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1.
Medicine (Baltimore) ; 99(51): e23764, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371141

RESUMO

ABSTRACT: Passive leg raising (PLR) is a convenient and reliable test to predict fluid responsiveness. The ability of thoracic electrical bioimpedance cardiography (TEB) to monitor changes of cardiac output (CO) during PLR is unknown.In the present study, we measured CO in 61 patients with shock or dyspnea by TEB and transthoracic echocardiography (TTE) during PLR procedure. Positive PLR responsiveness was defined as the velocity-time integral (VTI) ≥10% after PLR. TTE measured VTI in the left ventricular output tract. The predictive value of TEB parameters in PLR responders was tested. Furthermore, the agreement of absolute CO values between TEB and TTE measurements was assessed.Among the 61 patients, there were 28 PLR-responders and 33 non-responders. Twenty-seven patients were diagnosed with shock and 34 patients with dyspnea, with 55.6% (15/27) and 54.6% (18/34) non-responders, respectively. A change in TEB measured CO (ΔCO) ≥9.8% predicted PLR responders with 75.0% sensitivity and 78.8% specificity, the area under the receiver operating characteristic curve (AUROC) was 0.79. The Δd2Z/dt2 (a secondary derivative of the impedance wave) showed the best predictive value with AUROC of 0.90, the optimal cut point was -7.1% with 85.7% sensitivity and 87.9% specificity. Bias between TEB and TTE measured CO was 0.12 L/min, and the percentage error was 65.8%.TEB parameters had promising performance in predicting PLR responders, and the Δd2Z/dt2 had the best predictive value. The CO values measured by TEB were not interchangeable with TTE in critically ill settings.


Assuntos
Débito Cardíaco/fisiologia , Cardiografia de Impedância/instrumentação , Hemodinâmica/fisiologia , Adulto , Idoso , Área Sob a Curva , Cardiografia de Impedância/métodos , China , Estado Terminal , Ecocardiografia/métodos , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/tendências , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Estatísticas não Paramétricas
2.
J Prev Med Public Health ; 53(6): 387-396, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33296578

RESUMO

OBJECTIVES: The lack of advance planning in a public health emergency can lead to wasted resources and inadvertent loss of lives. This study is aimed at forecasting the needs for healthcare resources following the expansion of the coronavirus disease 2019 (COVID-19) outbreak in the Republic of Kazakhstan, focusing on hospital beds, equipment, and the professional workforce in light of the developing epidemiological situation and the data on resources currently available. METHODS: We constructed a forecast model of the epidemiological scenario via the classic susceptible-exposed-infected-removed (SEIR) approach. The World Health Organization's COVID-19 Essential Supplies Forecasting Tool was used to evaluate the healthcare resources needed for the next 12 weeks. RESULTS: Over the forecast period, there will be 104 713.7 hospital admissions due to severe disease and 34 904.5 hospital admissions due to critical disease. This will require 47 247.7 beds for severe disease and 1929.9 beds for critical disease at the peak of the COVID-19 outbreak. There will also be high needs for all categories of healthcare workers and for both diagnostic and treatment equipment. Thus, Republic of Kazakhstan faces the need for a rapid increase in available healthcare resources and/or for finding ways to redistribute resources effectively. CONCLUSIONS: Republic of Kazakhstan will be able to reduce the rates of infections and deaths among its population by developing and following a consistent strategy targeting COVID-19 in a number of inter-related directions.


Assuntos
/epidemiologia , Controle de Doenças Transmissíveis/tendências , Surtos de Doenças/prevenção & controle , Pessoal de Saúde/tendências , Pandemias/prevenção & controle , /terapia , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/tendências , Cazaquistão/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde
3.
Diabetes Metab Syndr ; 14(6): 1979-1986, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33080538

