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1. Brain MRI and neuropsychological findings at long-term follow-up after COVID-19 hospitalisation: an observational cohort study

Author

Anestis Divanoglou, Lovisa Hellgren, Ulrika Birberg Thornberg, Kersti Samuelsson, Richard Levi, and Ida Blystad

Subjects
Medicine
Abstract

Objectives To report findings on brain MRI and neurocognitive function, as well as persisting fatigue at long-term follow-up after COVID-19 hospitalisation in patients identified as high risk for affection of the central nervous system.Design Ambidirectional observational cohort study.Setting All 734 patients from a regional population in Sweden with a laboratory-confirmed COVID-19 diagnosis admitted to hospital during the period 1 March to 31 May 2020.Participants A subgroup (n=185) with persisting symptoms still interfering with daily life at a telephone follow-up 4 months after discharge were invited for a medical and neuropsychological evaluation. Thirty-five of those who were assessed with a neurocognitive test battery at the clinical visit, and presented a clinical picture concerning for COVID-19-related brain pathology, were further investigated by brain MRI.Main outcome measures Findings on brain MRI, neurocognitive test results and reported fatigue.Results Twenty-five patients (71%) had abnormalities on MRI; multiple white matter lesions were the most common finding. Sixteen patients (46%) demonstrated impaired neurocognitive function, of which 10 (29%) had severe impairment. Twenty-six patients (74%) reported clinically significant fatigue. Patients with abnormalities on MRI had a lower Visuospatial Index (p=0.031) compared with the group with normal MRI findings.Conclusions In this group of patients selected to undergo MRI after a clinical evaluation, a majority of patients had abnormal MRI and/or neurocognitive test results. Abnormal findings were not restricted to patients with severe disease.

Published
2021
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2. Incidence and characteristics of ventilator-associated pneumonia in a regional non-tertiary Australian intensive care unit: protocol for a retrospective clinical audit study

Author

Anestis Divanoglou, David Austin, Luke J. Heales, Karen Smith, Jeremy Fernando, Elise Tan, Kirsty Watson, and Josephine Reoch

Subjects
0301 basic medicine, Clinical audit, medicine.medical_specialty, Anestesi och intensivvård, medicine.medical_treatment, education, 030106 microbiology, law.invention, respiratory infections, 03 medical and health sciences, 0302 clinical medicine, law, Intensive care, Epidemiology, Protocol, medicine, Humans, respiratory medicine (see thoracic medicine), 030212 general & internal medicine, Retrospective Studies, Mechanical ventilation, Medical Audit, Anesthesiology and Intensive Care, business.industry, Incidence, Medical record, Incidence (epidemiology), clinical audit, Intensive Care, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, General Medicine, bacterial infections and mycoses, medicine.disease, Intensive care unit, Hospitals, respiratory tract diseases, Intensive Care Units, Research Design, Emergency medicine, epidemiology, Queensland, business
Abstract

IntroductionVentilator-associated pneumonia (VAP) is a medical complication associated with prolonged mechanical ventilation. Most studies looking at VAP originate from major, tertiary intensive care units (ICUs). Our understanding of VAP in regional hospitals is limited. Given that patient characteristics often differ between metropolitan and regional centres, it is important to investigate VAP in a regional non-tertiary ICU. This project will establish and report the incidence, case characteristics and outcomes including mortality and length of stay related to VAP in a regional non-tertiary Australian ICU. Furthermore, it will compare the incidence of VAP in accordance with consultant diagnosed cases in the medical record, and by a post hoc screening of all cases against a list of previously published diagnostic criteria.Methods and analysisThis retrospective clinical audit study will screen medical records from the period 1 January 2013 to 31 December 2016. All cases requiring mechanical ventilation for ≥72 hours will be screened against previously reported diagnostic criteria for VAP. At the same time, their medical records will be screened for a documented diagnosis of VAP.Ethics and disseminationThis study has been granted ethical approval from the Central Queensland Hospital and Health Service (CQHHS) Human Research Ethics Committee (HREC/17/QCQ/11) and the Central Queensland University Human Research Ethics Committee (H17/05-102). This study will be submitted for publication in a peer-reviewed scientific journal and presented at internal workshops (within Queensland Health) and national and/or international scientific conferences.

Published
2018
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