Increased 30-Day Mortality in Very Old ICU Patients with COVID-19 Compared to Patients with Respiratory Failure without COVID-19

Purpose: The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods: Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results: 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion: Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear.info:eu-repo/semantics/publishedVersio

Biological and host range characteristics of lysathia flavipes (Coleoptera: Chrysomelidae), a candidate biological control agent of invasive Ludwigia spp. (Onagraceae) in the USA.

Simple Summary: Exotic water primroses (Ludwigia spp.) are aggressive plant invaders in aquatic ecosystems worldwide. Management of exotic Ludwigia spp. is limited to physical and chemical control methods. Biological control, the use of insects to control exotic plants, is an alternative approach forthe management of exotic Ludwigia spp. However, little is known regarding the natural enemies of these plants in their native range in South America. In this study, we investigated the biology and hostrange of a natural enemy, the flea beetle Lysathia flavipes, to determine its suitability as a biocontrol agentfor exotic Ludwigia spp. in the USA. The beetle matures from egg to adult in approximately 20 days at 25 ?C. Females lived approximately 86 days and laid 278?2456 eggs over their lifespans. No-choice development and oviposition tests were conducted using four exotic Ludwigia species and seven nativeUSA plant species. The beetle showed little discrimination between plant species: larvae aggressively fed and completed development, and females laid eggs on most plant species regardless of origin. These results indicate that the beetle is not sufficiently host-specific for further consideration as a biologicalcontrol agent of exotic Ludwigia spp. in the USA and further testing is not warranted.Abstract: Exotic water primroses (Ludwigia spp.) are aggressive invaders in aquatic ecosystems worldwide. To date, management of exotic Ludwigia spp. has been limited to physical and chemical control methods. Biological control provides an alternative approach for the management of invasive Ludwigiaspp. but little is known regarding the natural enemies of these exotic plants. Herein the biology and host range of Lysathia flavipes (Boheman), a herbivorous beetle associated with Ludwigia spp. in Argentina and Uruguay, was studied to determine its suitability as a biocontrol agent for multiple closely relatedtarget weeds in the USA. The beetle matures from egg to adult in 19.9 ± 1.4 days at 25 ?C; females lived 86.3 ± 35.6 days and laid 1510.6 ± 543.4 eggs over their lifespans. No-choice development and oviposition tests were conducted using four Ludwigia species and seven native plant species. Lysathia flavipes showed little discrimination between plant species: larvae aggressively fed and completed development, and the resulting females (F1 generation) oviposited viable eggs on most plant species regardless of origin. These results indicate that L. flavipes is not sufficiently host-specific for further consideration as a biocontrol agent of exotic Ludwigia spp. in the USA and further testing is not warranted

Sedation in non-invasive ventilation: do we know what to do (and why)?

This review examines some of the issues encountered in the use of sedation in patients receiving respiratory support from non-invasive ventilation (NIV). This is an area of critical and intensive care medicine where there are limited (if any) robust data to guide the development of best practice and where local custom appears to exert a strong influence on patterns of care. We examine aspects of sedation for NIV where the current lack of structure may be contributing to missed opportunities to improve standards of care and examine the existing sedative armamentarium. No single sedative agent is currently available that fulfils the criteria for an ideal agent but we offer some observations on the relative merits of different agents as they relate to considerations such as effects on respiratory drive and timing, and airways patency. The significance of agitation and delirium and the affective aspect(s) of dyspnoea are also considered. We outline an agenda for placing the use of sedation in NIV on a more systematic footing, including clearly expressed criteria and conditions for terminating NIV and structural and organizational conditions for prospective multicentre trials

The importance of long‐term post‐release studies in classical biological control: Insect–plant monitoring and public awareness of water hyacinth management ( Pontederia crassipes ) in Dique Los Sauces, Argentina

