Assessing the cost-effectiveness of capnography for end-tidal CO2 monitoring during in-hospital cardiac arrest: A middle-income country perspective analysis.

Study objective: To evaluate the cost-effectiveness of EtCO2 monitoring during in-hospital cardiorespiratory arrest (CA) care outside the intensive care unit (ICU) and emergency room department. Design: We performed a cost-effectiveness analysis based on a simple decision model cost analysis and reported the study using the CHEERS checklist. Model inputs were derived from a retrospective Brazilian cohort study, complemented by information obtained through a literature review. Cost inputs were gathered from both literature sources and contacts with hospital suppliers. Setting: The analysis was carried out from the perspective of a tertiary referral hospital in a middle-income country. Participants: The study population comprised individuals experiencing in-hospital CA who received cardiopulmonary resuscitation (CPR) by rapid response team (RRT) in a hospital ward, not in the ICU or emergency room department. Interventions: Two strategies were assumed for comparison: one with an RRT delivering care without capnography during CPR and the other guiding CPR according to the EtCO2 waveform. Main outcome measures: Incremental cost-effectiveness rate (ICER) to return of spontaneous circulation (ROSC), hospital discharge, and hospital discharge with good neurological outcomes. Results: The ICER for EtCO2 monitoring during CPR, resulting in an absolute increase of one more case with ROSC, hospital discharge, and hospital discharge with good neurological outcome, was calculated at Int$ 515.78 (361.57-1201.12), Int$ 165.74 (119.29-248.4), and Int$ 240.55, respectively. Conclusion: In managing in-hospital CA in the hospital ward, incorporating EtCO2 monitoring is likely a cost-effective measure within the context of a middle-income country hospital with an RRT.

Bacterial coinfections in COVID-19-hospitalized patients.

OBJECTIVE: The aim of this study was to assess the rate of bacterial infections in COVID-19-hospitalized patients and to analyze the most prevalent germs, sources, risk factors, and its impact on in-hospital mortality. METHODS: This observational retrospective study was conducted on 672 patients hospitalized between April and August 2020 in Nossa Senhora da Conceição Hospital, a public hospital located in Porto Alegre, Brazil. The inclusion criterion was adult patients hospitalized with confirmed COVID-19. Data were collected through chart review. Risk factors for bacterial infection and mortality were analyzed using both univariate and multivariate robust Poisson regression models. RESULTS: Bacterial coinfection was observed in 22.2% of patients. Risk factors for bacterial infections were dementia (RR=2.06 (1.18-3.60); p=0.011), cerebrovascular disease (RR=1.75 (1.15-2.67); p=0.009), active cancer (RR=1.52 (1.082-2.15); p=0.01), need for noninvasive ventilation (RR=2.320 (1.740-3.094); p<0.01), invasive mechanical ventilation (RR=4.63 (2.24-9.56); p<0.01), and renal replacement therapy (RR=1.68 (1.26-2.25); p<0.01). In the adjusted model, bacterial infections were not associated with mortality (0.96 (0.75-1.24); p=0.79). The most common source of infection was due to respiratory, blood, and central venous catheters, with 69 (29.36%), 61 (25.96%), and 59 (25.11%) positive cultures, respectively. CONCLUSION: We observed a high rate of bacterial infections in COVID-19-hospitalized patients, most commonly of respiratory source. Neurologic and oncologic morbidities and need for ventilation and renal replacement therapy was associated with risk factors for bacterial infections. Nevertheless, an association between bacterial infections and hospital mortality was not established.

Bacterial coinfections in COVID-19-hospitalized patients

SUMMARY OBJECTIVE: The aim of this study was to assess the rate of bacterial infections in COVID-19-hospitalized patients and to analyze the most prevalent germs, sources, risk factors, and its impact on in-hospital mortality. METHODS: This observational retrospective study was conducted on 672 patients hospitalized between April and August 2020 in Nossa Senhora da Conceição Hospital, a public hospital located in Porto Alegre, Brazil. The inclusion criterion was adult patients hospitalized with confirmed COVID-19. Data were collected through chart review. Risk factors for bacterial infection and mortality were analyzed using both univariate and multivariate robust Poisson regression models. RESULTS: Bacterial coinfection was observed in 22.2% of patients. Risk factors for bacterial infections were dementia (RR=2.06 (1.18-3.60); p=0.011), cerebrovascular disease (RR=1.75 (1.15-2.67); p=0.009), active cancer (RR=1.52 (1.082-2.15); p=0.01), need for noninvasive ventilation (RR=2.320 (1.740-3.094); p<0.01), invasive mechanical ventilation (RR=4.63 (2.24-9.56); p<0.01), and renal replacement therapy (RR=1.68 (1.26-2.25); p<0.01). In the adjusted model, bacterial infections were not associated with mortality (0.96 (0.75-1.24); p=0.79). The most common source of infection was due to respiratory, blood, and central venous catheters, with 69 (29.36%), 61 (25.96%), and 59 (25.11%) positive cultures, respectively. CONCLUSION: We observed a high rate of bacterial infections in COVID-19-hospitalized patients, most commonly of respiratory source. Neurologic and oncologic morbidities and need for ventilation and renal replacement therapy was associated with risk factors for bacterial infections. Nevertheless, an association between bacterial infections and hospital mortality was not established.

Internal medicine consultation for high-risk surgical patients: reflection on hospital mortality and readmission rates in a low-income country.

OBJECTIVE: The objective of this study was to assess the impact of internal medicine consultation on mortality, 30-day readmission, and length of stay in surgical patients. METHODS: This is a retrospective descriptive study developed in a public Brazilian teaching hospital with 850 beds. RESULTS: A total of 70,245 patients were admitted from 2010 to 2018 to the surgery departments. The main outcomes measured were patients' mortality, 30-day readmission, and length of stay. Mortality of high-risk patients was lower when followed by internal medicine consultation: patients with ASA≥3 (RR 0.89 [95% confidence interval (95%CI) 0.80-0.99], p=0.02), patients with ASA≥3 plus≥65 years (RR 0.88 [95%CI 0.78-0.99], p=0.04), patients with ASA≥3 plus high-risk surgery (RR 0.86 [95%CI 0.77-0.97], p=0.01), and patients with ASA≥4 plus age ≥65 years (RR 0.83 [95%CI 0.72-0.96], p=0.01). The 30-day readmission of high-risk patients was lower when followed by internal medicine consultation: patients with ≥65 years (RR 0.57 [95%CI 0.37-0.89], p=0.01) and patients with high-risk surgery (RR 0.63 [95%CI 0.46-0.57], p=0.005). The Poisson multivariate regression with adjustment in variances showed that all the variables (namely, age, ASA, morbidity index, surgery risk, and internal medicine consultation) were associated with higher mortality of patients; however, internal medicine consultation was associated with a reduction of mortality in high-risk patients (RR 0.72 [95%CI 0.65-0.84], p=0.02) and an increase of mortality in low-risk patients (RR 1.55 [95%CI 1.31-1.67], p=0.01). CONCLUSION: High-risk surgical patients may benefit from perioperative internal medicine consultations, which probably decrease hospital mortality and 30-day hospital readmission.