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Wyświetlanie 1-10 z 31
Tytuł:
Reliability of the Clinical Frailty Scale in very elderly ICU patients : a prospective European study
Autorzy:
Nalapko, Yuriy
Moreno, Rui
Oeyen, Sandra
Jung, Christian
Artigas, Antonio
Leaver, Susannah
Marsh, Brian
Fjolner, Jesper
Andersen, Finn H.
Joannidis, Michael
Elhadi, Muhammed
Watson, Ximena
Walther, Sten
Zafeiridis, Tilemachos
Guidet, Bertrand
Szczeklik, Wojciech
Boumendil, Ariane
Schefold, Joerg C.
Cecconi, Maurizio
Flaatten, Hans
De Lange, Dylan W.
Opis:
Purpose: Frailty is a valuable predictor for outcome in elderly ICU patients, and has been suggested to be used in various decision-making processes prior to and during an ICU admission. There are many instruments developed to assess frailty, but few of them can be used in emergency situations. In this setting the clinical frailty scale (CFS) is frequently used. The present study is a sub-study within a larger outcome study of elderly ICU patients in Europe (the VIP-2 study) in order to document the reliability of the CFS. Materials and methods: From the VIP-2 study, 129 ICUs in 20 countries participated in this sub-study. The patients were acute admissions≥80 years of age and frailty was assessed at admission by two independent observers using the CFS. Information was obtained from the patient, if not feasible, from the family/caregivers or from hospital fles. The profession of the rater and source of data were recorded along with the score. Interrater variability was calculated using linear weighted kappa analysis. Results: 1923 pairs of assessors were included and background data of patients were similar to the whole cohort (n=3920). We found a very high inter-rater agreement (weighted kappa 0.86), also in subgroup analyses. The agreement when comparing information from family or hospital records was better than using only direct patient information, and pairs of raters from same profession performed better than from diferent professions. Conclusions: Overall, we documented a high reliability using CFS in this setting. This frailty score could be used more frequently in elderly ICU patients in order to create a more holistic and realistic impression of the patient´s condition prior to ICU admission.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
Noninvasive ventilation in COVID-19 patients aged >= 70 years - a prospective multicentre cohort study
Autorzy:
Moreno, Rui
Wernly, Bernhard
Polok, Kamil
Oeyen, Sandra
Artigas, Antonio
Jung, Christian
Studzińska, Dorota
Leaver, Susannah
Marsh, Brian
Fjolner, Jesper
Andersen, Finn H.
Joannidis, Michael
Bollen Pinto, Bernardo
Bruno, Raphael Romano
Guidet, Bertrand
Szczeklik, Wojciech
Schefold, Joerg C.
Cecconi, Maurizio
Flaatten, Hans
Beil, Michael
Sviri, Sigal
Fronczek, Jakub
de Lange, Dylan W.
Opis:
Background: Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. Methods: This is a substudy of COVIP study—an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. Results: Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36–5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06–2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI − 2.27 to − 0.46 days) compared to primary IMV group (n = 1876). Conclusions: Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic
Autorzy:
Moreno, Rui
Wernly, Bernhard
Polok, Kamil
Oeyen, Sandra
Artigas, Antonio
Jung, Christian
Studzińska, Dorota
Pinto, Bernardo Bollen
Leaver, Susannah
Marsh, Brian
Fjolner, Jesper
Andersen, Finn H.
Joannidis, Michael
Bruno, Raphael Romano
Guidet, Bertrand
Szczeklik, Wojciech
Schefold, Joerg C.
Cecconi, Maurizio
Flaatten, Hans
Beil, Michael
Sviri, Sigal
Fronczek, Jakub
De Lange, Dylan W.
Opis:
Background Non-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic. Methods We analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2—2018 to 2019) and admitted due to COVID-19 (COVIP—March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days). Results The final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80). Conclusion The outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Wyświetlanie 1-10 z 31

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