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1.
Medicine (Baltimore) ; 99(40): e21987, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019391

RESUMO

Intravenous fluid prescription is an essential part of postoperative care and may play a causal role in postoperative complications. The objective of the present study was to evaluate the relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of pediatric patients.This analysis included a retrospective review of 172 patients who underwent gastroenterological surgery from January 2012 to September 2018 at an academic tertiary care hospital. Patients were evaluated based on the median amount of corrected crystalloids and subsequently dichotomized as low (<25.89 mL/kg h) versus high (>25.89 mL/kg h). The primary outcome measure was the postoperative length of hospital stay (pLOS). Secondary outcome measures included the postoperative time to restore gastroenterological functions and postoperative complications.Patients who received larger amounts of crystalloids were more likely to have a lower intraoperative level of hemoglobin (P = .78) and an intraoperative blood transfusion (P = .27). There were trends toward lower incidence rates of hyperchloremic acidosis (P = .375) and metabolic acidosis (P = .54) in the high crystalloid administration cohort. The incidence of postoperative complications increased as the amount of administered fluid decreased (P = .046). The total length of hospital stay was shorter in patients who received high volumes of crystalloid fluid (19.5 [15.75-32.25] days) than in patients who received low volumes (22 [16-29.5] days, P = .283).Significant and multifaceted variability in crystalloid administration was noted among pediatric patients undergoing major surgery. High fluid administration was associated with favorable postoperative outcomes; these findings could be applied to improve patient safety and facilitate better quality of care.


Assuntos
Soluções Cristaloides/administração & dosagem , Enterocolite Necrosante/terapia , Hidratação/métodos , Administração Intravenosa , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Laparotomia/efeitos adversos , Laparotomia/métodos , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(40): e22195, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019394

RESUMO

BACKGROUND: Conflicting data have been reported related to the impact of atrial fibrillation (AF) on outcomes after transcatheter mitral valve repair with MitraClip (MC) implantation. In this study, we assessed the prognosis of MC-treated patients according to the presence of pre-existing AF. METHODS: Randomized and observational studies reporting outcomes of pre-existing AF or sinus rhythm in patients undergoing MC treatment were identified with an electronic search. Outcomes of interest were short-and long-term mortality, stroke, bleeding, rehospitalization, myocardial infarction (MI), cardiogenic shock, acute procedure success, the hospital stay, and the number of Clips implanted. RESULTS: Eight studies (8466 individuals) were eligible. Compared to sinus rhythm, long-term mortality, the risk of bleeding, rehospitalization, and longer hospital stay were significantly higher in AF groups, whereas similar correlations were found in the analysis of other outcomes. CONCLUSION: AF may be related with worse outcomes in patients undergoing MC implantation, including long-term mortality, major bleeding, and rehospitalization. AF should be taken into account when referring a patient for MC treatment.


Assuntos
Fibrilação Atrial/mortalidade , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Implante de Prótese de Valva Cardíaca/mortalidade , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Readmissão do Paciente/estatística & dados numéricos
3.
Medicine (Baltimore) ; 99(40): e22431, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019422

RESUMO

BACKGROUND: In this analysis, we aimed to systematically compare the procedural and post-operative complications (POC) associated with laparoscopic versus open abdominal surgery for right-sided colonic cancer resection. METHODS: We searched MEDLINE, http://www.ClinicalTrials.gov, EMBASE, Web of Science, Cochrane Central, and Google scholar for English studies comparing the POC in patients who underwent laparoscopic versus open surgery (OS) for right colonic cancer. Data were assessed by the Cochrane-based RevMan 5.4 software (The Cochrane Community, London, UK). Mean difference (MD) with 95% confidence intervals (CIs) were used to represent the results for continuous variables, whereas risk ratios (RR) with 95% CIs were used for dichotomous data. RESULTS: Twenty-six studies involving a total number of 3410 participants with right colonic carcinoma were included in this analysis. One thousand five hundred and fifteen participants were assigned to undergo invasive laparoscopic surgery whereas 1895 participants were assigned to the open abdominal surgery. Our results showed that the open resection was associated with a shorter length of surgery (MD: 48.63, 95% CI: 30.15-67.12; P = .00001) whereas laparoscopic intervention was associated with a shorter hospital stay [MD (-3.09), 95% CI [-5.82 to (-0.37)]; P = .03]. In addition, POC such as anastomotic leak (RR: 0.96, 95% CI: 0.60-1.55; P = .88), abdominal abscess (RR: 1.13, 95% CI: 0.52-2.49; P = .75), pulmonary embolism (RR: 0.40, 95% CI: 0.09-1.69; P = .21) and deep vein thrombosis (RR: 0.94, 95% CI: 0.39-2.28; P = .89) were not significantly different. Paralytic ileus (RR: 0.87, 95% CI: 0.67-1.11; P = .26), intra-abdominal infection (RR: 0.82, 95% CI: 0.15-4.48; P = .82), pulmonary complications (RR: 0.83, 95% CI: 0.57-1.20; P = .32), cardiac complications (RR: 0.73, 95% CI: 0.42-1.27; P = .27) and urological complications (RR: 0.83, 95% CI: 0.52-1.33; P = .44) were also similarly manifested. Our analysis also showed 30-day re-admission and re-operation, and mortality to be similar between laparoscopic versus OS for right colonic carcinoma resection. However, surgical wound infection (RR: 0.65, 95% CI: 0.50-0.86; P = .002) was significantly higher with the OS. CONCLUSIONS: In conclusion, laparoscopic surgery was almost comparable to OS in terms of post-operative outcomes for right-sided colonic cancer resection and was not associated with higher unwanted outcomes. Therefore, laparoscopic intervention should be considered as safe as the open abdominal surgery for right-sided colonic cancer resection, with a decreased hospital stay.


Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Idoso , Colectomia/efeitos adversos , Feminino , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia
4.
Einstein (Sao Paulo) ; 18: eAO5476, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33053018

RESUMO

OBJECTIVE: To propose a predictive model for the length of stay risk among children admitted to a pediatric intensive care unit based on demographic and clinical characteristics upon admission. METHODS: This was a retrospective cohort study conducted at a private and general hospital located in the municipality of Sao Paulo, Brazil. We used internal validation procedures and obtained an area under ROC curve for the to build of the predictive model. RESULTS: The mean hospital stay was 2 days. Predictive model resulted in a score that enabled the segmentation of hospital stay from 1 to 2 days, 3 to 4 days, and more than 4 days. The accuracy model from 3 to 4 days was 0.71 and model greater than 4 days was 0.69. The accuracy found for 3 to 4 days (65%) and greater than 4 days (66%) of hospital stay showed a chance of correctness, which was considering modest. Conclusion: Our results showed that low accuracy found in the predictive model did not enable the model to be exclusively adopted for decision-making or discharge planning. Predictive models of length of stay risk that consider variables of patients obtained only upon admission are limit, because they do not consider other characteristics present during hospitalization such as possible complications and adverse events, features that could impact negatively the accuracy of the proposed model.


Assuntos
Unidades de Terapia Intensiva Pediátrica , Tempo de Internação/estatística & dados numéricos , Brasil , Criança , Hospitalização , Humanos , Valor Preditivo dos Testes , Estudos Retrospectivos
5.
Artigo em Inglês | MEDLINE | ID: mdl-33080869

RESUMO

There are different patterns in the COVID-19 outbreak in the general population and amongst nursing home patients. We investigate the time from symptom onset to diagnosis and hospitalization or the length of stay (LoS) in the hospital, and whether there are differences in the population. Sciensano collected information on 14,618 hospitalized patients with COVID-19 admissions from 114 Belgian hospitals between 14 March and 12 June 2020. The distributions of different event times for different patient groups are estimated accounting for interval censoring and right truncation of the time intervals. The time between symptom onset and hospitalization or diagnosis are similar, with median length between symptom onset and hospitalization ranging between 3 and 10.4 days, depending on the age of the patient (longest delay in age group 20-60 years) and whether or not the patient lives in a nursing home (additional 2 days for patients from nursing home). The median LoS in hospital varies between 3 and 10.4 days, with the LoS increasing with age. The hospital LoS for patients that recover is shorter for patients living in a nursing home, but the time to death is longer for these patients. Over the course of the first wave, the LoS has decreased.


Assuntos
Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Hospitalização/estatística & dados numéricos , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Idoso , Bélgica/epidemiologia , Interpretação Estatística de Dados , Humanos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Casas de Saúde/estatística & dados numéricos , Pandemias , Resultado do Tratamento , Adulto Jovem
6.
Int J Med Sci ; 17(15): 2257-2263, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32922189

RESUMO

Background: Corona Virus Disease 2019 (COVID-19) has become a global pandemic. This study established prognostic scoring models based on comorbidities and other clinical information for severe and critical patients with COVID-19. Material and Methods: We retrospectively collected data from 51 patients diagnosed as severe or critical COVID-19 who were admitted between January 29, 2020, and February 18, 2020. The Charlson (CCI), Elixhauser (ECI), and age- and smoking-adjusted Charlson (ASCCI) and Elixhauser (ASECI) comorbidity indices were used to evaluate the patient outcomes. Results: The mean hospital length of stay (LOS) of the COVID-19 patients was 22.82 ± 12.32 days; 19 patients (37.3%) were hospitalized for more than 24 days. Multivariate analysis identified older age (OR 1.064, P = 0.018, 95%CI 1.011-1.121) and smoking (OR 3.696, P = 0.080, 95%CI 0.856-15.955) as positive predictors of a long LOS. There were significant trends for increasing hospital LOS with increasing CCI, ASCCI, and ASECI scores (OR 57.500, P = 0.001, 95%CI 5.687-581.399; OR 71.500, P = 0.001, 95%CI 5.689-898.642; and OR 19.556, P = 0.001, 95%CI 3.315-115.372, respectively). The result was similar for the outcome of critical illness (OR 21.333, P = 0.001, 95%CI 3.565-127.672; OR 13.000, P = 0.009, 95%CI 1.921-87.990; OR 11.333, P = 0.008, 95%CI 1.859-69.080, respectively). Conclusions: This study established prognostic scoring models based on comorbidities and clinical information, which may help with the graded management of patients according to prognosis score and remind physicians to pay more attention to patients with high scores.


