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1. Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

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Kloss, P, Lindholz, M, Milnik, A, Azoulay, E, Cecconi, M, Citerio, G, De Corte, T, Duska, F, Galarza, L, Greco, M, Girbes, A, Kesecioglu, J, Mellinghoff, J, Ostermann, M, Pellegrini, M, Teboul, J, De Waele, J, Wong, A, Schaller, S, Aires, B, Gira, A, Eller, P, Hamid, T, Haque, I, De Buyser, W, Cudia, A, De Backer, D, Foulon, P, Collin, V, Van Hecke, J, De Waele, E, Van Malderen, C, Mesland, J, Biston, P, Piagnerelli, M, Haentjens, L, De Schryver, N, Van Leemput, J, Vanhove, P, Bulpa, P, Ilieva, V, Katz, D, Binnie, A, Geagea, A, Tirapegui, F, Lago, G, Graf, J, Perez-Araos, R, Vargas, P, Martinez, F, Labarca, E, Franco, D, Parra-Tanoux, D, Yepes, D, Hammouda, A, Elmandouh, O, Azzam, A, Hussein, A, Galal, I, Awad, A, Azab, M, Abdalla, M, Assal, H, Alfishawy, M, Ghozy, S, Tharwat, S, Eldaly, A, Ellervee, A, Reinhard, V, Chrisment, A, Poyat, C, Badie, J, Berdaguer Ferrari, F, Weiss, B, Schellenberg, C, Grunow, J, Lorenz, M, Spieth, P, Bota, M, Fichtner, F, Fuest, K, Lahmer, T, Herrmann, J, Meybohm, P, Markou, N, Vasileiadou, G, Chrysanthopoulou, E, Papamichalis, P, Soultati, I, Jog, S, Kalvit, K, Nainan Myatra, S, Krupa, I, Tharwat, A, Nichol, A, Mccarthy, A, Mahmoodpoor, A, Tonetti, T, Isoni, P, Spadaro, S, Volta, C, Mirabella, L, Noto, A, Florio, G, Guzzardella, A, Paleari, C, Baccanelli, F, Savi, M, Antonelli, M, De Pascale, G, Vaccarini, B, Montrucchio, G, Sales, G, Donadello, K, Gottin, L, Nizzero, M, Polati, E, De Rosa, S, Sulemanji, D, Abusalama, A, Elhadi, M, Jesus, M, Gonzalez, D, Robles, V, Canedo, N, Chavez, A, Dendane, T, Grady, B, de Jong, B, van der Heiden, E, Thoral, P, van den Bogaard, B, Spronk, P, Achterberg, S, Groeneveld, M, So, R, de Wijs, C, Scholten, H, Beishuizen, A, Cornet, A, Reidinga, A, Kranen, H, Mensink, R, den Boer, S, de Groot, M, Beck, O, Bethlehem, C, van Bussel, B, Frenzel, T, de Jong, C, Wilting, R, Mehagnoul-Schipper, J, Alasia, D, Kumar, A, Qayyum, A, Rana, M, Jayyab, M, Sierra, R, Hernandez, A, Taborda, L, Anselmo, M, Ramires, T, Silva, C, Roriz, C, Morais, R, Póvoa, P, Patricio, P, Pinto, A, Santos, M, Costa, V, Cunha, P, Gonçalves, C, Nunes, S, Camões, J, Adrião, D, Oliveira, A, Omrani, A, Maslamani, M, Elbuzidi, A, Qudah, B, Akkari, A, Alkhatteb, M, Baiou, A, Husain, A, Alwraidat, M, Saif, I, Bakdach, D, Ahmed, A, Aleef, M, Bintaher, A, Petrisor, C, Popov, E, Popova, K, Dementienko, M, Teplykh, B, Pyregov, A, Davydova, L, Vladislav, B, Neporada, E, Zverev, I, Meshchaninova, S, Sokolov, D, Gavrilova, E, Shlyk, I, Poliakov, I, Vlasova, M, Aljuhani, O, Alkhalaf, A, Humaid, F, Arabi, Y, Kuhail, A, Elrabi, O, Ghannam, M, Kansal, A, Ho, V, Ng, J, García, R, Fraga, X, del Pilar García-Bonillo, M, Padilla-Serrano, A, Cuadrado, M, Ferrando, C, Catalan-Monzon, I, Frutos-Vivar, F, Jimenez, J, Rodríguez-Solis, C, Franquesa-Gonzalez, E, Acosta, G, Cabrera, L, Parra, J, Gonzalez, F, del Carmen Conesa, M, Varela, I, Pravia, O, Delgado, M, de Cabo, C, Ioan, A, Perez-Calvo, C, Santos, A, Abad-Motos, A, Ripolles-Melchor, J, Martin, B, Teruel, S, Lucas, J, Ortiz, A, de Pablo Sánchez, R, Barrueco-Francioni, J, Espina, L, Bonell-Goytisolo, J, Salaverria, I, Mir, A, Rodriguez-Ruiz, E, Valverde, V, Cubero, P, Linde, F, Leganes, N, Romeu, J, Concha, P, Berezo-Garcia, J, Fraile, V, Cuenca-Rubio, C, Pérez-Torres, D, Serrano, A, Valero, C, Suner, A, Larrañaga, L, Legaristi, N, Ferrigno, G, Khlafalla, S, Bihariesingh-Sanchit, R, Zoerner, F, Grip, J, Kilsand, K, Mårtensson, J, Österlind, J, von Seth, M, Berkius, J, Ceruti, S, Glotta, A, Izdes, S, Turan, I, Cosar, A, Halacli, B, Dereli, N, Yilmaz, M, Akbas, T, Elay, G, Eyüpoğlu, S, Bílír, Y, Saraçoğlu, K, Kaya, E, Sahin, A, Ekren, P, Mengi, T, Suner, K, Tomak, Y, Eroglu, A, Alsabbah, A, Hanlon, K, Gervin, K, Mcmahon, S, Hagan, S, Higenbottam, C, Mullhi, R, Poulton, L, Torlinski, T, Gareth, A, Truman, N, Vijayakumar, G, Hall, C, Jubb, A, Cagova, L, Jones, N, Graham, S, Robin, N, Cowton, A, Donnelly, A, Singatullina, N, Kent, M, Boulanger, C, Campbell, Z, Potter, E, Duric, N, Szakmany, T, Kviatkovske, O, Marczin, N, Ellis, C, Saha, R, Sri-Chandana, C, Allan, J, Mumelj, L, Venkatesh, H, Gotz, V, Cochrane, A, Ficial, B, Kamble, S, Lumlertgul, N, Oddy, C, Jain, S, Crapelli, G, Vlachou, A, Golden, D, Garrioch, S, Henning, J, Loveleena, G, Davey, M, Grauslyte, L, Salciute-Simene, E, Cook, M, Barling, D, Broadhurst, P, Purvis, S, Spivey, M, Shuker, B, Grecu, I, Harding, D, Dean, J, Nielsen, N, Al-Bayati, S, Al-Sadawi, M, Charron, M, Stubenrauch, P, Santanilla, J, Wentowski, C, Rosenberger, D, Eksarko, P, Jawa, R, Kloss, Philipp, Lindholz, Maximilian, Milnik, Annette, Azoulay, Elie, Cecconi, Maurizio, Citerio, Giuseppe, De Corte, Thomas, Duska, Frantisek, Galarza, Laura, Greco, Massimiliano, Girbes, Armand R. J., Kesecioglu, Jozef, Mellinghoff, Johannes, Ostermann, Marlies, Pellegrini, Mariangela, Teboul, Jean-Louis, De Waele, Jan, Wong, Adrian, Schaller, Stefan J., Aires, Buenos, Gira, Alicia, Eller, Philipp, Hamid, Tarikul, Haque, Injamam Ull, De Buyser, Wim, Cudia, Antonella, De Backer, Daniel, Foulon, Pierre, Collin, Vincent, Van Hecke, Jolien, De Waele, Elisabeth, Van Malderen, Claire, Mesland, Jean-Baptiste, Biston, Patrick, Piagnerelli, Michael, Haentjens, Lionel, De Schryver, Nicolas, Van Leemput, Jan, Vanhove, Philippe, Bulpa, Pierre, Ilieva, Viktoria, Katz, David, Binnie, Alexandra, Geagea, Anna, Tirapegui, Fernando, Lago, Gustavo, Graf, Jerónimo, Perez-Araos, Rodrigo, Vargas, Patricio, Martinez, Felipe, Labarca, Eduardo, Franco, Daniel Molano, Parra-Tanoux, Daniela, Yepes, David, Hammouda, Ahmed, Elmandouh, Omar, Azzam, Ahmed, Hussein, Aliae Mohamed, Galal, Islam, Awad, Ahmed K., Azab, Mohammed A., Abdalla, Maged, Assal, Hebatallah, Alfishawy, Mostafa, Ghozy, Sherief, Tharwat, Samar, Eldaly, Abdullah, Ellervee, Anneli, Reinhard, Veronika, Chrisment, Anne, Poyat, Chrystelle, Badie, Julio, Berdaguer Ferrari, Fernando, Weiss, Björn, Schellenberg, Clara, Grunow, Julius J, Lorenz, Marco, Schaller, Stefan J, Spieth, Peter, Bota, Marc, Fichtner, Falk, Fuest, Kristina, Lahmer, Tobias, Herrmann, Johannes, Meybohm, Patrick, Markou, Nikolaos, Vasileiadou, Georgia, Chrysanthopoulou, Evangelia, Papamichalis, Panagiotis, Soultati, Ioanna, Jog, Sameer, Kalvit, Kushal, Nainan Myatra, Sheila, Krupa, Ivan, Tharwat, Aisa, Nichol, Alistair, McCarthy, Aine, Mahmoodpoor, Ata, Tonetti, Tommaso, Isoni, Paolo, Spadaro, Savino, Volta, Carlo Alberto, Mirabella, Lucia, Noto, Alberto, Florio, Gaetano, Guzzardella, Amedeo, Paleari, Chiara, Baccanelli, Federica, Savi, Marzia, Antonelli, Massimo, De Pascale, Gennaro, Vaccarini, Barbara, Montrucchio, Giorgia, Sales, Gabriele, Donadello, Katia, Gottin, Leonardo, Nizzero, Marta, Polati, Enrico, De Rosa, Silvia, Sulemanji, Demet, Abusalama, Abdurraouf, Elhadi, Muhammed, Jesus, Montelongo Felipe De, Gonzalez, Daniel Rodriguez, Robles, Victor Hugo Madrigal, Canedo, Nancy, Chavez, Alejandro Esquivel, Dendane, Tarek, Grady, Bart, de Jong, Ben, van der Heiden, Eveline, Thoral, Patrick, van den Bogaard, Bas, Spronk, Peter E., Achterberg, Sefanja, Groeneveld, Melanie, So, Ralph K. L., de Wijs, Calvin, Scholten, Harm, Beishuizen, Albertus, Cornet, Alexander D., Reidinga, Auke C., Kranen, Hetty, Mensink, Roos, den Boer, Sylvia, de Groot, Marcel, Beck, Oliver, Bethlehem, Carina, van Bussel, Bas, Frenzel, Tim, de Jong, Celestine, Wilting, Rob, Mehagnoul-Schipper, Jannet, Alasia, Datonye, Kumar, Ashok, Qayyum, Ahad, Rana, Muhammad, Jayyab, Mustafa Abu, Sierra, Rosario Quispe, Hernandez, Aaron