Tineke Winters

Return to Work and Participation in Society After Out-of-Hospital Cardiac Arrest

Background: The aim of this study was to describe out-of-hospital cardiac arrest (OHCA) survivors’ ability to participate in activities of everyday life and society, including return to work. The specific aim was to evaluate potential effects of cognitive impairment. Methods and Results: Two hundred eighty-seven OHCA survivors included in the TTM trial (Target Temperature Management) and 119 matched control patients with ST-segment–elevation myocardial infarction participated in a follow-up 180 days post-event that included assessments of participation, return to work, emotional problems, and cognitive impairment. On the Mayo-Portland Adaptability Inventory-4 Participation Index, OHCA survivors (n=270) reported more restricted participation In everyday life and in society (47% versus 30%; P<0.001) compared with ST-segment–elevation myocardial infarction controls (n=118). Furthermore, 27% (n=36) of pre-event working OHCA survivors (n=135) compared with 7% (n=3) of pre-event working ST-segment–elevation myocardial infarction controls (n=45) were on sick leave (odds ratio, 4.9; 95% confidence interval, 1.4–16.8; P=0.01). Among the OHCA survivors assumed to return to work (n=135), those with cognitive impairment (n=55) were 3× more likely (odds ratio, 3.3; 95% confidence interval, 1.2–9.3; P=0.02) to be on sick leave compared with those without cognitive impairment (n=40; 36%, n=20, versus 15%, n=6). For OHCA survivors, the variables that were found most predictive for a lower participation were depression, restricted mobility, memory impairment, novel problem-solving difficulties, fatigue, and slower processing speed. Conclusions: OHCA survivors reported a more restricted societal participation 6 months post-arrest, and their return to work was lower compared with ST-segment–elevation myocardial infarction controls. Cognitive impairment was significantly associated with lower participation, together with the closely related symptoms of fatigue, depression, and restricted mobility. These predictive variables may be used during follow-up to identify OHCA survivors at risk of a less successful recovery that may benefit from further support and rehabilitation. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01946932.

Respiratory Viruses in Invasively Ventilated Critically Ill Patients-A Prospective Multicenter Observational Study

Objectives: The presence of respiratory viruses and the association with outcomes were assessed in invasively ventilated ICU patients, stratified by admission diagnosis. Design: Prospective observational study. Setting: Five ICUs in the Netherlands. Patients: Between September 1, 2013, and April 30, 2014, 1,407 acutely admitted and invasively ventilated patients were included. Interventions: None. Measurements and Main Results: Nasopharyngeal swabs and tracheobronchial aspirates were collected upon intubation and tested for 14 respiratory viruses. Out of 1,407 patients, 156 were admitted because of a severe acute respiratory infection and 1,251 for other reasons (non–severe acute respiratory infection). Respiratory viruses were detected in 28.8% of severe acute respiratory infection patients and 17.0% in non–severe acute respiratory infection (p < 0.001). In one third, viruses were exclusively detected in tracheobronchial aspirates. Rhinovirus and human metapneumovirus were more prevalent in severe acute respiratory infection patients (9.6% and 2.6% vs 4.5 and 0.2%; p = 0.006 and p < 0.001). In both groups, there were no associations between the presence of viruses and the number of ICU-free days at day 28, crude mortality, and mortality in multivariate regression analyses. Conclusions: Respiratory viruses are frequently detected in acutely admitted and invasively ventilated patients. Rhinovirus and human metapneumovirus are more frequently found in severe acute respiratory infection patients. Detection of respiratory viruses is not associated with worse clinically relevant outcomes in the studied cohort of patients.

Course â Prevalence, Clinical Outcomes and Viral Shedding Patternsduring Viral Respiratory Tract Infections in Intubated Intensive CareUnitâÂÂpatients: Design and Protocol

Background: There is uncertainty about the prevalence of viral respiratory tract infections in intensive care unit (ICU) patients, and whether these infections contribute to disease severity and final outcome. Furthermore, the pattern of viral shedding during influenza infections in critically ill patients is largely unknown. Objectives: This study will assess prevalence of viral respiratory tract infections in intubated and ventilated ICU patients. Secondary objectives are to assess risk factors for and burden of viral respiratory tract infections, to describe the proportion of these infections missed in routine care, and to describe viral shedding patterns during influenza infection. Design: This is an investigator–initiated national multicenter prospective observational study conducted during one influenza season. Consecutive intubated and ventilated adult critically ill patients are included, regardless of admission diagnosis. Nasopharyngeal swabs and tracheobronchial aspirates are collected daily till patients are weaned of mechanical ventilation. Samples will be tested using multiplex real–time polymerase chain reaction (RT–PCR) for respiratory viruses. In influenza–positive patients, subsequent daily samples will be tested for influenza via RT–PCR until viral clearance. Influenza RT–PCR positive samples will be cultured and influenza subtyping will be performed. The primary endpoint is prevalence of viral respiratory tract infections in ICU patients. Discussion: COURSE will provide insight into the prevalence of, risk factors for, burden of and shedding patterns in viral respiratory tract infections in intubated and ventilated ICU patients during one winter season in the Netherlands. It is the largest prospective observational study thus far, with simultaneous sampling of both upper and lower respiratory tract of consecutive acutely admitted intubated and ventilated ICU patients, regardless of the admission diagnosis. Results of COURSE may guide future allocation and methods of viral diagnostic testing, quarantine practices, and duration of treatment with anti–viral drugs in ICU patients.