Editorial
Defining the prevalence of chronic critical illness
M. Polastria,
, V. Comellinib,c, L. Pisanib,c
Corresponding author
massimiliano.polastri@aosp.bo.it
Corresponding author at: Physical Medicine and Rehabilitation, St Orsola University Hospital, Via G. Massarenti 9, Bologna 40138, Italy.
Corresponding author at: Physical Medicine and Rehabilitation, St Orsola University Hospital, Via G. Massarenti 9, Bologna 40138, Italy.
a Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, St Orsola University Hospital, Bologna, Italy
b Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
c Respiratory and Critical Care Unit, St Orsola University Hospital, Bologna, Italy
Read
5531
Timeswas read the article
2180
Total PDF
3351
Total HTML
Share statistics
array:24 [ "pii" => "S2531043719302119" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2019.11.003" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "1424" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "edi" "cita" => "Pulmonol. 2020;26:119-20" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 192 "formatos" => array:3 [ "EPUB" => 21 "HTML" => 107 "PDF" => 64 ] ] "itemSiguiente" => array:19 [ "pii" => "S2531043720300027" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2020.01.002" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "1437" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "edi" "cita" => "Pulmonol. 2020;26:121-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 64 "formatos" => array:3 [ "EPUB" => 8 "HTML" => 30 "PDF" => 26 ] ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">EDITORIAL</span>" "titulo" => "Hypersensitivity pneumonitis: Need for a better diagnostic evaluation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "121" "paginaFinal" => "122" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Claudia Ravaglia" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Claudia" "apellidos" => "Ravaglia" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043720300027?idApp=UINPBA00004E" "url" => "/25310437/0000002600000003/v1_202005111106/S2531043720300027/v1_202005111106/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2531043720300751" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2020.03.002" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "1457" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "edi" "cita" => "Pulmonol. 2020;26:117-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "The COVID-19 outbreak: From “black swan” to global challenges and opportunities" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "117" "paginaFinal" => "118" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Stefano Mazzoleni, Giuseppe Turchetti, Nicolino Ambrosino" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Stefano" "apellidos" => "Mazzoleni" ] 1 => array:2 [ "nombre" => "Giuseppe" "apellidos" => "Turchetti" ] 2 => array:2 [ "nombre" => "Nicolino" "apellidos" => "Ambrosino" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043720300751?idApp=UINPBA00004E" "url" => "/25310437/0000002600000003/v1_202005111106/S2531043720300751/v1_202005111106/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Defining the prevalence of chronic critical illness" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "119" "paginaFinal" => "120" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Polastri, V. Comellini, L. Pisani" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Polastri" "email" => array:1 [ 0 => "massimiliano.polastri@aosp.bo.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "V." "apellidos" => "Comellini" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Pisani" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, St Orsola University Hospital, Bologna, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Respiratory and Critical Care Unit, St Orsola University Hospital, Bologna, Italy" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Physical Medicine and Rehabilitation, St Orsola University Hospital, Via G. Massarenti 9, Bologna 40138, Italy." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Since the survival rates of patients with life-threatening conditions admitted to intensive care units (ICUs), has significantly increased thanks to the improvements in medical care, interest in outcome measures has expanded to include survivors. ICU survivors frequently face a complex recovery trajectory; it is increasingly recognised that chronic critical illness (CI) is a medical condition in itself and these patients are prone to physical, psychological, and cognitive-related dysfunctions during the hospital stay and after discharge.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> So far, more attention has been given to the physical conditions of critically ill patients, and this is particularly evident in respiratory settings. However, limited data are available to guide therapeutic choices in these subjects, and a univocal definition is not available yet to precisely identify chronic CI.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Marchioni and Colleagues report the results of an interesting observational prospective cohort study, exploring the prevalence and the development of chronic CI in a population of patients with de novo acute respiratory failure (ARF) admitted to a specialised respiratory intensive care unit (RICU).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It is well known that about 20–30 % of patients hospitalised in RICUs for ARF will require a tracheostomy to be weaned off mechanical ventilation (MV). These tracheostomies will usually be removed before hospital discharge, although some patients who require prolonged MV keep the tracheostomy longer, experiencing long-term complications.