Assuntos
Comorbidade , Infecções por Coronavirus/mortalidade , Estado Terminal/mortalidade , Modelos Estatísticos , Pneumonia Viral/mortalidade , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Tomada de Decisão Clínica , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos
7.
Bone Joint J ; 102-B(9): 1167-1175, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862686

RESUMO

AIMS: The aim of this prospective multicentre study was to describe trends in length of stay and early complications and readmissions following unicompartmental knee arthroplasty (UKA) performed at eight different centres in Denmark using a fast-track protocol and to compare the length of stay between centres with high and low utilization of UKA. METHODS: We included data from eight dedicated fast-track centres, all reporting UKAs to the same database, between 2010 and 2018. Complete ( > 99%) data on length of stay, 90-day readmission, and mortality were obtained during the study period. Specific reasons for a length of stay of > two days, length of stay > four days, and 30- and 90-day readmission were recorded. The use of UKA in the different centres was dichotomized into ≥ 20% versus < 20% of arthroplasties which were undertaken being UKAs, and ≥ 52 UKAs versus < 52 UKAs being undertaken annually. RESULTS: A total of 3,927 procedures were included. Length of stay (mean 1.1 days (SD 1.1), median 1 (IQR 0 to 1)) was unchanged during the study period. The proportion of procedures with a length of stay > two days was also largely unchanged during this time. The percentage of patients discharged on the day of surgery varied greatly between centres (0% to 50% (0 to 481)), with centres with high UKA utilization (both usage and volume) having a larger proportion of same-day discharges. The 30- and 90-day readmissions were 166 (4.2%) and 272 (6.9%), respectively; the 90-day mortality was 0.08% (n = 3). CONCLUSION: Our findings suggest general underutilization of the potential for quicker recovery following UKA in a fast-track setup. Cite this article: Bone Joint J 2020;102-B(9):1167-1175.


Assuntos
Artroplastia do Joelho/métodos , Idoso , Protocolos Clínicos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fatores de Tempo
8.
Crit Care Resusc ; 22(3): 237-244, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32900330

RESUMO

OBJECTIVES: To describe the characteristics and outcomes of adults with a subarachnoid haemorrhage (SAH) admitted to Australian and New Zealand intensive care units (ICUs) with a cardiac arrest in the preceding 24 hours. DESIGN: Retrospective cohort study. SETTING: Study data from 144 Australian and New Zealand ICUs were obtained from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database. PARTICIPANTS: A total of 439 of 11 047 (3.9%) patients admitted to an ICU with a SAH had a documented cardiac arrest in the 24 hours preceding their ICU admission. The mean age of patients with SAH and a preceding cardiac arrest was 55.3 years (SD, 13.7) and 251 of 439 (57.2%) were female. MAIN OUTCOME MEASURES: The primary outcome of interest was in-hospital mortality. Key secondary outcomes were ICU mortality, ICU and hospital lengths of stay, the proportion of patients discharged home. RESULTS: SAH patients with a history of cardiac arrest preceding ICU admission had a higher mortality rate (81.5% v 23.3%; P < 0.0001) and a lower rate of discharge home (4.6% v 37.0%; P < 0.0001) compared with patients with SAH who did not have a cardiac arrest. Among patients with SAH who had a cardiac arrest and survived, 20 of 81 (24.7%) were discharged home. In SAH patients with cardiac arrest, having a GCS of 3, the Australian and New Zealand Risk of Death score, and being admitted to ICU for palliative care or organ donation were significant predictors of in-hospital death. CONCLUSIONS: Almost one in five SAH patients who had a documented cardiac arrest in the 24 hours preceding ICU admission to an Australian and New Zealand ICU survived to hospital discharge, with around a quarter of these survivors discharged home. The neurological outcomes of these patients are uncertain, and understanding the burden of disability in survivors is an important area for further research.


