Abstract Background There is conflicting evidence on association between quick sequential organ failure assessment (qSOFA) and sepsis mortality in ICU patients. The primary aim of this study was to determine the association between qSOFA and 28-day mortality in ICU patients admitted for sepsis. Association of qSOFA with early (3-day), medium (28-day), late (90-day) mortality was assessed in low and lower middle income (LLMIC), upper middle income (UMIC) and high income (HIC) countries/regions. Methods This was a secondary analysis of the MOSAICS II study, an international prospective observational study on sepsis epidemiology in Asian ICUs. Associations between qSOFA at ICU admission and mortality were separately assessed in LLMIC, UMIC and HIC countries/regions. Modified Poisson regression was used to determine the adjusted relative risk (RR) of qSOFA score on mortality at 28 days with adjustments for confounders identified in the MOSAICS II study. Results Among the MOSAICS II study cohort of 4980 patients, 4826 patients from 343 ICUs and 22 countries were included in this secondary analysis. Higher qSOFA was associated with increasing 28-day mortality, but this was only observed in LLMIC ( p < 0.001) and UMIC ( p < 0.001) and not HIC ( p = 0.220) countries/regions. Similarly, higher 90-day mortality was associated with increased qSOFA in LLMIC ( p < 0.001) and UMIC ( p < 0.001) only. In contrast, higher 3-day mortality with increasing qSOFA score was observed across all income countries/regions ( p < 0.001). Multivariate analysis showed that qSOFA remained associated with 28-day mortality (adjusted RR 1.09 (1.00–1.18), p = 0.038) even after adjustments for covariates including APACHE II, SOFA, income country/region and administration of antibiotics within 3 h. Conclusions qSOFA was independently associated with 28-day mortality in ICU patients admitted for sepsis. In LLMIC and UMIC countries/regions, qSOFA was associated with early to late mortality but only early mortality in HIC countries/regions. Graphical Abstract
This corrects the article "Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study" in volume 35 on page 255.
In Asian countries, nationwide data on patients undergoing home mechanical ventilation are limited.
METHODS:
This study investigated the prevalence and primary indications for home mechanical ventilation use in South Korea by using nationwide registry data from the National Health Insurance Service.
RESULTS:
The study period included a total of 4,785 subjects on home mechanical ventilation (mean ± SD age, 56.0 ± 23.9 y; females, 40.1%). The estimated overall prevalence of home mechanical ventilation use in South Korea was 9.3 per 100,000, with a prevalence of 6.3 per 100,000 among children (ages < 15 y). The most common primary diagnoses were neuromuscular diseases (42.0%) and lung and/or airway diseases (27.7%). The prevalence of lung and/or airway and cerebrovascular diseases as the primary diagnosis increased with age (r = 0.310, P < .001; and r = 0.156, P < .001, respectively). Noninvasive ventilation was used by 37.2% of all the subjects, with the highest prevalence in those with neuromuscular diseases (54.4%) or chest wall diseases (53.4%). Noninvasive ventilation use was lowest among subjects with brain lesions. Home mechanical ventilation was most commonly prescribed by internists (41.3% of cases), followed by rehabilitation and neurology physicians.
CONCLUSIONS:
These data will aid in planning the optimal health-care system for users of home mechanical ventilation locally and will allow for comparison of home mechanical ventilation use rates among countries.
Despite the increased use of home mechanical ventilation (HMV), data on home care services for HMV users in Asian countries are scarce. This study investigated the current status of HMV use in the Seoul metropolitan area.This cross-sectional study involved three university-affiliated hospitals. Subjects who were receiving HMV at home for >3 months were included, and door-to-door visits were done to collect data (e.g., on devices, caregivers, and healthcare service use) from the subjects or their families.Among the 140 individuals who were initially screened, 38 adults and 26 children were finally enrolled; the duration of HMV use was 14.5 (8.8-37.5) months and 20.5 (7.0-28.0) months, respectively. Tracheostomy ventilation was performed in 36.8% of the adults and 61.5% of the children, and life-support ventilator in 55.3% and 96.2%, respectively. Regarding ancillary devices, 42.1% of the adults and 80.8% of the children had an oxygen monitoring device, while only one member of each group had a cough assist device. Among those with a tracheostomy, 64.3% of adults and 81.3% of children had an AMBU-bag. Reliance on a family member for care was determined in 65.8% of adults and 88.5% of children, but a home visit by a hospital nurse during the previous year occurred in only 26.3% of the adults and 3.8% of the children. Emergency incidents at home occurred in 39.5% of the adults and 50.0% of the children, with dyspnea being the most common cause. Out-of-pocket expenses tended to be higher in the tracheostomy (vs. non-tracheostomy) group and in children (vs. adults).Our study highlights the challenges faced by adults and children dependent on HMV, and their families. There is an urgent need for nationwide standardization of care for patients receiving HMV at home.