RESUMO

BACKGROUND AND AIMS: Given the limited information describing the connection between metabolic syndrome (MetS) and Coronavirus Disease 2019 (COVID-19), we aimed to assess the impact of MetS on morbidity and mortality among COVID-19 patients. METHODS: This retrospective cohort study was performed from 1st April to May 3, 2020 on 157 ICU-admitted COVID-19 patients in Shahid Modarres Hospital in Tehran, Iran. Patients' clinical, laboratory and radiological findings, and subsequent complications, were collected and compared between MetS and non-MetS groups. RESULTS: 74 of all cases had MetS. Among the MetS components, waist circumference (p-value = 0.006 for men; p-value<0.0001 for women), Triglycerides (p-value = 0.002), and Fasting Blood Sugar (p-value = 0.007) were significantly higher in MetS group; with no statistical difference found in HDL levels (p-value = 0.21 for men; p-value = 0.13 for women), systolic blood pressure(p-value = 0.07), and diastolic blood pressure (p-value = 0.18) between two groups. Length of ICU admission (p-value = 0.009), the need for invasive mechanical ventilation (p-value = 0.0001), respiratory failure (p-value = 0.0008), and pressure ulcers (p-value = 0.02) were observed significantly more in MetS group. The Odds Ratio (OR) of mortality with 0(OR = 0.3660), 1(OR = 0.5155), 2(OR = 0.5397), 3(OR = 1.9511), 4(OR = 5.7018), and 5(OR = 8.3740) MetS components showed an increased mortality risk as the components' count increased. The patient with BMI>40 (OR = 6.9368) had more odds of fatality comparing to those with BMI>35 (OR = 4.0690) and BMI>30 (OR = 2.5287). Furthermore, the waist circumference (OR = 8.31; p-value<0.0001) and fasting blood sugar (OR = 2.4588; p-value = 0.0245) were obtained by multivariate logistic regression as independent prognostic factors for mortality. CONCLUSION: The findings suggest a strong relationship between having MetS and increased risk of severe complications and mortality among COVID-19 ICU-admitted patients.


Assuntos
/diagnóstico , Unidades de Terapia Intensiva/tendências , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/mortalidade , Admissão do Paciente/tendências , Idoso , Estudos de Coortes , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Síndrome Metabólica/terapia , Pessoa de Meia-Idade , Morbidade/tendências , Mortalidade/tendências , Estudos Retrospectivos
4.
Intensive Care Med ; 46(12): 2423-2435, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33095284

RESUMO

Obesity is an important risk factor for major complications, morbidity and mortality related to intubation procedures and ventilation in the intensive care unit (ICU). The fall in functional residual capacity promotes airway closure and atelectasis formation. This narrative review presents the impact of obesity on the respiratory system and the key points to optimize airway management, noninvasive and invasive mechanical ventilation in ICU patients with obesity. Non-invasive strategies should first optimize body position with reverse Trendelenburg position or sitting position. Noninvasive ventilation (NIV) is considered as the first-line therapy in patients with obesity having a postoperative acute respiratory failure. Positive pressure pre-oxygenation before the intubation procedure is the method of reference. The use of videolaryngoscopy has to be considered by adequately trained intensivists, especially in patients with several risk factors. Regarding mechanical ventilation in patients with and without acute respiratory distress syndrome (ARDS), low tidal volume (6 ml/kg of predicted body weight) and moderate to high positive end-expiratory pressure (PEEP), with careful recruitment maneuver in selected patients, are advised. Prone positioning is a therapeutic choice in severe ARDS patients with obesity. Prophylactic NIV should be considered after extubation to prevent re-intubation. If obesity increases mortality and risk of ICU admission in the overall population, the impact of obesity on ICU mortality is less clear and several confounding factors have to be taken into account regarding the "obesity ICU paradox".


Assuntos
Unidades de Terapia Intensiva/tendências , Obesidade/terapia , Respiração Artificial/métodos , /fisiopatologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Obesidade/fisiopatologia , Respiração Artificial/tendências , Fatores de Risco , Volume de Ventilação Pulmonar
5.
Healthc (Amst) ; 8(4): 100489, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33129180

RESUMO

BACKGROUND: In anticipation of patient surge due to COVID-19, many states are working to increase the available healthcare workforce. To help inform state policies and initiatives aimed at physician deployment during COVID-19, we used predictions of peak patient volume for hospitals and intensive care units (ICU) and regional physician workforce estimates to measure patient to physician ratios at the peak of the pandemic for each state. METHODS: We estimated the number of potentially available physicians based on Medicare Part B billings for the care of hospitalized and critically ill patients in 2017, adjusted for attrition due to exposure to SARS-CoV-2 and relevant experience. We used estimates from the Institute of Health Metrics and Evaluation to determine the number of hospitalized and ICU patients expected at the peak of the pandemic in each state. We then determined the expected ratio of patients per physician for each state at the peak of the pandemic. RESULTS: The median number of hospitalized patients per physician was 13 (low estimate) to 18 (high estimate). At the high estimate of hospitalized patients, 35 states would have a patient to physician ratio of more than 15:1 (patient to physician ratios above 15:1 have been associated with poor outcomes). For ICU patients, the median number of patients each physician would treat across states would be 8-11 patients. Nine states would experience patient to physician ratios above 15:1 at the higher end of estimates. Patient-physician ratios decreased if the available physician pool was broadened to include physicians without recent experience treating hospitalized patients, and physicians in surgical specialties with experience treating acutely hospitalized patients. CONCLUSIONS/IMPLICATIONS: We estimate that most states will have sufficient physician capacity to manage hospitalized patients at the peak of the pandemic. However, at the high estimates of hospitalized patients, some Midwestern states will experience high patient to provider ratios that may adversely affect patient outcomes. LEVEL OF EVIDENCE: State.


