Objective: To measure the point prevalence of delirium in the patients admitted to the cardiac ICU with acute coronary syndromes, with particular attention to the most commonly noted delirium and the impact on ICU mortality and length of ICU stay. Study Design: Prospective cohort study. Place and Study Duration: National Institute of Cardiovascular Diseases, Karachi Pakistan, from Mar and Jul 2021. Methodology: Consecutive adult patients with age >18 years admitted to the cardiac ICU after acute coronary syndromes were assessed for delirium using the confusion assessment method (CAM)-ICU tool and Richmond agitation sedation score (>-3). The types of delirium were also assessed. Results: 201 patients were enrolled, half of patients with ST-elevation MI (51.2%) and shock (45.8%). Delirium was identified in 71 (35.3%) patients, 30 (42.2%) had hypoactive delirium and 41 (57.7%) had hyperactive delirium. In multivariable regression, independent risk factors for delirium were: sepsis 3.19 (1.15-8.87), uremia 4.12 (1.18-14.46), mechanical ventilation 7.58 (1.2-47.99), and non-invasive ventilation 8.55 (2.9-25.2). Overall mortality was 35 (17.4%); 27/71 (38%) vs. 8/130 (6.2%); p 0.001 in patients with and without delirium, respectively. In multivariable regression, delirium was an independent risk factor for mortality at 7.12 (2.16-2.23). The mean ICU stay was 7.772.36 days vs. 3.91.44 days; p 0.001 for patients with and without delirium. Conclusion: The deleterious effect of delirium in terms of higher morbidity and mortality cannot be overemphasised. Hypoactive delirium is as common as the hyperactive type, with the same mortality risk. Assessment for delirium is mandatory for all patients admitted..............
Objectives: This study describes three surges of COVID-19 hypoxemic respiratory failure and our experience with using iCPAP in patients with cardiovascular diseases at a tertiary cardiac care centre. Methodology: This observational study was conducted from March 23rd 2020 to May 31st 2021, at The National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. This is an analysis of data from the PRICE Network Registry. Data was collected for all adult patients with cardiovascular diseases admitted with acute hypoxemic respiratory failure and a confirmed diagnosis of SARS CoV-2. Results: Among 362 patients with 'severe’ or 'critical’ COVID-19 were hospitalized; 163 (45%) in the 1st surge, 92 (25.4%) in the 2nd and 107 (29.6 %) in the 3rd surge. All-cause mortality was 118 (32.6%). iCPAP was used in 39% (141) patients, 19% (69) patients required oxygen only, 25.4% (92) were on BiPAP support and 16.6% (60) were intubated. ‘iCPAP failure’ occurred in 48/141 (34%) patients. iCPAP failure occurred in patients with higher APACHE II scores (16.3 ±5.7 v/s 21.3±6, p ≤0.001), lower ROX index on admission (5.0±2.2 vs. 10.4±5.4, p≤0.001), lesser degree of improvement in ROX index at 48 hours (Day 3 ROX 18.7±8.9 vs. 9.9±6.3, p≤0.001). Mortality rate on iCPAP was 44 (31.2%). Conclusion: COVID-19 outcomes in a resource-limited setting in patients having cardiovascular diseases, appear comparable to global reports. A modification of standard CPAP (iCPAP) appeared to be safe and effective. This modification of standard CPAP (iCPAP) identifies an option for resource-limited or resource-exhausted critical care units.
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