ABSTRACT
Introduction: Coronavirus is a family of viruses that can cause illnesses such as the common cold, Severe Acute Respiratory Distress Syndrome & Middle East Respiratory Syndrome. In 2019 new coronavirus was identified, originating in China. The emergence of COVID-19 disease has led to high demand for intensive care services worldwide. Materials And Methods: It is a cross-sectional hospital-based observational study of the clinical profile and outcome of laboratory-confirmed COVID-19 cases admitted in the intensive care unit (ICU) at C.U. Shah Medical College and hospital between October 2020 to March 2021. We have taken a detailed clinical history of patients regarding symptoms of COVID-19 according to the predefined COVID-19 questionaries. Allied history from the patient's relatives was taken regarding contact with COVID-19-positive patients and recent travel history. Emphasis was also made on comorbidities, past medications, and past medical events like ischemic heart disease (IHD), stroke, diabetes mellitus, thyroid disorders, and hypertension. Result(s): In the present study, the most common symptom of COVID-19 disease is breathlessness, followed by fever and cough. Peak incidence was noted in the older age group. Diabetes and hypertension are associated with a more severe form of COVID-19 disease. Most patients have been admitted due to severe acute hypoxemia and tachypnoea. Most patients required mechanical ventilation, although most died due to severe acute respiratory syndrome. Conclusion(s): In a hospital-based cross-sectional study of laboratory-confirmed COVID-19 patients, males and females are at equal risk of COVID-19 infection, and there was no significant difference in severity among them. Hypertension and diabetes, and old age are the most common risk factors for severity and ICU admission in covid-19 patients. Proper strategies regarding covid-19 management and practical training of healthcare personnel with adequate health resources can dramatically reduce mortality in COVID-19 patients. Copyright © 2022 Ubiquity Press. All rights reserved.
ABSTRACT
IntroductionThere remains significant variation in treatment of COVID-19 associated respiratory failure. Although Continuous Positive Airway Pressure (CPAP) has shown to improve outcome in single centre studies, inclusion criteria for commencement of CPAP varies significantly (Ashish et al., 2020;Nightingale et al., 2020). This respiratory-led ward-level dedicated CPAP unit provided CPAP to COVID-19 patients through the ‘second wave’. This study aims to evaluate the efficacy and appropriateness of CPAP for COVID-19 management in an elderly population.MethodsThis retrospective observational study included all patients aged 75 and over who received CPAP for COVID-19 infection, admitted to a district general hospital between 1 October 2020 and 16 February 2021. Fifty-seven patients were included. Data were collected from computerised clinical notes for analysis.ResultsOf 57 patients (39 male and mean age 80), 47 (82.5%) patients died during admission or within 5 days of discharge. 10 (17.5%) patients survived to discharge. Non-survivors had a median CFS of 4;IQR 3–5, as did survivors (median CFS 4;IQR 3–4). Non-survivors had a median of 3 (IQR 2–4) significant comorbidities, and survivors had 2.5 (IQR 2–3.8). Median P/F (PaO2/FiO2) ratio prior to commencing CPAP was 10.5 (IQR 8.4–12.6) for non-survivors and 14.4 (IQR 12.9–18.8) for survivors. The odds of death were 6.8 (p value <0.01) in those with a severe P/F ratio (<13.3).ConclusionThis evidence indicates that CPAP used in patients aged 75 and over, particularly those with a severe P/F ratio prior to commencing CPAP, does not improve mortality. These findings can inform future decision-making and CPAP protocol development to potentially limit its use in this group. Further study of less invasive alternative management options, such as nasal high flow oxygen, is recommended.