Assuntos
Parada Cardíaca/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Hemorragia Subaracnóidea/mortalidade , Adulto , Austrália/epidemiologia , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Hemorragia Subaracnóidea/terapia
9.
BMC Med ; 18(1): 270, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32878619

RESUMO

BACKGROUND: The COVID-19 pandemic has placed an unprecedented strain on health systems, with rapidly increasing demand for healthcare in hospitals and intensive care units (ICUs) worldwide. As the pandemic escalates, determining the resulting needs for healthcare resources (beds, staff, equipment) has become a key priority for many countries. Projecting future demand requires estimates of how long patients with COVID-19 need different levels of hospital care. METHODS: We performed a systematic review of early evidence on length of stay (LoS) of patients with COVID-19 in hospital and in ICU. We subsequently developed a method to generate LoS distributions which combines summary statistics reported in multiple studies, accounting for differences in sample sizes. Applying this approach, we provide distributions for total hospital and ICU LoS from studies in China and elsewhere, for use by the community. RESULTS: We identified 52 studies, the majority from China (46/52). Median hospital LoS ranged from 4 to 53 days within China, and 4 to 21 days outside of China, across 45 studies. ICU LoS was reported by eight studies-four each within and outside China-with median values ranging from 6 to 12 and 4 to 19 days, respectively. Our summary distributions have a median hospital LoS of 14 (IQR 10-19) days for China, compared with 5 (IQR 3-9) days outside of China. For ICU, the summary distributions are more similar (median (IQR) of 8 (5-13) days for China and 7 (4-11) days outside of China). There was a visible difference by discharge status, with patients who were discharged alive having longer LoS than those who died during their admission, but no trend associated with study date. CONCLUSION: Patients with COVID-19 in China appeared to remain in hospital for longer than elsewhere. This may be explained by differences in criteria for admission and discharge between countries, and different timing within the pandemic. In the absence of local data, the combined summary LoS distributions provided here can be used to model bed demands for contingency planning and then updated, with the novel method presented here, as more studies with aggregated statistics emerge outside China.


Assuntos
Infecções por Coronavirus , Alocação de Recursos para a Atenção à Saúde , Tempo de Internação , Pandemias/estatística & dados numéricos , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/tendências , Número de Leitos em Hospital , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia
10.
Med Sci Monit ; 26: e926651, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: covidwho-792226

RESUMO

BACKGROUND Use of renin-angiotensin-aldosterone system inhibitors in coronavirus disease 2019 (COVID-19) patients lacks evidence and is still controversial. This study was designed to investigate effects of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on clinical outcomes of COVID-19 patients and to assess the safety of ACEIs/ARBs medication. MATERIAL AND METHODS COVID-19 patients with hypertension from 2 hospitals in Wuhan, China, from 17 Feb to 18 Mar 2020 were retrospectively screened and grouped according to in-hospital medication. We performed 1: 1 propensity score matching (PSM) analysis to adjust for confounding factors. RESULTS We included 210 patients and allocated them to ACEIs/ARBs (n=81; 46.91% males) or non-ACEIs/ARBs (n=129; 48.06% males) groups. The median age was 68 [interquartile range (IQR) 61.5-76] and 66 (IQR 59-72.5) years, respectively. General comparison showed mortality in the ACEIs/ARBs group was higher (8.64% vs. 3.88%) but the difference was not significant (P=0.148). ACEIs/ARBs was associated with significantly more cases 7-categorical ordinal scale >2 at discharge, more cases requiring Intensive Care Unit (ICU) stay, and increased values and ratio of days that blood pressure (BP) was above normal range (P<0.05). PSM analysis showed no significant difference in mortality, cumulative survival rate, or other clinical outcomes such as length of in-hospital/ICU stay, BP fluctuations, or ratio of adverse events between groups after adjustment for confounding parameters on admission. CONCLUSIONS We found no association between ACEIs/ARBs and clinical outcomes or adverse events, thus indicating no evidence for discontinuing use of ACEIs/ARBs in the COVID-19 pandemic.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/complicações , Hipertensão/complicações , Pandemias , Pneumonia Viral/complicações , Idoso , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Anti-Hipertensivos/efeitos adversos , China , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Hipertensão/tratamento farmacológico , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Peptidil Dipeptidase A/biossíntese , Peptidil Dipeptidase A/efeitos dos fármacos , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
11.
S Afr Med J ; 110(6): 537-539, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880568

