Topics: Nonobstetric Maternal Disease, Maternal Morbidity and Mortality, Critical Care M aternal death occurs rarely in wealthy nations and therefore measuring "near-miss" maternal mortality might offer more meaningful information about severe obstetric complications than mortality measures. Although the definition of near-miss mortality varies between institutions, 1 accepted measure is intensive care unit (ICU) admission. This study was designed to examine the demographic, medical, and pregnancy-related variables associated with maternal ICU admissions and near-miss maternal morbidities. Maternal and neonatal outcomes were obtained for an obstetric population admitted to ICUs in a tertiary care center.Obstetric patients admitted to the ICUs from January 2005 to April 2011 at the authors' institution were asked to participate in the study. Their data were included in an obstetric ICU registry. Maternal demographic data that were collected included age, parity, body mass index (BMI), race and ethnicity, primary language, insurance status, employment status, marital status, city and county of origin, and receipt of prenatal care. Obstetric and neonatal clinical data were obtained from review of maternal records and bedside observations. Two of the investigators reviewed all records and verified the primary diagnoses leading to ICU admission.During the study period, 19,575 births occurred and of the 94 obstetric patients (5/1000 deliveries) admitted to ICUs, 86 patients were included in the final analysis. Five mothers died; 2 from metastatic cancer, 2 secondary to complications from cystic fibrosis, and 1 from sepsis. Of these 86, 32 were white, 39 were African American, 9 were Hispanic, and 6 were of other race/ethnicity origin. Gestational age and neonate birth weight were similar among the women. The mean BMI of the entire cohort was 32.3 ± 9.7; BMIs for white, African American, and Hispanic women and the "other" group were 28.2 ± 6.5, 35.6 ± 10.8, 36.1 ± 11.1, and 25.9 ± 2.4, respectively (P < 0.01 for comparison between Hispanic and African American vs. white women). African American and Hispanic women were more likely than white women to have Medicaid insurance or no insurance (25.6% for African American women and 11.1% for Hispanic women vs. 37.5% for white women; P < 0.000) and more likely to be unmarried and multiparous. No significant differences in admission diagnosis, maternal medical comorbidities, or neonatal outcomes were apparent when assessed based on maternal race and ethnicity or maternal BMI. Most women (87%) of those transferred to the ICUs were admitted postpartum [mean of 2 ± 3.7 d (SD) postpartum]; 38.4%, 30.2%, 25.6%, and 5.8% were admitted to the surgical, coronary care unit, medical, or other type of ICU, respectively. The mean length of stay was 10 ± 8 days. The main ICU admission diagnosis was cardiac disease in 36% of patients. Both obstetric and nonobstetric maternal hemorrhage accounted for 29% of ICU admissions followed by hypertensive conditions (9%) and sepsis (9%). For the 31 pa...
Background: Hospital-acquired influenza (HA flu) lacks a consensus definition. However, it is known to be associated with increased inpatient morbidity and mortality. Objective: To describe the clinical course of HA flu in a cohort population. Methods: A retrospective cohort study was conducted at a tertiary-care adult and pediatric teaching hospital. Patients with HA flu during 3 seasons, 2016 through 2019, were identified from medical record information based on timing of the onset of signs and symptoms and positive virologic testing >72 hours after admission. Influenza infection was confirmed by multiplex respiratory PCR, influenza A/B PCR, or direct fluorescent antibody tests. Chart review was performed to abstract patient demographics and comorbidities, length of stay, testing, and timing to antiviral administration as well as diagnosis of pneumonia, coinfections, and 30-day mortality. Escalation of care during hospitalization was defined as a new requirement of supplemental oxygen, invasive or noninvasive ventilation, and transfer to an intensive care unit. Results: During the 3 flu seasons, 132 patients were identified with HA flu; 76 (58%) were women, 6 (4.6%) were aged <18 years, and 126 (95.4%) were adults. Annually, HA-flu patients accounted for 5%–7.8% of all patients hospitalized with laboratory-proven influenza. The median duration between hospitalization and positive flu test was 15 days, and the median length of stay after influenza diagnosis was 6 days. Antiviral treatment was received by 96% of the patients. In total, 41 patients (31%) showed radiographic evidence for pneumonia. Coinfection with either a viral or bacterial pathogen was identified in 25% of the cases. In addition, 26% of the patients experienced an escalation of care, and 20 patients (15%) were transferred to the intensive care unit after HA flu diagnosis. Furthermore, 4 deaths (3%) were attributed to influenza during their hospitalization. Conclusions: HA flu was a frequent cause for escalation in care and was associated with a mortality rate substantially higher than is typically seen in community-based populations with influenza. Coinfection was mostly related to bacteremia and pneumonia, yet not all pneumonias had an associated microbiological diagnosis other than influenza, and there was no significant association between coinfection and mortality. Future work should explore more precise definitions for HA flu as well as its complications.Funding: NoneDisclosures: None
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