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the study by Marchioni and Colleagues, chronic CI was defined as the condition of ICU survivors with both a hospital stay >8 days and with tracheostomy due to the need of MV > 21 consecutive days for at least 6 h/day.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In the cohort investigated, about one-third of the patients developed chronic CI during the RICU stay. The majority of them were affected by an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and septic shock; 45 %, and 19 %, respectively.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We must underline the study has some limitations. First, the use of the term ‘de novo’ respiratory failure is questionable. Although severe end-stage COPD patients, requiring home oxygen and/or ventilatory support, were excluded by definition, ‘de novo’ respiratory failure refers specifically to a respiratory failure occurring in subjects without prior history of chronic respiratory disease.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Second, the definition of chronic CI in the study excluded patients with persistent signs of organ dysfunction (i.e., renal failure) or without any need for tracheostomy and prolonged MV. As clinicians interpreting these data, it is crucial to understand the target population. A multicentre research would have doubtlessly returned more robust figures. However, we must recognise that the interesting findings from this study highlight the need to understand ICU survivorship better and providing targeted support to this population.</p><p id="par0035" class="elsevierStylePara elsevierViewall">An exciting aspect that emerged from the study by Marchioni and Colleagues is the possibility of enrolling patients, developing chronic CI resulting from de novo ARF, in a daily mobility programme during the RICU stay.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Due to profound deconditioning after critical illness, the importance of focusing on attempting to restore physical function is well established. Limiting the period of immobility and promoting early physiotherapy, are interventions directed at enhancing the recovery and preventing physical impairments and poor outcomes. In this context, The European Respiratory Society and European Society of Intensive Care Medicine recommends a comprehensive treatment for ICU survivors during all phases of the recovery pathway.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> A particular target of rehabilitative interest is the diaphragm muscle, as pointed out by the results of the study which show that diaphragmatic dysfunction represents a risk factor in the specific population of difficult-to-wean patients.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This field deserves additional further investigation, aimed at establishing targets for physiotherapy among patients with chronic CI. These subgroups of subjects should be identified to provide them with different types of care, from acute respiratory interventions to early rehabilitation.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The evaluation of the diaphragm muscle with ultrasounds and the early detection of its dysfunction help to identify those patients who are most likely to benefit from an intensive respiratory rehabilitation programme. Such practice can contribute to reducing the adverse effects of critical illness and MV on the respiratory system; to restoring both physical and respiratory functions; preventing the need of MV and subsequent hospitalisation, resulting in improved patients’ quality of life. An extensive body of evidence is already present in the literature, highlighting both appropriateness and feasibility of rehabilitation in acute respiratory settings.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Another exciting topic explored by Marchioni and Colleagues is the correlation between C-reactive protein (CRP) serum levels — and their increase during the first week of hospital admission —, and chronic CI.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Although specific inflammatory cytokines were not assessed, stratifying patients according to the level of CRP should help to identify those subjects most likely to benefit from rehabilitation.</p><p id="par0050" class="elsevierStylePara elsevierViewall">On the other hand, high costs related to the hospitalisation of chronic CI patients in acute settings, have contributed and still are contributing, to the growth of the number of long-term acute care facilities — particularly in the United States.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Although these centres appear to offer a more favourable ratio between costs/quality and services/outcomes, Italy still seems to have a long way to go in this specific direction. In fact, due to the paucity of specialised post-acute facilities, chronic Italian CI patients are currently prone to the risk of prolonging their hospitalisation in acute settings. Prevalence of chronic CI — if related to rehabilitation — seems to be another factor that certainly deserves further analysis to plan appropriate and effective physiotherapeutic interventions.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Defining prevalence in chronic CI is a challenging effort because of varied definitions of the condition. Additionally, the increased risk of detrimental complications of chronic CI, even after stabilisation of the clinical conditions, necessitates the development of a universal and concordant definition.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The study by Marchioni and Colleagues<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> contributes to estimating the prevalence of chronic CI also encouraging rigorous randomised trials to explore further — through an interdisciplinary approach including physicians and physiotherapists — which are the specific interventions and the expected outcomes in patients with chronic CI.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-11-14" "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional disability 5 years after acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.S. Herridge" 1 => "C.M. Tansey" 2 => "A. Matté" 3 => "G. Tomlinson" 4 => "N. Diaz-Granados" 5 => "A. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1011802" "Revista" => array:7 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "364" "numero" => "14" "paginaInicial" => "1293" "paginaFinal" => "1304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21470008" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Unroe" 1 => "J.M. Kahn" 2 => "S.S. Carson" 3 => "J.A. Govert" 4 => "T. Martinu" 5 => "S.J. Sathy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-153-3-201008030-00007" "Revista" => array:7 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2010" "volumen" => "153" "numero" => "3" "paginaInicial" => "167" "paginaFinal" => "175" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20679561" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and development of chronic critical illness in acute admitted to a respiratory intensive care setting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Marchioni" 1 => "R. Tonelli" 2 => "A. Sdanganelli" 3 => "F. Gozzi" 4 => "L. Musarò" 5 => "R. Fantini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pulmoe.2019.09.006" "Revista" => array:2 [ "tituloSerie" => "Pulmonology" "fecha" => "2019" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tracheostomy: epidemiology, indications, timing, technique and outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.H. Cheung" 1 => "L.M. Napolitano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4187/respcare.02971" "Revista" => array:7 [ "tituloSerie" => "Respir Care" "fecha" => "2014" "volumen" => "59" "numero" => "6" "paginaInicial" => "895" "paginaFinal" => "915" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24891198" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Rochwerg" 1 => "L. Brochard" 2 => "M.V. Elliott" 3 => "D. Hess" 4 => "N.S. Hill" 5 => "S. Nava" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Resp J" "fecha" => "2017" "volumen" => "50" "numero" => "2" "paginaInicial" => "1602426" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Gosselink" 1 => "J. Bott" 2 => "M. Johnson" 3 => "E. Dean" 4 => "S. Nava" 5 => "N. Norrenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-008-1026-7" "Revista" => array:7 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2008" "volumen" => "34" "numero" => "7" "paginaInicial" => "1188" "paginaFinal" => "1199" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18283429" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic critical illness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.E. Nelson" 1 => "C.E. Cox" 2 => "A.A. Hope" 3 => "S.S. Carson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201002-0210CI" "Revista" => array:7 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2010" "volumen" => "182" "numero" => "4" "paginaInicial" => "446" "paginaFinal" => "454" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20448093" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25310437/0000002600000003/v1_202005111106/S2531043719302119/v1_202005111106/en/main.assets" "Apartado" => array:4 [ "identificador" => "74414" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorials" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25310437/0000002600000003/v1_202005111106/S2531043719302119/v1_202005111106/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043719302119?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 3 | 9 |
| 2024 October | 50 | 39 | 89 |
| 2024 September | 54 | 27 | 81 |
| 2024 August | 61 | 32 | 93 |
| 2024 July | 69 | 28 | 97 |
| 2024 June | 52 | 25 | 77 |
| 2024 May | 48 | 32 | 80 |
| 2024 April | 34 | 35 | 69 |
| 2024 March | 44 | 23 | 67 |
| 2024 February | 42 | 25 | 67 |
| 2024 January | 32 | 20 | 52 |
| 2023 December | 18 | 25 | 43 |
| 2023 November | 51 | 47 | 98 |
| 2023 October | 27 | 40 | 67 |
| 2023 September | 41 | 37 | 78 |
| 2023 August | 26 | 21 | 47 |
| 2023 July | 23 | 26 | 49 |
| 2023 June | 18 | 17 | 35 |
| 2023 May | 50 | 34 | 84 |
| 2023 April | 21 | 13 | 34 |
| 2023 March | 35 | 20 | 55 |
| 2023 February | 31 | 23 | 54 |
| 2023 January | 23 | 17 | 40 |
| 2022 December | 43 | 30 | 73 |
| 2022 November | 41 | 42 | 83 |
| 2022 October | 59 | 35 | 94 |
| 2022 September | 24 | 34 | 58 |
| 2022 August | 58 | 33 | 91 |
| 2022 July | 57 | 58 | 115 |
| 2022 June | 51 | 42 | 93 |
| 2022 May | 69 | 35 | 104 |
| 2022 April | 54 | 39 | 93 |
| 2022 March | 33 | 51 | 84 |
| 2022 February | 34 | 37 | 71 |
| 2022 January | 45 | 44 | 89 |
| 2021 December | 38 | 40 | 78 |
| 2021 November | 42 | 48 | 90 |
| 2021 October | 91 | 60 | 151 |
| 2021 September | 91 | 47 | 138 |
| 2021 August | 88 | 39 | 127 |
| 2021 July | 41 | 27 | 68 |
| 2021 June | 57 | 46 | 103 |
| 2021 May | 63 | 51 | 114 |
| 2021 April | 226 | 145 | 371 |
| 2021 March | 84 | 62 | 146 |
| 2021 February | 58 | 36 | 94 |
| 2021 January | 65 | 38 | 103 |
| 2020 December | 43 | 22 | 65 |
| 2020 November | 48 | 22 | 70 |
| 2020 October | 68 | 28 | 96 |
| 2020 September | 58 | 41 | 99 |
| 2020 August | 106 | 45 | 151 |
| 2020 July | 149 | 74 | 223 |
| 2020 June | 122 | 54 | 176 |
| 2020 May | 133 | 47 | 180 |
| 2020 April | 70 | 20 | 90 |
| 2020 March | 60 | 19 | 79 |
| 2020 February | 43 | 28 | 71 |
| 2020 January | 49 | 27 | 76 |
| 2019 December | 34 | 25 | 59 |
Show all