RESUMO

BACKGROUND: Unplanned readmission within 30 days is currently being used in high-income countries (HICs) for measuring the quality of surgical care. Surgical site infection (SSI), abdominal complaints and pain are the most common causes for such readmission. The correlation between readmission rates and mortality, increased patient volumes and complexity of surgery remains controversial. OBJECTIVES: To explore the risk factors for unplanned readmission in the surgical population in a low- and middle-income country setting. METHODS: This is a retrospective review of prospectively collected data of unplanned 30-day readmissions from January 2014 to December 2017 in the Department of General Surgery, Worcester Hospital, South Africa (SA). Basic patient demographics, reasons for readmission, operative urgency and severity, wound class, length of stay and final outcomes were used to compare the inpatient cohort and identify predictors for unplanned readmission. RESULTS: A total of 9 649 patients were admitted to the general surgery department at Worcester Hospital - 2.87% (n=270) were unplanned readmissions within 30 days. The mean age of this cohort was 42 (standard deviation (SD) 22) years, with 61% male patients. SSI (60.37%; n=163), gastrointestinal complications (24.44%; n=66) and blood transfusion (7.03%; n=19) were the most common causes for readmission. Median initial length of stay (LOS) was 4 days; after readmission it was 5 days. Readmissions were responsible for 1 914 additional patient days. Operative Portsmouth-POSSUM (P-POSSUM) (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) score (p<0.001), increase in operative wound classification (p=0.001) and emergency surgical procedures (p=0.001) were significant risk factors for readmission within 30 days. CONCLUSIONS: The Department of General Surgery, Worcester Hospital, had a readmission rate comparable with that in HICs. Readmission rate is an indicator of advanced surgical pathology requiring an operative intervention of greater magnitude, often presenting as an emergency. Our results can be used to improve postoperative surveillance and ultimately improve outcomes in high-risk surgical populations. This study provides a benchmark for other regional hospitals in SA and has implications for quality-improvement programmes.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde , Procedimentos Cirúrgicos Operatórios , Adulto , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , África do Sul
12.
Med Sci Monit ; 26: e927212, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32883943

RESUMO

BACKGROUND The rapid worldwide spread of the coronavirus disease 2019 (COVID-19) epidemic has placed patients with pre-existing conditions at risk of severe morbidity and mortality. The present study investigated the clinical characteristics and outcomes of patients with severe COVID-19 and chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS This study enrolled 336 consecutive patients with confirmed severe COVID-19, including 28 diagnosed with COPD, from January 20, 2020, to April 1, 2020. Demographic data, symptoms, laboratory values, comorbidities, and clinical results were measured and compared in survivors and non-survivors. RESULTS Patients with severe COVID-19 and COPD were older than those without COPD. The proportions of men, of patients admitted to the intensive care unit (ICU) and of those requiring invasive ventilation were significantly higher in patients with than without COPD. Leukocyte and neutrophil counts, as well as the concentrations of NT-proBNP, hemoglobin, D-dimer, hsCRP, ferritin, IL-2R, TNF-alpha and procalcitonin were higher, whereas lymphocyte and monocyte counts were lower, in patients with than without COPD. Of the 28 patients with COPD, 22 (78.6%) died, a rate significantly higher than in patients without COPD (36.0%). A comparison of surviving and non-surviving patients with severe COVID-19 and COPD showed that those who died had a longer history of COPD, more fatigue, and a higher ICU occupancy rate, but a shorter average hospital stay, than those who survived. CONCLUSIONS COPD increases the risks of death and negative outcomes in patients with severe COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Distribuição por Idade , Idoso , Biomarcadores , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/terapia , Cuidados Críticos , Diabetes Mellitus/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Renal Crônica/epidemiologia , Respiração Artificial , Distribuição por Sexo , Sobreviventes , Resultado do Tratamento
13.
Med Sci Monit ; 26: e926393, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32914767

RESUMO

BACKGROUND The aim of this study was to determine the effect of C-reactive protein (CRP), lymphocytes (LYM), and the ratio of CRP to LYM (CRP/LYM) on assessing the prognosis of COVID-19 severity at early stages of disease. MATERIAL AND METHODS A total of 108 hospitalized patients diagnosed with COVID-19 in Zhongnan Hospital of Wuhan University from January 17, 2020 to March 12, 2020 were enrolled. Data of demographic parameters, clinical characteristics, laboratory indicators, clinical manifestation, and outcome of disease were collected. The patients were divided into a severe group and a non-severe group according to diagnosis and classification, which followed the guidelines and management of the Chinese National Health Council COVID-19. The receiver-operating characteristic (ROC) analysis and comparison of ROC curves were used for the laboratory findings for assessment of COVID-19 severity. RESULTS Of the 108 patients, 42 patients (38.9%) were male and 24 patients (22.2%) were considered severe cases, with the mean age of 51.0 years old. Males and patients with comorbidities were more likely to become severe cases. CRP increased and LYM decreased in the severe group.The results for the areas under the curve (AUC) of CRP/LYM and CRP used to assess severe COVID-19 were 0.787 (95% CI 0.698-0.860, P<0.0001) and 0.781 (95% CI 0.693-0.856, P<0.0001), respectively; both results were better than that of LYM. The associated criterion value of CRP/LYM was calculated, with an excellent sensitivity of 95.83%. CONCLUSIONS The effect of CRP/LYM and CRP on the assessment for severe COVID-19 may be superior to LYM alone. CRP/LYM is a highly sensitive indicator to assess the severity of COVID-19 in the early stage of disease.