Assuntos
Hospitalização/tendências , Unidades de Terapia Intensiva/tendências , Médicos/provisão & distribução , Humanos , Medicare/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Pandemias , Estados Unidos
6.
BMJ ; 371: m3588, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028597

RESUMO

OBJECTIVE: To replicate and analyse the information available to UK policymakers when the lockdown decision was taken in March 2020 in the United Kingdom. DESIGN: Independent calculations using the CovidSim code, which implements Imperial College London's individual based model, with data available in March 2020 applied to the coronavirus disease 2019 (covid-19) epidemic. SETTING: Simulations considering the spread of covid-19 in Great Britain and Northern Ireland. POPULATION: About 70 million simulated people matched as closely as possible to actual UK demographics, geography, and social behaviours. MAIN OUTCOME MEASURES: Replication of summary data on the covid-19 epidemic reported to the UK government Scientific Advisory Group for Emergencies (SAGE), and a detailed study of unpublished results, especially the effect of school closures. RESULTS: The CovidSim model would have produced a good forecast of the subsequent data if initialised with a reproduction number of about 3.5 for covid-19. The model predicted that school closures and isolation of younger people would increase the total number of deaths, albeit postponed to a second and subsequent waves. The findings of this study suggest that prompt interventions were shown to be highly effective at reducing peak demand for intensive care unit (ICU) beds but also prolong the epidemic, in some cases resulting in more deaths long term. This happens because covid-19 related mortality is highly skewed towards older age groups. In the absence of an effective vaccination programme, none of the proposed mitigation strategies in the UK would reduce the predicted total number of deaths below 200 000. CONCLUSIONS: It was predicted in March 2020 that in response to covid-19 a broad lockdown, as opposed to a focus on shielding the most vulnerable members of society, would reduce immediate demand for ICU beds at the cost of more deaths long term. The optimal strategy for saving lives in a covid-19 epidemic is different from that anticipated for an influenza epidemic with a different mortality age profile.


Assuntos
Infecções por Coronavirus/mortalidade , Transmissão de Doença Infecciosa/estatística & dados numéricos , Previsões , Pneumonia Viral/mortalidade , Quarentena/tendências , Instituições Acadêmicas/organização & administração , Betacoronavirus , Simulação por Computador , Infecções por Coronavirus/transmissão , Feminino , Humanos , Unidades de Terapia Intensiva/tendências , Masculino , Irlanda do Norte/epidemiologia , Pandemias , Pneumonia Viral/transmissão , Quarentena/métodos , Reino Unido/epidemiologia
7.
BMJ Open Qual ; 9(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32948600

RESUMO

OBJECTIVE: We aimed to explore: the exposure of healthcare workers to a delirium guidelines implementation programme; effects on guideline adherence at intensive care unit (ICU) level; impact on knowledge and barriers, and experiences with the implementation. DESIGN: A mixed-methods process evaluation of a prospective multicentre implementation study. SETTING: Six ICUs. PARTICIPANTS: 4449 adult ICU patients and 500 ICU professionals approximately. INTERVENTION: A tailored implementation programme. MAIN OUTCOME MEASURE: Adherence to delirium guidelines recommendations at ICU level before, during and after implementation; knowledge and perceived barriers; and experiences with the implementation. RESULTS: Five of six ICUs were exposed to all implementation strategies as planned. More than 85% followed the required e-learnings; 92% of the nurses attended the clinical classroom lessons; five ICUs used all available implementation strategies and perceived to have implemented all guideline recommendations (>90%). Adherence to predefined performance indicators (PIs) at ICU level was only above the preset target (>85%) for delirium screening. For all other PIs, the inter-ICU variability was between 34% and 72%. The implementation of delirium guidelines was feasible and successful in resolving the majority of barriers found before the implementation. The improvement was well sustained 6 months after full guideline implementation. Knowledge about delirium was improved (from 61% to 65%). The implementation programme was experienced as very successful. CONCLUSIONS: Multifaceted implementation can improve and sustain adherence to delirium guidelines, is feasible and can largely be performed as planned. However, variability in delirium guideline adherence at individual ICUs remains a challenge, indicating the need for more tailoring at centre level.


