30 research outputs found
Does malnutrition influence outcome in children undergoing congenital heart surgery in a developing country?
Background Most children undergoing cardiac surgery for
congenital heart disease (CHD) in developing countries are
malnourished. Malnutrition is known as a co-morbidity factor
that might predict and influence outcomes after surgery.
Objectives To evaluate the effect of malnutrition and other
associated risk factors on post-operative outcomes in children
with CHDs underwent cardiac surgery.
Methods We conducted a retrospective cohort study in a single
center tertiary pediatric cardiac intensive care unit (PCICU)
in Indonesia. Our cohort included all children between 5 and
36 months of age undergoing congenital heart surgery with
cardiopulmonary bypass from November 2011 until February
2014. Outcomes measured were the length of intubation and the
length of ICU stay. Variables for potential influence investigated
were the nutritional status, age, gender, type of cardiac anomaly
(acyanotic vs. cyanotic), Aristotle score, cardiopulmonary bypass
time, aortic cross-clamp time, and Pediatric Risk of Mortality
(PRISM) III score.
Results Out of 249 patients included, 147 (59%) showed
malnourishment on admission. Malnourished patients were
significantly younger in age, presented with an acyanotic heart
defects, and had higher PRISM III score. Additionally, they also
had a longer mechanical ventilation time and ICU stay than
those with a normal nutritional status. After adjusting for various
variables using a multiple logistic regression model it could be
demonstrated that a higher Z-score for weight to age was a
significant protective factor for the intubation time of more than
29 hours with an odds ratio of 0.66 (95% CI 0.48 to 0.92, P =
0.012). Non-malnourished patients had a 49% significantly higher
chance for extubation with a hazard ratio of 1.49 (95% CI 1.12
to 1.99, P= 0.007).
Conclusion Malnourishment is clearly associated in a linear
fashion with longer mechanical ventilation and ICU stay. As one of
significant and potentially treatable co-morbidity factors, prevention
of malnourishment by early diagnosis and optimal timing for surgery
is important
Characteristics and outcomes of patients with severe COVID-19 in Indonesia: Lessons from the first wave.
BackgroundIndonesia's national response to COVID-19 evolved rapidly throughout 2020. Understanding pandemic response and outcomes is crucial for better mitigation strategies ahead. This study describes the characteristics and outcomes of patients admitted to ICU during the early stages of the pandemic.MethodsThis is a multi-centre prospective observational study including patients from twelve collaborating hospitals in Indonesia. All patients were clinically suspected or laboratory-confirmed COVID-19 cases admitted to ICU between January 2020 and March 2021. The primary outcome was monthly ICU mortality. Descriptive statistics of patient characteristics and treatment were generated as secondary outcomes.ResultsFrom 559 subjects, the overall mortality was 68% and decreased over the study period, while the mortality of patients that received mechanical ventilation was 92%, consistently high over the study period. Fatal cases showed 2- and 4-day delays from symptoms onset to hospital admissions and ICU admissions, respectively. Evidence-backed approaches which could influence patient outcome, such as extracorporeal membrane oxygenation, prone positioning, renal replacement therapy, and neuromuscular blockade were scarcely administered.ConclusionsThe mortality rate of COVID-19 patients in Indonesia was extremely high during the first major outbreak of disease, particularly in those mechanically ventilated. Delayed admission and unavailability of evidence-based approaches due to high burden on health facility during COVID-19 crisis could be addressed by efficient public health measures and enhancing health infrastructure to improve the future pandemic response
COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study
Background:
The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms.
Methods:
International, prospective observational study of 60â109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms.
Results:
âTypicalâ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (â€â18 years: 69, 48, 23; 85%), older adults (â„â70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each Pâ<â0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country.
