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Introduction: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with ARDS due to COVID-19. In vivo hemolysis (ivH) is one of its complications, characterised by peaks of plasma free hemoglobin (fHb). However, an increase in carboxyhemoglobin (COHb) has also been observed due to Hb metabolism by heme-oxygenase that releases carbon monoxide. The aim of this study is to evaluate the incidence of ivH events and their relation to COHb in COVID-19 patients undergoing ECMO. Method(s): Single-centre observational retrospective study that included 33 COVID-19 patients with ARDS who received VV-ECMO treatment in the ICU from March 2020 to September 2021. Daily analytical monitoring was carried out including arterial blood gas test with cooximetry and biochemical parameters, incorporating the estimation of fHb using quantitative hemolysis index (HI). Significant ivH was considered with fHb > 50 mg/dL after discarding in vitro hemolysis. Daily maximum values of HI and COHb were recorded and paired in order to evaluate their correlation by generalised linear model. Result(s): The total prevalence of patients having ivH in our cohort was 27.3%. Mortality during ECMO treatment in our study was 57.6%, higher within the group of patients with ivH events (77.8% vs 50%). A total of 777 daily maximum values of fHb from all the patients were obtained. Values of COHb were significantly higher during ivH episodes. Furthermore, positive significant correlation was obtained between daily analytical values of fHb and COHb (B coefficient 42.156;p = 0.042), as shown in Fig. 1. The cut-off value of COHb to be discriminative for hemolysis (fHb > 50 mg/dL) was 3.85% COHb (90.5% sensitivity and 83.3% specificity). Conclusion(s): Point-of-care carboxyhemoglobin is a cheap and widely available parameter that could be useful when detecting in vivo hemolysis during ECMO treatment.
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Introduction: Evaluation of prognostic factors in patients with ventilator- associated pneumonia (VAP) due to P. aeruginosa. The effectiveness of novel antipseudomonal antibiotics was reviewed. Method(s): Retrospective, single-center cohort analysis between April 2018 and June 2022. Data were obtained from the ENVIN-HELICS and electronic medical records. Demographic variables, underlying diseases and diagnosis to admission were registered. We considered each treatment appropriate according to Tamma PD et al. [1] criteria. We registered ventilator-associated tracheobronchitis (VAT) and pneumonia (VAP) episodes together with the recurrency of the infection. Result(s): From 61 patients included, 77% were admitted for ARDS due to COVID-19. The mean APACHE-II was 14.3 +/- 6.6. 7 patients required ECMO and 4 required RRT. The median length of stay in the ICU was 52 (ICR 36-84) days. 91 respiratory infections were recorded: 60 VAP and 31 VAT. On the first episode, carbapenem-resistance to meropenem was 40%;rising up to 58% on the second one. 6 patients developed a third episode (VAT) with a 100% of carbapenem- resistance. 13 (14%) respiratory infections showed resistance to the novel beta-lactamase inhibitor cephalosporins (8 to ceftalozanetazobactam and 5 to ceftazidime-avibactam). No resistance to cefiderocol was detected. During ICU stay, 21 patients (34%) developed secondary bacteremia from other foci and 7 (11%) invasive mycoses. Overall mortality was 49.2%. On the univariate analysis we found statistical significant relationships between mortality and COVID-19 admission, SOFA >= 7 points on the first VAP or the development of secondary bacteremia (Table 1). Conclusion(s): COVID-19 admission, SOFA >= 7 points on the first VAP or other secondary bacteremia were associated with mortality. The 14.3% of respiratory infections were resistant to the new beta-lactamase inhibitor cephalosporins. No resistance to cefiderocol was detected.
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The increasing availability of behavioral data about consumers offers great promise for understanding their shifting preferences over time. This poses an important challenge for business practitioners - particularly entrepreneurs and investors - who wish to be the first to identify and satisfy consumers' unmet needs. Here, we introduce the Consumer Deviation Index (CDI) as a means of generating forecasts from historical time series data in order to isolate emerging behaviors that fall outside the realm of expectation. These deviations serve as leading indicators of market opportunities to fulfill pockets of "latent demand"before they fully manifest across a consumer population. We illustrate the application of this methodology to behavior change during the height of COVID-19 stay-at-home restrictions, and to the initial reopening of the U.S. economy post-pandemic. We discuss implications for optimizing product development and innovation to better serve consumers' ever-changing needs. © 2022 ACM.
