ABSTRACT
Introduction: Mechanically ventilated COVID-19 patients have unusually high requirements for analgesics and sedatives compared to non-COVID 19 patients, and the need for higher dosages coupled with prolonged infusions can contribute to critical drug shortages. In an attempt to preserve the limited supply of the injectable formulations at our institution, use of enteral opioids and benzodiazepines was implemented. Research Question or Hypothesis: To evaluate potential differences in clinical effect and analgesic/sedative usage between two groups of mechanically ventilated COVID-19 patients based on route of administration: IV+enteral versus IV alone. Study Design: Retrospective cohort study Methods: This IRB-approved study evaluated ventilation time and fentanyl or midazolam usage when used concurrently with enteral hydromorphone and lorazepam. Inclusion criteria: 18-89 years old patients admitted to ICU with positive SARS-CoV-2 RT-PCR or antigen test and respiratory failure requiring invasive mechanical ventilation for >72 hours. Exclusion criteria: pregnancy or breast-feeding, and chronic opioid or benzodiazepine use within 30 days prior to admission. Data were collected in Microsoft Excel for initial analyses with subsequent inferential testing (Student's t-tests) performed using STATA® 13.1, College Station, TX. Significance for all testing was defined as alpha less than 0.05. Results: One hundred patients were evaluated, 55 in IV+enteral group and 45 in IV only group. There was no significant difference in ventilation time between two groups (20.7±13 vs. 16.5±12 days, p=0.1068). However, there was a statistically significant increase in fentanyl (1869.2±850.5 vs. 2281.6±853.4, p=0.0002) and midazolam (126±76.7 vs. 148.9±77.2, p=0.0061) requirements on day 3 in IV alone group and increase in fentanyl requirements when compared to IV+enteral group (33±842 vs.-412.4±673.6, p= 0.0050). Conclusion: Duration of mechanical ventilation in patients with COVID-19 is not reduced with combined IV+enteral compared to IV only analgesics/sedatives, but the combination may reduce IV analgesic requirements ameliorating the impact of IV shortages.
ABSTRACT
Social media has been the primary source of information from mainstream news agencies due to the large number of users posting their feedback. The COVID-19 outbreak did not only bring a virus with it but it also brought fear and uncertainty along with inaccurate and misinformation spread on social media platforms. This phenomenon caused a state of panic among people. Different studies were conducted to stop the spread of fake news to help people cope with the situation. In this paper, a semantic analysis of three levels (negative, neutral, and positive) is used to gauge the feelings of Gulf countries towards the pandemic and the lockdown, on basis of a Twitter dataset of 2 months, using Natural Language Processing (NLP) techniques. It has been observed that there are no mixed emotions during the pandemic as it started with a neutral reaction, then positive sentiments, and lastly, peaks of negative reactions. The results show that the feelings of the Gulf countries towards the pandemic depict approximately a 50.5% neutral, a 31.2% positive, and an 18.3% negative sentiment overall. The study can be useful for government authorities to learn the discrepancies between different populations from diverse areas to overcome the COVID-19 spread accordingly.