ABSTRACT
Background: Invasive mechanical ventilation as a therapeutic strategy is not without complications. It is imperative to have protective ventilation parameters in those patients who are subjected to it. We aim to demonstrate whether mechanical power as a ventilatory parameter has prognostic validity for mortality in critically ill patients with prolonged invasive mechanical ventilation. Material and Methods: An analytical cross-sectional study was carried out of critically ill patients on prolonged invasive mechanical ventilation due to Acute Respiratory Distress Syndrome due to COVID-19 who were admitted to the Intensive Care Unit of the Hospital Regional de Trujillo during the March 2020 to March 2021 period.
ABSTRACT
Introduction: The COVID-19 disease is complicated by severe acute respiratory syndrome (ARDS), which is considered the main cause of mortality within intensive care units, despite providing early and optimal ventilatory support. However, it is necessary to identify the factors associated with mortality in these patients.
ABSTRACT
Objective: To establish the diagnostic validity of the CALL score as a predictor of mortality in patients with severe COVID-19 in the Intensive Care Unit of the Trujillo Regional Teaching Hospital from April 2020 to July 2021. Material and methods: An analytical, retrospective study was carried out, in which 177 patients with severe COVID-19 admitted to the Intensive Care Unit of the Regional Teaching Hospital of Trujillo were included, according to selection criteria, the CALL score was calculated for each one and was associated with the mortality found;applying the statistical chi 2 test;Subsequently, a multivariate regression analysis was performed to identify risk factors associated with mortality. In turn, the AUROC (area under the ROC curve) was used to establish the predictive performance of the CALL score.
ABSTRACT
TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bronchopulmonary sequestration (BPS), is defined as a non-functional mass of lung tissue with systemic arterial blood supply, but without normal tracheobronchial communication. BPS often presents in adulthood with recurrent pulmonary infections and even fatal hemoptysis. We present a case of a 53-year-old African American male with large volume hemoptysis while hiking in upstate New York, who was found to have right lower lobe intralobar pulmonary sequestration. CASE PRESENTATION: A 53-year-old African American male with a past medical history of hypertension, hyperlipidemia, and diabetes mellitus presented with a subacute cough for one month and one episode of large volume hemoptysis while hiking. Review of systems was negative for fever, chills, chest pain, pleurisy, history of tuberculosis, weight loss, and anticoagulation use. He admitted to recreational marajuana use, but denied smoking cigarettes. Initially he was tachypneic, saturating 91% on room air, but hemodynamically stable. Computed tomography angiography (CTA) revealed right lower lobe intralobar pulmonary sequestration with internal locules of air suggesting superimposed infection. Flexible bronchoscopy revealed fresh blood in the right mainstem and lower lobe. Thoracotomy was followed by a lower lobectomy, which confirmed the diagnosis as it demonstrated an aberrant arterial supply from the descending thoracic aorta. There was no envelopment of pleura around the lung fed by the large pulsatile artery. DISCUSSION: Pulmonary airway malformations are the most common type of congenital abnormalities of the lower respiratory tract, diagnosed 1 in 10,000 to 35,000 live births [1]. An intralobar sequestration (IS) is located in a normal lobe and an extralobar sequestration (ES) is outside, with both having their own visceral pleura. Hybrid lesions are most common and have features of both. ES presents early with associated congenital malformations, whereas IS presents later with hemoptysis and recurrent pulmonary infections [2]. BPS can appear as other pathologies on CT such as a mass lesion, cyst, cavity lesion and localized emphysema [3,4]. Lobectomy should be prompt to prevent complications, such as fatal hemoptysis [5]. Shorter recovery times have been noted with video-assisted thoracoscopic surgery (VATS) [6,7]. Postoperative complications include empyema, hemoptysis, prolonged air leak, and fistula formation. Berna et al described their surgical approach in 25 patients in 2011, and all patients were doing well at long-term follow-up [7]. CONCLUSIONS: BPS can be fatal despite its rarity and