Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study)

Purpose: Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU). Methods: Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap). Results: Six hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR > 4), pulmonary embolism (OR > 5) and increased PaCO2. Exploratory analyses showed that patients with ACP and older age were more likely to die in hospital (including ICU). Conclusion: Almost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort

Full and simplified assessment of left ventricular diastolic function in covid-19 patients admitted to ICU. feasibility, incidence, and association with mortality

Purpose: Left ventricular diastolic dysfunction (LVDD) is associated with poor outcomes in the intensive care unit (ICU). Nonetheless, precise reporting of LVDD in COVID-19 patients is currently lacking and assessment could be challenging. Methods: We performed an echocardiography study in COVID-19 patients admitted to ICU with the aim to describe the feasibility of full or simplified LVDD assessment and its incidence. We also evaluated the association of LVDD or of single echocardiographic parameters with hospital mortality. Results: Between 06.10.2020 and 18.02.2021, full diastolic assessment was feasible in 74% (n = 26/35) of patients receiving a full echocardiogram study. LVDD incidence was 46% (n = 12/26), while the simplified assessment produced different results (incidence 81%, n = 21/26). Nine patients with normal function on full assessment had LVDD with simplified criteria (grade I = 2; grade II = 3; grade III = 4). Nine patients were hospital-survivors (39%); the incidence of LVDD (full assessment) was not different between survivors (n = 2/9, 22%) and non-survivors (n = 10/17, 59%; p =.11). The E/e’ ratio lateral was lower in survivors (7.4 [3.6] vs. non-survivors 10.5 [6.3], p =.03). We also found that s’ wave was higher in survivors (average, p =.01). Conclusion: In a small single-center study, assessment of LVDD according to the latest guidelines was feasible in three quarters of COVID-19 patients. Non-survivors showed a trend toward greater LVDD incidence; moreover, they had significantly worse s’ values (all) and higher E/e’ ratio (lateral)

The effects of exposure to severe hyperoxemia on neurological outcome and mortality after cardiac arrest

INTRODUCTION: Hyperoxemia during cardiac arrest (CA) may increase chances of successful resuscitation. However, episodes of severe hyperoxemia after intensive care unit admission occurs frequently (up to 60%), and these have been associated with higher mortality in CA patients. The impact of severe hyperoxemia on neurological outcome is more unclear. EVIDENCE ACQUISITION: We conducted a systematic review and meta-analysis on Pubmed and EMBASE to evaluate the effects of severe hyperoxemia according to arterial blood gas analysis on neurological outcome and mortality in patients resuscitated from CA and admitted to intensive care unit. EVIDENCE SYNTHESIS: Thirteen observational studies were included, eight of them reporting data on neurological outcome and ten on mortality. Most studies reported odds ratio adjusted for confounders. Severe hyperoxemia was associated with worse neurological outcome (OR 1.37 [95%CI 1.01,1.86], P=0.04) and higher mortality at longest follow-up (OR 1.32 [95%CI 1.11,1.57], P=0.002). Subgroup analyses according to timing of hyperoxemia showed that any hyperoxemia during the first 36 hours was associated with worse neurological outcome (OR 1.52 [95%CI 1.12,2.08], P=0.008) and higher mortality (OR 1.40 [95%CI 1.18,1.66], P=0.0001), whilst early hyperoxemia was not (neurological: P=0.29; mortality: P=0.19). Sensitivity analyses mostly confirmed the results of the primary analyses. CONCLUSIONS: Severe hyperoxemia is associated with worse neurological outcome and lower survival in CA survivors admitted to intensive care unit. Clinical efforts should be made to avoid severe hyperoxemia during at least the first 36 hours after cardiac arrest

A Community-Driven Nature-Based Design Framework for the Regeneration of Neglected Urban Public Spaces

Nature-based solutions are a popularising concept within current urban regeneration literature, exploring differing themes in the context of optimising public spaces. Focus on the adaptation of public space design, with the community at the forefront, has been documented to a limited degree, with few studies concentrating on possible design strategies. This literature review revealed that the majority of nature-based design frameworks, since 2017, have suggested the benefits of nature in public spaces to human health and well-being: whether physically or psychologically, and either within the full framework or as part of the framework’s scope. There are however variations in the number and clarity of steps needed to follow each framework, and it is evident that the importance of community driven designs is understated within built environment literature. Many frameworks favoured the use of academic studies as a secondary source for their creation, with few using primary analysis of community acceptance and co-creation. This paper explores the literature available on nature-based solutions and their design frameworks. It maps out the existing studies, to date, and reports on the initial findings for this progressing PhD research. Public spaces are, in their very definition, a space for the public; despite this, development of these spaces, as well as the literature around the subject, is far more theoretical and professionally inclined, rather than community influenced. With an emphasis on sustainable development, this paper suggests that community views on nature-based public spaces need to be the focal point of design frameworks for public urban spaces, which may then be used as a protocol for the production of optimal and effective nature-based public space regeneration