Citations 4
Variation in Use of High-Flow Nasal Cannula and Noninvasive Ventilation Among Patients With COVID-19
Garcia, Michael A. , Johnson, Shelsey W. , Sisson, Emily, Sheldrick, Christopher R, Kumar, Vishakha K. , Boman, Karen , Bolesta, Scott , Bansal, Vikas , Bogojevic, Marija , Domecq, J. P., Lal, Amos , Heavner, Smith F. , Lee, Donna, Anderson, Harry L, Investigators, from the Society of Critical Care Medicine's Discovery Viral Infection and Respiratory Illness Universal Study, Tierney, David M. , Заболотских, И. Б. , Asghar, Muhammad Sohaib , Galet, Colette , Lal, Amos , Bansal, Vikas , Asghar, Muhammad S , Domecq Graces, Juan Pablo , Sheldrick, Christopher R, Cheruku, Sreekanth , Anderson, Harry L, Denson, Joshua L. , Gajic, Ognjen , Kashyap, Rahul , Walkey, Allan J. , Investigators, from the Society of Critical Care Medicine's Discovery Viral Infection and Respiratory Illness Universal Study
Respiratory Care | June 7, 2022 | Volume: 67 | Issue: 8 | Pages: 929-938
BACKGROUND: The use of high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) for hypoxemic respiratory failure secondary to COVID-19 are recommended by critical-care guidelines; however, apprehension about viral particle aerosolization and patient self-inflicted lung injury may have limited use. We aimed to describe hospital variation in the use and clinical outcomes of HFNC and NIV for the management of COVID-19. METHODS: This was a retrospective observational study of adults hospitalized with COVID-19 who received supplemental oxygen between February 15, 2020, and April 12, 2021, across 102 international and United States hospitals by using the COVID-19 Registry. Associations of HFNC and NIV use with clinical outcomes were evaluated by using multivariable adjusted hierarchical random-effects logistic regression models. Hospital variation was characterized by using intraclass correlation and the median odds ratio. RESULTS: Among 13,454 adults with COVID-19 who received supplemental oxygen, 8,143 (60%) received nasal cannula/face mask only, 2,859 (21%) received HFNC, 878 (7%) received NIV, 1,574 (12%) received both HFNC and NIV, with 3,640 subjects (27%) progressing to invasive ventilation. The hospital of admission contributed to 24% of the risk-adjusted variation in HFNC and 30% of the risk-adjusted variation in NIV. The median odds ratio for hospital variation of HFNC was 2.6 (95% CI 1.4–4.9) and of NIV was 3.1 (95% CI 1.2-8.1). Among 5,311 subjects who received HFNC and/or NIV, 2,772 (52%) did not receive invasive ventilation and survived to hospital discharge. Hospital-level use of HFNC or NIV were not associated with the rates of invasive ventilation or mortality. CONCLUSIONS: Hospital variation in the use of HFNC and NIV for acute respiratory failure secondary to COVID-19 was great but was not associated with intubation or mortality. The wide variation and relatively low use of HFNC/NIV observed within our study signaled that implementation of increased HFNC/NIV use in patients with COVID-19 will require changes to current care delivery practices. (ClinicalTrials.gov registration NCT04323787.)
Metabolic Syndrome and Acute Respiratory Distress Syndrome in Hospitalized Patients With COVID-19
Gillet, A.S. , Zu, Yuanhao, Brown, Margo, Pham, Thaidan , Yoshida, Yilin , Douglas, Ivor S. , Moore, Mathew, Tea, Kevin, Wetherbie, Andrew, Stevens, Rachael, Lefante, John J., Shaffer, Jeffrey G. , Armaignac, Donna Lee , Belden, Katherine A. , Kaufman, Margit, Heavner, Smith F. , Danesh, Valerie , Hill, Catherine A. St., Boman, Karen , Bansal, Vikas , Kumar, Vishakha K. , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator, Mesland, Jean-Baptiste , Henin, Pierre , Petre, Hélène, Buelens, Isabelle, Gérard, A , Granado, Rolando Claure-Del, Vega-Terraza, Esdenka, Iturricha-Cáceres, Maria F., Garza, Rubén , Chan, Victoria , Gavidia, Oscar Y., Pachon, Felipe, Tawheed, Ahmed , Pineda, Estela , Guillen, Gabina María Reyes, Soto, Helin Archaga, Lizardo, Ana Karen Vallecillo, Segu, Smitha, Chakraborty, T., Joyce, Epcebha, Kasumalla, Phani Sreeharsha, Vadgaonkar, Girish, Ediga, Rekha, Basety, Shilpa, Dammareddy, Shwetha, Raju, Umamaheswara, Manduva, Janaki, Kolakani, Naresh, Sripathi, Shreeja , Chaitanya, Sheetal, Parameswaran, Sreejith , Parthiban, Magesh, Menu, P., Daga, Mardul Kumar, Agarwal, Munisha , Rohtagi, Ishan, Papani, Sridhar, Kamuram, Mahesh, Agrawal, Kamlesh Kumar , Baghel, Vijendra, Patel, K, Mohan, Surapaneni Krishna, Jyothisree, Ekambaram, Dalili, Nooshin , Nafa, Mohsen, Matsuda, Wataru , Suzuki, Reina , Horikita, Sho, Kodate, Akira, Takahashi, Yuki , Moriki, Koyo, Iwasaki, Yudai , Rodríguez‐Gutiérrez, René , Gonzale, Jose Gerardo, Salcido‐Montenegro, Alejandro , Hassan-Hanga, Fatimah , Gezawa, Abubakar Shehu, Kabir, Halima , Amole, Taiwo Gboluwaga , Haliru, Dalha Gwarzo, Ibrahim, Abdullahi S., Asghar, Muhammad Sohaib , Syed, Mashaal , Naqvi, Syed Anosh Ali, Заболотских, И. 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JAMA Network Open | December 22, 2021 | Volume: 4 | Issue: 12 | Pages: e2140568
Variation in Use of Repurposed Medications Among Patients With Coronavirus Disease 2019. From The Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 Registry Investigator Group
Garcia, Michael A. , Johnson, Shelsey W. , Sisson, Emily, Sheldrick, Christopher R., Kumar, Vishakha K. , Boman, Karen , Bolesta, Scott , Bansal, Vikas , Domecq, J. P., Lal, Amos , Christie, Amy B. , Sanghavi, Devang , Vadgaonkar, Girish, Investigators, for the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study, Kaur, Nirmaljot , Camazine, Maraya , Заболотских, И. Б. , Asghar, Muhammad Sohaib , Lal, Amos , Bansal, Vikas , Kaur, Nirmaljot , Asghar, Muhammad S , Domecq Graces, Juan Pablo , Bosch, Nicholas A. , Sheldrick, Christopher R., Deo, Neha , Banner‐Goodspeed, Valerie , Gajic, Ognjen , Kashyap, Rahul , Walkey, Allan J. , Investigators, for the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study
Critical Care Explorations | November 3, 2021 | Volume: 3 | Issue: 11 | Pages: e0566
IMPORTANCE: At the start of the coronavirus disease 2019 pandemic, medications repurposed for management of coronavirus disease 2019 were used in the absence of clinical trial evidence. OBJECTIVES: To describe the variation and evolution in use of repurposed medications for coronavirus disease 2019. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of adults hospitalized with coronavirus disease 2019 between February 15, 2020, and April 12, 2021, across 76 United States and international hospitals within the Society of Critical Care Medicine’s Discovery Viral Infection and Respiratory Illness Universal Study coronavirus disease 2019 registry. MAIN OUTCOMES AND MEASURES: Hospital variation was quantified using multivariable adjusted random effects logistic regression models and unsupervised clustering. Repurposed medications included antivirals, corticosteroids, hydroxychloroquine, immunomodulators, and therapeutic dose anticoagulants. RESULTS: Among 7,069 adults hospitalized with coronavirus disease 2019, 1,979 (28%) received antivirals, 2,876 (41%) received corticosteroids, 1,779 (25%) received hydroxychloroquine, 620 (9%) received immunomodulators, and 2,154 (31%) received therapeutic dose anticoagulants. Contribution of hospital site to risk-adjusted variation was 46% for antivirals, 30% for corticosteroids, 48% for hydroxychloroquine, 46% for immunomodulators, and 52% for therapeutic dose anticoagulants. Compared with the early pandemic, the later pandemic practice phenotypes converged with increased use of antivirals (odds ratio, 3.14; 95% CI, 2.40–4.10) and corticosteroids (odds ratio, 5.43; 95% CI, 4.23–6.97), with decreased use of hydroxychloroquine (odds ratio, 0.02; 95% CI, 0.01–0.04) and immunomodulators (odds ratio, 0.49; 95% CI, 0.34–0.70). There was no clinically significant change in the use of therapeutic dose anticoagulants (odds ratio, 1.01; 95% CI, 1.01–1.02). There were no differences in risk-adjusted mortality between hospitals with high rates of repurposed medication use compared with hospitals with low rates of use. CONCLUSIONS AND RELEVANCE: Hospital variation in the use of repurposed medications varied widely across hospitals early in the pandemic and later converged with the emergence of randomized clinical trials. Platforms developed for rapid activation and enrollment in clinical trials of repurposed medications are needed prior to the next pandemic to expedite effective, evidence-based practice.