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Introduction: During the COVID-19 pandemic, many studies have been published on diagnostic tests, aimed at determining their accuracy, balance between benefits, risks, costs, fairness, and feasibility. A summary of the recommendations on the different tests available and on the different analytical or radiological characteristics that can support the diagnosis or have prognostic value is presented. Material and methods: PICO questions were formulated and a systematic search for information was carried out. The information obtained was evaluated, synthesized, and classified following the GRADE methodology. Finally, evidence tables with recommendations were prepared. Results and Discussion: Reverse transcription polymerase chain reaction is considered the gold standard, all trademarks are effective. Salivary samples have similar validity to nasopharyngeal samples and may be an option in low-prevalence outpatient settings. Antigenic tests have lower sensitivity and specificity, although they could be considered in patients with symptoms lasting less than 5 days. Serological tests are highly specific, offering better results 14 days after onset and could be useful in cases of multisystem inflammatory syndrome. In moderate and severe cases, analysis with LDH, C-reactive protein, ferritin and procalcitonin is recommended, due to the risk of coinfection. In these patients, bedside point of care-ultrasound could be an alternative in the case of trained clinicians. The quality of the evidence is, in general, low and most of the recommendations present a very low degree of evidence. © 2022, Spanish Association of Primary Care Pediatrics. All rights reserved.
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Purpose - This paper uses a supplemented health belief model (HBM) to explain the risk perception of COVID-19 coronavirus infection by potential and actual domestic and international travelers (from primarily European countries) in the early pre-vaccine phase of the pandemic and its influence on their travel intentions, decisions, and actions. With a health crisis of this magnitude, it is vital to understand the effect of COVID-19-associated containment measures and safety industry strategies in abating public fear and apprehension associated with non-essential travel. Design/methodology/approach - The authors used a sequential transformative design consisting of a (QUAN + Qual) survey to explore the HBM dimensions. The questions in the quantitative part of the survey were disseminated online examine perceptions of the severity and susceptibility of the disease, travel risks and willingness to travel. The questions in the qualitative face-to-face survey examined, how international/cross-border travelers (from Spain and Germany) perceive the benefits and barriers of personal protective behavior and the potential influence of cues to action. Findings - Results suggest that despite potential fear arousal and confusion associated with this infectious disease, people were willing to travel during periodic on-and-off travel restrictions and perceive the benefits of such travel as outweighing barriers like wearing masks, social distancing and other containment measures. Research limitations/implications - The conceptual model enabled the capture of real-time traveler's feelings about the benefits of traveling in the presence of the coronavirus and their perceptions of COVID-19 safety strategies used at destinations. This study adds to the lack of existing knowledge about potential psychological factors influencing travel decisions and behavior, including self-protective behavior. As borders reopen and we progress towards tourism and hospitality recovery, the results of this study can assist organizations, including health officials and governments, by reminding them of the likelihood of residual public fear when planning their COVID-19 safety strategies. Originality/value - Given the scarcity of COVID-19 research on people's travel intentions and behavior following periods of social isolation due to lockdowns and border closures, this study captures sample public perceptions at two stages early in the pandemic. It is the first to apply all of the HBM dimensions with the addition of travel risk as a construct to investigate people's travel intentions and behaviors without vaccinations or treatments and to include cues to action in the investigation.
ABSTRACT
The outbreak caused by the SARS-CoV-2 virus is currently very active in Spain. Many infected people still require to be hospitalized. Around 10-15 % of hospitalized patients require intensive care, where they are intubated for a prolonged period, needing tracheotomies some weeks after the intubation. We will be conducting an observational study of the tracheotomies performed by our oral and maxillofacial Department to COVID-19 patients on intensive care units between March 17th and April 17th, 2020. This study will be analyzing the patients’ epidemiological and clinical aspects, surgical technique employed, surgical time, type of cannula used, postoperative complications and the patients’ clinical monitoring. A total of 22 patients underwent open elective tracheotomy. There were twenty-two males and three females aged between 40 and 77 (mean: 64,9 years-old). In all cases tracheotomy was carried out due to pulmonary process caused by COVID-19 bilateral pneumonia. Two patients presented pneumothorax in the immediate postoperatory care as a complication, one perished during the procedure and another did so after arriving to the Intensive Care Unit after the tracheotomy surgery. Even though tracheotomy is a ruled surgical technique, the special characteristics of COVID-19 patients make of this procedure a critical situation, mainly due to lung instability and quick desaturation of the patients. This requires the surgery to be carried out by experienced physicians in order to reduce operative time and to be able to react to any eventualities that may arise. © 2020 SECOM.