Infectious Disease

Loss of life on account of pulmonary dysfunction frequent in COVID-19

January 27, 2021

2 min read

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Ketcham does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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Pulmonary dysfunction and septic shock were the leading causes of death in a cohort of patients hospitalized with COVID-19, according to a new study published in the Annals of the American Thoracic Society.

The retrospective cohort study looked at specific causes of death, the prevalence of lung failure, and end-of-life intensive care care in 82 adults (mean age 71 years; 33% women) who were hospitalized with COVID-19 at Michigan Medicine and died. The researchers obtained data on organ system dysfunction, septic shock, leading cause of death, and deprivation of life from each patient. The causes of death were compared with those of a previous cohort of 385 patients who were hospitalized with acute hypoxemic respiratory failure and who died in hospital.

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Before death, the most common organ dysfunction was pulmonary (81.7%), neurological (57.3%), and renal (39%). Mechanical ventilation was used in 74.4% of patients during the hospital stay. 67% of patients had multiple organ failure and 41.5% had co-infection. Septic shock occurred in 40% of the patients, of whom 24.3% had a co-infection.

Pulmonary dysfunction (56.1%) and septic shock (26.8%) were the most common primary causes of death. Patients with COVID-19 died more often from pulmonary dysfunction (56.1% versus 21.6%; P <0.01) and less from heart disease (7.3% versus 16.1%; P = 0.04) or neurological diseases (P = 0.01). 6.1% vs. 19.5%; P <0.01) dysfunction compared to cohort of patients with non-COVID-19 related respiratory failure.

In more than 76% of the patients there was a withdrawal or a restriction of life support measures. At the time of death, 25.6% of patients were receiving invasive mechanical ventilation.

The discussion of treatment goals was documented for 97.6% of patients with COVID-19 who died in hospital. Within 72 hours of first admission to the intensive care unit, 59.7% of patients treated in an intensive care unit had conversations about the treatment goals over the phone (91.3%), in person (43.8%), or video conference (2.5%). When visiting family and friends within 24 hours of death, 34.1% of patients had face-to-face visits, 15.9% had virtual visits, 4.9% had both face-to-face and virtual visits, and 54.9% had none.

In the early months of the pandemic, the ability of friends and family to communicate personally or practically with critically ill patients with COVID-19 was restricted across the country, and even when family visits were allowed, family members did not choose to do so, according to one Press release to come out of fear for their own safety.

“The medical therapies we use to treat COVID-19 patients are important, but it is also important to remember not only to treat these patients, but also to treat them,” said Dr. Scott W. Ketcham, an internist in the department of internal medicine at The University of Michigan, Ann Arbor, said in the news release. “We need to think about the individual as a whole, emotionally, spiritually and socially. We need to look at what we can gain from the Visiting Policies regarding transmission and how we can use technology to connect providers with families and patients with families and friends. “

The researchers noted several limitations to the study, including the small sample size, behavior in a single center, and possible changes in cause of death.

“These results underscore the importance of attempting evidence-based interventions for respiratory failure in COVID-19 patients as the pandemic progresses, especially when employing professionals who do not normally treat the disease or who work in an intensive care unit,” Ketcham said in the publication. “This means prone position, a good understanding of mechanical ventilation, appropriate patient selection to receive high-flow, heated oxygen, and early detection and treatment of infections. In other words, follow the guidelines previously developed by individuals who specialize in the management of respiratory failure such as acute respiratory distress syndrome and sepsis. “

Reference:

Press release.

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