Mark, Taborda, Lúcia, Anselmo, Mónica, Ramires, Tiago, Silva, Catarina, Roriz, Carolina, Morais, Rui, Póvoa, Pedro, Patricio, Patricia, Pinto, André, Santos, Maria Lurdes, Costa, Vasco, Cunha, Pedro, Gonçalves, Celina, Nunes, Sandra, Camões, João, Adrião, Diana, Oliveira, Ana, Omrani, Ali, Maslamani, Muna Al, elbuzidi, Abdurrahmaan Suei, qudah, Bara Mahmoud Al, Akkari, Abdel Rauof, Alkhatteb, Mohamed, Baiou, Anas, Husain, Ahmed, Alwraidat, Mohamed, Saif, Ibrahim Abdulsalam, Bakdach, Dana, Ahmed, Amna, Aleef, Mohamed, Bintaher, Awadh, Petrisor, Cristina, Popov, Evgeniy, Popova, Ksenia, Dementienko, Mariia, Teplykh, Boris, Pyregov, Alexey, Davydova, Liubov, Vladislav, Belskii, Neporada, Elena, Zverev, Ivan, Meshchaninova, Svetlana, Sokolov, Dmitry, Gavrilova, Elena, Shlyk, Irina, Poliakov, Igor, Vlasova, Marina, Aljuhani, Ohoud, Alkhalaf, Amina, Humaid, Felwa Bin, Arabi, Yaseen, Kuhail, Ahmed, Elrabi, Omar, Ghannam, Madihah E., Kansal, Amit, Ho, Vui Kian, Ng, Jensen, García, Raquel Rodrígez, Fraga, Xiana Taboada, del Pilar García-Bonillo, Ma, Padilla-Serrano, Antonio, Cuadrado, Marta Martin, Ferrando, Carlos, Catalan-Monzon, Ignacio, Frutos-Vivar, Fernando, Jimenez, Jorge, Rodríguez-Solis, Carmen, Franquesa-Gonzalez, Enric, Acosta, Guillermo Pérez, Cabrera, Luciano Santana, Parra, Juan Pablo Aviles, Gonzalez, Francisco Muñoyerro, del Carmen Conesa, Maria Lorente, Varela, Ignacio Yago Martinez, Pravia, Orville Victoriano Baez, Delgado, Maria Cruz Martin, de Cabo, Carlos Munoz, Ioan, Ana-Maria, Perez-Calvo, Cesar, Santos, Arnoldo, Abad-Motos, Ane, Ripolles-Melchor, Javier, Martin, Belén Civantos, Teruel, Santiago Yus, Lucas, Juan Higuera, Ortiz, Aaron Blandino, de Pablo Sánchez, Raúl, Barrueco-Francioni, Jesús Emilio, Espina, Lorena Forcelledo, Bonell-Goytisolo, José M., Salaverria, Iñigo, Mir, Antonia Socias, Rodriguez-Ruiz, Emilio, Valverde, Virginia Hidalgo, Cubero, Patricia Jimeno, Linde, Francisca Arbol, Leganes, Nieves Cruza, Romeu, Juan Maria, Concha, Pablo, Berezo-Garcia, José Angel, Fraile, Virginia, Cuenca-Rubio, Cristina, Pérez-Torres, David, Serrano, Ainhoa, Valero, Clara Martínez, Suner, Andrea Ortiz, Larrañaga, Leire, Legaristi, Noemi, Ferrigno, Gerardo, Khlafalla, Safa, Bihariesingh-Sanchit, Rosita, Zoerner, Frank, Grip, Jonathan, Kilsand, Kristina, Mårtensson, Johan, Österlind, Jonas, von Seth, Magnus, Berkius, Johan, Ceruti, Samuele, Glotta, Andrea, Izdes, Seval, Turan, Işıl Özkoçak, Cosar, Ahmet, Halacli, Burcin, Dereli, Necla, Yilmaz, Mehmet, Akbas, Türkay, Elay, Gülseren, Eyüpoğlu, Selin, Bílír, Yelíz, Saraçoğlu, Kemal Tolga, Kaya, Ebru, Sahin, Ayca Sultan, Ekren, Pervin Korkmaz, Mengi, Tuğçe, Suner, Kezban Ozmen, Tomak, Yakup, Eroglu, Ahmet, Alsabbah, Asad, Hanlon, Katie, Gervin, Kevin, McMahon, Sean, Hagan, Samantha, Higenbottam, Caroline V, Mullhi, Randeep, Poulton, Lottie, Torlinski, Tomasz, Gareth, Allen, Truman, Nick, Vijayakumar, Gopal, Hall, Chris, Jubb, Alasdair, Cagova, Lenka, Jones, Nicola, Graham, Sam, Robin, Nicole, Cowton, Amanda, Donnelly, Adrian, Singatullina, Natalia, Kent, Melanie, Boulanger, Carole, Campbell, Zoë, Potter, Elizabeth, Duric, Natalie, Szakmany, Tamas, Kviatkovske, Orinta, Marczin, Nandor, Ellis, Caroline, Saha, Rajnish, Sri-Chandana, Chunda, Allan, John, Mumelj, Lana, Venkatesh, Harish, Gotz, Vera Nina, Cochrane, Anthony, Ficial, Barbara, Kamble, Shruthi, Lumlertgul, Nuttha, Oddy, Christopher, Jain, Susan, Crapelli, Giulia Beatrice, Vlachou, Aikaterini, Golden, David, Garrioch, Sweyn, Henning, Jeremy, Loveleena, Gupta, Davey, Miriam, Grauslyte, Lina, Salciute-Simene, Erika, Cook, Martin, Barling, Danny, Broadhurst, Phil, Purvis, Sarah, Spivey, Michael, Shuker, Benjamin, Grecu, Irina, Harding, Daniel, Dean, James T., Nielsen, Nathan D., Al-Bayati, Sama, Al-Sadawi, Mohammed, Charron, Mariane, Stubenrauch, Peter, Santanilla, Jairo, Wentowski, Catherine, Rosenberger, Dorothea, Eksarko, Polikseni, Jawa, Randeep, Kloss, P, Lindholz, M, Milnik, A, Azoulay, E, Cecconi, M, Citerio, G, De Corte, T, Duska, F, Galarza, L, Greco, M, Girbes, A, Kesecioglu, J, Mellinghoff, J, Ostermann, M, Pellegrini, M, Teboul, J, De Waele, J, Wong, A, Schaller, S, Aires, B, Gira, A, Eller, P, Hamid, T, Haque, I, De Buyser, W, Cudia, A, De Backer, D, Foulon, P, Collin, V, Van Hecke, J, De Waele, E, Van Malderen, C, Mesland, J, Biston, P, Piagnerelli, M, Haentjens, L, De Schryver, N, Van Leemput, J, Vanhove, P, Bulpa, P, Ilieva, V, Katz, D, Binnie, A, Geagea, A, Tirapegui, F, Lago, G, Graf, J, Perez-Araos, R, Vargas, P, Martinez, F, Labarca, E, Franco, D, Parra-Tanoux, D, Yepes, D, Hammouda, A, Elmandouh, O, Azzam, A, Hussein, A, Galal, I, Awad, A, Azab, M, Abdalla, M, Assal, H, Alfishawy, M, Ghozy, S, Tharwat, S, Eldaly, A, Ellervee, A, Reinhard, V, Chrisment, A, Poyat, C, Badie, J, Berdaguer Ferrari, F, Weiss, B, Schellenberg, C, Grunow, J, Lorenz, M, Spieth, P, Bota, M, Fichtner, F, Fuest, K, Lahmer, T, Herrmann, J, Meybohm, P, Markou, N, Vasileiadou, G, Chrysanthopoulou, E, Papamichalis, P, Soultati, I, Jog, S, Kalvit, K, Nainan Myatra, S, Krupa, I, Tharwat, A, Nichol, A, Mccarthy, A, Mahmoodpoor, A, Tonetti, T, Isoni, P, Spadaro, S, Volta, C, Mirabella, L, Noto, A, Florio, G, Guzzardella, A, Paleari, C, Baccanelli, F, Savi, M, Antonelli, M, De Pascale, G, Vaccarini, B, Montrucchio, G, Sales, G, Donadello, K, Gottin, L, Nizzero, M, Polati, E, De Rosa, S, Sulemanji, D, Abusalama, A, Elhadi, M, Jesus, M, Gonzalez, D, Robles, V, Canedo, N, Chavez, A, Dendane, T, Grady, B, de Jong, B, van der Heiden, E, Thoral, P, van den Bogaard, B, Spronk, P, Achterberg, S, Groeneveld, M, So, R, de Wijs, C, Scholten, H, Beishuizen, A, Cornet, A, Reidinga, A, Kranen, H, Mensink, R, den Boer, S, de Groot, M, Beck, O, Bethlehem, C, van Bussel, B, Frenzel, T, de Jong, C, Wilting, R, Mehagnoul-Schipper, J, Alasia, D, Kumar, A, Qayyum, A, Rana, M, Jayyab, M, Sierra, R, Hernandez, A, Taborda, L, Anselmo, M, Ramires, T, Silva, C, Roriz, C, Morais, R, Póvoa, P, Patricio, P, Pinto, A, Santos, M, Costa, V, Cunha, P, Gonçalves, C, Nunes, S, Camões, J, Adrião, D, Oliveira, A, Omrani, A, Maslamani, M, Elbuzidi, A, Qudah, B, Akkari, A, Alkhatteb, M, Baiou, A, Husain, A, Alwraidat, M, Saif, I, Bakdach, D, Ahmed, A, Aleef, M, Bintaher, A, Petrisor, C, Popov, E, Popova, K, Dementienko, M, Teplykh, B, Pyregov, A, Davydova, L, Vladislav, B, Neporada, E, Zverev, I, Meshchaninova, S, Sokolov, D, Gavrilova, E, Shlyk, I, Poliakov, I, Vlasova, M, Aljuhani, O, Alkhalaf, A, Humaid, F, Arabi, Y, Kuhail, A, Elrabi, O, Ghannam, M, Kansal, A, Ho, V, Ng, J, García, R, Fraga, X, del Pilar García-Bonillo, M, Padilla-Serrano, A, Cuadrado, M, Ferrando, C, Catalan-Monzon, I, Frutos-Vivar, F, Jimenez, J, Rodríguez-Solis, C, Franquesa-Gonzalez, E, Acosta, G, Cabrera, L, Parra, J, Gonzalez, F, del Carmen Conesa, M, Varela, I, Pravia, O, Delgado, M, de Cabo, C, Ioan, A, Perez-Calvo, C, Santos, A, Abad-Motos, A, Ripolles-Melchor, J, Martin, B, Teruel, S, Lucas, J, Ortiz, A, de Pablo Sánchez, R, Barrueco-Francioni, J, Espina, L, Bonell-Goytisolo, J, Salaverria, I, Mir, A, Rodriguez-Ruiz, E, Valverde, V, Cubero, P, Linde, F, Leganes, N, Romeu, J, Concha, P, Berezo-Garcia, J, Fraile, V, Cuenca-Rubio, C, Pérez-Torres, D, Serrano, A, Valero, C, Suner, A, Larrañaga, L, Legaristi, N, Ferrigno, G, Khlafalla, S, Bihariesingh-Sanchit, R, Zoerner, F, Grip, J, Kilsand, K, Mårtensson, J, Österlind, J, von