Several components of classical biological control (CBC) programmes are necessary to assess the success of the management strategy (e.g., post-release monitoring) and also help prevent reintroductions or resurgences of invasive species (e.g., public awareness). Water hyacinth, Pontederia (= Eichhornia) crassipes (Mart.) Solms (Pontederiaceae) is an aquatic plant naturally distributed in the north-eastern region of the Del Plata basin in Argentina. In the 1960s it was introduced into the Dique Los Sauces reservoir located outside of its native range in La Rioja Province, in western Argentina, where it became invasive. The natural enemy, Neochetina bruchi Hustache (Coleoptera: Curculionidae), was intentionally introduced in 1974 to control the weed. To assess the success of this CBC programme, a long-term post-release study was conducted. Between 1965 and 2023, we monitored plant coverage, estimated N. bruchi densities, and quantified the associated damage by reanalysing previously published data and incorporating new sampling. We also conducted an online survey to analyse public knowledge and perception about this programme. Water hyacinth coverage fluctuated from its first record in 1965 (maximum coverage 90%) until the control of germinated plants (coverage 0%) in 2018. The plant decline was accompanied by an increase in the weevil population. In our survey, out of 325 respondents only a small group of mostly middle-aged and elderly people knew that the restoration had been achieved through a management strategy and even fewer were aware of the biocontrol approach taken. Respondents who had a positive approach to biological control were more aware of the management plan than respondents who had neutral or negative opinions. Neochetina bruchi has played a key factor in the control of P. crassipes. The intrinsic dynamics of these populations, the dormant seed bank, and the lack of public awareness support the need for long post-release evaluations including outreach campaigns to make a sustainable successful management programme.Fil: Faltlhauser, Ana Claudia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para el Estudio de Especies Invasivas; ArgentinaFil: Jiménez, Nadia Lis. Fundación para el Estudio de Especies Invasivas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Righetti, Tomás. Fundación para el Estudio de Especies Invasivas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Visintin, Andrés Mario. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Centro de Investigaciones Entomológicas de Córdoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones Biológicas y Tecnológicas. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Instituto de Investigaciones Biológicas y Tecnológicas; ArgentinaFil: Torrens, Javier. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Salinas, Nicolas Alejandro. Fundación para el Estudio de Especies Invasivas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mc Kay, Fernando. Fundación para el Estudio de Especies Invasivas; ArgentinaFil: Hill, Martin. Rhodes University; SudáfricaFil: Cordo, Hugo A.. Fundación para el Estudio de Especies Invasivas; ArgentinaFil: Sosa, Alejandro Joaquín. Fundación para el Estudio de Especies Invasivas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Current clinical use of intravenous fosfomycin in ICU patients in two European countries

Purpose In Europe, intravenous fosfomycin (IV) is used particularly in difficult-to- treat or complex infections, caused by both Gram-positive and Gram-negative pathogens including multidrug-resistant strains. Here, we investigated the efficacy and safety of intravenous fosfomycin under real-life conditions. Methods Prospective, multi-center, and non-interventional study in patients with bacterial infections from 20 intensive care units (ICU) in Germany and Austria (NCT01173575). Results Overall, 209 patients were included (77 females, 132 males, mean age: 59 +/- 16 years), 194 of which were treated in intensive care (APACHE II score at the beginning of fosfomycin therapy: 23 +/- 8). Main indications (+/- bacteremia or sepsis) were infections of the CNS (21.5%), community- (CAP) and hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP, 15.3%), bone and joint infections (BJI, 11%), abdominal infections (11%), and bacteremia (10.5%). Most frequently identified pathogens were S. aureus (22.3%), S. epidermidis (14.2%), Enterococcus spp. (10.8%), E. coli (12.3%) and Klebsiella spp. (7.7%). At least one multidrug-resistant (MDR) pathogen was isolated from 51 patients (24.4%). Fosfomycin was administered with an average daily dose of 13.7 +/- 3.5 g over 12.4 +/- 8.6 days, almost exclusively (99%) in combination with other antibiotics. The overall clinical success was favorable in 81.3% (148/182) of cases, and in 84.8% (39/46) of patients with >= 1 MDR pathogen. Noteworthy, 16.3% (34/209) of patients developed at least one, in the majority of cases non-serious, adverse drug reaction during fosfomycin therapy. Conclusion Our data suggest that IV fosfomycin is an effective and safe combination partner for the treatment of a broad spectrum of severe bacterial infections in critically ill patients

Erratum to: The Intensive Care Global Study on Severe Acute Respiratory Infection (ICâGLOSSARI): a multicenter, multinational, 14-day inception cohort study (Intensive Care Medicine, (2016), 42, 5, (953), 10.1007/s00134-016-4317-4)

In both the original publication (DOI 10.1007/s00134-015-4206-2) and the first erratum (DOI 10.1007/s00134-016-4317-4), the members of the IC-GLOSSARI Investigators and the ESICM Trials Group were provided in such a way that they could not be indexed as collaborators on PubMed. The publisher apologizes for these errors and is pleased to list the members of the groups here: (Table presented.)

Noninvasive ventilation in COVID-19 patients aged ≥ 70 years : a prospective multicentre cohort study

Background: Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. Methods: This is a substudy of COVIP study-an international prospective observational study enrolling patients aged >= 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. Results: Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36-5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06-2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI - 2.27 to - 0.46 days) compared to primary IMV group (n = 1876). Conclusions: Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV