ABSTRACT
Background: Severe COVID-19 pneumonitis in elderly frail patients is associated with poor outcomes, and therefore invasive mechanical ventilation is often deemed an inappropriate course of action. Some evidence suggests high-flow nasal oxygen (HFNO) may prevent the need for invasive ventilation in other groups of patients, but whether it is an appropriate ceiling of care for older frail patients is unknown. Method(s): We retrospectively identified patients with severe COVID-19 pneumonitis requiring FiO2 >60% who were deemed inappropriate for invasive ventilation or non-invasive continuous positive airway pressure ventilation (CPAP). Our local protocol based on national guidance suggested these patients should be considered for HFNO. We observed whether the patients received HFNO or standard oxygen therapy (SOT) and compared mortality and survival time in these groups. Result(s): We identified 81 patients meeting the inclusion criteria. From this group, 24 received HFNO and 57 received SOT. The HFNO group was similar in age, BMI and co-morbidities to the SOT group but less frail, as determined by the Clinical Frailty Scale (CFS). All 24 patients that received HFNO died in comparison to 46 patients (80.7%) in the SOT group. Mortality in the HFNO group was significantly higher than in the SOT group. Conclusion(s): Elderly frail patients with severe COVID-19 pneumonitis deemed inappropriate for invasive ventilation and did not benefit from HFNO. Further, HFNO may have been associated with harm in this group. Copyright © 2022 Merchant et al.
ABSTRACT
The novel coronavirus disease 2019 (COVID-19) was characterized as a global pandemic by the World Health Organization (WHO) on March 11, 2020. The present pandemic has caused an intolerable impact on the health structure as well as the pharmaceutical sector, which in ultimatum has created enormous issues in the everyday lives of the patient community. On the other hand, the situation may appear in short and long-term time-horizon and need identifiication along with appropriate planning to reduce their socio-economic burden. The Indian pharmaceutical industry is the world's third-largest drug producer by volume. India supplies affordable and low-cost generic drugs to millions of people around the globe and operates more than 250 United States Food and Drug Administration (USFDA) and United Kingdom Medicine and Healthcare products Regulatory Agency (UKMHRA) approved plants. Given the Indian pharmaceutical industry, the source of Active Pharmaceutical Ingredients (APIs) for multiple diseases is much crucial part of the Pharma industry's strategic plan to combat the COVID-19 pandemic. China is the top global producer and exporter of APIs by volume and Indian pharmaceutical industries are also rely heavily on APIs from China for the production of their medicine formulations by importing around 70 percent of the total requirement. However, the present pandemic situation has exposed the world's over-reliance on China in terms of API import and bound world leaders to fig. out sustainable alternatives.