ABSTRACT
Aim and background: Management in COVID-19 includes the use of steroids, prolonged hospital stay, and long-term ventilatory care using muscle relaxants for lung-protective ventilation. These patients are subjected to fluctuating hemodynamics, blood sugar levels, secondary sepsis, systemic inflammatory response syndrome, and multi-organ dysfunction. This causes an increased risk for developing critical illness polyneuropathy and myopathy. Objectives: The literature assessing the effect of these risk factors on mortality in patients with COVID-19 is scarce. Hence, we assessed the effect of various risk factors and interventions on the long-term outcome in these patients. Materials and methods: We collected retrospective data of critically ill COVID-19 patients who developed from critical illness myopathy. The demographic details, clinical parameters, laboratory values, effect of protocol-based physiotherapy intervention, and long-term outcome of patients in term of residual weakness, dependency, and mortality was collected. Results: Out of the total 324 critically ill COVID-19 patients, 11 patients were diagnosed with critical illness myopathy and were included for data collection. Among the patients who developed critical illness myopathy, in-hospital mortality was around 36.4%. The use of protocol-based physiotherapy interventions like long sitting (P = 0.007) and, chair mobilization (p = 0.001) led to a significant reduction in mortality in COVID-19 patients. Conclusion: In patients with COVID-19 related critical illness myopathy, the use of protocol-based physiotherapy interventions leads to improved survival. Key messages: In patients with COVID-19 related critical illness myopathy, the use of protocol-based physiotherapy interventions has survival benefits.
ABSTRACT
Introduction: COVID-19 causes various cardiopulmonary manifestations. Bedside point of care ultrasound helps in the rapid diagnosis of these manifestations. Vscan Extend (GE, Wauwatosa, WI, US) is a handheld ultrasound device with a dual probe and an artificial intelligence application to detect ejection fraction. It can help in reducing the time for diagnosis, duration, and number of HCW exposed to COVID-19. Objectives: This is a prospective observational study comparing the cardiorespiratory parameters assessed by Vscan Extend with the conventional ultrasound machine. This evaluates the safety and accuracy of Vscan Extend and its utility in reducing the time duration for diagnosis. Materials and methods: Paired observations were made in 96 COVID-19 patients admitted to the intensive care unit by two intensivists. Intensivist A used the Vscan Extend device to assess the cardiac function, lung fields, diaphragm, deep veins, and abdomen. Intensivist B used routine investigation tools like clinical examination, X-ray chest, ECG, and conventional echocardiogram. The agreement between the findings and the time duration required in both the methods was compared. Results: The median duration of examination using handheld ultrasound was 9 (8.0-11.0) minutes, compared to 20(17-22) minutes with the conventional method (P < 0.001). The Cohen Kappa Coefficient was 1.0 for LV systolic function, most of the lung fields and diaphragmatic movement. Discussions: The use of handheld ultrasound has significantly decreased the time required for bedside examination of patients than the conventional method. The agreement was perfect between both the methods for systolic function, lung fields, and diaphragmatic movement. Conclusion: Vscan Extend handheld device helps in the rapid identification and diagnosis of cardiopulmonary manifestations in COVID-19 patients. The agreement between the handheld device and the conventional method proves its efficacy and safety.
ABSTRACT
A recent global pandemic has resulted from the outbreak of coronavirus disease (COVID-19) infection. One of the key clinical features of this infection is the presence of severe acute respiratory syndrome coronavirus 2 virus. The port of entry for COVID-19 is the lung and if the infection worsens, it progresses to acute respiratory distress syndrome (ARDS). As the pandemic continue to surge, findings from studies and case reports suggest that the ARDS caused by COVID-19 might have different characteristics than what we refer to as non-COVID-19 (Typical) ARDS. By applying the differences in clinical features between COVID-19-related ARDS and typical ARDS, clinicians may develop appropriate therapeutic protocols to treat these patients effectively. Our review article intends to elucidate these differences in clinical features based on time of onset, radiological specifications, lung mechanics, phenotypical characters, inflammatory mediator response, and nature of coagulation abnormality.