Assuntos
Delírio/terapia , Desenvolvimento de Programas/métodos , Adulto , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes , Guias como Assunto , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/tendências , Masculino , Programas de Rastreamento/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Estudos Prospectivos
8.
Diabetes Metab Syndr ; 14(6): 1595-1602, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32862098

RESUMO

BACKGROUND & AIMS: Coronavirus disease 2019 (COVID-19) spreads rapidly and within no time, it has been declared a pandemic by the World Health Organization. Evidence suggests diabetes to be a risk factor for the progression and poor prognosis of COVID-19. Therefore, we aimed to understand the pooled prevalence of diabetes in patients infected with COVID-19. We also aimed to compute the risk of mortality and ICU admissions in COVID-19 patients with and without diabetes. METHODS: A comprehensive literature search was performed in PubMed to identify the articles reporting the diabetes prevalence and risk of mortality or ICU admission in COVID-19 patients. The primary outcome was to compute the pooled prevalence of diabetes in COVID-19 patients. Secondary outcomes included risk of mortality and ICU admissions in COVID-19 patients with diabetes compared to patients without diabetes. RESULTS: This meta-analysis was based on a total of 23007 patients from 43 studies. The pooled prevalence of diabetes in patients infected with COVID-19 was found to be 15% (95% CI: 12%-18%), p = <0.0001. Mortality risk was found to be significantly higher in COVID-19 patients with diabetes as compared to COVID-19 patients without diabetes with a pooled risk ratio of 1.61 (95% CI: 1.16-2.25%), p = 0.005. Likewise, risk of ICU admission rate was significantly higher in COVID-19 patients with diabetes as compared to COVID-19 patients without diabetes with a pooled risk ratio of 1.88 (1.20%-2.93%), p = 0.006. CONCLUSION: This meta-analysis found a high prevalence of diabetes and higher mortality and ICU admission risk in COVID-19 patients with diabetes.


Assuntos
/mortalidade , Efeitos Psicossociais da Doença , Diabetes Mellitus/mortalidade , Ensaios Clínicos Pragmáticos como Assunto , /diagnóstico , Diabetes Mellitus/diagnóstico , Hospitalização/tendências , Humanos , Unidades de Terapia Intensiva/tendências , Ensaios Clínicos Pragmáticos como Assunto/métodos , Estudos Retrospectivos
9.
J Antimicrob Chemother ; 75(11): 3359-3365, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32829390

RESUMO

BACKGROUND: Remdesivir is a prodrug with in vitro activity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Its clinical efficacy in patients with COVID-19 under mechanical ventilation remains to be evaluated. METHODS: This study includes patients under mechanical ventilation with confirmed SARS-CoV-2 infection admitted to the ICU of Pesaro hospital between 29 February and 20 March 2020. During this period, remdesivir was provided on a compassionate use basis. Clinical characteristics and outcome of patients treated with remdesivir were collected retrospectively and compared with those of patients hospitalized in the same time period. RESULTS: A total of 51 patients were considered, of which 25 were treated with remdesivir. The median (IQR) age was 67 (59-75.5) years, 92% were men and symptom onset was 10 (8-12) days before admission to ICU. At baseline, there was no significant difference in demographic characteristics, comorbidities and laboratory values between patients treated and not treated with remdesivir. Median follow-up was 52 (46-57) days. Kaplan-Meier curves showed significantly lower mortality among patients who had been treated with remdesivir (56% versus 92%, P < 0.001). Cox regression analysis showed that the Charlson Comorbidity Index was the only factor that had a significant association with higher mortality (OR 1.184; 95% CI 1.027-1.365; P = 0.020), while the use of remdesivir was associated with better survival (OR 3.506; 95% CI 1.768-6.954; P < 0.001). CONCLUSIONS: In this study the mortality rate of patients with COVID-19 under mechanical ventilation is confirmed to be high. The use of remdesivir was associated with a significant beneficial effect on survival.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/mortalidade , Unidades de Terapia Intensiva , Pneumonia Viral/mortalidade , Respiração Artificial/mortalidade , Monofosfato de Adenosina/uso terapêutico , Idoso , Alanina/uso terapêutico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Seguimentos , Humanos , Unidades de Terapia Intensiva/tendências , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Respiração Artificial/tendências , Estudos Retrospectivos , Resultado do Tratamento
10.
NeuroRehabilitation ; 47(2): 143-152, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32741786

