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Limitation of life-sustaining therapies in critically ill patients with COVID-19: a descriptive epidemiological investigation from the COVID-ICU study

Giabicani, Mikhael ; Le Terrier, Christophe ; Poncet, Antoine ; [et al.]

Springer Science and Business Media LLC ; 2023

In: Critical Care Vol. 27, No. 1 ( 2023-03-11)

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In: Critical Care, Springer Science and Business Media LLC, Vol. 27, No. 1 ( 2023-03-11)

Abstract: Limitations of life-sustaining therapies (LST) practices are frequent and vary among intensive care units (ICUs). However, scarce data were available during the COVID-19 pandemic when ICUs were under intense pressure. We aimed to investigate the prevalence, cumulative incidence, timing, modalities, and factors associated with LST decisions in critically ill COVID-19 patients. Methods We did an ancillary analysis of the European multicentre COVID-ICU study, which collected data from 163 ICUs in France, Belgium and Switzerland. ICU load, a parameter reflecting stress on ICU capacities, was calculated at the patient level using daily ICU bed occupancy data from official country epidemiological reports. Mixed effects logistic regression was used to assess the association of variables with LST limitation decisions. Results Among 4671 severe COVID-19 patients admitted from February 25 to May 4, 2020, the prevalence of in-ICU LST limitations was 14.5%, with a nearly six-fold variability between centres. Overall 28-day cumulative incidence of LST limitations was 12.4%, which occurred at a median of 8 days (3–21). Median ICU load at the patient level was 126%. Age, clinical frailty scale score, and respiratory severity were associated with LST limitations, while ICU load was not. In-ICU death occurred in 74% and 95% of patients, respectively, after LST withholding and withdrawal, while median survival time was 3 days (1–11) after LST limitations. Conclusions In this study, LST limitations frequently preceded death, with a major impact on time of death. In contrast to ICU load, older age, frailty, and the severity of respiratory failure during the first 24 h were the main factors associated with decisions of LST limitations.

Type of Medium: Online Resource

ISSN: 1364-8535

URL: Article

DOI: 10.1186/s13054-023-04349-1

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2023

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Early prone positioning in acute respiratory distress syndrome related to COVID-19: a propensity score analysis from the multicentric cohort COVID-ICU network—the ProneCOVID study

Le Terrier, Christophe ; Sigaud, Florian ; Lebbah, Said ; [et al.]

Springer Science and Business Media LLC ; 2022

In: Critical Care Vol. 26, No. 1 ( 2022-12)

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In: Critical Care, Springer Science and Business Media LLC, Vol. 26, No. 1 ( 2022-12)

Abstract: Delaying time to prone positioning (PP) may be associated with higher mortality in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). We evaluated the use and the impact of early PP on clinical outcomes in intubated patients hospitalized in intensive care units (ICUs) for COVID-19. Methods All intubated patients with ARDS due to COVID-19 were involved in a secondary analysis from a prospective multicenter cohort study of COVID-ICU network including 149 ICUs across France, Belgium and Switzerland. Patients were followed-up until Day-90. The primary outcome was survival at Day-60. Analysis used a Cox proportional hazard model including a propensity score. Results Among 2137 intubated patients, 1504 (70.4%) were placed in PP during their ICU stay and 491 (23%) during the first 24 h following ICU admission. One hundred and eighty-one patients (36.9%) of the early PP group had a PaO 2 /FiO 2 ratio 〉 150 mmHg when prone positioning was initiated. Among non-early PP group patients, 1013 (47.4%) patients had finally been placed in PP within a median delay of 3 days after ICU admission. Day-60 mortality in non-early PP group was 34.2% versus 39.3% in the early PP group ( p = 0.038). Day-28 and Day-90 mortality as well as the need for adjunctive therapies was more important in patients with early PP. After propensity score adjustment, no significant difference in survival at Day-60 was found between the two study groups (HR 1.34 [0.96–1.68], p = 0.09 and HR 1.19 [0.998–1.412], p = 0.053 in complete case analysis or in multiple imputation analysis, respectively). Conclusions In a large multicentric international cohort of intubated ICU patients with ARDS due to COVID-19, PP has been used frequently as a main treatment. In this study, our data failed to show a survival benefit associated with early PP started within 24 h after ICU admission compared to PP after day-1 for all COVID-19 patients requiring invasive mechanical ventilation regardless of their severity.

Type of Medium: Online Resource

ISSN: 1364-8535

URL: Article

DOI: 10.1186/s13054-022-03949-7

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2022

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3

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Benefits and risks of noninvasive oxygenation strategy in COVID-19: a multicenter, prospective cohort study (COVID-ICU) in 137 hospitals

COVID-ICU group, for the REVA network, COVID-ICU investigators ; Schmidt, Matthieu ; Demoule, Alexandre ; [et al.]