Seth, M, Berkius, J, Ceruti, S, Glotta, A, Izdes, S, Turan, I, Cosar, A, Halacli, B, Dereli, N, Yilmaz, M, Akbas, T, Elay, G, Eyüpoğlu, S, Bílír, Y, Saraçoğlu, K, Kaya, E, Sahin, A, Ekren, P, Mengi, T, Suner, K, Tomak, Y, Eroglu, A, Alsabbah, A, Hanlon, K, Gervin, K, Mcmahon, S, Hagan, S, Higenbottam, C, Mullhi, R, Poulton, L, Torlinski, T, Gareth, A, Truman, N, Vijayakumar, G, Hall, C, Jubb, A, Cagova, L, Jones, N, Graham, S, Robin, N, Cowton, A, Donnelly, A, Singatullina, N, Kent, M, Boulanger, C, Campbell, Z, Potter, E, Duric, N, Szakmany, T, Kviatkovske, O, Marczin, N, Ellis, C, Saha, R, Sri-Chandana, C, Allan, J, Mumelj, L, Venkatesh, H, Gotz, V, Cochrane, A, Ficial, B, Kamble, S, Lumlertgul, N, Oddy, C, Jain, S, Crapelli, G, Vlachou, A, Golden, D, Garrioch, S, Henning, J, Loveleena, G, Davey, M, Grauslyte, L, Salciute-Simene, E, Cook, M, Barling, D, Broadhurst, P, Purvis, S, Spivey, M, Shuker, B, Grecu, I, Harding, D, Dean, J, Nielsen, N, Al-Bayati, S, Al-Sadawi, M, Charron, M, Stubenrauch, P, Santanilla, J, Wentowski, C, Rosenberger, D, Eksarko, P, Jawa, R, Kloss, Philipp, Lindholz, Maximilian, Milnik, Annette, Azoulay, Elie, Cecconi, Maurizio, Citerio, Giuseppe, De Corte, Thomas, Duska, Frantisek, Galarza, Laura, Greco, Massimiliano, Girbes, Armand R. J., Kesecioglu, Jozef, Mellinghoff, Johannes, Ostermann, Marlies, Pellegrini, Mariangela, Teboul, Jean-Louis, De Waele, Jan, Wong, Adrian, Schaller, Stefan J., Aires, Buenos, Gira, Alicia, Eller, Philipp, Hamid, Tarikul, Haque, Injamam Ull, De Buyser, Wim, Cudia, Antonella, De Backer, Daniel, Foulon, Pierre, Collin, Vincent, Van Hecke, Jolien, De Waele, Elisabeth, Van Malderen, Claire, Mesland, Jean-Baptiste, Biston, Patrick, Piagnerelli, Michael, Haentjens, Lionel, De Schryver, Nicolas, Van Leemput, Jan, Vanhove, Philippe, Bulpa, Pierre, Ilieva, Viktoria, Katz, David, Binnie, Alexandra, Geagea, Anna, Tirapegui, Fernando, Lago, Gustavo, Graf, Jerónimo, Perez-Araos, Rodrigo, Vargas, Patricio, Martinez, Felipe, Labarca, Eduardo, Franco, Daniel Molano, Parra-Tanoux, Daniela, Yepes, David, Hammouda, Ahmed, Elmandouh, Omar, Azzam, Ahmed, Hussein, Aliae Mohamed, Galal, Islam, Awad, Ahmed K., Azab, Mohammed A., Abdalla, Maged, Assal, Hebatallah, Alfishawy, Mostafa, Ghozy, Sherief, Tharwat, Samar, Eldaly, Abdullah, Ellervee, Anneli, Reinhard, Veronika, Chrisment, Anne, Poyat, Chrystelle, Badie, Julio, Berdaguer Ferrari, Fernando, Weiss, Björn, Schellenberg, Clara, Grunow, Julius J, Lorenz, Marco, Schaller, Stefan J, Spieth, Peter, Bota, Marc, Fichtner, Falk, Fuest, Kristina, Lahmer, Tobias, Herrmann, Johannes, Meybohm, Patrick, Markou, Nikolaos, Vasileiadou, Georgia, Chrysanthopoulou, Evangelia, Papamichalis, Panagiotis, Soultati, Ioanna, Jog, Sameer, Kalvit, Kushal, Nainan Myatra, Sheila, Krupa, Ivan, Tharwat, Aisa, Nichol, Alistair, McCarthy, Aine, Mahmoodpoor, Ata, Tonetti, Tommaso, Isoni, Paolo, Spadaro, Savino, Volta, Carlo Alberto, Mirabella, Lucia, Noto, Alberto, Florio, Gaetano, Guzzardella, Amedeo, Paleari, Chiara, Baccanelli, Federica, Savi, Marzia, Antonelli, Massimo, De Pascale, Gennaro, Vaccarini, Barbara, Montrucchio, Giorgia, Sales, Gabriele, Donadello, Katia, Gottin, Leonardo, Nizzero, Marta, Polati, Enrico, De Rosa, Silvia, Sulemanji, Demet, Abusalama, Abdurraouf, Elhadi, Muhammed, Jesus, Montelongo Felipe De, Gonzalez, Daniel Rodriguez, Robles, Victor Hugo Madrigal, Canedo, Nancy, Chavez, Alejandro Esquivel, Dendane, Tarek, Grady, Bart, de Jong, Ben, van der Heiden, Eveline, Thoral, Patrick, van den Bogaard, Bas, Spronk, Peter E., Achterberg, Sefanja, Groeneveld, Melanie, So, Ralph K. L., de Wijs, Calvin, Scholten, Harm, Beishuizen, Albertus, Cornet, Alexander D., Reidinga, Auke C., Kranen, Hetty, Mensink, Roos, den Boer, Sylvia, de Groot, Marcel, Beck, Oliver, Bethlehem, Carina, van Bussel, Bas, Frenzel, Tim, de Jong, Celestine, Wilting, Rob, Mehagnoul-Schipper, Jannet, Alasia, Datonye, Kumar, Ashok, Qayyum, Ahad, Rana, Muhammad, Jayyab, Mustafa Abu, Sierra, Rosario Quispe, Hernandez, Aaron Mark, Taborda, Lúcia, Anselmo, Mónica, Ramires, Tiago, Silva, Catarina, Roriz, Carolina, Morais, Rui, Póvoa, Pedro, Patricio, Patricia, Pinto, André, Santos, Maria Lurdes, Costa, Vasco, Cunha, Pedro, Gonçalves, Celina, Nunes, Sandra, Camões, João, Adrião, Diana, Oliveira, Ana, Omrani, Ali, Maslamani, Muna Al, elbuzidi, Abdurrahmaan Suei, qudah, Bara Mahmoud Al, Akkari, Abdel Rauof, Alkhatteb, Mohamed, Baiou, Anas, Husain, Ahmed, Alwraidat, Mohamed, Saif, Ibrahim Abdulsalam, Bakdach, Dana, Ahmed, Amna, Aleef, Mohamed, Bintaher, Awadh, Petrisor, Cristina, Popov, Evgeniy, Popova, Ksenia, Dementienko, Mariia, Teplykh, Boris, Pyregov, Alexey, Davydova, Liubov, Vladislav, Belskii, Neporada, Elena, Zverev, Ivan, Meshchaninova, Svetlana, Sokolov, Dmitry, Gavrilova, Elena, Shlyk, Irina, Poliakov, Igor, Vlasova, Marina, Aljuhani, Ohoud, Alkhalaf, Amina, Humaid, Felwa Bin, Arabi, Yaseen, Kuhail, Ahmed, Elrabi, Omar, Ghannam, Madihah E., Kansal, Amit, Ho, Vui Kian, Ng, Jensen, García, Raquel Rodrígez, Fraga, Xiana Taboada, del Pilar García-Bonillo, Ma, Padilla-Serrano, Antonio, Cuadrado, Marta Martin, Ferrando, Carlos, Catalan-Monzon, Ignacio, Frutos-Vivar, Fernando, Jimenez, Jorge, Rodríguez-Solis, Carmen, Franquesa-Gonzalez, Enric, Acosta, Guillermo Pérez, Cabrera, Luciano Santana, Parra, Juan Pablo Aviles, Gonzalez, Francisco Muñoyerro, del Carmen Conesa, Maria Lorente, Varela, Ignacio Yago Martinez, Pravia, Orville Victoriano Baez, Delgado, Maria Cruz Martin, de Cabo, Carlos Munoz, Ioan, Ana-Maria, Perez-Calvo, Cesar, Santos, Arnoldo, Abad-Motos, Ane, Ripolles-Melchor, Javier, Martin, Belén Civantos, Teruel, Santiago Yus, Lucas, Juan Higuera, Ortiz, Aaron Blandino, de Pablo Sánchez, Raúl, Barrueco-Francioni, Jesús Emilio, Espina, Lorena Forcelledo, Bonell-Goytisolo, José M., Salaverria, Iñigo, Mir, Antonia Socias, Rodriguez-Ruiz, Emilio, Valverde, Virginia Hidalgo, Cubero, Patricia Jimeno, Linde, Francisca Arbol, Leganes, Nieves Cruza, Romeu, Juan Maria, Concha, Pablo, Berezo-Garcia, José Angel, Fraile, Virginia, Cuenca-Rubio, Cristina, Pérez-Torres, David, Serrano, Ainhoa, Valero, Clara Martínez, Suner, Andrea Ortiz, Larrañaga, Leire, Legaristi, Noemi, Ferrigno, Gerardo, Khlafalla, Safa, Bihariesingh-Sanchit, Rosita, Zoerner, Frank, Grip, Jonathan, Kilsand, Kristina, Mårtensson, Johan, Österlind, Jonas, von Seth, Magnus, Berkius, Johan, Ceruti, Samuele, Glotta, Andrea, Izdes, Seval, Turan, Işıl Özkoçak, Cosar, Ahmet, Halacli, Burcin, Dereli, Necla, Yilmaz, Mehmet, Akbas, Türkay, Elay, Gülseren, Eyüpoğlu, Selin, Bílír, Yelíz, Saraçoğlu, Kemal Tolga, Kaya, Ebru, Sahin, Ayca Sultan, Ekren, Pervin Korkmaz, Mengi, Tuğçe, Suner, Kezban Ozmen, Tomak, Yakup, Eroglu, Ahmet, Alsabbah, Asad, Hanlon, Katie, Gervin, Kevin, McMahon, Sean, Hagan, Samantha, Higenbottam, Caroline V, Mullhi, Randeep, Poulton, Lottie, Torlinski, Tomasz, Gareth, Allen, Truman, Nick, Vijayakumar, Gopal, Hall, Chris, Jubb, Alasdair, Cagova, Lenka, Jones, Nicola, Graham, Sam, Robin, Nicole, Cowton, Amanda, Donnelly, Adrian, Singatullina, Natalia, Kent, Melanie, Boulanger, Carole, Campbell, Zoë, Potter, Elizabeth, Duric, Natalie, Szakmany, Tamas, Kviatkovske, Orinta, Marczin, Nandor, Ellis, Caroline, Saha, Rajnish, Sri-Chandana, Chunda, Allan, John, Mumelj, Lana, Venkatesh, Harish, Gotz, Vera Nina, Cochrane, Anthony, Ficial, Barbara, Kamble, Shruthi, Lumlertgul, Nuttha, Oddy, Christopher, Jain, Susan, Crapelli, Giulia Beatrice, Vlachou, Aikaterini, Golden, David, Garrioch, Sweyn, Henning, Jeremy, Loveleena, Gupta, Davey, Miriam, Grauslyte, Lina, Salciute-Simene, Erika, Cook, Martin, Barling, Danny, Broadhurst, Phil, Purvis, Sarah, Spivey, Michael, Shuker, Benjamin, Grecu, Irina, Harding, Daniel, Dean, James T., Nielsen, Nathan D., Al-Bayati, Sama, Al-Sadawi, Mohammed, Charron, Mariane, Stubenrauch, Peter, Santanilla, Jairo, Wentowski, Catherine, Rosenberger, Dorothea, Eksarko, Polikseni, and Jawa, Randeep

