The funder had no role in the design and conduct of the study, collection, management, analysis,

Rational To evaluate the respective impact of standard oxygen, high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) on oxygenation failure rate and mortality in COVID-19 patients admitted to intensive care units (ICUs). Methods Multicenter, prospective cohort study (COVID-ICU) in 137 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, oxygenation failure, and survival data were collected. Oxygenation failure was defined as either intubation or death in the ICU without intubation. Variables independently associated with oxygenation failure and Day-90 mortality were assessed using multivariate logistic regression. Results From February 25 to May 4, 2020, 4754 patients were admitted in ICU. Of these, 1491 patients were not intubated on the day of ICU admission and received standard oxygen therapy (51%), HFNC (38%), or NIV (11%) (P < 0.001). Oxygenation failure occurred in 739 (50%) patients (678 intubation and 61 death). For standard oxygen, HFNC, and NIV, oxygenation failure rate was 49%, 48%, and 60% (P < 0.001). By multivariate analysis, HFNC (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.36–0.99, P = 0.013) but not NIV (OR 1.57, 95% CI 0.78–3.21) was associated with a reduction in oxygenation failure). Overall 90-day mortality was 21%. By multivariable analysis, HFNC was not associated with a change in mortality (OR 0.90, 95% CI 0.61–1.33), while NIV was associated with increased mortality (OR 2.75, 95% CI 1.79–4.21, P < 0.001). Conclusion In patients with COVID-19, HFNC was associated with a reduction in oxygenation failure without improvement in 90-day mortality, whereas NIV was associated with a higher mortality in these patients. Randomized controlled trials are needed.

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Background FIGHTDIGO study has shown the feasibility of handgrip strength (HGS) measurements in 201 consecutive digestive cancer patients undergoing chemotherapy. Objective This study focuses on a secondary aim of FIGHTDIGO study: the relationship between muscle mass and HGS. Design Two consecutive bilateral measures of HGS were performed using a Jamar dynamometer before the start of each chemotherapy. The highest value was chosen for final evaluation. Dynapenia (loss of muscle strength) was defined as HGS < 30 kg (men) and < 20 kg (women). Muscle mass was measured at lumbar level (L3) on Computed Tomography (CT) scans performed less than 3 weeks before or after the measurement of HGS. Muscle mass loss was defined by skeletal muscle index (SMI) < 53 cm 2 /m 2 (in men with a body mass index (BMI)> 25 kg/m 2 ), < 43 cm 2 /m 2 (in men with a BMI < 25 kg/m 2 ), and < 41 cm 2 /m 2 (in women regardless of BMI). Sarcopenia was defined by the association of a dynapenia and a loss of muscle mass. Results A total of 150 patients were included in this analysis (mean age: 65.6 ± 10.9 years, 87 males (58%), colorectal cancer (47.3%), metastatic stage (76.7%)). A total of 348 CT scans were evaluated. For the 348 measurements, mean SMI and HGS were 41.8 ± 8.7 cm 2 /m 2 and 32.1 ± 11.0 kg, respectively. Muscle mass loss, dynapenia, or sarcopenia were reported at least once, in 120 (80%), 45 (30%), and 30 (20%) patients, respectively. SMI was significantly correlated with HGS (Pearson coefficient = 0.53, P < 0.0001). At concordance analysis, 188 dyad SMI/HGS (54%) were in agreement (Kappa = 0.14 [95% CI, 0.07‐0.21]). Conclusion Correlation between the measurements of HGS and SMI is strong but the concordance between dynapenia and muscle mass loss is poor. Further studies should be performed to confirm the diagnostic thresholds, and to study the chronology of dynapenia and loss of muscle mass.

Background Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring intensive care unit (ICU) have a high incidence of hospital-acquired infections; however, data regarding hospital acquired bloodstream infections (BSI) are scarce. We aimed to investigate risk factors and outcome of BSI in critically ill coronavirus infectious disease-19 (COVID-19) patients. Patients and methods We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU study) that included 4010 COVID-19 ICU patients. For the present analysis, only those with data regarding primary outcome (death within 90 days from admission) or BSI status were included. Risk factors for BSI were analyzed using Fine and Gray competing risk model. Then, for outcome comparison, 537 BSI-patients were matched with 537 controls using propensity score matching. Results Among 4010 included patients, 780 (19.5%) acquired a total of 1066 BSI (10.3 BSI per 1000 patients days at risk) of whom 92% were acquired in the ICU. Higher SAPS II, male gender, longer time from hospital to ICU admission and antiviral drug before admission were independently associated with an increased risk of BSI, and interestingly, this risk decreased over time. BSI was independently associated with a shorter time to death in the overall population (adjusted hazard ratio (aHR) 1.28, 95% CI 1.05–1.56) and, in the propensity score matched data set, patients with BSI had a higher mortality rate (39% vs 33% p = 0.036). BSI accounted for 3.6% of the death of the overall population. Conclusion COVID-19 ICU patients have a high risk of BSI, especially early after ICU admission, risk that increases with severity but not with corticosteroids use. BSI is associated with an increased mortality rate.