ABSTRACT
Objective: The body of literature regarding coronavirus disease 2019 infection in kidney transplant recipients is growing every day but is mostly comprised of case reports, small case series, and small cohorts. The aim of the current study was to describe our experiences with coronavirus disease 2019-positive kidney transplant recipients to reduce the difficulties that these patients face with coronavirus disease 2019. Methods: This retrospective cohort study included 54 kidney transplant recipients diagnosed with coronavirus disease 2019, between April 1, 2020, and February 1, 2021, from our Kidney Transplant Center. The participants were followed up for a period of at least 30 days or until death. Results: Of the 54 patients, 36 (66.66%) were followed up as outpatients and 18 (33.33%) were hospitalized, of which 13 (24.07%) were followed up in the service and 5 (9.26%) needed intensive care. All 5 patients (9.26%) in need of intensive care died and the remaining 49 (90.74%) recovered from coronavirus disease 2019 infection. None of the patients developed graft loss during follow-up. Conclusion: The results indicated that the neutrophil-to-lymphocyte ratio and lactate dehydrogenase-to-lymphocyte ratio can be used to support the diagnosis and determine prognosis in kidney transplant recipients with suspected coronavirus disease 2019. In both the group comparisons and univariate logistic regression analyses, smoking was seen to be a significant risk factor for the development of pneumonia and mortality due to coronavirus disease 2019. Therefore, all patients must be strongly reminded and encouraged to stop smoking.
ABSTRACT
BACKGROUND: Exposure of respiratory therapists (RTs) during aerosol-generating procedures such as endotracheal intubation is an occupational hazard. Depending on the hospital, RTs may serve as laryngoscopist or in a role providing ventilation support and initiating mechanical ventilation. This study aimed to evaluate the potential exposure of RTs serving in either of these roles. METHODS: We set up a simulated patient with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in an ICU setting requiring endotracheal intubation involving a laryngoscopist, a nurse, and an RT supporting the laryngoscopist. All participants wore appropriate personal protective equipment (PPE). A fluorescent marker was sprayed by an atomizer during the procedure using 3 different methods for endotracheal intubation. The 3 techniques included PPE alone, a polycarbonate intubating box, or a coronavirus flexible enclosure, which consisted of a Mayo stand with plastic covering. The laryngoscopist and the supporting RT were assessed with a black light for contamination with the fluorescent marker. All simulations were recorded. RESULTS: When using only PPE, both the laryngoscopist and the RT were grossly contaminated. When using the intubating box, the laryngoscopist's contamination was detectable only on the gloves: the gown and face shield remained uncontaminated; the RT was still grossly contaminated on the gloves, gown, neck, and face shield. When using the coronavirus flexible enclosure system, both the laryngoscopist and the RT were better protected, with contamination detected only on the gloves of the laryngoscopist and the RT. CONCLUSIONS: Of the 3 techniques, the coronavirus flexible enclosure contained the fluorescent marker more effectively during endotracheal intubation than PPE alone or the intubating box based on exposure of the laryngoscopist and supporting RT. Optimizing containment during aerosol-generating procedures like endotracheal intubation is a critical component of minimizing occupational and nosocomial spread of SARS-CoV-2 to RTs who may serve as either the laryngoscopist or a support role.