A Patient With Coronavirus Disease 2019 Pneumonia and Sudden Decompensation While Receiving Mechanical Ventilatory Support.
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ABSTRACT:
SUBMITTER: Fryman C
PROVIDER: S-EPMC8021966 | biostudies-literature | 2021 Apr
REPOSITORIES: biostudies-literature
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A Patient With Coronavirus Disease 2019 Pneumonia and Sudden Decompensation While Receiving Mechanical Ventilatory Support.
Chest 20210406 4
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Project description:OBJECTIVES:Music intervention has been shown to reduce anxiety and sedative exposure among mechanically ventilated patients. Whether music intervention reduces ICU costs is not known. The aim of this study was to examine ICU costs for patients receiving a patient-directed music intervention compared with patients who received usual ICU care. DESIGN:A cost-effectiveness analysis from the hospital perspective was conducted to determine if patient-directed music intervention was cost-effective in improving patient-reported anxiety. Cost savings were also evaluated. One-way and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness. SETTING:Midwestern ICUs. PATIENTS:Adult ICU patients from a parent clinical trial receiving mechanical ventilatory support. INTERVENTIONS:Patients receiving the experimental patient-directed music intervention received a MP3 player, noise-canceling headphones, and music tailored to individual preferences by a music therapist. MEASUREMENTS AND MAIN RESULTS:The base case cost-effectiveness analysis estimated patient-directed music intervention reduced anxiety by 19 points on the Visual Analogue Scale-Anxiety with a reduction in cost of $2,322/patient compared with usual ICU care, resulting in patient-directed music dominance. The probabilistic cost-effectiveness analysis found that average patient-directed music intervention costs were $2,155 less than usual ICU care and projected that cost saving is achieved in 70% of 1,000 iterations. Based on break-even analyses, cost saving is achieved if the per-patient cost of patient-directed music intervention remains below $2,651, a value eight times the base case of $329. CONCLUSIONS:Patient-directed music intervention is cost-effective for reducing anxiety in mechanically ventilated ICU patients.
| S-EPMC6095811 | biostudies-literature
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| S-EPMC7859694 | biostudies-literature
Project description:ImportanceAlternatives to sedative medications, such as music, may alleviate the anxiety associated with ventilatory support.ObjectiveTo test whether listening to self-initiated patient-directed music (PDM) can reduce anxiety and sedative exposure during ventilatory support in critically ill patients.Design, setting, and patientsRandomized clinical trial that enrolled 373 patients from 12 intensive care units (ICUs) at 5 hospitals in the Minneapolis-St Paul, Minnesota, area receiving acute mechanical ventilatory support for respiratory failure between September 2006 and March 2011. Of the patients included in the study, 86% were white, 52% were female, and the mean (SD) age was 59 (14) years. The patients had a mean (SD) Acute Physiology, Age and Chronic Health Evaluation III score of 63 (21.6) and a mean (SD) of 5.7 (6.4) study days.InterventionsSelf-initiated PDM (n = 126) with preferred selections tailored by a music therapist whenever desired while receiving ventilatory support, self-initiated use of noise-canceling headphones (NCH; n = 122), or usual care (n = 125).Main outcomes and measuresDaily assessments of anxiety (on 100-mm visual analog scale) and 2 aggregate measures of sedative exposure (intensity and frequency).ResultsPatients in the PDM group listened to music for a mean (SD) of 79.8 (126) (median [range], 12 [0-796]) minutes/day. Patients in the NCH group wore the noise-abating headphones for a mean (SD) of 34.0 (89.6) (median [range], 0 [0-916]) minutes/day. The mixed-models analysis showed that at any time point, patients in the PDM group had an anxiety score that was 19.5 points lower (95% CI, -32.2 to -6.8) than patients in the usual care group (P = .003). By the fifth study day, anxiety was reduced by 36.5% in PDM patients. The treatment × time interaction showed that PDM significantly reduced both measures of sedative exposure. Compared with usual care, the PDM group had reduced sedation intensity by -0.18 (95% CI, -0.36 to -0.004) points/day (P = .05) and had reduced frequency by -0.21 (95% CI, -0.37 to -0.05) points/day (P = .01). The PDM group had reduced sedation frequency by -0.18 (95% CI, -0.36 to -0.004) points/day vs the NCH group (P = .04). By the fifth study day, the PDM patients received 2 fewer sedative doses (reduction of 38%) and had a reduction of 36% in sedation intensity.Conclusions and relevanceAmong ICU patients receiving acute ventilatory support for respiratory failure, PDM resulted in greater reduction in anxiety compared with usual care, but not compared with NCH. Concurrently, PDM resulted in greater reduction in sedation frequency compared with usual care or NCH, and greater reduction in sedation intensity compared with usual care, but not compared with NCH.Trial registrationclinicaltrials.gov Identifier: NCT00440700.
