Clinical characteristics and outcomes of critically ill patients with COVID-19 in a tertiary community hospital in upstate New York

Lenka, Jyotirmayee; Chhabria, Mamta; Sharma, Nupur; Tan, Bryan E‐Xin; Boppana, Leela Krishna Teja; Venugopal, Sharini; Sondhi, Damanpaul

doi:10.1080/20009666.2020.1811070

Cited by 11 publications

(12 citation statements)

References 23 publications

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“…Peak CRP level of 125 mg/dL was noticed on day 4 of non-surviving intubated patients, contrary to this surviving patients had levels below 50 mg/dL on the same day followed by a declining pattern [15]. Lowest lymphocyte count of 400 cells/µL, peak CRP levels of 214.7 mg/L, peak procalcitonin 0.4 ng/mL, peak dimer 2.02 mcg/mL, peak LDH 475 U/L, peak ferritin 1442 ng/mL, and peak thrombocytopenia of 166 x10 9 /µL were observed according to one study [16]. Another similar study compared these markers among survivors and non-survivors showed that lymphocyte count decreased significantly in both survivors (from 0.94 to 0.51 × 10 9 cells/L) and non-survivors (from 1.24 to 0.61 × 10 9 cells/L), respectively.…”

Section: Discussionmentioning

confidence: 92%

Comparison of first and second waves of COVID-19 through severity markers in ICU patients of a developing country

Asghar

Yasmin

Alvi

et al. 2021

Journal of Community Hospital Internal Medicine Perspectives

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Background: Many countries are experiencing outbreaks of the second wave of COVID-19 infection. With these outbreaks, the severity of the disease is still ambiguously projected. Certain inflammatory markers are known to be associated with the severity of the disease and regular monitoring of these biomarkers in intensive care unit admissions is paramount to improve clinical outcomes. Objectives: This study was aimed to compare the severity markers of the patients infected during the first wave versus the second wave in an intensive care unit. Methods: We conducted a retrospective study obtaining patient's data from hospital records, admitted during the first wave in March-May 2020, and compared the data with those COVID-19 patients admitted during the second wave from October-November 2020. A descriptive comparison was done among the patients admitted to intensive care unit (ICU) during both waves of the pandemic. Results: 92 patients from first wave and 68 patients from second wave were included in the analysis, all admitted to ICU with equal gender distribution. Increased age and length of ICU stay was observed during the first wave. BMI, in-hospital mortality and invasive ventilation were statistically indifferent between both the waves. There was significantly higher APACHE-II during first wave (p = 0.007), but SOFA at day 1 (p = 0.213) and day 7 of ICU stay remain indifferent (p = 0.119). Inflammatory markers were less severe during second wave while only neutrophils and lymphocytes were found to peak higher. Conclusion: Most of the severity markers were less intense during the early analysis of second wave.

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Section: Discussionmentioning

confidence: 92%

Comparison of first and second waves of COVID-19 through severity markers in ICU patients of a developing country

Asghar

Yasmin

Alvi

et al. 2021

Journal of Community Hospital Internal Medicine Perspectives

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“…As shown in Table 1 , 18 of the included studies were from Asia [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], 10 from Europe [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] and 12 from North American [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. 23 studies (57.5%) were conducted in single center and 17 were (42.5%) multicenter.…”

Section: Resultsmentioning

confidence: 99%

Respiratory supports of COVID-19 patients in intensive care unit: A systematic review

Ouyang

Zhu

et al. 2021

Heliyon

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Introduction We aimed to describe the respiratory supports and determine their association with clinical outcomes of COVID-19 patients in intensive care unit (ICU). Methods A systemic literature search was conducted in PubMed, EMBASE, MedRxiv and BioRxiv database from December 2019 to 2 July 2020. Studies reporting the application of respiratory supports in COVID-19 patients admitted to ICU were included. Results Forty studies with 15320 COVID-19 patients were included in this systematic review. The proportion of invasive mechanical ventilation (IMV) application in ICU patients with COVID-19 was 73.8%. Further analysis elucidated that the use rate of IMV in Asia, Europe and North America was 47%, 76.2% and 80.2%, respectively. The proportion of patients treated with prone positioning and IMV was 29.4%. 25.5% of COVID-19 patients requiring IMV developed ventilator-associated pneumonia. The mortality of patients treated with IMV was 51.1%, while only 17.5% of critically ill COVID-19 patients treated with non-IMV respiratory support died. Additionally, the utilization rate of IMV in non-survival patients was shown 17.26-folds (95%CI 2.89–103.24, p = 0.002) higher than that in survival patients, while the use rate of ECMO was no significant difference. Conclusions Our findings highlight respiratory supports of COVID-19 patients admitted to ICU in different continents. IMV is a life-saving strategy for critically ill COVID-19 patients with ARDS, yet the mortality remains very high.

