Early Intervention of Non-Invasive Positive Pressure Ventilation in Elderly Patients with Rib Fractures

Rib fractures in the elderly population, 65 years and older, is more prevalent than any other population. Mortality increases with each year over the age of 65 and with each number of ribs fractured. Rib fractures are painful and can lead to a decreased respiratory effort. This results in complications such as pneumonia, respiratory depression, respiratory failure, Acute Respiratory Distress Syndrome (ARDS), and respiratory infections. Non-Invasive Positive Pressure Ventilation (NIPPV) assists with reducing the patient efforts to breathe while also ensuring spontaneous lung expansion. NIPPV can assist with promoting positive outcomes in patients with respiratory complications. The purpose of this study was to analyze the effectiveness of early NIPPV intervention in elderly patients with rib fractures. A retrospective data analysis was completed with a total of 117 patients from 2013 and 2014. The data included time frame from arrival to NIPPV intervention, unplanned ICU admission and length of stay, overall hospital length of stay, need for other invasive interventions, ISS, pre-existing comorbidities, complications, pain management, and discharge disposition. Patients who never had NIPPV intervention had a significantly lower LOS in the ICU and hospital than those that required NIPPV in the first 24 hours or greater. Patients with complications were significantly more likely to have NIPPV within the first 24 hours or more. Patients admitted to the ICU were significantly less likely to never have had NIPPV. Time until NIPPV intervention was not significant in the LOS of ICU patients or overall hospital LOS. The beneficial factor of early intervention of NIPPV could be disguised by the fact more serious complications require NIPPV intervention. The study did not show significance for correlations with positive or negative outcomes and NIPPV intervention. NIPPV intervention in elderly patients 65 years and older with rib fractures is a proactive approach in potentially decreasing complications and negative outcomes

The Rothman Index predicts unplanned readmissions to intensive care associated with increased mortality and hospital length of stay: a propensity-matched cohort study

Abstract Background Patients with unplanned readmissions to the intensive care unit (ICU) are at high risk of preventable adverse events. The Rothman Index represents an objective real-time grading system of a patient’s clinical condition and a predictive tool of clinical deterioration over time. This study was designed to test the hypothesis that the Rothman Index represents a sensitive predictor of unanticipated ICU readmissions. Methods A retrospective propensity-matched cohort study was performed at a tertiary referral academic medical center in the United States from January 1, 2022, to December 31, 2022. Inclusion criteria were adult patients admitted to an ICU and readmitted within seven days of transfer to a lower level of care. The control group consisted of patients who were downgraded from ICU without a subsequent readmission. The primary outcome measure was in-hospital mortality or discharge to hospice for end-of-life care. Secondary outcome measures were overall hospital length of stay, ICU length of stay, and 30-day readmission rates. Propensity matching was used to control for differences between the study cohorts. Regression analyses were performed to determine independent risk factors of an unplanned readmission to ICU. Results A total of 5,261 ICU patients met the inclusion criteria, of which 212 patients (4%) had an unanticipated readmission to the ICU within 7 days. The study cohort and control group were stratified by propensity matching into equal group sizes of n = 181. Lower Rothman Index scores (reflecting higher physiologic acuity) at the time of downgrade from the ICU were significantly associated with an unplanned readmission to the ICU (p < 0.0001). Patients readmitted to ICU had a lower mean Rothman Index score (p < 0.0001) and significantly increased rates of mortality (19.3% vs. 2.2%, p < 0.0001) and discharge to hospice (14.4% vs. 6.1%, p = 0.0073) compared to the control group of patients without ICU readmission. The overall length of ICU stay (mean 8.0 vs. 2.2 days, p < 0.0001) and total length of hospital stay (mean 15.8 vs. 7.3 days, p < 0.0001) were significantly increased in patients readmitted to ICU, compared to the control group. Conclusion The Rothman Index represents a sensitive predictor of unanticipated readmissions to ICU, associated with a significantly increased mortality and overall ICU and hospital length of stay. The Rothman Index should be considered as a real-time objective measure for prediction of a safe downgrade from ICU to a lower level of care

Hen egg white bovine colostrum supplement reduces symptoms of mild/moderate COVID-19: a randomized control trial

Aim: The ability of a hen egg white bovine colostrum supplement to prevent severe COVID-19 was tested in a double-blind randomized control study. Methods: Adults with mild/moderate COVID-19, risk factors for severe disease, and within 5 days of symptom onset were assigned to the intervention (n = 77) or placebo (n = 79) arms. Symptoms were documented until day 42 post-enrollment and viral clearance was assessed at 11–13 days post-symptom onset. Results: One participant developed severe COVID-19. The severe-type symptom score was lower in the active arm at 11–13 days post-symptom onset (p = 0.049). Chest pain, fever/chills, joint pain/malaise, and sore throat were significantly less frequent in the active arm. No differences in viral clearance were observed. Conclusion: The intervention reduced symptoms of mild/moderate COVID-19. Clinical Trial Registration: DOH-27-062021-9191 (South African National Clinical Trials Register

Hen egg white bovine colostrum supplement reduces symptoms of mild/moderate COVID-19: a randomized control trial: Supplementary files

Aim: The ability of a hen egg white bovine colostrum supplement to prevent severe COVID-19 was tested in a double-blind randomized control study. Methods: Adults with mild/moderate COVID-19, risk factors for severe disease, and within 5 days of symptom onset were assigned to the intervention (n = 77) or placebo (n = 79) arms. Symptoms were documented until day 42 post-enrollment and viral clearance was assessed at 11–13 days post-symptom onset. Results: One participant developed severe COVID-19. The severe-type symptom score was lower in the active arm at 11–13 days post-symptom onset (p = 0.049). Chest pain, fever/chills, joint pain/malaise, and sore throat were significantly less frequent in the active arm. No differences in viral clearance were observed. Conclusion: The intervention reduced symptoms of mild/moderate COVID-19.</p