Abstract

Background: Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods: This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results: Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions: Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04

Published
2023

2. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

Author

Greco, M, De Corte, T, Ercole, A, Antonelli, M, Azoulay, E, Citerio, G, Morris, A, De Pascale, G, Duska, F, Elbers, P, Einav, S, Forni, L, Galarza, L, Girbes, A, Grasselli, G, Gusarov, V, Jubb, A, Kesecioglu, J, Lavinio, A, Delgado, M, Mellinghoff, J, Myatra, S, Ostermann, M, Pellegrini, M, Povoa, P, Schaller, S, Teboul, J, Wong, A, De Waele, J, Cecconi, M, Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R J, Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J, Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J, Cecconi, Maurizio, Greco, M, De Corte, T, Ercole, A, Antonelli, M, Azoulay, E, Citerio, G, Morris, A, De Pascale, G, Duska, F, Elbers, P, Einav, S, Forni, L, Galarza, L, Girbes, A, Grasselli, G, Gusarov, V, Jubb, A, Kesecioglu, J, Lavinio, A, Delgado, M, Mellinghoff, J, Myatra, S, Ostermann, M, Pellegrini, M, Povoa, P, Schaller, S, Teboul, J, Wong, A, De Waele, J, Cecconi, M, Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R J, Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J, Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J, and Cecconi, Maurizio

Abstract

Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%–50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality.

Published
2022

3. Correction to: Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

Author

Greco, Massimiliano, Greco, M, De Corte, T, Ercole, A, Antonelli, M, Azoulay, E, Citerio, G, Morris, A, De Pascale, G, Duska, F, Elbers, P, Einav, S, Forni, L, Galarza, L, Girbes, A, Grasselli, G, Gusarov, V, Jubb, A, Kesecioglu, J, Lavinio, A, Delgado, M, Mellinghoff, J, Myatra, S, Ostermann, M, Pellegrini, M, Povoa, P, Schaller, S, Teboul, J, Wong, A, De Waele, J, Cecconi, M, Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R J, Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J, Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J, Cecconi, Maurizio, Greco, Massimiliano, Greco, M, De Corte, T, Ercole, A, Antonelli, M, Azoulay, E, Citerio, G, Morris, A, De Pascale, G, Duska, F, Elbers, P, Einav, S, Forni, L, Galarza, L, Girbes, A, Grasselli, G, Gusarov, V, Jubb, A, Kesecioglu, J, Lavinio, A, Delgado, M, Mellinghoff, J, Myatra, S, Ostermann, M, Pellegrini, M, Povoa, P, Schaller, S, Teboul, J, Wong, A, De Waele, J, Cecconi, M, Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R J, Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J, Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J, and Cecconi, Maurizio

Abstract

In the original version of this article, the given and family names of Kristina Fuest, Tobias Lahmer, Johannes Herrmann, Patrick Meybohm, Nikolaos Markou, Georgia Vasileiadou were incorrectly structured. The Publisher apologises for this mistake.