Assuntos
Betacoronavirus , Proteína C-Reativa/análise , Infecções por Coronavirus/sangue , Contagem de Linfócitos , Pandemias , Pneumonia Viral/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Síndrome da Liberação de Citocina/sangue , Síndrome da Liberação de Citocina/etiologia , Progressão da Doença , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
15.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32913133

RESUMO

BACKGROUND: Despite the standardization of care, formula feeding varied across sites of the Ohio Perinatal Quality Collaborative (OPQC). We used orchestrated testing (OT) to learn from this variation and improve nonpharmacologic care of infants with neonatal abstinence syndrome (NAS) requiring pharmacologic treatment in Ohio. METHODS: To test the impact of formula on length of stay (LOS), treatment failure, and weight loss among infants hospitalized with NAS, we compared caloric content (high versus standard) and lactose content (low versus standard) using a 22 factorial design. During October 2015 to June 2016, OPQC sites joined 1 of 4 OT groups. We used response plots to examine the effect of each factor and control charts to track formula use and LOS. We used the OT results to revise the nonpharmacologic bundle and implemented it during 2017. RESULTS: Forty-seven sites caring for 546 NAS infants self-selected into the 4 OT groups. Response plots revealed the benefit of high-calorie formula (HCF) on weight loss, treatment failure, and LOS. The nonpharmacologic treatment bundle was updated to recommend HCF when breastfeeding was not possible. During implementation, HCF use increased, and LOS decreased from 17.1 to 16.4 days across the OPQC. CONCLUSIONS: OT revealed that HCF was associated with shorter LOS in OPQC sites. Implementation of a revised nonpharmacologic care bundle was followed by additional LOS improvement in Ohio. Despite some challenges in the implementation of OT, our findings support its usefulness for learning in improvement networks.


Assuntos
Ingestão de Energia , Fórmulas Infantis , Tempo de Internação/estatística & dados numéricos , Síndrome de Abstinência Neonatal/terapia , Feminino , Humanos , Recém-Nascido , Lactose/administração & dosagem , Metadona/administração & dosagem , Metadona/efeitos adversos , Morfina/administração & dosagem , Morfina/efeitos adversos , Ohio , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Melhoria de Qualidade/organização & administração , Ganho de Peso
16.
Cochrane Database Syst Rev ; 9: CD000433, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32964431

RESUMO

BACKGROUND: Preterm infants require high protein intake to achieve adequate growth and development. Although breast milk feeding has many benefits for this population, the protein content is highly variable, and inadequate to support rapid infant growth. This is a 2020 update of a Cochrane Review first published in 1999. OBJECTIVES: To determine whether protein-supplemented human milk compared with unsupplemented human milk, fed to preterm infants, improves growth, body composition, cardio-metabolic, and neurodevelopmental outcomes, without significant adverse effects. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL 2019, Issue 8) in the Cochrane Library and MEDLINE via PubMed on 23 August 2019. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: Published and unpublished RCTs were eligible if they used random or quasi-random methods to allocate hospitalised preterm infants who were being fed human milk, to additional protein supplementation or no supplementation. DATA COLLECTION AND ANALYSIS: Two review authors independently abstracted data, assessed risk of bias and the quality of evidence at the outcome level, using GRADE methodology. We performed meta-analyses, using risk ratio (RR) for dichotomous data, and mean difference (MD) for continuous data, with their respective 95% confidence intervals (CIs). We used a fixed-effect model and had planned to explore potential causes of heterogeneity via subgroup or sensitivity analyses. MAIN RESULTS: We included six RCTs, involving 204 preterm infants. The risk of bias for most methodological domains was unclear as there was insufficient detail reported. Low-quality evidence showed that protein supplementation of human milk may increase in-hospital rates of growth in weight (MD 3.82 g/kg/day, 95% CI 2.94 to 4.7; five RCTs, 101 infants; I² = 73%), length (MD 0.12 cm/wk, 95% CI 0.07 to 0.17; four RCTs, 68 infants; I² = 89%), and head circumference (MD 0.06 cm/wk, 95% CI 0.01 to 0.12; four RCTs, 68 infants; I² = 84%). Protein supplementation may lead to longer hospital stays (MD 18.5 days, 95% CI 4.39 to 32.61; one RCT, 20 infants; very low-quality evidence). Very low quality evidence means that the effect of protein supplementation on the risk of feeding intolerance (RR 2.70, 95% CI 0.13 to 58.24; one RCT, 17 infants), or necrotizing enterocolitis (RR 1.11, 95% CI 0.07 to 17.12; one RCT, 76 infants) remains uncertain. No data were available about the effects of protein supplementation on neurodevelopmental outcomes. AUTHORS' CONCLUSIONS: Low-quality evidence showed that protein supplementation of human milk, fed to preterm infants, increased short-term growth. However, the small sample sizes, low precision, and very low-quality evidence regarding duration of hospital stay, feeding intolerance, and necrotising enterocolitis precluded any conclusions about these outcomes. There were no data on outcomes after hospital discharge. Our findings may not be generalisable to low-resource settings, as none of the included studies were conducted in these settings. Since protein supplementation of human milk is now usually done as a component of multi-nutrient fortifiers, future studies should compare different amounts of protein in multi-component fortifiers, and be designed to determine the effects on duration of hospital stay and safety, as well as on long-term growth, body composition, cardio-metabolic, and neurodevelopmental outcomes.