Interpretation:
This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men
Inhaled prostacyclin for Eisenmenger syndrome complicated with miliary tuberculosis
Eisenmenger syndrome occurs in patients with large congenital cardiac or extracardiac left-to-right shunts. Clinically, Eisenmenger syndrome is characterized by multiple organ involvement and progressive deterioration of function over time. In the advanced stages, signs and symptoms of Eisenmenger syndrome include central cyanosis, dyspnea, fatigue, hemoptysis, syncope and right-sided heart failure. Survival of patients with Eisenmenger syndrome is generally poor, but appears to be better than that of patients with idiopathic pulmonary arterial hypertension (PAH) in a comparable functional class.
Did Malnutrition Affect Post-Operative Somatic Growth in Pediatric Patients Undergoing Surgical Procedures for Congenital Heart Disease?
Number of cases and their outcome by month.
(A) Overall in-hospital mortality. (B) In-hospital mortality of mechanically ventilated patients; The bar graphs show the number of cases, and the line graphs show mortality (percentage).</p
Differences in the time course from symptom onset between survivors and deaths with additional bar for patients with unknown final outcome.
Differences in the time course from symptom onset between survivors and deaths with additional bar for patients with unknown final outcome.</p
Changes of laboratory parameters in the first week of ICU stay, stratified by outcome with 95% confidence intervals depicted by shaded regions.
(A)White Blood Cell Count, (B) Lymphocyte Count, (C) Neutrophil Count, (D) C-Reactive Protein, (E) Platelet Count; ICU intensive care unit.</p
Baseline characteristics.
BackgroundIndonesiaâs national response to COVID-19 evolved rapidly throughout 2020. Understanding pandemic response and outcomes is crucial for better mitigation strategies ahead. This study describes the characteristics and outcomes of patients admitted to ICU during the early stages of the pandemic.MethodsThis is a multi-centre prospective observational study including patients from twelve collaborating hospitals in Indonesia. All patients were clinically suspected or laboratory-confirmed COVID-19 cases admitted to ICU between January 2020 and March 2021. The primary outcome was monthly ICU mortality. Descriptive statistics of patient characteristics and treatment were generated as secondary outcomes.ResultsFrom 559 subjects, the overall mortality was 68% and decreased over the study period, while the mortality of patients that received mechanical ventilation was 92%, consistently high over the study period. Fatal cases showed 2- and 4-day delays from symptoms onset to hospital admissions and ICU admissions, respectively. Evidence-backed approaches which could influence patient outcome, such as extracorporeal membrane oxygenation, prone positioning, renal replacement therapy, and neuromuscular blockade were scarcely administered.ConclusionsThe mortality rate of COVID-19 patients in Indonesia was extremely high during the first major outbreak of disease, particularly in those mechanically ventilated. Delayed admission and unavailability of evidence-based approaches due to high burden on health facility during COVID-19 crisis could be addressed by efficient public health measures and enhancing health infrastructure to improve the future pandemic response.</div
Complications during ICU stay.
BackgroundIndonesiaâs national response to COVID-19 evolved rapidly throughout 2020. Understanding pandemic response and outcomes is crucial for better mitigation strategies ahead. This study describes the characteristics and outcomes of patients admitted to ICU during the early stages of the pandemic.MethodsThis is a multi-centre prospective observational study including patients from twelve collaborating hospitals in Indonesia. All patients were clinically suspected or laboratory-confirmed COVID-19 cases admitted to ICU between January 2020 and March 2021. The primary outcome was monthly ICU mortality. Descriptive statistics of patient characteristics and treatment were generated as secondary outcomes.ResultsFrom 559 subjects, the overall mortality was 68% and decreased over the study period, while the mortality of patients that received mechanical ventilation was 92%, consistently high over the study period. Fatal cases showed 2- and 4-day delays from symptoms onset to hospital admissions and ICU admissions, respectively. Evidence-backed approaches which could influence patient outcome, such as extracorporeal membrane oxygenation, prone positioning, renal replacement therapy, and neuromuscular blockade were scarcely administered.ConclusionsThe mortality rate of COVID-19 patients in Indonesia was extremely high during the first major outbreak of disease, particularly in those mechanically ventilated. Delayed admission and unavailability of evidence-based approaches due to high burden on health facility during COVID-19 crisis could be addressed by efficient public health measures and enhancing health infrastructure to improve the future pandemic response.</div