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

A Flexible Medical Image Archiving and Reporting System

Nowadays diagnostic imaging systems have being used as a daily routine in medical institutions. The evolution of electronics, image technologies and communications has led to quick growing a quantity of medical applications and devices, that process visual information for diagnosing and treatment purposes. For quality management and patient protection reasons these systems are integrated into complex hospital information systems (HIS). Radiological imaging has the highest standardisation level and is widely used with PACS and within Radiology Information Systems (RIS). Unfortunately, other modalities, e.g. ultrasound, microscopy and etc., are suffering from a lack of standards for creating, processing and archiving image material. To fill this gap, many research and commercial organisations have been proposing various local solutions. This paper describes an approach in the application development that supports physicians in selecting appropriate decisions and provides image archiving in a flexible way. The application is positioned first to be used in echocardiography

A Flexible Medical Image Archiving and Reporting System

Nowadays diagnostic imaging systems have being used as a daily routine in medical institutions. The evolution of electronics, image technologies and communications has led to quick growing a quantity of medical applications and devices, that process visual information for diagnosing and treatment purposes. For quality management and patient protection reasons these systems are integrated into complex hospital information systems (HIS). Radiological imaging has the highest standardisation level and is widely used with PACS and within Radiology Information Systems (RIS). Unfortunately, other modalities, e.g. ultrasound, microscopy and etc., are suffering from a lack of standards for creating, processing and archiving image material. To fill this gap, many research and commercial organisations have been proposing various local solutions. This paper describes an approach in the application development that supports physicians in selecting appropriate decisions and provides image archiving in a flexible way. The application is positioned first to be used in echocardiography

How to solve difficult side branch access?

Safe guidewire placement in the main vessel (MV) and in the side branch (SB) does represent the key point for successful percutaneous coronary interventions (PCI) in bifurcated lesions. During bifurcation PCI, SB wiring is systematically performed as a first step and is often repeated ("rewiring") during the procedure in order to treat the SB after MV stenting. Wiring and rewiring are crucial phases of bifurcation PCI which require, in the most complex cases, specific operator experience. In the present paper, the classic SB wiring techniques necessary for routine bifurcation interventions (antegrade and pullback wiring technique) as well as "advanced" wiring techniques ("reverse wire" technique, Venture-facilitate wiring, MV balloon predilation or debulking) are described. Moreover, the rewiring technique is discussed in detail, with particular attention on the tips and tricks which may facilitate the achievement of optimal result with provisional stenting (pullback rewiring) and help manage bail out situations like acute SB flow impairment after MV stenting