Springer Science and Business Media LLC ; 2021

In: Critical Care Vol. 25, No. 1 ( 2021-12)

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In: Critical Care, Springer Science and Business Media LLC, Vol. 25, No. 1 ( 2021-12)

Abstract: To evaluate the respective impact of standard oxygen, high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) on oxygenation failure rate and mortality in COVID-19 patients admitted to intensive care units (ICUs). Methods Multicenter, prospective cohort study (COVID-ICU) in 137 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, oxygenation failure, and survival data were collected. Oxygenation failure was defined as either intubation or death in the ICU without intubation. Variables independently associated with oxygenation failure and Day-90 mortality were assessed using multivariate logistic regression. Results From February 25 to May 4, 2020, 4754 patients were admitted in ICU. Of these, 1491 patients were not intubated on the day of ICU admission and received standard oxygen therapy (51%), HFNC (38%), or NIV (11%) ( P 〈 0.001). Oxygenation failure occurred in 739 (50%) patients (678 intubation and 61 death). For standard oxygen, HFNC, and NIV, oxygenation failure rate was 49%, 48%, and 60% ( P 〈 0.001). By multivariate analysis, HFNC (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.36–0.99, P = 0.013) but not NIV (OR 1.57, 95% CI 0.78–3.21) was associated with a reduction in oxygenation failure). Overall 90-day mortality was 21%. By multivariable analysis, HFNC was not associated with a change in mortality (OR 0.90, 95% CI 0.61–1.33), while NIV was associated with increased mortality (OR 2.75, 95% CI 1.79–4.21, P 〈 0.001). Conclusion In patients with COVID-19, HFNC was associated with a reduction in oxygenation failure without improvement in 90-day mortality, whereas NIV was associated with a higher mortality in these patients. Randomized controlled trials are needed.

Type of Medium: Online Resource

ISSN: 1364-8535

URL: Article

DOI: 10.1186/s13054-021-03784-2

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2021

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Characteristics and prognosis of bloodstream infection in patients with COVID-19 admitted in the ICU: an ancillary study of the COVID-ICU study

Massart, Nicolas ; Maxime, Virginie ; Fillatre, Pierre ; [et al.]

Springer Science and Business Media LLC ; 2021

In: Annals of Intensive Care Vol. 11, No. 1 ( 2021-12)

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In: Annals of Intensive Care, Springer Science and Business Media LLC, Vol. 11, No. 1 ( 2021-12)

Abstract: Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring intensive care unit (ICU) have a high incidence of hospital-acquired infections; however, data regarding hospital acquired bloodstream infections (BSI) are scarce. We aimed to investigate risk factors and outcome of BSI in critically ill coronavirus infectious disease-19 (COVID-19) patients. Patients and methods We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU study) that included 4010 COVID-19 ICU patients. For the present analysis, only those with data regarding primary outcome (death within 90 days from admission) or BSI status were included. Risk factors for BSI were analyzed using Fine and Gray competing risk model. Then, for outcome comparison, 537 BSI-patients were matched with 537 controls using propensity score matching. Results Among 4010 included patients, 780 (19.5%) acquired a total of 1066 BSI (10.3 BSI per 1000 patients days at risk) of whom 92% were acquired in the ICU. Higher SAPS II, male gender, longer time from hospital to ICU admission and antiviral drug before admission were independently associated with an increased risk of BSI, and interestingly, this risk decreased over time. BSI was independently associated with a shorter time to death in the overall population (adjusted hazard ratio (aHR) 1.28, 95% CI 1.05–1.56) and, in the propensity score matched data set, patients with BSI had a higher mortality rate (39% vs 33% p = 0.036). BSI accounted for 3.6% of the death of the overall population. Conclusion COVID-19 ICU patients have a high risk of BSI, especially early after ICU admission, risk that increases with severity but not with corticosteroids use. BSI is associated with an increased mortality rate.

Type of Medium: Online Resource

ISSN: 2110-5820

URL: Article

DOI: 10.1186/s13613-021-00971-w

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2021

detail.hit.zdb_id: 2617094-2

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Predicting 90-day survival of patients with COVID-19: Survival of Severely Ill COVID (SOSIC) scores

Schmidt, Matthieu ; Guidet, Bertrand ; Demoule, Alexandre ; [et al.]