Published
2022

4. Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Author

Conway Morris, Andrew, Kohler, Katharina, De Corte, Thomas, Ercole, Ari, De Grooth, Harm-Jan, Elbers, Paul W G, Povoa, Pedro, Morais, Rui, Koulenti, Despoina, Jog, Sameer, Nielsen, Nathan, Jubb, Alasdair, Cecconi, Maurizio, De Waele, Jan, Marco, Bezzi, Alicia, Gira, Philipp, Eller, Tarikul, Hamid, Injamam Ull Haque, Wim De Buyser, Antonella, Cudia, Daniel De Backer, Pierre, Foulon, Vincent, Collin, Jan De Waele, Jolien Van Hecke, Elisabeth De Waele, Claire Van Malderen, Jean-Baptiste, Mesland, Patrick, Biston, Michael, Piagnerelli, Lionel, Haentjens, Nicolas De Schryver, Jan Van Leemput, Philippe, Vanhove, Pierre, Bulpa, Viktoria, Ilieva, David, Katz, Alexandra, Binnie, Anna, Geagea, Fernando, Tirapegui, Gustavo, Lago, Jerónimo, Graf, Rodrigo, Perez-Araos, Patricio, Vargas, Felipe, Martinez, Eduardo, Labarca, Daniel Molano Franco, Daniela, Parra-Tanoux, Luis Felipe Reyes, David, Yepes, Filip, Periš, Sanda Stojanović Stipić, Cynthia Vanessa Campozano Burgos, Paulo Roberto Navas Boada, Jose Luis Barberan Brun, Juan Pablo Paredes Ballesteros, Gamal, Abdelnasser, Ahmed, Hammouda, Omar, Elmandouh, Ahmed, Azzam, Aliae Mohamed Hussein, Islam, Galal, Ahmed, K Awad, Mohammed, A Azab, Maged, Abdalla, Hebatallah, Assal, Mostafa, Alfishawy, Sherief, Ghozy, Samar, Tharwat, Abdullah, Eldaly, Anneli, Ellervee, Veronika, Reinhard, Anne, Chrisment, Chrystelle, Poyat, Julio, Badie, Fernando Berdaguer Ferrari, Björn, Weiss, Clara, Schellenberg, Julius, J Grunow, Marco, Lorenz, Stefan, J Schaller, Peter, Spieth, Marc, Bota, Falk, Fichtner, Kristina, Fuest, Tobias, Lahmer, Johannes, Herrmann, Patrick, Meybohm, Nikolaos, Markou, Georgia, Vasileiadou, Evangelia, Chrysanthopoulou, Panagiotis, Papamichalis, Ioanna, Soultati, Sameer, Jog, Kushal, Kalvit, Sheila Nainan Myatra, Ivan, Krupa, Aisa, Tharwat, Alistair, Nichol, Aine, Mccarthy, Ata, Mahmoodpoor, Tommaso, Tonetti, Paolo, Isoni, Savino, Spadaro, Carlo Alberto Volta, Lucia, Mirabella, Alberto, Noto, Gaetano, Florio, Amedeo, Guzzardella, Chiara, Paleari, Federica, Baccanelli, Marzia, Savi, Massimo, Antonelli, Gennaro De Pascale, San, Luca, Barbara, Vaccarini, Giorgia, Montrucchio, Gabriele, Sales, Donadello, Katia, Leonardo, Gottin, Marta, Nizzero, Enrico, Polati, De Rosa, Silvia, Demet, Sulemanji, Abdurraouf, Abusalama, Muhammed, Elhadi, Montelongo De FelipeJesus, Daniel Rodriguez Gonzalez, Victor Hugo Madrigal Robles, Nancy, Canedo, Alejandro Esquivel Chavez, Tarek, Dendane, Bart, Grady, Ben de Jong, Eveline van der Heiden, Patrick, Thoral, Bas van den Bogaard, Peter, E Spronk, Sefanja, Achterberg, Melanie, Groeneveld, Ralph K, L So, Calvin de Wijs, Harm, Scholten, Albertus, Beishuizen, Alexander, D Cornet, Auke, C Reidinga, Hetty, Kranen, Roos, Mensink, Spaarne, Gasthuis, Sylvia den Boer, Marcel de Groot, Oliver, Beck, Carina, Bethlehem, Bas van Bussel, Tim, Frenzel, Celestine de Jong, Rob, Wilting, Jozef, Kesecioglu, Jannet, Mehagnoul-Schipper, Datonye, Alasia, Ashok, Kumar, Ahad, Qayyum, Muhammad, Rana, Mustafa Abu Jayyab, Rosario Quispe Sierra, Aaron Mark Hernandez, José de Almeida, Lúcia, Taborda, Mónica, Anselmo, Tiago, Ramires, Catarina, Silva, Carolina, Roriz, Rui, Morais, Pedro, Póvoa, Patricia, Patricio, André, Pinto, Maria Lurdes Santos, Vasco, Costa, Pedro, Cunha, Celina, Gonçalves, Sandra, Nunes, João, Camões, Diana, Adrião, Ana, Oliveira, Ali, Omrani, Muna Al Maslamani, Abdurrahmaan Suei Elbuzidi, Bara Mahmoud Al Qudah, Abdel Rauof Akkari, Mohamed, Alkhatteb, Anas, Baiou, Ahmed, Husain, Mohamed, Alwraidat, Ibrahim Abdulsalam Saif, Dana, Bakdach, Amna, Ahmed, Mohamed, Aleef, Awadh, Bintaher, Cristina, Petrisor, Evgeniy, Popov, Ksenia, Popova, Mariia, Dementienko, Boris, Teplykh, Alexey, Pyregov, Liubov, Davydova, Belskii, Vladislav, Elena, Neporada, Ivan, Zverev, Svetlana, Meshchaninova, Dmitry, Sokolov, Elena, Gavrilova, Irina, Shlyk, Igor, Poliakov, Marina, Vlasova, Ohoud, Aljuhani, Amina, Alkhalaf, Felwa Bin Humaid, Yaseen, Arabi, Ahmed, Kuhail, Omar, Elrabi, Madihah, E Ghannam, Ng Teng Fong, Amit, Kansal, Vui Kian Ho, Jensen, Ng, Raquel Rodrígez García, Xiana Taboada Fraga, Mª Del Pilar García-Bonillo, Antonio, Padilla-Serrano, Marta Martin Cuadrado, Carlos, Ferrando, Ignacio, Catalan-Monzon, Laura, Galarza, Fernando, Frutos-Vivar, Jorge, Jimenez, Carmen, Rodríguez-Solis, Enric, Franquesa-Gonzalez, Guillermo Pérez Acosta, Luciano Santana Cabrera, Juan Pablo Aviles Parra, Francisco Muñoyerro Gonzalez, Maria Del Carmen Lorente Conesa, Ignacio Yago Martinez Varela, Orville Victoriano Baez Pravia, Maria Cruz Martin Delgado, Carlos Munoz de Cabo, Ana-Maria, Ioan, Cesar, Perez-Calvo, Arnoldo, Santos, Ane, Abad-Motos, Javier, Ripolles-Melchor, Belén Civantos Martin, Santiago Yus Teruel, Juan Higuera Lucas, Aaron Blandino Ortiz, Raúl de Pablo Sánchez, Jesús Emilio Barrueco-Francioni, Lorena Forcelledo Espina, José, M Bonell-Goytisolo, Iñigo, Salaverria, Antonia Socias Mir, Emilio, Rodriguez-Ruiz, Virginia Hidalgo Valverde, Patricia Jimeno Cubero, Francisca Arbol Linde, Nieves Cruza Leganes, Juan Maria Romeu, Pablo, Concha, José Angel Berezo-Garcia, Virginia, Fraile, Cristina, Cuenca-Rubio, David, Pérez-Torres, Ainhoa, Serrano, Clara Martínez Valero, Andrea Ortiz Suner, Leire, Larrañaga, Noemi, Legaristi, Gerardo, Ferrigno, Safa, Khlafalla, Rosita, Bihariesingh-Sanchit, Hallands, Sjukhus, Frank, Zoerner, Jonathan, Grip, Kristina, Kilsand, Johan, Mårtensson, Jonas, Österlind, Akademiska, Sjukhuset, Magnus von Seth, Västerviks, Sjukhus, Johan, Berkius, Samuele, Ceruti, Andrea, Glotta, Seval, Izdes, Işıl Özkoçak Turan, Ahmet, Cosar, Burcin, Halacli, Necla, Dereli, Mehmet, Yilmaz, Türkay, Akbas, Gülseren, Elay, Selin, Eyüpoğlu, Yelíz, Bílír, Kemal Tolga Saraçoğlu, Ebru, Kaya, Ayca Sultan Sahin, Pervin Korkmaz Ekren, Tuğçe, Mengi, Kezban Ozmen Suner, Yakup, Tomak, Ahmet, Eroglu, Asad, Alsabbah, Katie, Hanlon, Kevin, Gervin, Sean, Mcmahon, Samantha, Hagan, Caroline, V Higenbottam, Randeep, Mullhi, Lottie, Poulton, Tomasz, Torlinski, Allen, Gareth, Nick, Truman, Gopal, Vijayakumar, Chris, Hall, Alasdair, Jubb, Lenka, Cagova, Nicola, Jones, Sam, Graham, Nicole, Robin, Amanda, Cowton, Adrian, Donnelly, Natalia, Singatullina, Melanie, Kent, Carole, Boulanger, Zoë, Campbell, Elizabeth, Potter, Natalie, Duric, Tamas, Szakmany, Royal, Brompton, Orinta, Kviatkovske, Nandor, Marczin, Caroline, Ellis, Rajnish, Saha, Chunda, Sri-Chandana, John, Allan, Lana, Mumelj, Harish, Venkatesh, Vera