innocent presentation. Radiographic ambiguity and nonspecific symptoms may delay appropriate management. It is imperative to include BPS on the initial query when managing hemoptysis. In the era of COVID-19, where hemoptysis may herald a deadly disease, understanding the broad differential of hemoptysis expedites appropriate management. REFERENCE #1: [1] Durell J, Thakkar H, Gould S, Fowler D, Lakhoo K. Pathology of asymptomatic, prenatally diagnosed cystic lung malformations. J Pediatr Surg. 2016;51(2):231-235. doi:10.1016/j.jpedsurg.2015.10.061 REFERENCE #2: [2] Van Raemdonck D, De Boeck K, Devlieger H, et al. Pulmonary sequestration: a comparison between pediatric and adult patients. Eur J Cardiothorac Surg. 2001;19(4):388-395. doi:10.1016/s1010-7940(01)00603-0 REFERENCE #3: [3] Wei Y, Li F. Pulmonary sequestration: a retrospective analysis of 2625 cases in China. Eur J Cardiothorac Surg. 2011;40(1):e39-e42. doi:10.1016/j.ejcts.2011.01.080[4] Qi W, Zhao J, Shi G, Yang F. Intralobar pulmonary sequestration displayed as localized emphysema on computed tomography image. J Cardiothorac Surg. 2017;12(1):83. Published 2017 Sep 8. doi:10.1186/s13019-017-0646-9[5] Rubin EM, Garcia H, Horowitz MD, Guerra JJ Jr. Fatal massive hemoptysis secondary to intralobar sequestration. Chest. 1994 Sep;106(3):954-5. doi: 10.1378/chest.106.3.954. PMID: 8082388.[6] Sun X, Xiao Y. Pulmonary sequestration in dult patients: a retrospective study. Eur J Cardiothorac Surg. 2015;48(2):279-282. doi:10.1093/ejcts/ezu397[7] Polaczek, M., Baranska, I., Szolkowska, M., Zych, J., Rudzinski, P., Szopinski, J., Orlowski, T., & Roszkowski-Sliz, K. (2017). Clinical presentation and characteristics of 25 adult cases of pulmonary sequestration. Journal of thoracic disease, 9(3), 762–767. https://doi.org/10.21037/jtd.2017.03.107 DISCLOSURES: No relevant relationships by Christian Castaneda, source=Web Response no disclosure on file for Rammohan Gumpeni;No relevant relationships by Sophia Ji, source=Web Response No relevant relationships by Parmjyot Singh, source=Web Response No relevant relationships by Anthony Smith, source=Web Response
ABSTRACT
Objectives: To describe risk perception and its relationship with sources of information consulted, actions, and the impact of the pandemic on the physical and mental health as well as social aspects of a group of patients from the rheumatology consultation. Methods: A survey was conducted from August 10 to November 29, 2020 in rheumatic diseases (RD) patients who returned to an outpatient clinic in Mexico following the Stay at home program implemented from March 23 to July 31. An online questionnaire was administered on mobile devices. Measurements: Assessment of the patient's health status by rheumatologist (visual analog scale ranging 0-10) and some sections of the UNIV-COVID-19 questionnaire. A descriptive analysis was performed. Measures of central tendency and dispersion for continuous variables and frequency measures for categorical variables. Normality was checked with the Shapiro-Wilk test. Inferential statistical tests were performed to determine differences between the COVID-19 + vs -groups with Chi-square and Student's t test for nominal and continuous sociodemographic variables, respectively. Logistic regressions were performed. Results: A total of 471 patients with RD were included, 84.5% women, aged 46.9 (SD 14.5) years old;rheumatoid arthritis (RA) was the most prevalent diagnosis 42.4%. 4.8%had SARS-CoV-2 infection, 21.74% required hospitalization. Treatment modification was reported in 36.1% (66.6% discontinued);health condition worsened in 39.1% of the patients. 52.1% of the patients who made modifications in their treatment had COVID-19 and 39.1% of those who had COVID-19 reported that their health condition worsened. The perception of risk was 85.9% (very serious/serious). The preventive action carried out was home isolation 44.3%. Television was consulted 88.7%and alert 74.5%the most prevalent feeling, while 7% said they felt discriminated. The logistic regression analysis revealed that having SpA, taking leflunomide, feeling discriminated, and greater perception of risk were associated with having COVID-19. The bimodal results for each variable are presented to indicate the change on action taken per group. Conclusion: The risk perception in RD patients was very high. 5% had COVID-19. The impact on disease activity, physical/mental health was greater in patients with COVID-19. Discrimination of RD and COVID-19 patients is an important phenomenon.