Springer Science and Business Media LLC ; 2021

In: Annals of Intensive Care Vol. 11, No. 1 ( 2021-12)

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In: Annals of Intensive Care, Springer Science and Business Media LLC, Vol. 11, No. 1 ( 2021-12)

Abstract: Predicting outcomes of critically ill intensive care unit (ICU) patients with coronavirus-19 disease (COVID-19) is a major challenge to avoid futile, and prolonged ICU stays. Methods The objective was to develop predictive survival models for patients with COVID-19 after 1-to-2 weeks in ICU. Based on the COVID–ICU cohort, which prospectively collected characteristics, management, and outcomes of critically ill patients with COVID-19. Machine learning was used to develop dynamic, clinically useful models able to predict 90-day mortality using ICU data collected on day (D) 1, D7 or D14. Results Survival of Severely Ill COVID (SOSIC)-1, SOSIC-7, and SOSIC-14 scores were constructed with 4244, 2877, and 1349 patients, respectively, randomly assigned to development or test datasets. The three models selected 15 ICU-entry variables recorded on D1, D7, or D14. Cardiovascular, renal, and pulmonary functions on prediction D7 or D14 were among the most heavily weighted inputs for both models. For the test dataset, SOSIC-7’s area under the ROC curve was slightly higher (0.80 [0.74–0.86]) than those for SOSIC-1 (0.76 [0.71–0.81] ) and SOSIC-14 (0.76 [0.68–0.83]). Similarly, SOSIC-1 and SOSIC-7 had excellent calibration curves, with similar Brier scores for the three models. Conclusion The SOSIC scores showed that entering 15 to 27 baseline and dynamic clinical parameters into an automatable XGBoost algorithm can potentially accurately predict the likely 90-day mortality post-ICU admission (sosic.shinyapps.io/shiny). Although external SOSIC-score validation is still needed, it is an additional tool to strengthen decisions about life-sustaining treatments and informing family members of likely prognosis.

Type of Medium: Online Resource

ISSN: 2110-5820

URL: Article

DOI: 10.1186/s13613-021-00956-9

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2021

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Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19: An Emulated Target Trial Analysis

Hajage, David ; Combes, Alain ; Guervilly, Christophe ; [et al.]

American Thoracic Society ; 2022

In: American Journal of Respiratory and Critical Care Medicine Vol. 206, No. 3 ( 2022-08-01), p. 281-294

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In: American Journal of Respiratory and Critical Care Medicine, American Thoracic Society, Vol. 206, No. 3 ( 2022-08-01), p. 281-294

Type of Medium: Online Resource

ISSN: 1073-449X , 1535-4970

URL: Article

DOI: 10.1164/rccm.202111-2495OC

RVK:

XA 21200

Language: English

Publisher: American Thoracic Society

Publication Date: 2022

detail.hit.zdb_id: 1468352-0

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Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study

Massart, Nicolas ; Maxime, Virginie ; Fillatre, Pierre ; [et al.]

Springer Science and Business Media LLC ; 2022

In: Annals of Intensive Care Vol. 12, No. 1 ( 2022-12)

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In: Annals of Intensive Care, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2022-12)

Type of Medium: Online Resource

ISSN: 2110-5820

URL: Article

DOI: 10.1186/s13613-022-00979-w

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2022

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Effect of Tocilizumab vs Usual Care in Adults Hospitalized With COVID-19 and Moderate or Severe Pneumonia : A Randomized Clinical Trial

Hermine, Olivier ; Mariette, Xavier ; Tharaux, Pierre-Louis ; [et al.]

American Medical Association (AMA) ; 2021

In: JAMA Internal Medicine Vol. 181, No. 1 ( 2021-01-01), p. 32-

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In: JAMA Internal Medicine, American Medical Association (AMA), Vol. 181, No. 1 ( 2021-01-01), p. 32-

Type of Medium: Online Resource

ISSN: 2168-6106

URL: Article

DOI: 10.1001/jamainternmed.2020.6820

Language: English

Publisher: American Medical Association (AMA)

Publication Date: 2021

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Sarilumab in adults hospitalised with moderate-to-severe COVID-19 pneumonia (CORIMUNO-SARI-1): An open-label randomised controlled trial

Mariette, Xavier ; Hermine, Olivier ; Tharaux, Pierre-Louis ; [et al.]

Elsevier BV ; 2022

In: The Lancet Rheumatology Vol. 4, No. 1 ( 2022-01), p. e24-e32

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In: The Lancet Rheumatology, Elsevier BV, Vol. 4, No. 1 ( 2022-01), p. e24-e32

Type of Medium: Online Resource

ISSN: 2665-9913

URL: Article

DOI: 10.1016/S2665-9913(21)00315-5

Language: English

Publisher: Elsevier BV

Publication Date: 2022

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Effect of anakinra versus usual care in adults in hospital with COVID-19 and mild-to-moderate pneumonia (CORIMUNO-ANA-1): a randomised controlled trial

Tharaux, Pierre-Louis ; Pialoux, Gilles ; Pavot, Arthur ; [et al.]

Elsevier BV ; 2021

In: The Lancet Respiratory Medicine Vol. 9, No. 3 ( 2021-03), p. 295-304

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In: The Lancet Respiratory Medicine, Elsevier BV, Vol. 9, No. 3 ( 2021-03), p. 295-304

Type of Medium: Online Resource

ISSN: 2213-2600

URL: Article

DOI: 10.1016/S2213-2600(20)30556-7

Language: English

Publisher: Elsevier BV

Publication Date: 2021

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