Nina Gotz, Anthony, Cochrane, Barbara, Ficial, Shruthi, Kamble, Nuttha, Lumlertgul, Christopher, Oddy, Susan, Jain, Giulia Beatrice Crapelli, Aikaterini, Vlachou, David, Golden, Sweyn, Garrioch, Jeremy, Henning, Gupta, Loveleena, Miriam, Davey, Lina, Grauslyte, Erika, Salciute-Simene, Martin, Cook, Danny, Barling, Phil, Broadhurst, Sarah, Purvis, Michael, Spivey, Benjamin, Shuker, Irina, Grecu, Daniel, Harding, James, T Dean, Nathan, D Nielsen, Sama, Al-Bayati, Mohammed, Al-Sadawi, Mariane, Charron, Peter, Stubenrauch, Jairo, Santanilla, Catherine, Wentowski, Dorothea, Rosenberger, Polikseni, Eksarko, Randeep, Jawa, Intensive care medicine, ACS - Microcirculation, ACS - Diabetes & metabolism, AII - Infectious diseases, Conway Morris, Andrew [0000-0002-3211-3216], Kohler, Katharina [0000-0003-1919-0193], De Corte, Thomas [0000-0001-5011-6640], Ercole, Ari [0000-0001-8350-8093], De Grooth, Harm-Jan [0000-0002-7499-076X], Elbers, Paul WG [0000-0003-0447-6893], Povoa, Pedro [0000-0002-7069-7304], Morais, Rui [0000-0003-4114-6949], Koulenti, Despoina [0000-0003-4364-2612], Jog, Sameer [0000-0002-1134-1260], Nielsen, Nathan [0000-0002-3131-7540], Jubb, Alasdair [0000-0001-5593-866X], Cecconi, Maurizio [0000-0002-4376-6538], De Waele, Jan [0000-0003-1017-9748], Apollo - University of Cambridge Repository, UCL - SSS/DDUV/GECE - Génétique cellulaire, UCL - (SLuc) Service de soins intensifs, Conway Morris A., Kohler K., De Corte T., Ercole A., De Grooth H.-J., Elbers P.W.G., Povoa P., Morais R., Koulenti D., Jog S., Nielsen N., Jubb A., Cecconi M., De Waele J., Bezzi M., Gira A., Eller P., Hamid T., Haque I.U., De Buyser W., Cudia A., De Backer D., Foulon P., Collin V., Van Hecke J., De Waele E., Van Malderen C., Mesland J.-B., Piagnerelli M., Haentjens L., De Schryver N., Van Leemput J., Vanhove P., Bulpa P., Ilieva V., Katz D., Geagea A., Binnie A., Tirapegui F., Lago G., Graf J., Perez-Araos R., Vargas P., Martinez F., Labarca E., Franco D.M., Parra-Tanoux D., Reyes L.F., Yepes D., Peris F., Stipic S.S., Burgos C.V.C., Boada P.R.N., Brun J.L.B., Ballesteros J.P.P., Hammouda A., Elmandouh O., Azzam A., Hussein A.M., Galal I., Awad A.K., Azab M.A., Abdalla M., Assal H., Alfishawy M., Ghozy S., Tharwat S., Eldaly A., Reinhard V., Chrisment A., Poyat C., Badie J., Ferrari F.B., Weiss B., Kuhn K.F., Grunow J.J., Lorenz M., Schaller S., Spieth P., Bota M., Fichtner F., Fuest K., Lahmer T., Herrmann J., Meybohm P., Markou N., Vasileiadou G., Chrysanthopoulou E., Papamichalis P., Soultati I., Kalvit K., Myatra S.N., Krupa I., Tharwat A., Nichol A., McCarthy A., Mahmoodpoor A., Tonetti T., Isoni P., Spadaro S., Volta C.A., Mirabella L., Noto A., Florio G., Guzzardella A., Paleari C., Baccanelli F., Savi M., Antonelli M., Vaccarini B., Montrucchio G., Sales G., Donadello K., Gottin L., Polati E., De Rosa S., Sulemanji D., Abusalama A., Elhadi M., De Jesus M.F., Gonzalez D.R., Canedo N., Chavez A.E., Dendane T., Grady B., de Jong B., van der Heiden E., Thoral P., van den Bogaard B., Spronk P.E., Achterberg S., Groeneveld M., So R.K.L., de Wijs C., Scholten H., Beishuizen A., Cornet A.D., Reidinga A.C., Kranen H., Mensink R., Boer S., de Groot M., Beck O., Bethlehem C., van Bussel B., Frenzel T., de Jong C., Wilting R., Kesecioglu J., Mehagnoul-Schipper J., Alasia D., Kumar A., Qayyum A., Rana M., Jayyab M.A., Sierra R.Q., Hernandez A.M., Taborda L., Ramires T., Silva C., Roriz C., Patricio P., Santos M.L., Costa V., Cunha P., Goncalves C., Nunes S., Camoes J., Adriao D., Oliveira A., Omrani A., Al Maslamani M., elbuzidi A.S., Al qudah B.M., Akkari A.R., Alkhatteb M., Baiou A., Husain A., Alwraidat M., Saif I.A., Bakdach D., Ahmed A., Aleef M., Bintaher A., Petrisor C., Popov E., Popova K., Dementienko M., Teplykh B., Pyregov A., Davydova L., Vladislav B., Neporada E., Zverev I., Meshchaninova S., Sokolov D., Gavrilova E., Shlyk I., Poliakov I., B?aco?a M., Aljuhani O., Alkhalaf A., Humaid F.B., Arabi Y., Kuhail A., Elrabi O., Alghnam M., Kansal A., Ho V.K., Ng J., Garcia R.R., Fraga X.T., del Pilar Garcia-Bonillo M., Padilla-Serrano A., Cuadrado M.M., Ferrando C., Catalan-Monzon I., Galarza L., Frutos-Vivar F., Jimenez J., Rodriguez-Solis C., Franquesa-Gonzalez E., Acosta G.P., Cabrera L.S., Parra J.P.A., Gonzalez F.M., del Carmen Lorente Conesa M., Varela I.Y.M., Pravia O.V.B., Delgado M.C.M., de Cabo C.M., Ioan A.-M., Perez-Calvo C., Santos A., Abad-Motos A., Ripolles-Melchor J., Martin B.C., Teruel S.Y., Lucas J.H., Ortiz A.B., de Pablo Sanchez R., Barrueco-Francioni J.E., Espina L.F., Bonell-Goytisolo J.M., Salaverria I., Mir A.S., Rodriguez-Ruiz E., Valverde V.H., Cubero P.J., Linde F.A., Leganes N.C., Romeu J.M., Concha P., Berezo-Garcia J.A., Fraile V., Cuenca-Rubio C., Perez-Torres D., Serrano A., Valero C.M., Suner A.O., Larranaga L., Legaristi N., Ferrigno G., Khlafalla S., Bihariesingh-Sanchit R., Zoerner F., Grip J., Kilsand K., Osterlind J., von Seth M., Berkius J., Ceruti S., Glotta A., Izdes S., Turan I.O., Cosar A., Halacli B., Dereli N., Yilmaz M., Akbas T., Elay G., Eyupoglu S., Bilir Y., Saracoglu K.T., Kaya E., Sahin A.S., Ekren P.K., Mengi T., Suner K.O., Tomak Y., Eroglu A., Alsabbah A., Hanlon K., Gervin K., McMahon S., Hagan S., Higenbottam C.V., Mullhi R., Poulton L., Torlinski T., Gareth A., Truman N., Vijayakumar G., Hall C., Cagova L., Jones N., Graham S., Robin N., Cowton A., Donnelly A., Singatullina N., Kent M., Boulanger C., Campbell Z., Potter E., Duric N., Szakmany T., Kviatkovske O., Marczin N., Ellis C., Saha R., Sri-Chandana C., Allan J., Mumelj L., Venkatesh H., Gotz V.N., Cochrane A., Lumlertgul N., Ficial B., Jain S., Crapelli G.B., Vlachou A., Golden D., Garrioch S., Henning J., Loveleena G., Davey M., Grauslyte L., Salciute-Simene E., Cook M., Barling D., Broadhurst P., Purvis S., Michael S., Shuker B., Grecu I., Harding D., Dean J.T., Nielsen N.D., Al-Bayati S., Al-Sadawi M., Charron M., Stubenrauch P., Santanilla J., Wentowski C., Rosenberger D., Eksarko P., and Jawa R.

