Clinical outcomes of moderate to severe COVID-19 patients receiving invasive vs. non-invasive ventilation

Objective: To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit (HDU) in relation to invasive vs. non-invasive mode of ventilation. Methods: In this study, the patients required either non-invasive [oxygen ≤10 L/min or >10 L/min through mask or nasal prongs, rebreather masks and bilevel positive airway pressure (BiPAP)] or invasive ventilation. For analysis of 30-day in hospital mortality in relation to use of different modes of oxygen, Kaplan Meier and log rank analyses were used. In the end, independent predictors of survival were determined by Cox regression analysis. Results: Invasive ventilation was required by 15.1% patients while 84.9% patients needed non-invasive ventilation. Patients with evidence of thromboembolism, high inflammatory markers and hypoxemia mainly required invasive ventilation. The 30-day in hospital mortality was 72.7% for the invasive group and 12.9% for the non-invasive group (1.8% oxygen 10 L/min, 3.6% rebreather mask and 4.5% BiPAP). The median time from hospital admission to outcome was 7 days for the invasive group and 18 days for the non-invasive group (P<0.05). Age, presence of co-morbidities, number of days requiring oxygen, rebreather, BiPAP and invasive ventilation were independent predictors of outcome. Conclusions: Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator associated lung injury. Thus, protective non-invasive ventilation remains the necessary and safe treatment for severely hypoxic COVID-19 patients.

prospective randomized trial comparing the spinal and general anesthesia in lumbar disc surgery: a study of 44 cases

General anesthesia is most frequently used for lumbar disc surgery despite the evidence that spinal anesthesia is as safe and may offer some additional advantages. The purpose of this study was to compare the intraoperative parameters and postoperative outcome after spinal and general anesthesia in demographically well matched patients undergoing elective lumbar Decompressive surgery. Prospective randomized controlled study. This study was carried out DHQ Hospital Mirpur AJK from January 2007 and May 2010. In this randomized controlled study we analyzed the outcome obtained in 44 patients in whom either spinal or general anesthesia was induced for lumber disc surgery. The variables recorded were anesthesia related class, surgical diagnosis, disc levels operated and pre, peri and postoperative measurements of variables like BP, and heart rate. All aspects of surgery, recovery, post anesthesia care and pain management were same irrespective of anesthetic type The narcotic and antiemetic requirement and length of stay in the hospital and incidence of urinary retention were also recorded in the post operative course. Demographically both groups were well matched. Anesthesia time was longer in patients receiving GA with increased heart rate and MABP perioperatively. There was more nausea and greater requirements for antiemetic and analgesics in patients receiving. GA [p value<0.05]. Perioperative heart rate and MABP was on normal side and there was no urinary retention in patients who received spinal anesthesia. Spinal anesthesia was a safe and effective as GA for patients undergoing lumbar Decompressive surgery. Spinal anesthesia had added advantages of short anesthesia duration, decreased antiemetic and analgesic requirements. GA general anesthesia, HR heart rate, I/V intravenous, MAP mean arterial pressure, PACU post anesthesia care unit, RCT randomized controlled trial, SA spinal anesthesia

Can heart rate and Qtc duration be used as a marker of cirrhotic cardiomyopathy? a case control study

To assess the value of QTc prolongation and heart rate variation as a marker of cirrhotic cardiomyopathy and severity of liver disease. This comparative study was conducted on selected patients with cirrhosis of liver, fulfilling inclusion criteria and were enrolled as group 1. An equal number of non cirrhotic patients were enrolled and included in group 2. QTc and heart rate were calculated and compared between the two groups. Analysis of QTc prolongation and increase in heart rate with regard to severity of liver disease was also made. Fifty confirmed cases of cirrhosis of liver were included in group 1 with equal number of age and sex matched non-cirrhotic patients included in group 2 as controls. The mean +/- SEM of QTc in group1 and group 2 were 0.4707 +/- 0.0065 and 0.3893 +/- 0.00542 seconds respectively. The mean +/- SEM of heart rate was 90.50 +/- 2.839 beats/min and 82.85 +/- 2.207 beats/min in group 1 and 2 respectively. The mean of QTc and heart rate in group 1 was significantly higher as compared to group 2 [p=.001 and p=.0179 respectively]. The mean of QTc and heart rate in subgroup 1A, 1B and 1C was not statistically significant. Patients with cirrhosis have a higher mean QTc and heart rate as compared to non cirrhotic adults. Both tests may be useful markers of Cirrhotic Cardiomyopathy