Background Data on noninvasive ventilation (NIV) use in intensive care units (ICUs) are very limited in South Korea. Methods A prospective observational study was performed in 20 ICUs of university-affiliated hospitals from June 2017 to February 2018. Adult patients (age>18 years) who were admitted to the ICU and received NIV treatment for acute respiratory failure were included. Results A total of 156 patients treated with NIV were enrolled (mean age, 71.9±11.6 years). The most common indications for NIV were acute hypercapnic respiratory failure (AHRF, n=89) and post-extubation respiratory failure (n=44). The main device for NIV was an invasive mechanical ventilator with an NIV module (61.5%), and the majority of patients (87.2%) used an oronasal mask. After the exclusion of 32 do-not-resuscitate patients, NIV success rate was 68.5% (85/124); ICU and hospital mortality rates were 8.9% and 15.3%, respectively. However, the success rate was lower in patients with de novo respiratory failure (27.3%) compared to that of patients with AHRF (72.8%) or post-extubation respiratory failure (75.0%). In multivariate analysis, immunocompromised state, de novo respiratory failure, post-NIV (2 hours) respiratory rate, NIV mode (i.e., non-pressure support ventilation mode), and the change of NIV device were significantly associated with a lower success rate of NIV. Conclusion AHRF and post-extubation respiratory failure were the most common indications for NIV in Korean ICUs. Overall NIV success was achieved in 68.5% of patients, with the lowest rate in patients with de novo respiratory failure. Keywords: Intensive Care Units; Noninvasive Ventilation; Masks
Backgrounds
We would improve the understanding and management preparation of human coronavirus (HCoV) disease by analyzing the epidemiology, clinical aspects, and prognostic factors of patients of all ages who were recently hospitalized with coronavirus.
Methods
This study was retrospectively performed at five university teaching hospitals between 1 January 2018 and 31 March 2020. Routine molecular testing using for multiplex real-time reverse transcription-polymerase chain reaction Methods was conducted on the respiratory viruses. We assessed the demographics, laboratory findings, and treatment of patients infected with coronavirus.
Results
There were 807 coronavirus-infected patients admitted to five hospitals for 27 months and 553 (69%) of them were <10 years age. All-cause mortality rates of patients admitted for seasonal HCoV disease were 3.1% in all patients, and 10.8% in patients aged ≥ 18 years. The Cox proportional hazard regression analysis was performed in patients aged ≥ 18 years. After adjusting for other clinical variables, general weakness symptoms (hazard ratio [HR], 2.65; 95% confidence interval [CI], 1.14-6.13, P = 0.023) , National Early Waring Score (NEWS) ≥2 (HR, 6.00; 95% CI, 1.40-25.81, P = 0.016), and coronavirus subtype OC43 (HR, 2.82; 95% CI, 1.21-6.58, P = 0.016) were significantly associated with death from coronavirus.
Conclusions
Coronavirus infection can reveal a higher mortality rate in patients of ≥18 years than those of <18 years, thus, adult patients require more careful treatment. Furthermore, in adult patients, the factors associated with death from coronavirus include general weakness symptoms, NEWS higher than 2, and OC43 subtype.