Subjects
Adult, Coronavirus Disease 2019 (COVID-19), Critical Illness, Intensive Care Unit, Pneumonia, Viral, NCT04836065, Adrenal Cortex Hormone, Critical Care and Intensive Care Medicine, co-infection, COVID-19 Testing, Adrenal Cortex Hormones, Anti-Bacterial Agent, Medicine and Health Sciences, Pneumonia, Bacterial, Humans, Pandemics, Pandemic, Coinfection, Research, Other Research Radboud Institute for Health Sciences [Radboudumc 0], respiratory failure, COVID-19, Anti-Bacterial Agents, Intensive Care Units, NCT, ICU, Critical Illne, Coronavirus Disease 2019 (COVID-19), co-infection, ICU, respiratory failure, Human
Abstract

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347, BACKGROUND: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. METHODS: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method. RESULTS: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. CONCLUSIONS: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)., European Society of Intensive Care Medicine ACM is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/V006118/1)

Published
2022

5. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave

Author

Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R J, Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J, Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J, Cecconi, Maurizio, Marco, Bezzi, Alicia, Gira, Philipp, Eller, Tarikul, Hamid, Injamam Ull Haque, Wim De Buyser, Antonella, Cudia, Daniel De Backer, Pierre, Foulon, Vincent, Collin, Jan De Waele, Jolien Van Hecke, Elisabeth De Waele, Claire Van Malderen, Jean-Baptiste, Mesland, Patrick, Biston, Michael, Piagnerelli, Lionel, Haentjens, Nicolas De Schryver, Jan Van Leemput, Philippe, Vanhove, Pierre, Bulpa, Viktoria, Ilieva, David, Katz, Alexandra, Binnie, Anna, Geagea, Fernando, Tirapegui, Gustavo, Lago, Jerónimo, Graf, Rodrigo, Perez-Araos, Patricio, Vargas, Felipe, Martinez, Eduardo, Labarca, Daniel Molano Franco, Daniela, Parra-Tanoux, Luis Felipe Reyes, David, Yepes, Filip, Periš, Sanda Stojanović Stipić, Cynthia Vanessa Campozano Burgos, Paulo Roberto Navas Boada, Jose Luis Barberan Brun, Juan Pablo Paredes Ballesteros, Gamal, Abdelnasser, Ahmed, Hammouda, Omar, Elmandouh, Ahmed, Azzam, Aliae Mohamed Hussein, Islam, Galal, Awad, Ahmed K., Azab, Mohammed A., Maged, Abdalla, Hebatallah, Assal, Mostafa, Alfishawy, Sherief, Ghozy, Samar, Tharwat, Abdullah, Eldaly, Anneli, Ellervee, Veronika, Reinhard, Anne, Chrisment, Chrystelle, Poyat, Julio, Badie, Fernando Berdaguer Ferrari, Björn, Weiss, Clara, Schellenberg, Grunow, Julius J., Marco, Lorenz, Schaller, Stefan J., Peter, Spieth, Marc, Bota, Falk, Fichtner, Kristina, Fuest, Tobias, Lahmer, Johannes, Herrmann, Patrick, Meybohm, Nikolaos, Markou, Georgia, Vasileiadou, Evangelia, Chrysanthopoulou, Panagiotis, Papamichalis, Ioanna, Soultati, Sameer, Jog, Kushal, Kalvit, Sheila Nainan Myatra, Ivan, Krupa, Aisa, Tharwat, Alistair, Nichol, Aine, Mccarthy, Ata, Mahmoodpoor, Tommaso, Tonetti, Paolo, Isoni, Savino, Spadaro, Carlo Alberto Volta, Lucia, Mirabella, Alberto, Noto, Gaetano, Florio, Amedeo, Guzzardella, Chiara, Paleari, Federica, Baccanelli, Marzia, Savi, Massimo, Antonelli, Gennaro De Pascale, San, Luca, Barbara, Vaccarini, Giorgia, Montrucchio, Gabriele, Sales, Donadello, Katia, Leonardo, Gottin, Marta, Nizzero, Enrico, Polati, De Rosa, Silvia, Demet, Sulemanji, Abdurraouf, Abusalama, Muhammed, Elhadi, Montelongo De FelipeJesus, Daniel Rodriguez Gonzalez, Victor Hugo Madrigal Robles, Nancy, Canedo, Alejandro Esquivel Chavez, Tarek, Dendane, Bart, Grady, Ben de Jong, Eveline van der Heiden, Patrick, Thoral, Bas van den Bogaard, Spronk, Peter E., Sefanja, Achterberg, Melanie, Groeneveld, Ralph K. L., So, Calvin de Wijs, Harm, Scholten, Albertus, Beishuizen, Cornet, Alexander D., Reidinga, Auke C., Hetty, Kranen, Roos, Mensink, Spaarne, Gasthuis, Sylvia den Boer, Marcel de Groot, Oliver, Beck, Carina, Bethlehem, Bas van Bussel, Tim, Frenzel, Celestine de Jong, Rob, Wilting, Jozef, Kesecioglu, Jannet, Mehagnoul-Schipper, Datonye, Alasia, Ashok, Kumar, Ahad, Qayyum, Muhammad, Rana, Mustafa Abu Jayyab, Rosario Quispe Sierra, Aaron Mark Hernandez, José de Almeida, Lúcia, Taborda, Mónica, Anselmo, Tiago, Ramires, Catarina, Silva, Carolina, Roriz, Rui, Morais, Pedro, Póvoa, Patricia, Patricio, André, Pinto, Maria Lurdes Santos, Vasco, Costa, Pedro, Cunha, Celina, Gonçalves, Sandra, Nunes, João, Camões, Diana, Adrião, Ana, Oliveira, Ali, Omrani, Muna Al Maslamani, Abdurrahmaan Suei elbuzidi, Bara Mahmoud Al qudah, Abdel Rauof Akkari, Mohamed, Alkhatteb, Anas, Baiou, Ahmed, Husain, Mohamed, Alwraidat, Ibrahim Abdulsalam Saif, Dana, Bakdach, Amna, Ahmed, Mohamed, Aleef, Awadh, Bintaher, Cristina, Petrisor, Evgeniy, Popov, Ksenia, Popova, Mariia, Dementienko, Boris, Teplykh, Alexey, Pyregov, Liubov, Davydova, Belskii, Vladislav, Elena, Neporada, Ivan, Zverev, Svetlana, Meshchaninova, Dmitry, Sokolov, Elena, Gavrilova, Irina, Shlyk, Igor, Poliakov, Marina, Vlasova, Ohoud, Aljuhani, Amina, Alkhalaf, Felwa Bin Humaid, Yaseen, Arabi, Ahmed, Kuhail, Omar, Elrabi, Ghannam, Madihah E., Ng Teng Fong, Amit, Kansal, Vui Kian Ho, Jensen, Ng, Raquel Rodrígez García, Xiana Taboada Fraga, Mª del Pilar García-Bonillo, Antonio, Padilla-Serrano, Marta Martin Cuadrado, Carlos, Ferrando, Ignacio, Catalan-Monzon, Laura, Galarza, Fernando, Frutos-Vivar, Jorge, Jimenez, Carmen, Rodríguez-Solis, Enric, Franquesa-Gonzalez, Guillermo Pérez Acosta, Luciano Santana Cabrera, Juan Pablo Aviles Parra, Francisco Muñoyerro Gonzalez, Maria del Carmen Lorente Conesa, Ignacio Yago Martinez Varela, Orville Victoriano Baez Pravia, Maria Cruz Martin Delgado, Carlos Munoz de Cabo, Ana-Maria, Ioan, Cesar, Perez-Calvo, Arnoldo, Santos, Ane, Abad-Motos, Javier, Ripolles-Melchor, Belén Civantos Martin, Santiago Yus Teruel, Juan Higuera Lucas, Aaron Blandino Ortiz, Raúl de Pablo Sánchez, Jesús Emilio Barrueco-Francioni, Lorena Forcelledo Espina, Bonell-Goytisolo, José M., Iñigo, Salaverria, Antonia Socias Mir, Emilio, Rodriguez-Ruiz, Virginia Hidalgo Valverde, Patricia Jimeno Cubero, Francisca Arbol Linde, Nieves Cruza Leganes, Juan Maria Romeu, Pablo, Concha, José Angel Berezo-Garcia, Virginia, Fraile, Cristina, Cuenca-Rubio, David, Pérez-Torres, Ainhoa, Serrano, Clara Martínez Valero, Andrea Ortiz Suner, Leire, Larrañaga, Noemi, Legaristi, Gerardo, Ferrigno, Safa, Khlafalla, Rosita, Bihariesingh-Sanchit, Hallands, Sjukhus, Frank, Zoerner, Jonathan, Grip, Kristina, Kilsand, Johan, Mårtensson, Jonas, Österlind, Akademiska, Sjukhuset, Magnus von Seth, Västerviks, Sjukhus, Johan, Berkius, Samuele, Ceruti, Andrea, Glotta, Seval, Izdes, Işıl Özkoçak Turan, Ahmet, Cosar, Burcin, Halacli, Necla, Dereli, Mehmet, Yilmaz, Türkay, Akbas, Gülseren, Elay, Selin, Eyüpoğlu, Yelíz, Bílír, Kemal Tolga Saraçoğlu, Ebru, Kaya, Ayca Sultan Sahin, Pervin Korkmaz Ekren, Tuğçe, Mengi, Kezban Ozmen Suner, Yakup, Tomak, Ahmet, Eroglu, Asad, Alsabbah, Katie, Hanlon, Kevin, Gervin, Sean, Mcmahon, Samantha, Hagan, Higenbottam, Caroline V., Randeep, Mullhi, Lottie, Poulton, Tomasz, Torlinski, Allen, Gareth, Nick, Truman, Gopal, Vijayakumar, Chris, Hall, Alasdair, Jubb, Lenka, Cagova, Nicola, Jones, Sam, Graham, Nicole, Robin, Amanda, Cowton, Adrian, Donnelly, Natalia, Singatullina, Melanie, Kent, Carole, Boulanger, Zoë, Campbell, Elizabeth, Potter, Natalie, Duric, Tamas, Szakmany, Royal, Brompton, Orinta, Kviatkovske, Nandor, Marczin, Caroline, Ellis, Rajnish, Saha, Chunda, Sri-Chandana, John, Allan, Lana, Mumelj, Harish, Venkatesh, Vera Nina Gotz, Anthony, Cochrane, Barbara, Ficial, Shruthi, Kamble, Nuttha, Lumlertgul, Christopher, Oddy, Susan, Jain, Giulia Beatrice Crapelli, Aikaterini, Vlachou, David, Golden, Sweyn, Garrioch, Jeremy, Henning, Gupta, Loveleena, Miriam, Davey, Lina, Grauslyte, Erika, Salciute-Simene, Martin, Cook, Danny, Barling, Phil, Broadhurst, Sarah, Purvis, Michael, Spivey, Benjamin, Shuker, Irina, Grecu, Daniel, Harding, Dean, James T., Nielsen, Nathan D., Sama, Al-Bayati, Mohammed, Al-Sadawi, Mariane, Charron, Peter, Stubenrauch, Jairo, Santanilla, Catherine, Wentowski, Dorothea, Rosenberger, Polikseni, Eksarko, and Randeep Jawa, Greco, Massimiliano [0000-0003-1003-4637], De Corte, Thomas [0000-0001-5011-6640], Ercole, Ari [0000-0001-8350-8093], Antonelli, Massimo [0000-0003-3007-1670], Azoulay, Elie [0000-0002-8162-1508], Citerio, Giuseppe [0000-0002-5374-3161], Morris, Andy Conway [0000-0002-3211-3216], De Pascale, Gennaro [0000-0002-8255-0676], Duska, Frantisek [0000-0003-1559-4078], Elbers, Paul [0000-0003-0447-6893], Einav, Sharon [0000-0001-8963-9633], Forni, Lui [0000-0002-0617-5309], Galarza, Laura [0000-0002-4658-748X], Girbes, Armand RJ [0000-0002-0711-0494], Grasselli, Giacomo [0000-0002-1735-1400], Gusarov, Vitaly [0000-0002-2900-1459], Jubb, Alasdair [0000-0001-5593-866X], Kesecioglu, Jozef [0000-0002-3007-8445], Lavinio, Andrea [0000-0002-8832-918X], Delgado, Maria Cruz Martin [0000-0002-7468-4594], Mellinghoff, Johannes [0000-0002-5455-8953], Myatra, Sheila Nainan [0000-0001-6761-163X], Ostermann, Marlies [0000-0001-9500-9080], Pellegrini, Mariangela [0000-0001-5668-7399], Povoa, Pedro [0000-0002-7069-7304], Schaller, Stefan J [0000-0002-6683-9584], Teboul, Jean-Louis [0000-0002-5748-7820], Wong, Adrian [0000-0003-4968-7328], De Waele, Jan J [0000-0003-1017-9748], Cecconi, Maurizio [0000-0002-4376-6538], Apollo - University of Cambridge Repository, Intensive care medicine, ACS - Diabetes & metabolism, AII - Infectious diseases, Greco, M, De Corte, T, Ercole, A, Antonelli, M, Azoulay, E, Citerio, G, Morris, A, De Pascale, G, Duska, F, Elbers, P, Einav, S, Forni, L, Galarza, L, Girbes, A, Grasselli, G, Gusarov, V, Jubb, A, Kesecioglu, J, Lavinio, A, Delgado, M, Mellinghoff, J, Myatra, S, Ostermann, M, Pellegrini, M, Povoa, P, Schaller, S, Teboul, J, Wong, A, De Waele, J, Cecconi, M, UCL - SSS/DDUV/GECE - Génétique cellulaire, UCL - (SLuc) Service de soins intensifs, investigators, ESICM UNITE-COVID, Girbes, Armand R. J. [0000-0002-0711-0494], Schaller, Stefan J. [0000-0002-6683-9584], and De Waele, Jan J. [0000-0003-1017-9748]

Subjects
Adult, Anestesi och intensivvård, Anesthesiology and Intensive Care, Original, SARS-CoV-2, Critical Illness, Other Research Radboud Institute for Health Sciences [Radboudumc 0], ACUTE KIDNEY INJURY, COVID-19, CORONAVIRUS DISEASE 2019, Pneumonia, Acute Kidney Injury, Critical Care and Intensive Care Medicine, Respiration, Artificial, Surge capacity, Critical care, Intensive Care Units, Settore MED/41 - ANESTESIOLOGIA, Medicine and Health Sciences, Humans, CRITICALLY-ILL PATIENTS
Abstract

Purpose To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality. Correction in: Intensive Care Medicine, vol. 48, issue 8, pages 1130-1131.DOI: 10.1007/s00134-022-06801-2

Published
2022

6. Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study.

