Lung Ultrasound to Assist ICU Admission Decision-Making Process of COVID-19 Patients With Acute Respiratory Failure

International audienceObjectives: There is only low-certainty evidence on the use of predictive models to assist COVID-19 patient's ICU admission decision-making process. Accumulative evidence suggests that lung ultrasound (LUS) assessment of COVID-19 patients allows accurate bedside evaluation of lung integrity, with the added advantage of repeatability, absence of radiation exposure, reduced risk of virus dissemination, and low cost. Our goal is to assess the performance of a quantified indicator resulting from LUS data compared with standard clinical practice model to predict critical respiratory illness in the 24 hours following hospital admission.Design: Prospective cohort study.Setting: Critical Care Unit from University Hospital Purpan (Toulouse, France) between July 2020 and March 2021.Patients: Adult patients for COVID-19 who were in acute respiratory failure (ARF), defined as blood oxygen saturation as measured by pulse oximetry less than 90% while breathing room air or respiratory rate greater than or equal to 30 breaths/min at hospital admission. Linear multivariate models were used to identify factors associated with critical respiratory illness, defined as death or mild/severe acute respiratory distress syndrome (Pao2/Fio2 < 200) in the 24 hours after patient's hospital admission.Intervention: LUS assessment.Measurements and main results: One hundred and forty COVID-19 patients with ARF were studied. This cohort was split into two independent groups: learning sample (first 70 patients) and validation sample (last 70 patients). Interstitial lung water, thickening of the pleural line, and alveolar consolidation detection were strongly associated with patient's outcome. The LUS model predicted more accurately patient's outcomes than the standard clinical practice model (DeLong test: Testing: z score = 2.50, p value = 0.01; Validation: z score = 2.11, p value = 0.03).Conclusions: LUS assessment of COVID-19 patients with ARF at hospital admission allows a more accurate prediction of the risk of critical respiratory illness than standard clinical practice. These results hold the promise of improving ICU resource allocation process, particularly in the case of massive influx of patients or limited resources, both now and in future anticipated pandemics

Influence of Early Dysnatraemia Correction on Survival of Critically Ill Patients.

International audienceBACKGROUND: Increasing evidence suggests that dysnatraemia at ICU admission may predict mortality. Little information is available, however, on the potential effect of dysnatraemia correction.Patients and MethodsObservational multicentre cohort study in patients admitted between 2005 and 2012 to 18 French ICUs. Hyponatraemia and hypernatraemia were defined as serum sodium concentration 145 mmoL/L, respectively. We assessed the influence on day-28 mortality of dysnatraemia correction by day 3 and of the dysnatraemia correction rate. RESULTS: Of 7067 included patients, 1830 (25.9%) had hyponatraemia and 634 (9.0%) hypernatraemia at ICU admission (day 1). By day 3, hyponatraemia had been corrected in 1019 (1019/1830, 55.7%) and hypernatraemia in 393 (393/634, 62.0%) patients. After adjustment for confounders, persistent hyponatraemia or hypernatraemia on day 3 was independently associated with higher day-28 mortality (odds ratio [OR], 1.31; 95% confidence interval [95%CI], 1.06-1.61; and OR, 1.86; 95%CI, 1.37-2.54; respectively). Hyponatraemia corrected by day 3, hypernatraemia corrected by day 3, and ICU-acquired hyponatraemia were not associated with day-28 mortality. Median correction rate from days 1 to 3 was 2.58 mmoL/L per day (IQR, 0.67-4.55). Higher natraemia correction rate was associated with lower crude and adjusted day-28 mortality rates (OR per mmoL/L per day, 0.97; 95%CI, 0.94-1.00; p = 0.04; and OR per mmoL/L per day, 0.93; 95%CI, 0.90-0.97; p = 0.0003, respectively). CONCLUSION: Our results indicate that dysnatraemia correction is independently associated with survival, with the effect being greater with faster correction rates of up to 12 mmoL/L/day

Acute Respiratory Distress Syndrome and Risk of AKI among Critically Ill Patients.

International audienceBACKGROUND AND OBJECTIVES: Increasing experimental evidence suggests that acute respiratory distress syndrome (ARDS) may promote AKI. The primary objective of this study was to assess ARDS as a risk factor for AKI in critically ill patients.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was an observational study on a prospective database fed by 18 intensive care units (ICUs). Patients with ICU stays >24 hours were enrolled over a 14-year period. ARDS was defined using the Berlin criteria and AKI was defined using the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria. Patients with AKI before ARDS onset were excluded.RESULTS: This study enrolled 8029 patients, including 1879 patients with ARDS. AKI occurred in 31.3% of patients and was more common in patients with ARDS (44.3% versus 27.4% in patients without ARDS; P<0.001). After adjustment for confounders, both mechanical ventilation without ARDS (odds ratio [OR], 4.34; 95% confidence interval [95% CI], 3.71 to 5.10) and ARDS (OR, 11.01; 95% CI, 6.83 to 17.73) were independently associated with AKI. Hospital mortality was 14.2% (n=1140) and was higher in patients with ARDS (27.9% versus 10.0% in patients without ARDS; P<0.001) and in patients with AKI (27.6% versus 8.1% in those without AKI; P<0.001). AKI was associated with higher mortality in patients with ARDS (42.3% versus 20.2%; P<0.001).CONCLUSIONS: ARDS was independently associated with AKI. This study suggests that ARDS should be considered as a risk factor for AKI in critically ill patients