RESUMO

BACKGROUND: Traumatic Brain Injury (TBI) is characterized by a highly heterogenous profile in terms of pathophysiology, clinical presentation and outcome. OBJECTIVE: This is the first population study investigating the epidemiology and outcomes of moderate-to-severe TBI in Cyprus. Patients treated in the Intensive Care Unit (ICU) of Nicosia General Hospital, the only Level 1 Trauma Centre in the country, were recruited between January 2013 and December 2016. METHODS: This was an observational cohort study, using longitudinal methods and six-month follow-up. Patients (N = 203) diagnosed with TBI were classified by the Glasgow Coma Scale at the Emergency Department as moderate or severe. RESULTS: Compared to international multicentre studies, the current cohort demonstrates a different case mix that includes older age, more motor vehicle collisions and lower mortality rates. There was a significantly higher proportion of injured males. Females were significantly older than males. There were no sex differences in the type, severity or place of injury. Sex did not yield differences in mortality or outcomes or on injury indices predicting outcomes. In contrast, older age was a predictor of higher mortality rates and worse outcomes. CONCLUSION: Trends as described in the study emphasize the importance of continuous evaluation of TBI epidemiology and outcome in different countries.


Assuntos
Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Cuidados Críticos/tendências , Vigilância da População , Adulto , Idoso , Lesões Encefálicas Traumáticas/diagnóstico , Estudos de Coortes , Chipre/epidemiologia , Serviço Hospitalar de Emergência/tendências , Feminino , Seguimentos , Escala de Coma de Glasgow/tendências , Humanos , Unidades de Terapia Intensiva/tendências , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Resultado do Tratamento , Adulto Jovem
12.
J Antimicrob Chemother ; 75(9): 2657-2660, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32688374

RESUMO

BACKGROUND: The combination lopinavir/ritonavir is recommended to treat HIV-infected patients at the dose regimen of 400/100 mg q12h, oral route. The usual lopinavir trough plasma concentrations are 3000-8000 ng/mL. A trend towards a 28 day mortality reduction was observed in COVID-19-infected patients treated with lopinavir/ritonavir. OBJECTIVES: To assess the plasma concentrations of lopinavir and ritonavir in patients with severe COVID-19 infection and receiving lopinavir/ritonavir. PATIENTS AND METHODS: Mechanically ventilated patients with COVID-19 infection included in the French COVID-19 cohort and treated with lopinavir/ritonavir were included. Lopinavir/ritonavir combination was administered using the usual adult HIV dose regimen (400/100 mg q12h, oral solution through a nasogastric tube). A half-dose reduction to 400/100 mg q24h was proposed if lopinavir Ctrough was >8000 ng/mL, the upper limit considered as toxic and reported in HIV-infected patients. Lopinavir and ritonavir pharmacokinetic parameters were determined after an intensive pharmacokinetic analysis. Biological markers of inflammation and liver/kidney function were monitored. RESULTS: Plasma concentrations of lopinavir and ritonavir were first assessed in eight patients treated with lopinavir/ritonavir. Median (IQR) lopinavir Ctrough reached 27 908 ng/mL (15 928-32 627). After the dose reduction to 400/100 mg q24h, lopinavir/ritonavir pharmacokinetic parameters were assessed in nine patients. Lopinavir Ctrough decreased to 22 974 ng/mL (21 394-32 735). CONCLUSIONS: In mechanically ventilated patients with severe COVID-19 infections, the oral administration of lopinavir/ritonavir elicited plasma exposure of lopinavir more than 6-fold the upper usual expected range. However, it remains difficult to safely recommend its dose reduction without compromising the benefit of the antiviral strategy, and careful pharmacokinetic and toxicity monitoring are needed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/sangue , Unidades de Terapia Intensiva/tendências , Lopinavir/sangue , Pneumonia Viral/sangue , Respiração Artificial/tendências , Ritonavir/sangue , Administração Oral , Infecções por Coronavirus/tratamento farmacológico , Inibidores do Citocromo P-450 CYP3A/administração & dosagem , Inibidores do Citocromo P-450 CYP3A/sangue , Quimioterapia Combinada , Feminino , Humanos , Lopinavir/administração & dosagem , Masculino , Pessoa de Meia-Idade , Pandemias , Soluções Farmacêuticas/administração & dosagem , Soluções Farmacêuticas/farmacocinética , Pneumonia Viral/tratamento farmacológico , Estudos Prospectivos , Ritonavir/administração & dosagem
14.
Am J Kidney Dis ; 76(3): 401-406, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32534129