Outcomes of Patients With Coronavirus Disease 2019 Receiving Organ Support Therapies: The International Viral Infection and Respiratory Illness Universal Study Registry
Domecq, Juan Pablo , Lal, Amos , Sheldrick, Christopher R., Kumar, Vishakha K. , Boman, Karen , Bolesta, Scott , Bansal, Vikas , Garcia, Michael A. , Kaufman, Margit, Danesh, Valerie , Anderson, Harry L., Milligan, Patrick S., Denson, Joshua L. , Hill, Catherine A. St., Dodd, Kenneth W. , Gajić, Ognjen, Kashyap, Rahul , Tierney, David M. , Camazine, Maraya , Dapul, Heda , Gharpure, Varsha , Koritala, Thoyaja , Заболотских, И. Б. , Kovačević, Peđja , Asghar, Muhammad Sohaib , McGonagill, Patrick W. , El‐Kassas, Mohamed , Parameswaran, Sreejith , Iwasaki, Yudai , Nenadić, Irina , Djuric, Marko , Lutrick, Karen , Lumelsky, David , Minear, Steven , Tarabichi, Yasir , Dy, Rajany , Galet, Colette , West, T. Eoin , Wilfong, Erin M. , Ramírez, Michelle , Law, Anica C. , Lal, Amos , Bansal, Vikas , Denson, Joshua L , Kashyap, Rahul , Gharpure, Varsha P , Asghar, Muhammad S , Domecq Graces, Juan Pablo , Sheldrick, Christopher R., Harhay, Michael Oscar , Cheruku, Sreekanth , Banner‐Goodspeed, Valerie , Anderson, Harry L., Martin, Greg S. , Gajic, Ognjen , Walkey, Allan J.
Critical Care Medicine | January 29, 2021 | Volume: 49 | Issue: 3 | Pages: 437-448
OBJECTIVES: To describe the outcomes of hospitalized patients in a multicenter, international coronavirus disease 2019 registry. DESIGN: Cross-sectional observational study including coronavirus disease 2019 patients hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection between February 15, 2020, and November 30, 2020, according to age and type of organ support therapies. SETTING: About 168 hospitals in 16 countries within the Society of Critical Care Medicine’s Discovery Viral Infection and Respiratory Illness University Study coronavirus disease 2019 registry. PATIENTS: Adult hospitalized coronavirus disease 2019 patients who did and did not require various types and combinations of organ support (mechanical ventilation, renal replacement therapy, vasopressors, and extracorporeal membrane oxygenation). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome was hospital mortality. Secondary outcomes were discharge home with or without assistance and hospital length of stay. Risk-adjusted variation in hospital mortality for patients receiving invasive mechanical ventilation was assessed by using multilevel models with hospitals as a random effect, adjusted for age, race/ethnicity, sex, and comorbidities. Among 20,608 patients with coronavirus disease 2019, the mean (± sd ) age was 60.5 (±17), 11,1887 (54.3%) were men, 8,745 (42.4%) were admitted to the ICU, and 3,906 (19%) died in the hospital. Hospital mortality was 8.2% for patients receiving no organ support ( n = 15,001). The most common organ support therapy was invasive mechanical ventilation ( n = 5,005; 24.3%), with a hospital mortality of 49.8%. Mortality ranged from 40.8% among patients receiving only invasive mechanical ventilation ( n =1,749) to 71.6% for patients receiving invasive mechanical ventilation, vasoactive drugs, and new renal replacement therapy ( n = 655). Mortality was 39% for patients receiving extracorporeal membrane oxygenation ( n = 389). Rates of discharge home ranged from 73.5% for patients who did not require organ support therapies to 29.8% for patients who only received invasive mechanical ventilation, and 8.8% for invasive mechanical ventilation, vasoactive drugs, and renal replacement; 10.8% of patients older than 74 years who received invasive mechanical ventilation were discharged home. Median hospital length of stay for patients on mechanical ventilation was 17.1 days (9.7-28 d). Adjusted interhospital variation in mortality among patients receiving invasive mechanical ventilation was large (median odds ratio 1.69). CONCLUSIONS: Coronavirus disease 2019 prognosis varies by age and level of organ support. Interhospital variation in mortality of mechanically ventilated patients was not explained by patient characteristics and requires further evaluation.