Background: Fixed airflow obstruction (FAO), particularly in non-smokers, is generally believed to be caused by airway remodeling, However, parenchymal destruction may also contribute to FAO and longitudinal decline in forced expiratory volume in 1 sec, (FEV1) Objectives: To evaluate parenchymal destruction using emphysema indices, exponent D and low attenuation area percent (LAA%) on computed tomography (CT), and test whether the parenchymal destruction is associated with FAO and FEV1 decline in both smoking and non-smoking asthma, independent of airway diseases.Methods: D, LAA%, wall area percent (WA%) at segmental airways, and airway fractal dimension (AFD) in asthmatics were measured on CT and compared to those in chronic obstructive pulmonary disease (COPD) patients.Results: D was lower and LAA% was higher in COPD (N = 42) and asthma with FAO (N = 101) than in asthma without FAO (N = 88).The decreased D and increased LAA % were found in a subgroup of either non-smokers, smokers, non-severe asthmatics, or severe asthmatics.In multivariable analysis, decreased D and increased LAA% were associated with an increased odds ratio of FAO and decreased FEV1, irrespective of WA% and AFD.Moreover, decreased D affected the longitudinal decline in FEV1 in severe asthmatics independent of smoking status despite no association between D and eosinophil counts in blood and sputum Conclusions: Asthmatics with FAO showed the parenchymal destruction irrespective of smoking status and asthma severity.The parenchymal destruction was associated with an accelerated FEV1 decline.
Backgrounds:Population worldwide is aging due to declines of both fertility and mortality rates. Consequently, demands for critical care and admission to intensive care unit (ICU) in very elderly patients are increasing. The evaluation of outcome and risk factor of very elderly patients admitted to ICU is important as implications on health resources in terms of triage. Methods:Clinical records of 183 patients (1.08 % of total 16939 ICU patients ≥ 18 years) over 90 years admitted to ICU were analyzed retrospectively from January 2003 to July 2012. Results:Causes of ICU admission were pneumonia(16%), heart failure(12%), cerebral infarction(11%). ICU mortality of patients over 90 years was 27% while ICU mortality of total patient ≥ 18 years was 14%. Risk factors of ICU mortality were analyzed in 155 patients except 33 patients transferred other healthcare center in state of hopeless. In univariate analysis, patients of chronic renal failure( p =0.023), pneumoni ( p =0.006), lymphocyte≤1000 /m3( p =0.035), creatinine≥1.0 mg/dL( p <0.001), albumin≤3.0 g/dL( p =0.012), cholesterol≤130 mg/dL( p =0.010), CRP≥66 mg/dL( p =0.012), SAPS II≥37( p <0.001), APACHE II ≥14( p <0.001), Mechanical ventilation( p <0.001), and vasopressor( p <0.001) showed higher mortality. In multivariate analysis by Cox hazard model, risk factors of ICU patients≥18 years were CRP≥66 mg/dL(HR=3.118, p =0.019), SAPS II≥37(HR=5.813, p =0.015), and vasopressor(HR=2.851, p =0.024). Conclusion:Mortality of very elderly patients over 90 years admitted to ICU is high. Furthermore, a requirement of vasopressor, a high CRP and a high SAPS II score had poor prognosis in very elderly patients over 90 years admitted to the ICU.
Spirometry is a physiological test for assessing the functional aspect of the lungs using an objective indicator to measure the maximum amount of air that a patient can inhale and exhale. Acceptable spirometry testing needs to be conducted three times by an acceptable and reproducible method for determining forced vital capacity (FVC). Until the results of three tests meet the criteria of reproducibility, the test should be repeated up to eight times. Interpretation of spirometry should be clear, concise, and informative. Additionally, spirometry should guarantee optimal quality prior to the interpreting spirometry results. Our guideline adopts a fixed normal predictive value instead of the lower limit of normal as the reference value because fixed value is more convenient and also accepts FVC instead of vital capacity (VC) because measurement of VC using a spirometer is impossible. The bronchodilator test is a method for measuring the changes in lung capacity after inhaling a short-acting β-agonist that dilates the airway. When an obstructive ventilatory defect is observed, this test helps to diagnose and evaluate asthma and chronic obstructive pulmonary disease by measuring reversibility with the use of an inhaled bronchodilator. A positive response to a bronchodilator is generally defined as an increase of ≥12% and ≥200 mL as an absolute value compared with a baseline in either forced expiratory volume at 1 second or FVC.
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