ABSTRACT
INTRODUCTION: Specific to COVID-19, patients are placed in isolation rooms, visitors are restricted, and clinicians are reducing in-person interactions with patients, significantly limiting the patient's communication with the medical providers and families. Communication limitations result in an increased risk of post-traumatic stress disorder and psychological distress post discharge from the ICU. Our study aimed to assess the impact of speech and swallow treatment frequency in COVID-19 patients post-extubation from mechanical ventilation in ICU. METHOD(S): In this case-control study based on a data pull and review of electronic medical records, we obtained and analyzed data from ARDS patients who were COVID-19 positive and COVID-19 negative and required intubation in the ICU to describe communication and swallowing characteristics and SLP interventions. Patients were eligible for inclusion if they were 18 years or older, seen by SLP during inpatient admission, and were intubated or had a tracheostomy during their admission. Exclusion criteria included: 1) gastrostomy tube at baseline, 2) documented baseline dysphagia, 3) laryngectomy, 4) open chest surgery (e.g., sternotomy) <=1 year, 5) known or suspected anatomical abnormalities or trauma of the oral cavity, pharynx, larynx, or esophagus, 6) head and/or neck disease (e.g., laryngeal cancer), 7) head and/or neck surgery (other than tonsillectomy) or head and/or neck radiation, and 8) progressive neurodegenerative disorders/diseases. RESULT(S): A total of 244 patients met the criteria for inclusion. There was an approximately even distribution, with 50% of patients diagnosed with COVID positive. The average age of the participants was 64+/-12, with 40% females. The mortality rate across all groups was 18%. We are still analyzing the remaining data and are confident that the data will be ready for presentation by January 2023. CONCLUSION(S): Given data extraction is in its early stages, we are unable to make confirmatory conclusions, but we think that being aware of the challenges with speech and swallowing post-extubation after suffering COVID-19. Nurses and Speech-Language Pathologists can be proactive in performing bedside swallow evaluation and using appropriate tools/devices for communication to improve the quality of life.
ABSTRACT
Introduction: Non-tested asymptomatic COVID-19 cases poses threat of transmitting the disease silently. The Siddha polyherbal formulation, hnology Kabasurakudineer, (KSK) was found to be effective in preventing viral replication of SARS-CoV-2 by in-silico studies. A pilot study was conducted to test the antiviral activity of KSK in asymptomatic individuals tested positive for COVID-19. Methods: A single centre, open labelled, randomized controlled study was carried out during June-August 2020, in Tertiary Medical College Hospital, after approval from the institutional ethics committee and registered in CTRI. RTPCR confirmed COVID-19 asymptomatic cases, aged 18-65 years, consented to participate were . included and those with co-morbidities like diabetes, hypertension, severe respiratory disease, malignancies, pregnant and lactating mothers were excluded. Hospitals of Semnan Uniiessi y 60 participants were randomly assigned to study and control group. Study group received KSK (60 ml) along with vitamin C in the morning and zinc in the night, while the control group (CZ) received vitamin C and zinc for 10 days. The primary outcome was the reduction in the SARS-CoV-2 load (ct value), prevention of progression to symptomatic state. Results: In the study group, there was faster reduction in the viral load in terms of ct value as all the 30 participants turned negative for SARS-Co-V2, while 4 remain positive in the control group on the 10th day. The inflammatory markers and serum cytokine findings were inconclusive. No one progressed to the symptomatic state and no adverse event was reported in either groups. Conclusion: This study demonstrated the potential of Kabasurakudineer in reducing the viral load. Further clinical studies are warranted with larger sample size.
ABSTRACT
Session Description: A landmark study found that in intensive care units (ICUs), tracheostomy incidents accounted for up to half of all airway-related deaths and hypoxic brain damage. Multidisciplinary adult and pediatric tracheostomy teams have achieved dramatic reductions in adverse events and improved patient outcomes, but dissemination of highly reliable practices has lagged. This panel addresses this gap by providing a strategy for rapid performance improvement with specific building blocks for enhancing care. Five key drivers-multidisciplinary ward rounds, standardized protocols, interdisciplinary education and staff allocation, patient and family involvement, and using data to drive improvement-can result in transformative change. We present data from 4 institutions, providing turnkey solutions and lessons learned from the creation of teams. We cover from the index procedure to decannulation and discharge, discussing obstacles encountered and how they are overcome. After presenting institution-level experience, we report on the largest implementation of these principles to date, drawing on prospectively captured patient-level global data from nearly 10,000 cases. We take a deep dive into a 3-year-long, 20-hospitalwide multipronged implementation that involved mixedmethods analysis, data tracking, and benchmarking to demonstrate powerful, statistically significant effects of reducing hospital and ICU length of stay, ventilator duration, time to cuff deflation, time to first vocalization, time to first oral intake, prevalence of anxiety and depression, and cost savings, projected at >$15,000 per patient. While heterogeneity is a defining feature of tracheostomy, we demonstrate how across age and geographies, multidisciplinary teams are a game changer in tracheostomy care. In addition, the imperatives of the COVID-19 pandemic have necessitated additional measures in relation to aerosol-generating procedures. We curate salient data and present practical evidence-based recommendations. Outcome Objectives: (1) Present building blocks and discuss obstacles to creating a multidisciplinary tracheostomy care team. (2) Leverage data-science and ongoing efforts to improve tracheostomy outcomes. (3) Compare the approaches of different hospital systems in the creation of tracheostomy care teams in the context of COVID-19.