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“…In only 4 (18%) studies did these demarcation thresholds exceed 16 cmH 2 O and only one reached 20 cmH 2 O. 128,144,148,150 By comparison, lower range PEEP requirements (ie. demarcated by 1 SD below the mean or 25 th percentile) were twice as frequent with 36% of studies reported values < 10 cmH 2 O.…”

Section: Peep and Tidal Volume Parametersmentioning

confidence: 97%

“…Twenty-four reviewed studies provided initial ventilator data (Table 3). 84,107,108,111,114,116,117,121,128,[141][142][143][144][145][146][147][148][149][150][151][152][153][154] In 22 of these mean/median PEEP requirements were 10-16 cmH 2 O (Table 3, Fig 1). A crude approach for determining the need for particularly high PEEP levels (ie, approaching the "super-PEEP" threshold of 20 cmH 2 O) are values demarcating 1 standard deviation (SD) above the mean, or the 75 th percentile.…”

Section: Peep and Tidal Volume Parametersmentioning

confidence: 99%

“…162 C RS values at 1 SD above the mean or the 75 th percentile > 50 mL/cmH 2 O were reported in 43% of studies (Fig 3). 68,70,107,145,147,148,153 However, with one exception, 68 the corresponding PEEP levels were 12-20 cmH 2 O; thus the relevance of higher C RS in assessing Type-L prevalance remains uncertain. In the largest study focused on COVID-19 lung mechanics C RS decreased over 14 days from 38±11 to 31±14 mL/cmH 2 O.…”

Section: Respiratory System Compliancementioning

confidence: 99%

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2020 Year in Review: Mechanical Ventilation During the First Year of the COVID-19 Pandemic

Kallet

2021

Respir Care

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Corona virus disease 2019 represents the greatest medical crisis encountered in the young history of critical care and respiratory care. During the early months of the pandemic, when little was known about the virus, the acute hypoxemic respiratory failure it caused did not appear to fit conveniently or consistently into our classification of acute respiratory distress syndrome (ARDS). This not only reignited a half-century's long simmering debate over taxonomy, but also fueled similar debates over how PEEP and lung-protective ventilation should be titrated, as well as the appropriate role of non-invasive ventilation in ARDS. Furthermore, COVID-19 ignited other debates on emerging concepts such as ARDS phenotypes and patient self-inflicted lung injury from vigorous spontaneous breathing. Over a year later these early perplexities have receded into the background without having been reviewed or resolved.With a full year of evidence having been published this narrative review systematically analyzes whether or not COVID-19 associated respiratory failure is essentially ARDS, with perhaps a somewhat different course of presentation. This includes a review of the severity of hypoxemia and derangements in pulmonary mechanics, PEEP requirements, recruitment potential, the ability to achieve lung-protective ventilation goals, duration of mechanical ventilation, associated mortality, and response to non-invasive ventilation. It also reviews the concepts of ARDS phenotypes and patient self-inflicted lung injury as these are crucial to understanding the contentious debate over the nature and management of COVID-19.

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Clinical characteristics and outcomes of critically ill patients with COVID-19 in a tertiary community hospital in upstate New York

Cited by 11 publications

References 23 publications

Comparison of first and second waves of COVID-19 through severity markers in ICU patients of a developing country

Comparison of first and second waves of COVID-19 through severity markers in ICU patients of a developing country

Respiratory supports of COVID-19 patients in intensive care unit: A systematic review

2020 Year in Review: Mechanical Ventilation During the First Year of the COVID-19 Pandemic

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