Chronic obstructive pulmonary disease (COPD) is a risk factor for death in patients admitted to intensive care units (ICUs) for respiratory support. Previous reports suggested higher mortality in COPD patients with COVID-19. It is yet unknown whether patients with COPD were treated differently compared to non-COPD patients. We compared the ventilation management and outcomes of invasive ventilation for COVID-19 in COPD patients versus non-COPD patients. This was a post hoc analysis of a nation-wide, observational study in the Netherlands. COPD patients were compared to non-COPD patients with respect to key ventilation parameters. The secondary endpoints included adjunctive treatments for refractory hypoxemia, and 28-day mortality. Of a total of 1090 patients, 88 (8.1%) were classified as having COPD. The ventilation parameters were not different between COPD patients and non-COPD patients, except for FiO2, which was higher in COPD patients. Prone positioning was applied more often in COPD patients. COPD patients had higher 28-day mortality than non-COPD patients. COPD had an independent association with 28-day mortality. In this cohort of patients who received invasive ventilation for COVID-19, only FiO2 settings and the use of prone positioning were different between COPD patients and non-COPD patients. COPD patients had higher mortality than non-COPD patients.
Background: The population ageing in most Western countries leads to a larger number of frail older people. These frail people are at an increased risk of negative health outcomes, such as functional decline, falls, institutionalisation and mortality. Many approaches are available for identifying frailty among older people. Researchers most often use Fried and colleagues’ description of the frailty phenotype. The authors describe five physical criteria. Other researchers prefer a combination of measurements in the social, psychological and/or physical domains. The aim of this study is to describe the levels of social, psychological and physical functioning according to Fried’s frailty stages using a large cohort of Dutch community-dwelling older people. Methods: There were 8,684 community-dwelling older people (65+) who participated in this cross-sectional study. Based on the five Fried frailty criteria (weight loss, exhaustion, low physical activity, slowness, weakness), the participants were divided into three stages: non-frail (score 0), pre-frail (score 1–2) and frail (score 3–5). These stages were related to scores in the social (social network type, informal care use, loneliness), psychological (psychological distress, mastery, self-management) and physical (chronic diseases, GARS IADL-disability, OECD disability) domains. Results: 63.2 % of the participants was non-frail, 28.1 % pre-frail and 8.7 % frail. When comparing the three stages of frailty, frail people appeared to be older, were more likely to be female, were more often unmarried or living alone, and had a lower level of education compared to their pre-frail and non-frail counterparts. The difference between the scores in the social, psychological and physical domains were statistically significant between the three frailty stages. The most preferable scores came from the non-frail group, and least preferable scores were from the frail group. For example use of informal care: non-frail 3.9 %, pre-frail 23.8 %, frail 60.6 %, and GARS IADL-disability mean scores: non-frail 9.2, pre-frail 13.0, frail 19.7. Conclusion: When older people were categorised according to the three frailty stages, as described by Fried and colleagues, there were statistically significant differences in the level of social, psychological and physical functioning between the non-frail, pre-frail and frail persons. Non-frail participants had consistently more preferable scores compared to the frail participants. This indicated that the Fried frailty criteria could help healthcare professionals identify and treat frail older people in an efficient way, and provide indications for problems in other domains.
Purpose Non-technical skills have gained attention, since enhancement of these skills is presumed to improve the process of trauma resuscitation. However, the reliability of assessing non-technical skills is underexposed, especially when using video analysis. Therefore, our primary aim was to assess the reliability of the Trauma Non-Technical Skills (T-NOTECHS) tool by video analysis. Secondarily, we investigated to what extent reliability increased when the T-NOTECHS was assessed by three assessors [average intra-class correlation (ICC)] instead of one (individual ICC). Methods As calculated by a pre-study power analysis, 18 videos were reviewed by three research assistants using the T-NOTECHS tool. Average and individual degree of agreement of the assessors was calculated using a two-way mixed model ICC. Results Average ICC was ‘excellent’ for the overall score and all five domains. Individual ICC was classified as ‘excellent’ for the overall score. Of the five domains, only one was classified as ‘excellent’, two as ‘good’ and two were even only ‘fair’. Conclusions Assessment of non-technical skills using the T-NOTECHS is reliable using video analysis and has an excellent reliability for the overall T-NOTECHS score. Assessment by three raters further improve the reliability, resulting in an excellent reliability for all individual domains.