ABSTRACT
This theoretical essay, linked to the Group of Studies and Research in Education, Childhood, and Critical Theory of the State University of Londrina, is part of the master's dissertation of the research line "Teacher Training" of the Graduate Program in Education of the respective university. It aims to reflect on teacher malaise in the face of the Pandemic event caused by COVID-19 and the imbrications in the educational formative field. However, it is known that teacher malaise is not something new. The pandemic in the world recorded crossings in education and formation, mainly through remote education, which changed the knowledge in the lives of students and teachers. The methodology is bibliographic research in light of the foundations of the Critical Theory of Society and contemporary interpreters who dialogue with this theoretical basis. The challenge lies in educational action via critical self-reflection in face of the virus that made children, young people, and adults stay at home. The study enabled reflection on paths that allow new pedagogical horizons in favor of everyone's life and well-being.
ABSTRACT
The measures to deal with the Covid-19 pandemic have had an enormous individual and social cost, affecting women and men differently. This article analyzes the differences by gender of some family and individual effects in the Universidad Nacional Autónoma de México (unam) population based on a survey of 12 158 university members. Women are having greater differential effects on everything, especially in their mental and physical health, and young female students are having greater effects than boys. Documenting this situation is important in order to be able to identify interventions during and after the pandemic aimed at responding equitably to the unequal impacts between genders. © 2021, Revista Mexicana de Sociologia. All Rights Reserved.
ABSTRACT
SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: After the novel coronavirus disease (COVID-19), was declared a pandemic, New York quickly became the new epicenter of the disease, with Queens County reporting the most confirmed cases in the United States. This study was conducted during the peak of COVID-19 in Queens. Due to the severity of the disease and limited resources, patients were intubated at varying degrees of oxygenation. This study examines the preoxygenation state of COVID-19 ARDS patients prior to intubation and its implication on clinical outcomes. METHODS: At a single acute tertiary care hospital located in Queens, New York, all patients admitted between March 15 and April 15, 2020 were screened. Active COVID-19 status was confirmed with reverse transcriptase-polymerase chain reaction assay on nasopharyngeal samples. All COVID-19 patients who were intubated with documented pre-intubation oxygen saturation (PreO2) were included. All data were collected from the electronic health record, including laboratory data, ventilator settings, and hospital course. Peri-intubation cardiac arrest events up to 24 hours post-intubation and mortality during the study period were examined as outcomes. Data was analyzed with SPSS (version 25). Continuous variables were tested using independent T-tests. All tests of significance were two-tailed, and a p-value of 0.05 was considered significant. RESULTS: A total of 192 patients were included in the study. They had a mean age of 61.2 ± 12.2 years, and 130 (64.1%) were men. The mean preO2 of all patients was 71.3 ± 13.6, and the mean peri-intubation PF ratio was 120.84 ± 58.6. 32 out of 192 patients (16.7%) with peri-intubation cardiac arrest demonstrated significantly lower preO2 (p=0.03) compared to those without. These 32 patients also demonstrated more days with symptoms prior to intubation (p=0.004). 121 patients who expired during the clinical course demonstrated lower PreO2 (p=0.60) and PF Ratios (p=0.48) compared to the 71 patients who did not, but these comparisons were not statistically significant. Patients who expired demonstrated fewer symptomatic days prior to intubation than those who did not, but this was not statistically significant (p=0.06). CONCLUSIONS: At the time of intubation, the patients had significant hypoxemia and severe ARDS by PF ratio. Lower oxygenation prior to intubation is associated with an increase in peri-intubation complications. CLINICAL IMPLICATIONS: Due to unclear pathophysiology of ARDS in COVID-19, the optimal timing of intubation continues to be debated. Physicians should consider intubation earlier in the disease course prior to significant hypoxemia, which may have a negative impact on peri-intubation complications. Clinical outcome was further impacted by the restriction on preoxygenation of the patients prior to intubation, given its risk of viral aerosolization. Means of preoxygenating with minimal risk of disease spread should continue to be explored. DISCLOSURES: Advisory Committee Member relationship with Ambu Please note: $1-$1000 by Olumayowa Abe, source=Admin input, value=Honoraria No relevant relationships by Ahmed Al-Ghrairi, source=Web Response No relevant relationships by Christian Castaneda, source=Web Response No relevant relationships by Ettaib El Marabti, source=Web Response No relevant relationships by Hadya Elshakh, source=Web Response No relevant relationships by Teressa Ju, source=Web Response No relevant relationships by Michael Karass, source=Admin input No relevant relationships by Miri Kim, source=Web Response No relevant relationships by Jack Mann, source=Web Response No relevant relationships by Christina Jee Ah Rhee, source=Web Response No relevant relationships by Fizza Sajid, source=Web Response No relevant relationships by Angelina Voronina, source=Web Response
ABSTRACT
SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a public health crisis that has resulted in the death of thousands within the United States. The large influx of patients requiring mechanical ventilation for acute respiratory distress syndrome (ARDS) has necessitated the utilization of ventilators from a variety of sources. We hypothesized that ventilator model may be an independent risk factor for mortality in mechanically ventilated patients with COVID-19. METHODS: We retrospectively reviewed the medical records of 147 patients admitted to the adult intensive care unit of a tertiary hospital [New York Presbyterian Queens (NYPQ), Flushing, NY] from 1 March 2020 to 2 April 2020 in whom COVID-19 was confirmed and mechanical ventilation was initiated. Patients <18 years old were excluded as were patients who were pregnant. Diagnosis of COVID-19 was based on a positive result from a probe-based reverse transcriptase polymerase chain reaction (RT-PCR) test for SARS-CoV-2 from a nasopharyngeal swab. This observational retrospective study without any specific intervention was reviewed and exempted by the hospital Institutional Review Board, and all data were deidentified prior to processing. RESULTS: Between 1 March 2020 to and 1 April 2020, we included 147 adult critically ill patients with confirmed COVID19 infection. The patients had a mean age of age of 60 ± 13 years, and 99/147 (67%) were men. 57/147 (39%) had a BMI >30 (Table 1). 87 of 147 patients were dead at 28 days. The 28-day mortality rate of mechanically ventilated patients with COVID-19 was 59%. As expected, the 28-day mortality rate was higher in patients who were >65 years old (p=0.02). Approximately, half of the patients were ventilated on the PB840, with the remaining divided evenly between the Servo-U and LTV1200. There was no association between ventilator type and 28-day mortality (p=0.73) CONCLUSIONS: To the best of our knowledge, this study is the first to analyze various ventilator models and their relationships with patient outcome. With a myriad of ventilator types on the market, and more companies developing ventilators with the advent of this outbreak, healthcare providers must understand the limitations of each individual machine. Our data has limited power, but suggests that type of ventilator was not associated with drastically different outcomes. CLINICAL IMPLICATIONS: We hope that this research serves as an impetus to the medical community to consider the features and limitations of the variety of ventilators being implemented during this crisis. Despite the trepidation we might have initially had using a limited, unfamiliar ventilator, there did not appear to be dramatic differences in outcomes with the LTV1200. DISCLOSURES: Advisory Committee Member relationship with Ambu Please note: $1-$1000 by Olumayowa Abe, source=Admin input, value=Honoraria No relevant relationships by Christian Castaneda, source=Web Response No relevant relationships by Christine Eng, source=Web Response No relevant relationships by Albert Magh, source=Web Response No relevant relationships by Jack Mann, source=Web Response No relevant relationships by Christina Jee Ah Rhee, source=Web Response no disclosure on file for Lourdes Sanso;
ABSTRACT
SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: As of May 2020, Queens County, New York reported the most confirmed cases of the novel coronavirus disease (COVID-19) in the United States. This study was conducted during the peak of COVID-19 in Queens. Many COVID-19 patients with acute respiratory distress syndrome (ARDS) required mechanical ventilation via endotracheal intubation for extended periods of time. This study examines the length of ventilation via endotracheal tube (ETT) and the outcome of extubation attempts (EXA). METHODS: At a single acute tertiary care hospital located in Queens, New York, all patients with COVID-19 admitted between March 15 to April 15, 2020, who were intubated with ETT were included. All data were collected from the electronic health