Introduction: Patients with spontaneous intraparenchymal hemorrhage (sIPH) often have high morbidity and mortality. Previous studies found that the first 24-hour systolic blood pressure variability (SBPV) was associated with worse functional outcome in patients. However, whether SBPV in the hyperacute phase in patients with sIPH is not known. We hypothesized that sBPV during patients’ resuscitation phase at the Critical Care Resuscitation (CCRU) at the University of Maryland Medical Center would correlate with increased hematoma progression (HP) and patients’ outcome. Methods: We retrospectively analyzed charts from adult patients who were admitted to the CCRU for management of sIPH from Jan. 2016 to Jan. 2021. Forward multivariable stepwise logistic regression was performed for the primary outcome of HP. We also performed multiple linear regression with Box-Cox transformation to normalize continuous components of BPV, namely Standard Deviation and Successive Variation in SBP (SBPSD) and SBPSV, respectively. Multivariable ordinal logistic regression was also performed for hospital disposition, ranking from discharge home to Dead/hospice. Results: We preliminarily analyzed 60 patients. Eighteen (30%) patients had HP. During CCRU stay, 23 (38%) required ventilation, 39 (65%) needed at least 1 antihypertensive infusion, 23 (38%) received hyperosmolar therapy, and 17 (28%) underwent external ventricular drain placement. Twelve (12, 20%) patients were discharged to home, 30 (50%) to rehabilitation facilities, 6 (10%) to skilled nursing homes, and 12 (20%) died. Our multivariable logistic regression found no factors in CCRU associated with HP. Highest SBP during CCRU stay (SBPmax) was associated with higher SBPSD (correlation coefficient =0.03, P< 0.001) and SBPSV (corr. coef. = 0.02, P< 0.001). High ICH score was associated with hospital disposition, higher ICH score was more likely associated with patient mortality (corr. Coeff = -1.2, OR 0.3, 95% CI 0.15-0.6, P< 0.001) Conclusions: SBPmax during CCRU stay was associated with higher SBPV in patients with sIPH during the resuscitation phase at the CCRU. Additionally, only one patients’ clinical factor, ICH score, was associated with levels of their hospital disposition. Additional studies with larger sample sizes are needed. 

1013: outcome from spontaneous intraparenchymal hemorrhage during critical care resuscitation unit stay

INTRODUCTION: Medical complications among pregnant peripartum patients are not common. However, certain disease such as obstetric hemorrhage or respiratory failure could be associated with poor outcome among obstetric patients whose biological systems are already stretched. When a peripartum patients encounter a severe medical condition, they are frequently transferred to a tertiary center for management of these patients' complex conditions. Our study investigated the outcomes of the peripartum patients who were transferred from other hospitals (Interhospital transfer [IHT]) to the Intensive Care Unit at an academic quaternary center. METHOD(S): We retrospectively analyzed all adult IHT peripartum patients to our institution's ICU between Jan. 2017 to Dec. 2021. We presented descriptive analysis for our patients and used multivariable ordinal regressions for association between demographic, clinical factors, and patients' length of stay (LOS) in the ICU (ICULOS), hospital (HLOS). RESULT(S): Among 1794 IHT peripartum patients, 59 patients were transferred directly to an ICU, 8 (13.6%) to Medical ICU, 2 (3.4%) Neuro ICU, 2 (3.4%) Surgical ICU and 47 (79.7%) to our Critical Care Resuscitation Unit. Patients' mean (Standard Deviation) age was 32 (6) years, SOFA score 3 (3), APACHE II 8 (4), median Respiratory Oxygenation (ROx) index was 13 [Interquartile Range 4-22], and serum lactate 11 [9-15] mmol/L. Respiratory failure occurred in 19 (32%), postpartum hemorrhage 9 (15%), sepsis 8 (14%) patients. 16 (27%) patients were infected with COVID-19. 24 (41%) needed intubation, 13 (22%) vasopressor, 4 (7%) Extracorporeal Membrane Oxygenation. Median ICULOS and HLOS was 5 [2-12], 8 [5-17] days. Only 1 (1.7%) died, while 45 (76.3%) were discharged home directly. Having COVID-19 infection was associated with both ICULOS (Correlation Coefficient -2,23, OR 0.06, 95%CI 0.02-0.65, P = 0.016) and HLOS (Corr. Coeff. -2.75, OR 0.06, 95%CI 0.01-0.37, P = 0.002). CONCLUSION(S): Although severe medical conditions were uncommon among interhospital transferred peripartum patients, they could be severe, especially during the COVID-19 pandemic. Fortunately, the mortality rate for peripartum patients in our study was very low. Further studies with larger sample sizes are needed to confirm our observation.

567: outcome predictors for interhospital obstetric patients transferred directly to intensive care units

Introduction: Skin and soft tissue infections (SSTIs) are a significant source of morbidity and mortality for hospitalized patients. Hyperbaric oxygen (HBO) therapy is offered as an adjunct to standard treatments at some centers, but the evidence for benefit in clinical practice in the literature is limited. Methods: This retrospective study involved adult patients who were admitted to a specialized Soft Tissue Service in 2019-2020 at a quaternary center. Logistic regression was performed on 18 factors to calculate propensity score for the need of hyperbaric treatment. Patients with soft tissue infection undergoing HBO were 1:1 propensity score matched with those that did not undergo HBO therapy. Clinical status, surgical treatments, and outcomes for each group were then examined. Results: Sixty-eight patients per group were analyzed. Patients were well-matched using demographic and clinical factors. When comparing the HBO groups versus the controls the median [IQR] SOFA score (2 [0,5], 2 [1,8]), mean (SD) LRINEC (7.5 (3), 7.3 (0.3)), serum lactate (2.0 (1), both), shock index (0.8 (0.2), 0.8 (0.3)), positive blood culture (3%, 1.5%), positive wound cultures (both 85%), closure at first debridement (16%, 22%), and rates of major amputation (9%, 15%) were not significantly different between the groups (all p>0.41). However, the HBO group had a significantly higher median number of debridement (3 [2,4], 2 [2,3]; p=0.008) and a longer median length of stay (14 [9-25], 10 [7-18] days; p=0.018). HBO patients were more likely to be discharged home as opposed to rehab or nursing facility (38% (59), 33% (49)), but was not significant (p=0.49). There was no significant difference in mortality between the two groups (3% (4), 4% (6); p=0.99). Conclusions: Patients with SSTI undergoing HBO had similar mortality to propensity-score matched patients who did not receive HBO, and a mean longer length of stay of 4 days. This difference could be due to the number of days required for HBO sessions. However, HBO patients were less likely to undergo a major amputation and more likely to be discharged home following treatment, although these differences were clinically significant but were not statistically significant. Further studies with large sample sizes are necessary. 

991: soft tissue infection: propensity score matching of outcome with or without hyperbaric treatment

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1013: outcome from spontaneous intraparenchymal hemorrhage during critical care resuscitation unit stay

567: outcome predictors for interhospital obstetric patients transferred directly to intensive care units

991: soft tissue infection: propensity score matching of outcome with or without hyperbaric treatment