácie, znižuje mortalitu a bráni nutnosti intubácie. V porovnaní s invazívnou mechanickou ventilačnou podporou je jednoduchší odvykací proces, znížené riziko nozokomiálnych infekcií dýchacích ciest a v neposlednom rade znížená mortalita. Indikácie na invazívnu pľúcnu ventiláciu sú zároveň aj indikáciami na preklad na OIM. Nepriaznivými faktormi invazívnej pľúcnej ventilácie je nutnosť analgosedácie a zabránenie prirodzenej schopnosti očisty dýchacích ciest. Záver: Rozvoj závažnej akútnej respiračnej nedostatočnosti u pacientov s vyššími štádiami CHOCHP predstavuje závažný medicínsky problém, ako aj nemalý ekonomický problém a odhaľuje aj etické problémy. U pacientov, ktorí vyžadujú ventilačnú podporu je napriek relatívne priaznivej krátkodobej prognóze, dlhodobá prognóza veľmi nepriaznivá.
Background: Chronic obstructive pulmonary disease (COPD) is characterized by impaired air flow in the bronchi. These changes are irreversible and usually progressive. COPD is classified based on functional parameters and phenotypes. Exacerbation of COPD accelerates the disease with negative impacts on the patient, course and prognosis. Development of acute respiratory insufficiency is a frequent cause of hospital admissions. One third of patFents hospitalized for respiratory Insufficiency require ventilatory support. Due to high mortality rates associated with invasive ventilation, conservative treatment and non-invasive ventilatory support are preferred today. The aim was a retrospective overview of the course, complications and patient mortality rates of advanced COPD with severe respiratory failure and a need for ventilatory support. Our experiences: Over a 1-year period at a department of pulmonary medicine intensive care unit, a success rate of up to 69% was achieved in the management of severe respiratory failure with non-invasive ventilation support. Thus, necessary intubation was avoided. The mean time of non-invasive intubation was 93 hours. Pressure controlled ventflation was preferred. Ventilation was intermittent with pauses after clinical condition improvement and normalization or stabilization of blood gases. The most frequent complication was patient non-compliance. Another group comprised COPD patients at a department of intensive care medicine (over a 1-year period) requiring invasive ventilation due to severe respiratory failure, with circulatory instability being present in most patients. All patients underwent tracheostomy due to expected prolonged ventilation and to facilitate weaning from artificial pulmonary ventilation. The mean time of artificial pulmonary ventilation was 12 days and the mean weaning time was 4 days. Discussion: The development of acute respiratory insufficiency is a frequent cause for hospitalization of patients with COPD. One third of hospitalized patients require ventilatory support. Given the mortality rates of up to 30 %, ventilatory support with invasive airway management is only used in tiiose COPD patients in whom less invasive procedures failed. The main goals of mechanical ventilation in patients with COPD exacerbations are to reduce problems and to decrease mortality and morbidity rates. Several studies have shown that non-invasive ventilatory support increases pH and lowers PaC02 in blood gases, decreases respiratory effort, reduces dyspnea, shortens hospital stays, reduces mortality and prevents the need for intubation. Unlike invasive mechanical ventilation, it is associated with a simpler weaning process, lower risk of nosocomial airway infections and, last but not least, reduced mortality. Indications for invasive pulmonary ventilation are also indications for transfer of patients to a department of intensive care medicine. The adverse factors of invasive pulmonary ventilation are the need for analgesia and sedation and inhibited ability to clear the airways. Conclusion: The development of acute respiratory insufficiency in patients with advanced COPD is both a serious health issue and not a small economic problem, also revealing ethical issues. Despite a relatively favorable short-time prognosis, patients requiring ventilatory support have a very poor long-term prognosis.
- MeSH
- chronická obstrukční plicní nemoc * epidemiologie etiologie komplikace MeSH
- lidé MeSH
- mortalita MeSH
- neinvazivní ventilace využití MeSH
- prognóza MeSH
- respirační insuficience epidemiologie etiologie terapie MeSH
- retrospektivní studie MeSH
- umělé dýchání * metody mortalita MeSH
- výběr pacientů MeSH
- Check Tag
- lidé MeSH
- MeSH
- lidé MeSH
- respirační insuficience diagnóza epidemiologie etiologie klasifikace patologie terapie MeSH
- Check Tag
- lidé MeSH
- MeSH
- chronická nemoc MeSH
- dospělí MeSH
- hypoxie komplikace MeSH
- lidé středního věku MeSH
- lidé MeSH
- obezita komplikace MeSH
- plicní hypertenze epidemiologie komplikace patologie MeSH
- respirační insuficience epidemiologie etiologie patologie MeSH
- senioři MeSH
- syndromy spánkové apnoe komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
