ABSTRACT
INTRODUCTION: Coronavirus disease-2019 (COVID-19) pandemic has overloaded the healthcare system beyond its functional capacity. Late referral to higher levels of care may be one of the factors associated with higher mortality. Therefore, we aimed to find simple demographic and laboratory parameters which predict the requirement of admission to a critical care unit. MATERIALS AND METHODS: A case-control study was undertaken in adult age population >18 years, admitted in a dedicated COVID hospital in South India. A total of 50 patients with severe disease (cases) were compared with 143 mild or asymptomatic cases (controls). Those demographic and laboratory parameters that were found to be significant on univariate analysis were used for multiple logistic regression analysis. RESULTS: Univariate analysis of demographic and laboratory data showed higher age, male sex, presence of diabetes mellitus, higher values of C-reactive protein, ferritin, D-dimer, neutrophil-lymphocyte ratio (NLR), and lactate dehydrogenase to be significantly associated with cases. Multivariate logistic regression analysis of these significant variables showed NLR and ferritin to be the independent predictors of the requirement of admission to a critical care unit. The receiver-operating characteristic curve showed an NLR value of 5.2 and a ferritin value of 462 µg/L that were able to predict the requirement of admission in critical care units. CONCLUSION: High ferritin and NLR were independent predictors of the requirement of admission in critical care units. NLR is a simple tool that can be used in resource-limited settings for triage and early referral to higher levels of care. HOW TO CITE THIS ARTICLE: Maddani SS, Gupta N, Umakanth S, Joylin S, Saravu K. Neutrophil-Lymphocyte Ratio in Patients with COVID-19 as a Simple Tool to Predict Requirement of Admission to a Critical Care Unit. Indian J Crit Care Med 2021;25(5):535-539.
ABSTRACT
INTRODUCTION: The pandemic coronavirus disease 2019 (COVID-19) is on the rise in our country and there is no specific treatment modality available presently. The treatment of the disease largely remains symptomatic but repurposed drugs used to treat other disease conditions are being used to treat moderate to severe form of the disease. As the clinical trials for these drugs are ongoing, we conducted this survey to know the physicians' medical treatment plan for COVID-19 patients. MATERIALS AND METHODS: It was a web-based questionnaire study. Institutional ethical committee clearance was taken before the commencement of the study. There were a total of 17 questions, the first 6 being about the demographics, place of work, and whether the clinician was involved in the care of COVID-19 patients. Subsequent 11 questions were to assess physician's awareness and plan of the medical management of the COVID-19 patients. RESULTS: The majority of the clinicians were aware of the various treatment modalities available for the treatment of COVID-19. Regarding the plan for use of hydroxychloroquine (HCQ), 55% of the total respondents intended to use the drug in combination with azithromycin, even as 62% agreed that there was no clear evidence yet. About 90% of all clinicians, from junior residents to consultants, were monitoring electrocardiogram (ECG) during HCQ therapy; however, there were 10% of physicians who were not practicing ECG monitoring. About 68% of clinicians were aware of the various therapeutic options being tested, like convalescent plasma, lopinavir-ritonavir, and 64% knew about remdesivir. There was divergence regarding the use of steroids in a cytokine storm among the physicians, with only 39% of consultants planning to use steroids whereas about 50% of junior residents and 79% of junior consultants were planning to use the drug. CONCLUSION: The majority of the clinicians involved in the management of COVID-19 were aware of the various drug modalities available for treatment. However, more emphasis on the adverse effects and possible drug interactions is required. There is disaccord regarding the use of steroids in cytokine storm in COVID-19 and further guidelines and educational programs should address these issues. CLINICAL SIGNIFICANCE: Clinicians have to be made more aware of the possible adverse effects and drug interactions of the medications used for the treatment of COVID-19. The treatment of the serious, cytokine storm syndrome and the role of steroids must be elucidated as soon as it is feasible. HOW TO CITE THIS ARTICLE: Maddani SS, Chaudhuri S, Deepa HC, Amara V. A Multicenter Questionnaire-based Study to Know the Awareness and Medical Treatment Plan of Physicians Involved in the Management of COVID-19 Patients. Indian J Crit Care Med 2020;24(10):919-925.
ABSTRACT
INTRODUCTION: COVID-19 has been declared a pandemic by the World Health Organization (WHO). Many of the COVID-19 patients develop acute respiratory distress syndrome (ARDS) and require ventilatory support based on their severity for which conventional strategies are being used along with few newer strategies. We conducted this multicenter survey to know the physician's current ventilation strategies adopted for the care of COVID-19 patients. MATERIALS AND METHODS: The survey was conducted after taking the ethical committee clearance. The web-based multicenter, cross-sectional questionnaire study was sent to physicians, who were involved in the management of COVID-19 patients. The questionnaire was segregated into three parts: part one consisted of general information and consent form, part two was concerned regarding demographic characteristics, and part three was concerned about their practices and strategies for ventilation of COVID-19 patients. RESULTS: A total of 223 responders replied for the questionnaire; 190 participated in the study saying that they are involved in the management of COVID-19 patients. The answers to the questionnaires were expressed as a percentage of total responses. 86% of the respondents said they have a designated intensive care unit (ICU) and 89% of the responders said they have an intubation/extubation protocol for suspect/confirmed COVID-19 patients. The responses of junior residents (JRs), senior residents (SRs), assistant professors/junior consultants, and professors/consultants were analyzed separately, and a few significant differences were observed. 39% of JRs were aware of prone ventilation as the most effective rescue ventilation strategy compared to 69% of consultants/professors. Extracorporeal membranous oxygenation (ECMO) strategy was also more significant in consultants/professors (40%) vs JRs (12%). The responders were also diverged based on medical college and corporate hospitals, and their responses were noted. Most commonly, responders in the corporate hospitals had a facility to ventilate COVID-19 patients in a negative pressure isolation facility compared to a nonnegative pressure room isolation facility in medical colleges. CONCLUSION: Most of the responders were practicing ventilation strategies in a standard manner. JRs need to undergo further training in a few aspects of the ventilatory management, and also, they need to update themselves with newer treatment modalities as they keep evolving. Medical colleges are providing at par facility compared to corporate hospitals except for few advance care facilities. CLINICAL SIGNIFICANCE: This study highlights the current practice of ventilatory management of COVID-19 patients, which is satisfactory. The survey can be used to develop study tools, to educate resident doctors, to further improve quality of care of critical COVID-19 patients. HOW TO CITE THIS ARTICLE: Maddani SS, Deepa HC, Rao S, Chaudhuri S. A Multicenter Cross-sectional Questionnaire-based Study to know the Practices and Strategies of Ventilatory Management of COVID-19 Patients among the Treating Physicians. Indian J Crit Care Med 2020;24(8):643-648.