Author

Kloss P, Lindholz M, Milnik A, Azoulay E, Cecconi M, Citerio G, De Corte T, Duska F, Galarza L, Greco M, Girbes ARJ, Kesecioglu J, Mellinghoff J, Ostermann M, Pellegrini M, Teboul JL, De Waele J, Wong A, and Schaller SJ

Abstract

Background: Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave., Methods: This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs., Results: Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI - 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI - 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates., Conclusions: Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)., (© 2023. The Author(s).)

Published
2023
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7. Generalizable calibrated machine learning models for real-time atrial fibrillation risk prediction in ICU patients.

Author

Verhaeghe J, De Corte T, Sauer CM, Hendriks T, Thijssens OWM, Ongenae F, Elbers P, De Waele J, and Van Hoecke S

Subjects
Humans, Risk Factors, Critical Care, Intensive Care Units, Machine Learning, Atrial Fibrillation diagnosis, Atrial Fibrillation epidemiology
Abstract

Background: Atrial Fibrillation (AF) is the most common arrhythmia in the intensive care unit (ICU) and is associated with increased morbidity and mortality. Identification of patients at risk for AF is not routinely performed as AF prediction models are almost solely developed for the general population or for particular ICU populations. However, early AF risk identification could help to take targeted preemptive actions and possibly reduce morbidity and mortality. Predictive models need to be validated across hospitals with different standards of care and convey their predictions in a clinically useful manner. Therefore, we designed AF risk models for ICU patients using uncertainty quantification to provide a risk score and evaluated them on multiple ICU datasets., Methods: Three CatBoost models, utilizing feature windows comprising data 1.5-13.5, 6-18, or 12-24 hours before AF occurrence, were built using 2-repeat-10-fold cross-validation on AmsterdamUMCdb, the first freely available European ICU database. Furthermore, AF Patients were matched with no-AF patients for training. Transferability was validated using a direct and a recalibration evaluation on two independent external datasets, MIMIC-IV and GUH. The calibration of the predicted probability, used as an AF risk score, was measured using the Expected Calibration Error (ECE) and the presented Expected Signed Calibration Error (ESCE). Additionally, all models were evaluated across time during the ICU stay., Results: The model performance reached Areas Under the Curve (AUCs) of 0.81 at internal validation. Direct external validation showed partial generalizability with AUCs reaching 0.77. However, recalibration resulted in performances matching or exceeding that of the internal validation. All models furthermore showed calibration capabilities demonstrating adequate risk prediction competence., Conclusion: Ultimately, recalibrating models reduces the challenge of generalization to unseen datasets. Moreover, utilizing the patient-matching methodology together with the assessment of uncertainty calibration can serve as a step toward the development of clinical AF prediction models., Competing Interests: Declaration of Competing Interest Jarne Verhaeghe is funded by the Research Foundation Flanders (FWO, Ref. 1S59522N). Part of the research was funded by the FWO Junior Research project HEROI2C which investigates hybrid machine learning for improved infection management in critically ill patients (Ref. 1881020N). Olivier W. M. Thijssens received funding from Pacmed; he disclosed work for hire. Christopher M. Sauer is supported by the German Research Foundation funded UMEA Clinician Scientist Program (grant FU356/12-2). Jan De Waele is a senior clinical investigator funded by the Research Foundation Flanders (FWO, Ref. 1881020N)., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Published
2023
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8. Pathogen-based target attainment of optimized continuous infusion dosing regimens of piperacillin-tazobactam and meropenem in surgical ICU patients: a prospective single center observational study.

Author

De Corte T, Verhaeghe J, Dhaese S, Van Vooren S, Boelens J, G Verstraete A, Stove V, Ongenae F, De Bus L, Depuydt P, Van Hoecke S, and J De Waele J

Abstract

Background: Several studies have indicated that commonly used piperacillin-tazobactam (TZP) and meropenem (MEM) dosing regimens lead to suboptimal plasma concentrations for a range of pharmacokinetic/pharmacodynamic (PK/PD) targets in intensive care unit (ICU) patients. These targets are often based on a hypothetical worst-case scenario, possibly overestimating the percentage of suboptimal concentrations. We aimed to evaluate the pathogen-based clinically relevant target attainment (CRTA) and therapeutic range attainment (TRA) of optimized continuous infusion dosing regimens of TZP and MEM in surgical ICU patients., Methods: A single center prospective observational study was conducted between March 2016 and April 2019. Free plasma concentrations were calculated by correcting total plasma concentrations, determined on remnants of blood gas samples by ultra-performance liquid chromatography with tandem mass spectrometry, for their protein binding. Break points (BP) of identified pathogens were derived from epidemiological cut-off values. CRTA was defined as a corrected measured total serum concentration above the BP and calculated for increasing BP multiplications up to 6 × BP. The upper limit of the therapeutic range was set at 157.2 mg/L for TZP and 45 mg/L for MEM. As a worst-case scenario, a BP of 16 mg/L for TZP and 2 mg/L for MEM was used., Results: 781 unique patients were included with 1036 distinctive beta-lactam antimicrobial prescriptions (731 TZP, 305 MEM) for 1003 unique infections/prophylactic regimens (750 TZP, 323 MEM). 2810 samples were available (1892 TZP, 918 MEM). The median corrected plasma concentration for TZP was 86.4 mg/L [IQR 56.2-148] and 16.2 mg/L [10.2-25.5] for MEM. CRTA and TRA was consistently higher for the pathogen-based scenario than for the worst-case scenario, but nonetheless, a substantial proportion of samples did not attain commonly used PK/PD targets., Conclusion: Despite these pathogen-based data demonstrating that CRTA and TRA is higher than in the often-used theoretical worst-case scenario, a substantial proportion of samples did not attain commonly used PK/PD targets when using optimised continuous infusion dosing regimens. Therefore, more dosing optimization research seems warranted. At the same time, a 'pathogen-based analysis' approach might prove to be more sensible than a worst-case scenario approach when evaluating target attainment and linked clinical outcomes., (© 2023. The Author(s).)

Published
2023
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9. Development and evaluation of uncertainty quantifying machine learning models to predict piperacillin plasma concentrations in critically ill patients.

Author

Verhaeghe J, Dhaese SAM, De Corte T, Vander Mijnsbrugge D, Aardema H, Zijlstra JG, Verstraete AG, Stove V, Colin P, Ongenae F, De Waele JJ, and Van Hoecke S

Subjects
Anti-Bacterial Agents pharmacokinetics, Anti-Bacterial Agents therapeutic use, Humans, Machine Learning, Piperacillin, Tazobactam Drug Combination, Uncertainty, Critical Illness, Piperacillin pharmacokinetics, Piperacillin therapeutic use
Abstract

Background: Beta-lactam antimicrobial concentrations are frequently suboptimal in critically ill patients. Population pharmacokinetic (PopPK) modeling is the golden standard to predict drug concentrations. However, currently available PopPK models often lack predictive accuracy, making them less suited to guide dosing regimen adaptations. Furthermore, many currently developed models for clinical applications often lack uncertainty quantification. We, therefore, aimed to develop machine learning (ML) models for the prediction of piperacillin plasma concentrations while also providing uncertainty quantification with the aim of clinical practice., Methods: Blood samples for piperacillin analysis were prospectively collected from critically ill patients receiving continuous infusion of piperacillin/tazobactam. Interpretable ML models for the prediction of piperacillin concentrations were designed using CatBoost and Gaussian processes. Distribution-based Uncertainty Quantification was added to the CatBoost model using a proposed Quantile Ensemble method, useable for any model optimizing a quantile function. These models are subsequently evaluated using the distribution coverage error, a proposed interpretable uncertainty quantification calibration metric. Development and internal evaluation of the ML models were performed on the Ghent University Hospital database (752 piperacillin concentrations from 282 patients). Ensuing, ML models were compared with a published PopPK model on a database from the University Medical Centre of Groningen where a different dosing regimen is used (46 piperacillin concentrations from 15 patients.)., Results: The best performing model was the Catboost model with an RMSE and [Formula: see text] of 31.94-0.64 and 33.53-0.60 for internal evaluation with and without previous concentration. Furthermore, the results prove the added value of the proposed Quantile Ensemble model in providing clinically useful individualized uncertainty predictions and show the limits of homoscedastic methods like Gaussian Processes in clinical applications., Conclusions: Our results show that ML models can consistently estimate piperacillin concentrations with acceptable and high predictive accuracy when identical dosing regimens as in the training data are used while providing highly relevant uncertainty predictions. However, generalization capabilities to other dosing schemes are limited. Notwithstanding, incorporating ML models in therapeutic drug monitoring programs seems definitely promising and the current work provides a basis for validating the model in clinical practice., (© 2022. The Author(s).)

Published
2022
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11. Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set.

Author

Conway Morris A, Kohler K, De Corte T, Ercole A, De Grooth HJ, Elbers PWG, Povoa P, Morais R, Koulenti D, Jog S, Nielsen N, Jubb A, Cecconi M, and De Waele J

Subjects
Adrenal Cortex Hormones therapeutic use, Adult, Anti-Bacterial Agents therapeutic use, COVID-19 Testing, Critical Illness, Humans, Intensive Care Units, Pandemics, COVID-19 complications, COVID-19 epidemiology, Coinfection drug therapy, Coinfection epidemiology, Pneumonia, Bacterial drug therapy, Pneumonia, Viral complications, Pneumonia, Viral drug therapy, Pneumonia, Viral epidemiology
Abstract

Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients., Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method., Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO., Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)., (© 2022. The Author(s).)

Published
2022
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12. Artificial Intelligence in Infection Management in the ICU.

Author

De Corte T, Van Hoecke S, and De Waele J

Subjects
Critical Care, Humans, Intensive Care Units, Artificial Intelligence, Emergency Medicine
Abstract

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2022. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2022 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 ., (© 2022. De Corte et al.)

Published
2022
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