通过第一,第二和第三波的危急COVID-19患者:回顾性观察性研究,比较重症监护病房的结果
Irene Coloretti1, Carlotta Farinelli1, Emanuela Biagioni1
1Intensive Care Unit, University Hospital of Modena, Modena, Italy.
Journal of thoracic disease
|July 10, 2023
概括
这项研究发现,尽管治疗方法在不断发展,但COVID-19患者的死亡率在整个大流行浪潮中没有显著改善. 然而,第三波死亡率下降的趋势和德甲的潜在益处被观察到.
科学领域:
- 临界护理医学 临界护理医学
- 传染性疾病 传染性疾病
- 流行病学 流行病学
背景情况:
- 随着COVID-19大流行逐波发展,重症监护室 (ICU) 的入院人数不断增加.
- 在疫情期间,基于不断增长的疾病知识,治疗策略得到了改进.
- 这项研究回顾性地分析了COVID-19患者在重症监护室的治疗结果.
研究的目的:
- 确定不断发展的治疗策略是否改善了ICU入院的COVID-19患者的治疗结果.
- 为了比较患者在三个不同的流行病浪潮中的结果.
- 调查治疗对死亡率和其他重症监护指标的影响.
主要方法:
- 连续入住ICU的成年COVID-19患者的回顾性分析.
- 患者根据入院日期分为三个波段 (波段1:2020年2月至7月,波段2:2020年9月至2021年2月,波段3:2021年2月至4月).
- 结果与使用多变量Cox模型和在侵袭性机械通风 (IMV) 患者的敏感性分析进行了比较.
主要成果:
- 分析了428名患者;在第3波 (P>0.05) 中,粗略的ICU和住院死亡率在数值上较低.
- 波3显示显着更多的ICU和没有住院的日子 (P=0.001).
- 倾向匹配分析显示,在第3波 (P=0.044) 中,医院死亡率减少了11%,而调整后的考克斯模型显示,在各波之间,死亡率HR没有显著差异.
结论:
- 尽管采用了最佳实践,但在三次COVID-19大流行浪潮中,ICU整体死亡率没有显著改善.
- 部分分析表明,第三波死亡率下降的趋势.
- 德克萨米他对死亡率产生了潜在的积极影响,而细菌感染增加了死亡风险.
相关概念视频
Acute Respiratory Failure-III
227
Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without...
227
Acute Coronary Syndrome III: Diagnostic Studies
10
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
10
Acute Respiratory Failure-II
278
Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
278
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
12
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
12
Pneumonia III: Complications and Assessment
274
Pneumonia poses the potential for numerous complications that warrant consideration. These complications include the following:
274
Acute Coronary Syndrome IV: Interprofessional Care
12
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
12