| S-EPMC3683448 | biostudies-literature
Project description:The purpose of this study was to identify miRNAs that were dysregulated after the onset of COVID-19 and thus potentially be used for risk stratification (i.e., mortality). Therefore, we conducted a multi-center, retrospective longitudinal cohort study enrolling 142 patients with laboratory-confirmed SARS-CoV-2 infection who presented to two Canadian hospitals from May 2020 – December 2020 along with a cohort of 27 SARS-CoV-2 patients with mild upper respiratory tract symptoms and 69 SARS-CoV-2-negative patients from the ICU. Blood was biobanked from SARS-CoV-2 positive patients in the emergency department (mild), ward (moderate) or intensive care unit (severe). Assessment of miRNA expression and co-regulatory network generation revealed significant transcriptome dyregulation in pateints with severe COVID-19 that was largely different from SARS-CoV-2 negative patients in the ICU.
2022-04-08 | GSE178246 | GEO
Project description:Direct acting antivirals and monoclonal antibodies reduce morbidity and mortality associated with severe acute respiratory syndrome coronavirus 2 infection. Persons at higher risk for disease progression and hospitalized patients with coronavirus disease-2019 (COVID-19) benefit most from available therapies. Following an emphasis on inpatient treatment of COVID-19 during the early pandemic, several therapeutic options were developed for outpatients with COVID-19. Additional clinical trials and real-world studies are needed to keep pace with the evolving pandemic.
| S-EPMC9701636 | biostudies-literature
Project description:ObjectivesIdentifying early markers of poor prognosis of coronavirus disease 2019 (COVID-19) is mandatory. Our purpose is to analyze by chest radiography if rapid worsening of COVID-19 pneumonia in the initial days has predictive value for ventilatory support (VS) need.MethodsAmbispective observational ethically approved study in COVID-19 pneumonia inpatients, validated in a second outpatient sample. Brixia score (BS) was applied to the first and second chest radiography required for suspected COVID-19 pneumonia to determine the predictive capacity of BS worsening for VS need. Intraclass correlation coefficient (ICC) was previously analyzed among three radiologists. Sensitivity, specificity, likelihood ratios, AUC, and odds ratio were calculated using ROC curves and binary logistic regression analysis. A value of p < .05 was considered statistically significant.ResultsA total of 120 inpatients (55 ± 14 years, 68 men) and 112 outpatients (56 ± 13 years, 61 men) were recruited. The average ICC of the BS was between 0.812 (95% confidence interval 0.745-0.878) and 0.906 (95% confidence interval 0.844-0.940). According to the multivariate analysis, a BS worsening per day > 1.3 points within 10 days of the onset of symptoms doubles the risk for requiring VS in inpatients and 5 times in outpatients (p < .001). The findings from the second chest radiography were always better predictors of VS requirement than those from the first one.ConclusionThe early radiological worsening of SARS-CoV-2 pneumonia after symptoms onset is a determining factor of the final prognosis. In elderly patients with some comorbidity and pneumonia, a 48-72-h follow-up radiograph is recommended.Key points• An early worsening on chest X-ray in patients with SARS-CoV-2 pneumonia is highly predictive of the need for ventilatory support. • This radiological worsening rate can be easily assessed by comparing the first and the second chest X-ray. • In elderly patients with some comorbidity and SARS-CoV-2 pneumonia, close early radiological follow-up is recommended.
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