Browsing by Subject "Acute respiratory distress syndrome (ARDS)"

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    Clinical Outcomes and Severity of Acute Respiratory Distress Syndrome in 1154 COVID-19 Patients: An Experience Multicenter Retrospective Cohort Study
    (MDPI, 2022) Al Mutair, Abbas; Alhumaid, Saad; Layqah, Laila; Shamou, Jinan; Ahmed, Gasmelseed Y.; Chagla, Hiba; Alsalman, Khulud; Alnasser, Fadhah Mohammed; Thoyaja, Koritala; Alhuqbani, Waad N.; Alghadeer, Mohammed; Al Mohaini, Mohammed; Almahmoud, Sana; Al-Tawfiq, Jaffar A.; Muhammad, Javed; Al-Jamea, Lamiaa H.; Woodman, Alexander; Alsaleh, Ahmed; Alsedrah, Abdulaziz M.; Alharbi, Hanan F.; Saha, Chandni; Rabaan, Ali A.; Medicine, School of Medicine
    Background: Acute Respiratory Distress Syndrome (ARDS) is caused by non-cardiogenic pulmonary edema and occurs in critically ill patients. It is one of the fatal complications observed among severe COVID-19 cases managed in intensive care units (ICU). Supportive lung-protective ventilation and prone positioning remain the mainstay interventions. Purpose: We describe the severity of ARDS, clinical outcomes, and management of ICU patients with laboratory-confirmed COVID-19 infection in multiple Saudi hospitals. Methods: A multicenter retrospective cohort study was conducted of critically ill patients who were admitted to the ICU with COVID-19 and developed ARDS. Results: During our study, 1154 patients experienced ARDS: 591 (51.2%) with severe, 415 (36.0%) with moderate, and 148 (12.8%) with mild ARDS. The mean sequential organ failure assessment (SOFA) score was significantly higher in severe ARDS with COVID-19 (6 ± 5, p = 0.006). Kaplan–Meier survival analysis showed COVID-19 patients with mild ARDS had a significantly higher survival rate compared to COVID-19 patients who experienced severe ARDS (p = 0.023). Conclusion: ARDS is a challenging condition complicating COVID-19 infection. It carries significant morbidity and results in elevated mortality. ARDS requires protective mechanical ventilation and other critical care supportive measures. The severity of ARDS is associated significantly with the rate of death among the patients.
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    Performance of crisis standards of care guidelines in a cohort of critically ill COVID-19 patients in the United States
    (Elsevier, 2021) Jezmir, Julia L.; Bharadwaj, Maheetha; Chaitoff, Alexander; Diephuis, Bradford; Crowley, Conor P.; Kishore, Sandeep P.; Goralnick, Eric; Merriam, Louis T.; Milliken, Aimee; Rhee, Chanu; Sadovnikoff, Nicholas; Shah, Sejal B.; Gupta, Shruti; Leaf, David E.; Feldman, William B.; Kim, Edy Y.; STOP-COVID Investigators; Graduate Medical Education, School of Medicine
    Many US states published crisis standards of care (CSC) guidelines for allocating scarce critical care resources during the COVID-19 pandemic. However, the performance of these guidelines in maximizing their population benefit has not been well tested. In 2,272 adults with COVID-19 requiring mechanical ventilation drawn from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID) multicenter cohort, we test the following three approaches to CSC algorithms: Sequential Organ Failure Assessment (SOFA) scores grouped into ranges, SOFA score ranges plus comorbidities, and a hypothetical approach using raw SOFA scores not grouped into ranges. We find that area under receiver operating characteristic (AUROC) curves for all three algorithms demonstrate only modest discrimination for 28-day mortality. Adding comorbidity scoring modestly improves algorithm performance over SOFA scores alone. The algorithm incorporating comorbidities has modestly worse predictive performance for Black compared to white patients. CSC algorithms should be empirically examined to refine approaches to the allocation of scarce resources during pandemics and to avoid potential exacerbation of racial inequities.