RESUMEN
PURPOSE: During a follow-up program of patients admitted for COVID-19 at our non-ICU Unit, we found that 37% of them had decreased diffusing lung capacity for carbon monoxide (DLCO) 3-6 months after discharge. This prospective observational study aimed to evaluate the evolution of changes in DLCO and respiratory symptoms at the 1-year follow-up visit. METHODS: Seventeen (mean age 71 years; 8 males) of 19 eligible patients (DLCO < 80% of predicted at the 3-6 months follow-up visit) completed the 1-year follow-up visit. One patient refused to participate and 1 patient had died 3 months earlier from myocardial infarction. The visit included a self-reported structured questionnaire, physical exam, blood tests, ECG, and spirometry with DLCO. RESULTS: Mean DLCO was significantly improved at the 1-year visit (from 64% of predicted at 3-6 months to 74% of predicted at 1 year; P = 0.003). A clinically significant increase in DLCO (10% or greater) was observed in 11 patients (65%) with complete normalization (> 80% of predicted) in 6 (35%); in the other 6 (35%) it remained unchanged. The prevalence of exertional dyspnea (65-35%, P = 0.17), cough (24-18%, P = 1), and fatigue (76-35%, P = 0.04) decreased at the 1-year visit. CONCLUSION: These results suggest that DLCO and respiratory symptoms tend to normalize or improve 1 year after hospitalization for COVID-19 in most patients. However, there is also a non-negligible number of patients (about one-third) in whom respiratory changes persist and will need prolonged follow-up.
Asunto(s)
COVID-19 , Anciano , COVID-19/complicaciones , Hospitalización , Humanos , Pulmón/diagnóstico por imagen , Masculino , Alta del Paciente , EspirometríaRESUMEN
BACKGROUND: The COVID-19 pandemic has put a strain on health systems. Predictors of adverse outcomes need to be investigated to properly manage COVID-19 patients. The Braden Scale (BS), commonly used for the assessment of pressure ulcer risk, has recently been proposed to identify frailty. OBJECTIVE: To investigate the predictive utility of the BS for prediction of in-hospital mortality in a cohort of COVID-19 patients admitted to non-ICU wards. METHODS: We conducted a retrospective single-center cohort study evaluating all patients with SARS-CoV-2 infection consecutively admitted over a 2-month period (from March 6 to May 7, 2020) to the COVID-19 general wards of our institution. Demographic, clinical, and nursing assessment data, including admission BS, were extracted from electronic medical records. Univariable and multivariable logistic regression models were used to explore the association between the BS score and in-hospital death. RESULTS: Braden Scale was assessed in 146 patients (mean age 74.7 years; 52% males). On admission, 46 had a BS ≤ 15, and 100 patients had a BS > 15. Mortality among patients with BS ≤ 15 was significantly higher than in patients with BS > 15 (45.7% vs. 16%; p < .001). On multivariable regression analysis, adjusting for potentials confounders (age, Barthel scale, chronic kidney disease, atrial fibrillation, and hypertension), the admission BS remained inversely associated with the risk of in-hospital mortality (OR = 0.76; 95% CI [0.60, 0.96]; p = .020). LINKING EVIDENCE TO ACTION: Admission BS could be used as a simple bedside predictive tool able to early identify non-ICU COVID-19 patients with poor prognosis who might benefit from specific and timely interventions.
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COVID-19/mortalidad , Fragilidad/diagnóstico , Mortalidad Hospitalaria , Admisión del Paciente/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , Estudios de Cohortes , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Valor Predictivo de las Pruebas , Estudios Retrospectivos , SARS-CoV-2RESUMEN
The role of noninvasive positive pressure ventilation (NIPPV) in COVID-19 patients with acute hypoxemic respiratory failure (AHRF) is uncertain, as no direct evidence exists to support NIPPV use in such patients. We retrospectively assessed the effectiveness and safety of NIPPV in a cohort of COVID-19 patients consecutively admitted to the COVID-19 general wards of a medium-size Italian hospital, from March 6 to May 7, 2020. Healthcare workers (HCWs) caring for COVID-19 patients were monitored, undergoing nasopharyngeal swab for SARS-CoV-2 in case of onset of COVID-19 symptoms, and periodic SARS-CoV-2 screening serology. Overall, 50 patients (mean age 74.6 years) received NIPPV, of which 22 (44%) were successfully weaned, avoiding endotracheal intubation (ETI) and AHRF-related death. Due to limited life expectancy, 25 (50%) of 50 NIPPV-treated patients received a "do not intubate" (DNI) order. Among these, only 6 (24%) were weaned from NIPPV. Of the remaining 25 NIPPV-treated patients without treatment limitations, 16 (64%) were successfully weaned, 9 (36%) underwent delayed ETI and, of these, 3 (33.3%) died. NIPPV success was predicted by the use of corticosteroids (OR 15.4, CI 1.79-132.57, p 0.013) and the increase in the PaO2/FiO2 ratio measured 24-48 h after NIPPV initiation (OR 1.02, CI 1-1.03, p 0.015), while it was inversely correlated with the presence of a DNI order (OR 0.03, CI 0.001-0.57, p 0.020). During the study period, 2 of 124 (1.6%) HCWs caring for COVID-19 patients were diagnosed with SARS-CoV-2 infection. Apart from patients with limited life expectancy, NIPPV was effective in a substantially high percentage of patients with COVID-19-associated AHRF. The risk of SARS-CoV-2 infection among HCWs was low.