record until April 25, 2020. Hospital course, extubation events, reintubation events, and number of tracheostomies were gathered. Number of ventilated days via ETT and mortality were studied as outcomes. Patients were divided into those who expired with ETT, were successfully extubated at first EXA, failed EXA, and underwent tracheostomy. Cardiac arrest and anoxic brain injury were studied as adverse events. RESULTS: 205 patients were included. Their mortality was 63.4% with 130 in-hospital deaths, of which 110 patients (54.7%) expired while on ventilator via ETT. 13 out of 205 patients (5.4%) were successfully extubated on first attempt, of which 2 were unplanned self-extubation events. The average ventilated days via ETT for this group was 9.36 days (SD 4.7 days). 7 out of 205 patients (3.4%) failed EXA. The average time to EXA in this group was 9.29 days (SD 5.8 days). There were 0 reported cardiac arrests or anoxic brain injuries following EXA. The average time from EXA to reintubation was 1.14 days (SD 1.9 days). 2 of the 7 patients who failed EXA expired on ventilator support via ETT. 36 out of 205 patients underwent tracheostomy. The mortality rate for this group was 19.4% (SD). The average ventilated days via ETT was 16.2 days (SD 5.3 days). CONCLUSIONS: COVID-19 patients that were intubated for severe ARDS had a notable mortality rate, and those who survived required a prolonged course of ventilation. Both groups of successful extubation and failed extubation had similar time on endotracheal ventilation prior to the attempt, making it an unlikely factor determining successful extubation. Patients who were able to undergo tracheostomy had lower mortality, but it is unclear if there was a direct correlation, as patients were generally less ill to be able to undergo such a procedure. CLINICAL IMPLICATIONS: Patients with severe ARDS in COVID-19 required a prolonged course of mechanical ventilation and exhibited a high likelihood of failure to extubate. In order to avoid the complications of prolonged ventilation via ETT, early tracheostomy should be considered. In the future, a larger cohort of patients should be examined to provide statistical reinforcement of our findings. DISCLOSURES: Advisory Committee Member relationship with Ambu Please note: $1-$1000 by Olumayowa Abe, source=Admin input, value=Honoraria No relevant relationships by Ahmed Al-Ghrairi, source=Web Response No relevant relationships by Christian Castaneda, source=Web Response No relevant relationships by Ettaib El Marabti, source=Web Response No relevant relationships by Hadya Elshakh, source=Web Response No relevant relationships by Teressa Ju, source=Web Response No relevant relationships by Michael Karass, source=Admin input No relevant relationships by Miri Kim, source=Web Response No relevant relationships by Jack Mann, source=Web Response No relevant relationships by Christina Jee Ah Rhee, source=Web Response No relevant relationships by Fizza Sajid, source=Web Response No relevant relationships by Angelina Voronina, source=Web Response
ABSTRACT
Introduction: COVID-19 is the most frequent cause of ARDS, generating mild, moderate and severe clinical symptoms, in the latter, patients could evolve to the need for orotracheal intubation and advanced ventilatory support;reporting mortality of 26-90% in these cases. This is why there is a need to identify risk factors and predictive tools for mortality. In this study, the diagnostic validity of the oxygen saturation and oxygenation indices as predictors of mortality prognosis in patients with severe ARDS due to COVID-19 who required invasive mechanical ventilation was determined. Material and methods: cross-sectional, analytical and retrospective study. The sample consisted of 176 medical records of critically ill patients. Bivariate and multivariate analyzes were performed, in addition to determining specificity, sensitivity, PPV, NPV, and AUC. Results: 57.37% (101/176) of the patients died, with a predominance of males 79% (80/101);with an average age of 56 years. Lactate (p=0.115) did not show a statistically significant association. Results: 57.37% (101/176) of the patients died, with a predominance of males 79% (80/101);with an average age of 56 years. Lactate (p=0.115) did not show a statistically significant association. Regarding the indices, OSI registered sensitivity and specificity of 33% and 96%, respectively;while IO had 33.6% sensitivity and 97.33% specificity;AUC 0.773 (CI: 0.677-0.868);that is, more than 77.3% probability of prognosis for mortality. Conclusion: OSI and OI are adequate predictors of mortality, with OI having better diagnostic validity. In addition, the male sex and increased glycemic values are confirmed as factors associated with the risk of developing serious conditions due to COVID-19. © 2022 Instituto de Altos Estudios de Salud Publica. All rights reserved.
