ABSTRACT
INTRODUCTION: Coronavirus disease 2019 (Covid-19) represents viral pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In non-COVID ARDS patients, high driving pressure (DP = Plateau pressure - PEEP) has been associated with higher mortality. Pathophysiological features of COVID ARDS have been considered different from non-COVID ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. The objective of this study is to evaluate the effect of DP on mortality in intubated COVID-19 ARDS patients. METHOD(S): All data were retrospectively collected from EHR of COVID-19 patients admitted to our ICU in2020. COVID ARDS patients in our institution are managed based on ARDS management guidelines that include lung protective ventilation strategy, PEEP protocol, and prone positioning for persistent PaO2/FiO2 (P/F) ratio < 150. Average P/F, Plateau pressure (PP), DP, and SOFA scores were collected and calculated on first three days of mechanical ventilation and correlated with mortality. RESULT(S): A total of 46 patients intubated with COVID-19 ARDS were included, with 25 survivors and 21 nonsurvivors (ICU mortality rate 46%). Compared to Non-survivor group, the survivor group had similar age (60 +/-12 vs 66 +/-12, p = 0.1), similar P/F ratios(D1: 147 +/-96 vs 136 +/-98, p = 0.7;D3: 136 +/-88 vs 128 +/-74, p = 0.7), similar PP (D1: 23 +/-7 vs 25 +/-6, p = 0.2;D2: 24 +/-6 vs 26 +/-7, p = 0.2;D3: 28 +/-7 vs 29 +/-7, p = 0.7), less number of comorbidities (1.7 +/-1.6 vs 3.2 +/-2.8, p = 0.03), better SOFA score change (SOFA D3 minus D1: 0.4 +/-0.5 vs 1.7 +/-1.7, p = 0.0006), and significantly less DP (D1: 11 +/-5 vs 15 +/-4, p = 0.006;D2: 12 +/-3 vs 15 +/-6, p = 0.01;D3: 14 +/-5 vs 19 +/-8, p = 0.02). CONCLUSION(S): Similar to other forms of ARDS, low driving pressure (less than 15 cmH2O) in COVID-19 ARDS is associated with lower mortality. These findings should be investigated in large multicenter prospective studies.
ABSTRACT
INTRODUCTION: Coronavirus disease 2019 (Covid-19) represents viral pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In ARDS patients, positive fluid balance has been associated with prolonged mechanical ventilation, longer length of stay, and higher mortality. As a result, restrictive fluid strategies improved oxygenation and reduced duration of mechanical ventilation. Optimal fluid management strategy for invasively ventilated COVID-19 patients is lacking. The objective of this study is to evaluate the effect of fluid balance on need for proning and successful liberation of invasive mechanical ventilation (MV) in patients with COVID-19 ARDS. METHOD(S): All data were retrospectively collected from EHR of COVID-19 patients admitted to our ICU. COVID ARDS patients in our institution are managed based on ARDS management guidelines that include lung protective ventilation strategy, PEEP protocol, and prone positioning for persistent PaO2/FiO2 (P/F) ratio < 150. Fluid balance in ml was calculated on Day 1 (F1) and Day 7 (F7) of ICU admission. Groups were divided into those successfully liberated (L-group) and those unable to be liberated from MV (U-group). RESULT(S): A total of 57 patients intubated with COVID-19 ARDS were included, with 29 in the L-group and 28 in the U-group. Compared to U-group, L-group had similar age (64 +/- 13 vs 64 +/- 13, p = 1.0), number of comorbidities (2.3 +/- 2.2 vs 2.7 +/- 2.5, p = 0.5), P/F ratio on day 1 (D1, 144 +/- 110 vs 130 +/- 95, p = 0.6), D1 SOFA score (6.4 +/- 4.5 vs 5.9 +/- 4.3, p = 0.7), and F1 (434 +/- 1106 vs 413 +/- 1301, p = 0.9). F7 was significantly less for L-group than U-group (290 +/- 2500 vs 2000 +/- 4000, p = 0.05). [F7 - F1] was also significantly less for L-group compared to U-group (- 144 +/- 1400 vs 1600 +/- 2800, p = 0.004). There was less need for proning (38 % vs 72 %, p = 0.01), and lower mortality (24% vs 86 %, p < 0.001) in the L-group compared to the U-group. CONCLUSION(S): In a cohort of invasively ventilated patients with COVID-19 ARDS, a lower cumulative fluid balance was associated with less need for proning and more successful liberation of MV, indicating that restricted fluid management in these patients may be beneficial. These findings should be investigated in large multicenter prospective studies.
ABSTRACT
BACKGROUND: Face mask use in the workplace has become widespread since the onset of the Covid-19 pandemic and has been anecdotally linked to adverse health consequences. AIMS: To examine reports of adverse health consequences of occupational face mask use received by The Health and Occupation Research (THOR) network before and after the pandemic onset. METHODS: THOR databases were searched to identify all cases of ill-health attributed to 'face mask' or similar suspected causative agent between 1 January 2010 and 30 June 2021. RESULTS: Thirty two cases were identified in total, 18 reported by occupational physicians and 14 by dermatologists. Seventy-five per cent of cases were reported after the pandemic onset and 91% cases were in the health and social care sector. 25 of the 35 (71%) diagnoses were dermatological, the most frequent diagnoses being contact dermatitis (14 cases) and folliculitis/acne (6 cases). Of the seven respiratory diagnoses, four were exacerbation of pre-existing asthma. CONCLUSIONS: There is evidence of an abrupt increase in reports of predominantly dermatological ill-health attributed to occupational face mask use since the start of the pandemic. Respiratory presentations have also occurred.