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Care Bundles to Improve Hemoperfusion Performance in Patients with Severe COVID-19: A Retrospective Study
Sirirat Mueankwan1, Konlawij Trongtrakul2, Pattraporn Tajarernmuang2
1Surgical Intensive Care Unit, Division of Nursing Services, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Insights
Care bundles improved hemoperfusion (HP) for severe COVID-19 patients by reducing adverse events, particularly hypothermia. While not statistically significant, HP success rates increased, suggesting bundle benefits require larger studies.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Biomedical Engineering
Background:
- Severe COVID-19 pneumonia can trigger cytokine storms, necessitating interventions like hemoperfusion (HP).
- Optimizing HP performance and safety is crucial for patient outcomes.
- Existing HP protocols require refinement to address performance and adverse events.
Purpose of the Study:
- To evaluate the impact of implemented care bundles on hemoperfusion (HP) success rates and safety in severe COVID-19 patients.
- To assess the effectiveness of specific interventions including temperature control, hemodynamic monitoring, and clot prevention.
- To compare HP-related adverse events and outcomes between pre- and post-bundle implementation phases.
Main Methods:
- Retrospective cohort study comparing two phases of HP treatment in severe COVID-19 pneumonia patients (≥20 years old).
- Phase I identified HP issues; Phase II implemented care bundles (temperature control, hemodynamic monitoring, clot prevention).
- Assessed HP success rates and adverse events (AEs) across 60 HP sessions (27 cases).
Main Results:
- Phase II showed a trend towards higher HP success rates (67% vs. 89%, p=0.19).
- Significantly fewer AEs occurred in Phase II (1 event/case vs. 3 events/case, p=0.014).
- Hypothermia incidence decreased significantly post-bundle implementation (33% vs. 78%, p=0.037), with adjusted OR 0.15.
Conclusions:
- Care bundles significantly improved hypothermia prevention in severe COVID-19 patients undergoing HP.
- While HP success rates showed a non-significant increase, AEs were substantially reduced.
- Larger studies are needed to definitively establish the overall advantages of these care bundles for HP efficacy.
Abstract:
Background/Objectives: Hemoperfusion (HP) is employed to modulate cytokine storms in severe coronavirus disease 2019 (COVID-19) patients, requiring careful attention for success and safety. Therefore, we investigated whether our care bundles could enhance HP performance. Methods: We conducted a retrospective cohort study on adult patients (≥20 years old) with severe COVID-19 pneumonia. In the first wave (Phase I), we identified HP-related issues and addressed them with care bundles in the second wave (Phase II). The care bundles included early temperature control, precise hemodynamic monitoring, and clot prevention measures for the HP membrane. The HP success rate and associated adverse events (AEs) were assessed between the two phases. Results: The study included 60 HP (HA330) sessions from 27 cases (Phase I: 21 sessions from 9 cases; Phase II: 39 sessions from 18 cases). Patient characteristics and treatments for COVID-19 were similar, except for baseline body temperature (BT) and heart rate (HR). Phase II showed a higher success rate (67% vs. 89%, p = 0.19), although it did not reach statistical significance. Phase I recorded a significantly higher frequency of AEs (3 [IQR 1, 4] events/case vs. 1 [IQR 0, 2] events/case, p = 0.014). After implementing the care bundles, hypothermia significantly decreased (78% vs. 33%, p = 0.037), with an adjusted odds ratio of 0.15; 95% CI 0.02-0.95, p = 0.044 for baseline BT. Conclusions: Further exploration with a larger sample size is required to establish the advantages of care bundles. However, the bundles' implementation has significantly improved hypothermia prevention.