RESUMO

At Montefiore Medical Center in The Bronx, NY, the first case of coronavirus disease 2019 (COVID-19) was admitted on March 11, 2020. At the height of the pandemic, there were 855 patients with COVID-19 admitted on April 13, 2020. Due to high demand for dialysis and shortages of staff and supplies, we started an urgent peritoneal dialysis (PD) program. From April 1 to April 22, a total of 30 patients were started on PD. Of those 30 patients, 14 died during their hospitalization, 8 were discharged, and 8 were still hospitalized as of May 14, 2020. Although the PD program was successful in its ability to provide much-needed kidney replacement therapy when hemodialysis was not available, challenges to delivering adequate PD dosage included difficulties providing nurse training and availability of supplies. Providing adequate clearance and ultrafiltration for patients in intensive care units was especially difficult due to the high prevalence of a hypercatabolic state, volume overload, and prone positioning. PD was more easily performed in non-critically ill patients outside the intensive care unit. Despite these challenges, we demonstrate that urgent PD is a feasible alternative to hemodialysis in situations with critical resource shortages.


Assuntos
Lesão Renal Aguda/terapia , Betacoronavirus , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde , Diálise Peritoneal/métodos , Pneumonia Viral/terapia , Lesão Renal Aguda/epidemiologia , Infecções por Coronavirus/epidemiologia , Soluções para Diálise/provisão & distribução , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Unidades de Terapia Intensiva/provisão & distribução , Unidades de Terapia Intensiva/tendências , Pandemias , Diálise Peritoneal/tendências , Pneumonia Viral/epidemiologia , Estados Unidos/epidemiologia
16.
PLoS One ; 15(5): e0233265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32421700

RESUMO

BACKGROUND AND OBJECTIVES: Incidence rates of healthcare-associated infections (HAIs) depend upon infection control policy and practices, and the effectiveness of the implementation of antibiotic stewardship. Amongst intensive care unit (ICU) patients with HAIs, a substantial number of pathogens were reported to be multidrug-resistant bacteria (MDRB). However, impacts of ICU HAIs due to MDRB (MDRB-HAIs) remain understudied. Our study aimed to evaluate the negative impacts of MRDB-HAIs versus HAIs due to non-MDRB (non-MRDB-HAIs). METHODS: Among 60,317 adult patients admitted at ICUs of a 2680-bed medical centre in Taiwan between January 2010 and December 2017, 279 pairs of propensity-score matched MRDB-HAI and non-MRDB-HAI were analyzed. PRINCIPAL FINDINGS: Between the MDRB-HAI group and the non-MDRB-HAI group, significant differences were found in overall hospital costs, costs of medical and nursing services, medication, and rooms/beds, and in ICU length-of-stay (LOS). As compared with the non-MDRB-HAI group, the mean of the overall hospital costs of patients in the MDRB-HAI group was increased by 26%; for categorized expenditures, the mean of costs of medical and nursing services of patients in the MDRB-HAI group was increased by 8%, of medication by 26.9%, of rooms/beds by 10.3%. The mean ICU LOS in the MDRB-HAI group was increased by 13%. Mortality rates in both groups did not significantly differ. CONCLUSIONS: These data clearly demonstrate more negative impacts of MDRB-HAIs in ICUs. The quantified financial burdens will be helpful for hospital/government policymakers in allocating resources to mitigate MDRB-HAIs in ICUs; in case of need for clarification/verification of the medico-economic burdens of MDRB-HAIs in different healthcare systems, this study provides a model to facilitate the evaluations.