ABSTRACT
Introduction: Due to the high morbidity and mortality associated with COVID-19, clinical risk stratification tools have been developed for these patients, in order to predict progression to severe disease and/or mortality. In this study, the Quick COVID19 Severity Index Scale was compared with News2 as a predictor of mortality in adults with SARS-CoV-2 infection, specifying its diagnostic validity. Materials and methods: Observational, retrospective, analytical study of diagnostic tests. 255 patients were included, over 18 years of age, hospitalized in Hospital II - I Moyobamba with a diagnosis of COVID-19, with an oxygen requirement of ≤6 Lt/min, from January to December 2020. Results: 13% (32/255) of the patients died, with a predominance of males 62.5% (20/32), with an average age of 50 years, the bioclinical parameters evaluated did not show a statistically significant association, except for the blood glucose p: 0.01. Regarding the scales, considering a high score ≥7 points;Quick Covid-19 Severity Index has no significant association as a predictor of mortality, with a sensitivity and specificity of 43.75% and 63.23%, respectively;while NEWS-2 showed sensitivity of 87.50%;specificity of 50.67%;AUC 0.768 (CI: 0.684-0.853, p 0.00);that is, there is more than 75% probability of prognosis. Conclusion: the NEWS-2 scale statistically showed to be a good tool for the prognosis of mortality in patients infected with SARS - CoV - 2, it is suggested to carry out studies that confirm the findings of this research and assess its applicability and reproducibility in other populations. © 2022 Instituto de Altos Estudios de Salud Publica. All rights reserved.
ABSTRACT
Introduction: COVID-19 is an infectious disease that causes significant respiratory dysfunctions with long-term repercussions, lasting after medical discharge. In this study, association between socio-demographic, clinical and healthcare factors with the impact of COVID-19 on post-discharge respiratory functional capacity was determinated. Material and methods: observational study, analytical, cross-sectional study. The sample made up of 385 patients diagnosed with COVID-19. A data collection form was applied;the respiratory functional capacity was estimated. A bivariate analysis was performed using the fe chi square test and prevalence ratio, considering a significance of 95% (p<0.05). Results: of the 385 patients, 228 (59.2%) had normal respiratory capacity, and decreased in 157 (40.8%). Contemporary adults (55.84%) and males (67.80%) were mostly affected. Comorbidity (p= 0,292) and Co-Rads (p= 0,797) were not shown to be directly associated with respiratory involvement;contrary to RALE ≥ 3 in chest X-ray (p=0,000). The time in hospitalization, ICU and mechanical ventilation suggests to be related to the respiratory decrease. However, by PCR there was no statically significant evidence. But, clinical severe 3,029 [1,611 – 5,696] p= 0.001 and RALE ≥3 4,079 [2,248 – 7,401] p= 0,000, showed association. Conclusion: the degree of severity and RALE ≥ 3 in chest X-ray were identified as associated factors. It is suggest to carry out studies that confirm the findings of this research and propose a comprehensive rehabilitation protocol aimed at post-covid-19 patients that allows them to recover normal respiratory functional capacity. © 2022 Instituto de Altos Estudios de Salud Publica. All rights reserved.