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Wyświetlanie 1-10 z 27
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:
Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe
Autorzy:
Moreno, Rui
Wernly, Bernhard
Andersen, Finn
Oeyen, Sandra
Jung, Christian
Artigas, Antonio
Leaver, Susannah
Wolff, Georg
Fjolner, Jesper
Czuczwar, Miroslaw
Joannidis, Michael
Bollen Pinto, Bernardo
Zafeiridis, Tilemachos
Bruno, Raphael Romano
Guidet, Bertrand
Szczeklik, Wojciech
Boumendil, Ariane
Schefold, Joerg C.
Flaatten, Hans
Beil, Michael
Sviri, Sigal
De Lange, Dylan
van Heerden, Peter Vernon
Kelm, Malte
Opis:
Background: The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe. Methods: This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265). Results: In total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO2/FiO2 ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78% versus 68%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57% vs 50%) as well as after 90 days (51% vs 40%). Conclusion: An unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
The impact of frailty on survival in elderly intensive care patients with COVID-19 : the COVIP study
Autorzy:
De Lange, Dylan W.
Wernly, Bernhard
Flaatten, Hans
Moreno, Rui
Guidet, Bertrand
Bruno, Raphael Romano
Artigas, Antonio
Czuczwar, Miroslaw
Szczeklik, Wojciech
Andersen, Finn H.
Leaver, Susannah
Zafeiridis, Tilemachos
Fjolner, Jesper
Wolff, Georg
Joannidis, Michael
Cecconi, Maurizio
Marsh, Brian
Oeyen, Sandra
Schefold, Joerg C.
Beil, Michael
Sviri, Sigal
van Heerden, Peter Vernon
Bollen Pinto, Bernardo
Kelm, Malte
Jung, Christian
Boumendil, Ariane
Elhadi, Muhammed
Opis:
Background: The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. Methods: A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. Results: The study included 1346 patients (28% female) with a median age of 75 years (IQR 72–78, range 70–96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56–62), with 66% (63–69) in fit, 53% (47–61) in vulnerable and 41% (35–47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival. Conclusion: Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19 : results from an international prospective multicentre trial
Autorzy:
Wernly, Bernhard
de Lange, Dylan W.
Binnebossel, Stephan
Flaatten, Hans
Moreno, Rui
Baldia, Philipp Heinrich
Guidet, Bertrand
Sigal, Sviri
Erkens, Ralf
Artigas, Antonio
Bruno, Raphael Romano
Szczeklik, Wojciech
Andersen, Finn H.
Leaver, Susannah
Fjolner, Jesper
Wolff, Georg
Joannidis, Michael
Marsh, Brian
Oeyen, Sandra
Schefold, Joerg C.
Beil, Michael
van Heerden, Peter Vernon
Bollen Pinto, Bernardo
Kelm, Malte
Jung, Christian
Elhadi, Muhammed
Opis:
Background: In the early COVID-19 pandemic concerns about the correct choice of analgesics in patients with COVID-19 were raised. Little data was available on potential usefulness or harmfulness of prescription free analgesics, such as paracetamol. This international multicentre study addresses that lack of evidence regarding the usefulness or potential harm of paracetamol intake prior to ICU admission in a setting of COVID-19 disease within a large, prospectively enrolled cohort of critically ill and frail intensive care unit (ICU) patients. Methods: This prospective international observation study (The COVIP study) recruited ICU patients ≥ 70 years admitted with COVID-19. Data on Sequential Organ Failure Assessment (SOFA) score, prior paracetamol intake within 10 days before admission, ICU therapy, limitations of care and survival during the ICU stay, at 30 days, and 3 months. Paracetamol intake was analysed for associations with ICU-, 30-day- and 3-month-mortality using Kaplan Meier analysis. Furthermore, sensitivity analyses were used to stratify 30-day-mortality in subgroups for patient-specific characteristics using logistic regression. Results: 44% of the 2,646 patients with data recorded regarding paracetamol intake within 10 days prior to ICU admission took paracetamol. There was no difference in age between patients with and without paracetamol intake. Patients taking paracetamol suffered from more co-morbidities, namely diabetes mellitus (43% versus 34%, p < 0.001), arterial hypertension (70% versus 65%, p = 0.006) and had a higher score on Clinical Frailty Scale (CFS; IQR 2–5 versus IQR 2–4, p < 0.001). Patients under prior paracetamol treatment were less often subjected to intubation and vasopressor use, compared to patients without paracetamol intake (65 versus 71%, p < 0.001; 63 versus 69%, p = 0.007). Paracetamol intake was not associated with ICU-, 30-day- and 3-month-mortality, remaining true after multivariate adjusted analysis. Conclusion: Paracetamol intake prior to ICU admission was not associated with short-term and 3-month mortality in old, critically ill intensive care patients suffering from COVID-19.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
Health-related quality of life in older patients surviving ICU treatment for COVID-19 : results from an international observational study of patients older than 70 years
Autorzy:
Wernly, Bernhard
de Lange, Dylan W.
Flaatten, Hans
Moreno, Rui
Guidet, Bertrand
Artigas, Antonio
Wollborn, Jakob
Szczeklik, Wojciech
Andersen, Finn H.
Leaver, Susannah
Zafeiridis, Tilemachos
Fjolner, Jesper
Bruno, Raphael R.
Joannidis, Michael
Marsh, Brian
Oeyen, Sandra
Schefold, Joerg C.
Beil, Michael
Sviri, Sigal
van Heerden, Peter Vernon
Bollen Pinto, Bernardo
Soliman, Ivo W.
Fuest, Kristina
Jung, Christian
Banzo, Maria Jose Arche
Boumendil, Ariane
Elhadi, Muhammed
Opis:
Background: health-related quality of life (HRQoL) is an important patient-centred outcome in patients surviving ICU admission for COVID-19. It is currently not clear which domains of the HRQoL are most affected. Objective: to quantify HRQoL in order to identify areas of interventions. Design: prospective observation study. Setting: admissions to European ICUs between March 2020 and February 2021. Subjects: patients aged 70 years or older admitted with COVID-19 disease.Methods: collected determinants include SOFA-score, Clinical Frailty Scale (CFS), number and timing of ICU procedures and limitation of care, Katz Activities of Daily Living (ADL) dependence score. HRQoL was assessed at 3 months after ICU admission with the Euro-QoL-5D-5L questionnaire. An outcome of ≥4 on any of Euro-QoL-5D-5L domains was considered unfavourable. Results: in total 3,140 patients from 14 European countries were included in this study. Three months after inclusion, 1,224 patients (39.0%) were alive and the EQ-5D-5L from was obtained. The CFS was associated with an increased odds ratio for an unfavourable HRQoL outcome after 3 months; OR 1.15 (95% confidence interval (CI): 0.71–1.87) for CFS 2 to OR 4.33 (95% CI: 1.57–11.9) for CFS ≧ 7. The Katz ADL was not statistically significantly associated with HRQoL after 3 months. Conclusions: in critically ill old intensive care patients suffering from COVID-19, the CFS is associated with the subjectively perceived quality of life. The CFS on admission can be used to inform patients and relatives on the risk of an unfavourable qualitative outcome if such patients survive.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Wyświetlanie 1-10 z 27

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