Assuntos
Proteínas na Dieta , Suplementos Nutricionais , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido Prematuro/crescimento & desenvolvimento , Leite Humano , Viés , Estatura , Enterocolite Necrosante/epidemiologia , Cabeça/crescimento & desenvolvimento , Humanos , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Leite Humano/química , Ensaios Clínicos Controlados Aleatórios como Assunto , Ganho de Peso
17.
Yonsei Med J ; 61(10): 851-859, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32975059

RESUMO

PURPOSE: Thrombocytopenia (platelet count <150×10³/µL) is associated with poor outcomes in various critical illness settings. However, the prognostic value of platelet count in patients with cardiogenic shock (CS) remains unclear. MATERIALS AND METHODS: We enrolled 1202 patients between January 2014 and December 2018 from a multicenter retrospective-prospective cohort registry of CS. Clinical characteristics and treatment outcomes were compared between the patients with and without thrombocytopenia. RESULTS: At presentation with CS, 244 (20.3%) patients had thrombocytopenia. The patients with thrombocytopenia had lower blood pressure, hemoglobin level, and worse liver and renal functions compared to the patients without. During hospitalization, the patients with thrombocytopenia had more frequent gastrointestinal bleeding (10.5% vs. 3.8%, p=0.009), sepsis (8.3% vs. 2.6%, p=0.013), requirement of renal replacement therapy (36.5% vs. 18.9%, p<0.001), requirement of mechanical ventilation (65.2% vs. 54.4%, p=0.003), longer intensive care unit stay (8 days vs. 4 days, p<0.001), and thirty-day mortality (40.2% vs. 28.5%, p<0.001) compared to those without. In addition, the platelet count was an independent predictor of 30-day mortality (per 103/µL decrease; adjusted hazard ratio: 1.002, 95% confidence interval: 1.000-1.003, p=0.021). CONCLUSION: Thrombocytopenia at CS presentation was associated with worse clinical findings, higher frequencies of complications, and longer stay at the intensive care unit. Also, thrombocytopenia was independently associated with increased 30-day mortality. (Clinical trial registration No. NCT02985008).


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Choque Cardiogênico , Trombocitopenia , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Estado Terminal , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Contagem de Plaquetas , Prevalência , Prognóstico , Estudos Prospectivos , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Sepse/sangue , Sepse/epidemiologia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/terapia , Trombocitopenia/diagnóstico , Trombocitopenia/mortalidade , Trombocitopenia/terapia , Resultado do Tratamento
18.
Medicine (Baltimore) ; 99(38): e22175, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957341

RESUMO

BACKGROUND: Management of malignant diseases in elderly patients has become a global clinical issue because of increased life expectancy worldwide. Advancements in surgical techniques and perioperative management have reduced age-related contraindications for LPD. Past articles have reported that elderly patients undergoing laproscopic pancreatoduodenectomy (LPD) are at an increased risk compared to younger patients. The aim of this article is to compare a multicenter center risk of LPD in elderly and nonelderly patients. METHODS: Retrospective review (n = 237) of perisurgical outcomes in patients undergoing LPD during the months of September 2012 to December 2017. Outcomes in elderly patients (aged ≥75 years) were compared with those in nonelderly patients. RESULTS: Transfer to ICU was more frequent in elderly patients (odds ratio [OR] 6.49, P = .001) and the mean hospital stay was longer (21.4 days compared with 16.6 days), (P = .0033) than for nonelderly patients. There was no statistically significant difference in operation time (P = .494), estimated blood loss (P = .0519), blood transfusion (P = .863), decreased gastric emptying (P = .397), abdominal pain (P = .454), food intake (P = .241), time to self-ambulation (P = 1), reoperation (P = .543), postoperative pancreatic fistula (POPF) grade A (P = .454), POPF grade B (P = .736), POPF grade C (P = .164), hemorrhage (P = .319), bile leakage (P = .428), infection (P = .259), GI bleeding (P = .286), morbidity (P = .272) or mortality (P = .449) between the 2 groups. CONCLUSIONS: Elderly patients who underwent LPD in this study had good overall outcomes after LPD that were similar to young patients. The perioperative and long-term outcomes of LPD are not worse. Rates of ICU admission and hospital stays increased in elderly patients undergoing LPD when compared with nonelderly ones. LPD can be performed on elderly patients with similar outcomes as younger patients; therefore, age itself should not be a contraindication for LPD for pancreatic cancer, but it suggests that elderly patients with comorbidities should be more stringently selected for surgery.


