Triaging Access to Critical Care Resources in Patients With Chronic Respiratory Diseases in the Event of a Major COVID-19 Surge

Gupta, Samir; Batt, Jane; Bourbeau, Jean; Gershon, Andrea S.; Granton, John; Hambly, Nathan; Hernández, Paul; Kolb, Martin; Mehta, Sanjay; Mielniczuk, Lisa; Provencher, Steeve; Stephenson, Anne L.; Swiston, John R.; Tullis, D. Elizabeth; Vozoris, Nicholas T.; Wald, Joshua; Weatherald, Jason; Bhutani, Mohit

doi:10.1016/j.chest.2020.07.018

Cited by 12 publications

(8 citation statements)

References 14 publications

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“…Because of the risks associated with intubation and mechanical ventilation in patients with PH, especially those with RV dysfunction, this is typically avoided, especially for older patients with PH and those with severe PH. Certain jurisdictions have recommended PH risk stratification in critical care resource triage during COVID-19 surges ( 38 ). In this study, it mainly consists of limitation of intubation, invasive ventilation, and/or cardiac resuscitation in patients with severe underlying diseases and severe COVID-19 with limited possibility of improvement.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in Patients with Pulmonary Hypertension: A National Prospective Cohort Study

Montani

Certain

Weatherald

et al. 2022

Am J Respir Crit Care Med

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Rationale Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with pulmonary endothelial dysfunction. There are limited data available on the outcomes of coronavirus disease (COVID-19) in patients with pulmonary hypertension (PH), a disease characterized by pulmonary endothelial dysfunction. Objectives To describe characteristics and outcomes of patients with precapillary PH and COVID-19. Methods We prospectively collected characteristics, management, and outcomes of adult patients with precapillary PH in the French PH network who had COVID-19 between February 1, 2020, and April 30, 2021. Clinical, functional, and hemodynamic characteristics of PH before COVID-19 were collected from the French PH registry. Measurements and Main Results A total of 211 patients with PH (including 123 with pulmonary arterial hypertension, 47 with chronic thromboembolic PH, and 41 with other types of PH) experienced COVID-19, and 40.3% of them were outpatients, 32.2% were hospitalized in a conventional ward, and 27.5% were in an ICU. Among hospitalized patients ( n = 126), 54.0% received corticosteroids, 37.3% high-flow oxygen, and 11.1% invasive ventilation. Right ventricular and acute renal failure occurred in 30.2% and 19.8% of patients, respectively. Fifty-two patients (all hospitalized) died from COVID-19. Overall mortality was 24.6% (95% CI [confidence interval], 18.8–30.5) and in-hospital mortality 41.3% (95% CI, 32.7–49.9). Nonsurvivors were significantly older, more frequently male and suffering comorbidities (diabetes, chronic respiratory diseases, systemic hypertension, chronic cardiac diseases, and/or chronic renal failure), and had more severe PH at their most recent evaluation preceding COVID-19 diagnosis (in terms of functional class and 6-minute-walk distance; all P < 0.05). Use of pulmonary arterial hypertension therapy was similar between survivors and nonsurvivors. Conclusions COVID-19 in patients with precapillary PH was associated with a high in-hospital mortality. The typical risk factors for severe COVID-19 and severity of PH were associated with mortality in this population.

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Section: Discussionmentioning

confidence: 99%

COVID-19 in Patients with Pulmonary Hypertension: A National Prospective Cohort Study

Montani

Certain

Weatherald

et al. 2022

Am J Respir Crit Care Med

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“…Sensitivity analyses. History of respiratory exacerbation, CHF complication and systemic corticosteroid receipt are all considered markers of IPF severity [32][33]39]. Therefore, outcomes were examined stratifying by each of these variables separately, in order to further minimize confounding by indication by evaluating outcomes among healthier subsets of persons, and to further minimize 'healthy user' bias by evaluating outcomes among sicker subgroups of individuals.…”

Section: Resultsmentioning

confidence: 99%

Morbidity and Mortality Reduction Associated with Polysomnography Testing in Idiopathic Pulmonary Fibrosis: A Population-Based Cohort Study

Vozoris

Wilton

Austin

et al. 2021

Preprint

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Background: It is not well-known if diagnosing and treating sleep breathing disorders among individuals with idiopathic pulmonary fibrosis (IPF) improves health outcomes. We evaluated the association between receipt of laboratory-based polysomnography (which is the first step in the diagnosis and treatment of sleep breathing disorders in Ontario, Canada) and respiratory-related hospitalization and all-cause mortality among individuals with IPF.Methods: We used a retrospective, population-based, cohort study design, analyzing health administrative data from Ontario, Canada, from 2007-2019. Individuals with IPF were identified using an algorithm based on health administrative codes previously developed by IPF experts. Propensity score matching was used to account for potential differences in 41 relevant covariates between individuals that underwent polysomnography (exposed) and individuals that did not undergo polysomnography (controls), in order minimize potential confounding. Respiratory-related hospitalization and all-cause mortality were evaluated up to 12 months after the index date. Results: Out of 5044 individuals with IPF identified, 201 (4.0%) received polysomnography, and 189 (94.0%) were matched to an equal number of controls. Compared to controls, exposed individuals had significantly reduced rates of respiratory-related hospitalization (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.24-0.75), p=0.003) and all-cause mortality (HR 0.49, 95% CI 0.30-0.80), p=0.004). Significantly reduced rate of respiratory-related hospitalization (but not all-cause mortality) was also observed among those with >=1 respiratory-related hospitalization (HR 0.38, 95% CI 0.15-0.99) and systemic corticosteroid receipt (HR 0.37, 95% CI 0.19-0.94) in the year prior to the index date, which reflect sicker subgroups of persons. Conclusions: Undergoing polysomnography was associated with significantly improved clinically-important health outcomes among individuals with IPF, highlighting the potential importance of incorporating this testing in IPF disease management.

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“…There are two possible reasons for the decrease in primary lung cancer surgeries during the pandemic: first, the triage of surgical procedures due to the decrease in hospital resources represented by the number of available beds in intensive care units [11] ; and second, the decrease in lung cancer diagnosis due to the decrease of lung cancer screening, which might be induced by the temporary closure of screening and the decreased motivation for attending screening due to COVID-19 related concerns [12] . If the main cause was triage of surgical procedures, one would expect a similar, not contrastive, trend for both primary and metastatic lung tumor surgery.…”

Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 on thoracic surgical procedures in Japan: Analysis of data from the National Clinical Database

Satô¹,

Yamamoto²,

Ikeda³

et al. 2022

Lung Cancer

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Triaging Access to Critical Care Resources in Patients With Chronic Respiratory Diseases in the Event of a Major COVID-19 Surge

Cited by 12 publications

References 14 publications

COVID-19 in Patients with Pulmonary Hypertension: A National Prospective Cohort Study

COVID-19 in Patients with Pulmonary Hypertension: A National Prospective Cohort Study

Morbidity and Mortality Reduction Associated with Polysomnography Testing in Idiopathic Pulmonary Fibrosis: A Population-Based Cohort Study

The impact of COVID-19 on thoracic surgical procedures in Japan: Analysis of data from the National Clinical Database

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