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(searched for: (title:(Patient Demographics Associated with ARDS Incidence, Hospital Length of Stay and Mortality)
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Tim W Gilmore, Clifton F Frilot
Journal of Biomedical Research & Environmental Sciences, Volume 6, pp 156-159; doi:10.37871/jbres1136

Abstract:
Introduction: Acute Respiratory Distress Syndrome (ARDS) is a common finding among pediatric and adult patient populations [1]. ARDS-related mortality remains high and is associated with prolonged hospital Length of Stay (LOS) and multiple ventilator days. Studies have sought to predict whether certain risk factors can be associated with ARDS development and mortality. It remains to be established whether a strong association exists between ARDS patient demographic characteristics, hospital LOS and overall ARDS-related mortality [4].
Laura B. Ngwenya, Catherine G. Suen, Phiroz E. Tarapore, Geoffrey T. Manley, Michael C. Huang
Journal of Neurosurgery, Volume 128, pp 1530-1537; doi:10.3171/2017.1.jns162234

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, Maria Katsiari, Stylianos Orfanos, , Christina Dimitrakopoulou, Anastasia Kotanidou
Health Science Journal, Volume 11; doi:10.21767/1791-809X.1000498

Abstract:
Background: Aging is associated with physiological changes in respiratory mechanical properties. In elderly patients an increased incidence of Acute Respiratory Distress Syndrome (ARDS) resulting in increased number of elderly patients treated in Intensive Care Units (ICUs), along with increased mortality has been reported. Aim of the present study was to identify potential age-related differences in respiratory mechanics, gas exchange and ventilator settings in patients with early ARDS. The relationship between age and ICU mortality was additionally assessed. Methods: In 58 consecutive early ARDS patients demographic and anthropometric characteristics, ventilatory settings, pulmonary physiologic measurements (arterial blood gases and static respiratory mechanics) and outcome within ICU setting were recorded. Patients were divided into three age groups, those <45 yrs old (Group A, n=16), those 45-65 yrs old (Group B, n=24) and those ≥ 65 yrs old (Group C, n=18). Results: Ventilatory settings did not differ among the three ARDS age groups studied. Arterial blood gases and static respiratory mechanics were also comparable. Similarly, alveolar to arterial oxygen gradient (A-aDO2) did not differ significantly between the three groups. The middle-aged and elderly patients compared to younger ones had significantly longer length of ICU stay (p=0.018) and higher, although not significant, ICU mortality (Group A: 25%; Group B: 41.67%; Group C: 61.1%). Conclusions: An overt impact of age on respiratory system mechanics and gas exchange in early ARDS patients was not detected in our cohort. Nevertheless, elderly patients demonstrated a trend for higher mortality, along with significantly longer hospitalization in the ICU.
Michael R. Kahn, Richard L. Watson, Jay T. Thetford, Joseph Isaac Wong,
Journal of Intensive Care Medicine; doi:10.1177/0885066621989959

Abstract:
Objective.: To report the high incidence of barotrauma in critically ill patients admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19) and to discuss its implications. Design.: Retrospective cohort study. Setting.: ICU of an academic county hospital in Los Angeles, CA admitted from March 15-June 20, 2020. Patients.: 77 patients with COVID-19 pneumonia. 75 patients met inclusion criteria. Results.: 21% of patients with severe COVID-19 sustained barotrauma (33% of patients receiving IMV, 8% of patients receiving (NIV). There were no differences between the barotrauma and non-barotrauma groups regarding demographics, illness severity, or medications received, nor tidal volume or average/peak airway pressures in those receiving IMV. In the barotrauma group there was a greater proportion of patients receiving therapeutic anticoagulation (81% vs. 47%, p = 0.023) and ventilated using airway pressure release ventilation mode (13% vs. 0%, p = 0.043). Barotrauma was associated with increased likelihood of receiving a tracheostomy (OR 2.58 [0.23-4.9], p = 0.018]), longer median ICU length of stay (17 days vs. 7 days, p = 0.03), and longer median length of hospitalization (26 days vs. 14 days, p < 0.001). There was also a trend toward prolonged median duration of IMV (12.5 days vs 7 days, p = 0.13) and higher average mortality (56% vs 37%, p = 0.25). Conclusions.: Barotrauma is seen in 5-12% of patients with ARDS receiving IMV and is exceedingly rare in patients receiving NIV. We report a high incidence of barotrauma observed in critically ill patients with COVID-19 requiring either NIV or IMV. While there was a trend toward increased mortality in patients with barotrauma, this did not reach statistical significance. The increased incidence of barotrauma with COVID-19 may be a product of the pathophysiology of this disease state and a heightened inflammatory response causing rampant acute lung injury. Evidence-based medicine and lung-protective ventilation should remain the mainstay of treatment.
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