Assuntos
Laparoscopia/métodos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos
19.
Medicine (Baltimore) ; 99(39): e22284, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991430

RESUMO

BACKGROUND: Plate fixation and intramedullary nail/Knowles pin fixation methods are commonly used to treat displaced midshaft clavicle fractures. However, the differences between these 2 methods are unclear. OBJECTIVE: This meta-analysis aimed to compare plate fixation and intramedullary nail/Knowles pin fixation for displaced midshaft clavicle fractures. METHODS: We searched PubMed, EBM reviews, and Ovid Medline online for studies related to comparison of plate fixation versus intramedullary nail/Knowles pin fixation for displaced midshaft clavicle fracture from inception to June 30, 2019. Relevant literature search, data extraction, and quality assessment will be performed by 2 researchers independently. The methodological quality of all included studies was appraised using the Cochrane system for randomized trials. The RevMan 5.2 software was used for heterogeneity assessment, generating funnel-plots, data synthesis, sensitivity analysis, and determining publication bias. The fixed-effects or random-effects model was used to calculate mean difference (MD)/relative risks (RRs) and 95% confidence intervals (CIs). RESULTS: This meta-analysis included 839 patients from 12 randomized controlled trials. We found that compared to plate fixation, intramedullary nail/Knowles pin fixation yielded a higher shoulder constant score [MD = -2.43, 95% CI (-3.46 to -1.41), P < .00001] and lower disabilities of the arm, shoulder and hand (DASH) score [MD = 2.98, 95% CI (0.16-5.81), P = .04], and lower infection rates [RR = 2.05, 95% CI (1.36-3.09), P = .003], operation time [MD = 20.20, 95% CI (10.80-29.60), P < .0001], incision size [MD = 6.09, 95% CI (4.54-7.65), P < .00001], and hospital stay [MD = 1.10, 95% CI (0.56-1.64), P < .00001] but with a higher removal rate [RR = 0.52, 95% CI (0.41-0.65), P < .00001] compared to plate fixation. There were no significant differences in nonunion, reintervention, or revision and refracture between these two methods. The limitation is that many studies did not demonstrate the random generated details, and only English articles were enrolled in this meta-analysis. CONCLUSIONS: Intramedullary nail/Knowles pin fixation might be an optimum choice for treating displaced midshaft clavicle fractures, with similar performance in terms of the nonunion, reintervention, or revision and refracture, and better shoulder constant and DASH scores, infection rates, and operative parameters.


Assuntos
Placas Ósseas/efeitos adversos , Clavícula/patologia , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Adulto , Pinos Ortopédicos/efeitos adversos , Avaliação da Deficiência , Feminino , Fixação Intramedular de Fraturas/instrumentação , Fraturas Ósseas/classificação , Fraturas não Consolidadas/epidemiologia , Humanos , Infecções/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Garantia da Qualidade dos Cuidados de Saúde/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/estatística & dados numéricos , Risco , Sensibilidade e Especificidade , Ferida Cirúrgica/classificação , Ferida Cirúrgica/epidemiologia
20.
A A Pract ; 14(9): e01295, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32909725

RESUMO

We report for the first time therapy-resistant hypernatremia (plasma sodium concentration ≥150 mmol per liter) developing in 6 of 12 critically ill coronavirus disease 2019 (COVID-19) patients age 57-84 years requiring mechanical ventilation. There was no correlation between plasma sodium concentrations and sodium input. Plasma concentrations of chloride were elevated, those of potassium decreased. These findings are consistent with abnormally increased renal sodium reabsorption, possibly caused by increased angiotensin II activity secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced downregulation of angiotensin-converting enzyme 2 (ACE2) receptors. As hypernatremia was associated with increased length of intensive care unit stay, special attention should be paid to the electrolyte status of COVID-19 patients.


Assuntos
Infecções por Coronavirus/complicações , Hidratação/métodos , Hipernatremia/complicações , Natriuréticos/uso terapêutico , Pneumonia Viral/complicações , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Estudos de Casos e Controles , Cloretos/sangue , Estudos de Coortes , Infecções por Coronavirus/sangue , Feminino , Hidratação/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Hipernatremia/sangue , Hipernatremia/epidemiologia , Hipernatremia/terapia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , Diálise Renal , Respiração Artificial , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Estudos Retrospectivos
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