Assuntos
Infecção Hospitalar/economia , Unidades de Terapia Intensiva/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Infecções Relacionadas a Cateter/epidemiologia , Cuidados Críticos , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Feminino , Custos Hospitalares , Hospitalização/economia , Hospitais , Humanos , Incidência , Controle de Infecções/economia , Controle de Infecções/métodos , Unidades de Terapia Intensiva/tendências , Tempo de Internação/economia , Masculino , Staphylococcus aureus Resistente à Meticilina/metabolismo , Pessoa de Meia-Idade , Pontuação de Propensão , Infecções Estafilocócicas/economia , Infecções Estafilocócicas/epidemiologia , Taiwan
19.
J Trauma Acute Care Surg ; 89(2): 279-288, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32384370

RESUMO

BACKGROUND: Epidemiologic assessment of surgical admissions into intensive care units (ICUs) provides a framework to evaluate health care system efficiency and project future health care needs. METHODS: We performed a 9-year (2008-2016), retrospective, cohort analysis of all adult admissions to 88 surgical ICUs using the prospectively and manually abstracted Cerner Acute Physiology and Chronic Health Evaluation Outcomes database. We stratified patients into 13 surgical cohorts and modeled temporal trends in admission, mortality, surgical ICU length of stay (LOS), and change in functional status (FS) using generalized mixed-effects and Quasi-Poisson models to obtain risk-adjusted outcomes. RESULTS: We evaluated 78,053 ICU admissions and observed a significant decrease in admissions after transplant and thoracic surgery, with a concomitant increase in admissions after otolaryngological and facial reconstructive procedures (all p < 0.05). While overall risk-adjusted mortality remained stable over the study period; mortality significantly declined in orthopedic, cardiac, urologic, and neurosurgical patients (all p < 0.05). Cardiac, urologic, gastrointestinal, neurosurgical, and orthopedic admissions showed significant reductions in LOS (all p < 0.05). The overall rate of FS deterioration increased per year, suggesting ICU-related disability increased over the study period. CONCLUSION: Temporal analysis demonstrates a significant change in the type of surgical patients admitted to the ICU over the last decade, with decreasing mortality and LOS in selected cohorts, but an increasing rate of FS deterioration. Improvement in ICU outcomes may highlight the success of health care advancements within certain surgical cohorts, while simultaneously identifying cohorts that may benefit from future intervention. Our findings have significant implications in health care systems planning, including resource and personnel allocation, education, and surgical training. LEVEL OF EVIDENCE: Economic/decision, level IV.Epidemiologic, level IV.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva/tendências , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/tendências , APACHE , Adulto , Utilização de Instalações e Serviços , Feminino , Mortalidade Hospitalar/tendências , Humanos , Unidades de Terapia Intensiva/normas , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Masculino , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/normas , Fatores de Tempo , Estados Unidos/epidemiologia
20.
Front Public Health ; 8: 153, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32391308

RESUMO

December 2019 saw a novel coronavirus (COVID-19) from China quickly spread globally. Currently, COVID-19, defined as the new pandemic by the World Health Organization (WHO), has reached over 750,000 confirmed cases worldwide. The virus began to spread in Italy from the 22nd February, and the number of related cases is still increasing. Furthermore, given that a relevant proportion of infected people need hospitalization in Intensive Care Units, this may be a crucial issue for National Healthcare System's capacity. WHO underlines the importance of specific disease regional estimates. Because of this, Italy aimed to put in place proportioned and controlled measures, and to guarantee adequate funding to both increase the number of ICU beds and increase production of personal protective equipment. Our aim is to investigate the current COVID-19 epidemiological context in Sardinia region (Italy) and to estimate the transmission parameters using a stochastic model to establish the number of infected, recovered, and deceased people expected. Based on available data from official Italian and regional sources, we describe the distribution of infected cases during the period between 2nd and 15th March 2020. To better reflect the actual spread of COVID-19 in Sardinia based on data from 15th March (first Sardinian declared outbreak), two Susceptible-Infectious-Recovered-Dead (SIRD) models have been developed, describing the best and worst scenarios. We believe that our findings represent a valid contribution to better understand the epidemiological context of COVID-19 in Sardinia. Our analysis can help health authorities and policymakers to address the right interventions to deal with the rapidly expanding health emergency.


Assuntos
/epidemiologia , Número de Leitos em Hospital/estatística & dados numéricos , Unidades de Terapia Intensiva/tendências , Modelos Estatísticos , Adulto , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Itália/epidemiologia , Pessoa de Meia-Idade , Equipamento de Proteção Individual/economia , /isolamento & purificação
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