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SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: High Flow Nasal Cannula (HFNC) is a non-invasive ventilation (NIV) device widely used to manage hypoxemic respiratory failure. Data about optimal flow rate and time length for safety is lacking. Cases of spontaneous pneumomediastinum (SP) during HFNC oxygen therapy in COVID-19 patients have been recently reported. A study in airway models suggests a non-linear increase in PEEP up to 10 cmH2O in adults on maximum tested flows. Prolonged use of NIV could also delay escalation to invasive ventilation and use of lung-protective volumes (LPV). The ROX-index is a predictive tool for NIV failure and continuous evaluation of intubation indications. This study aimed to identify risk factors associated with the development of SP in COVID-19 ARDS on HFNC support and establish mitigating behavior that will aid in safer COVID-19 treatment modalities. METHODS: Cases from 2020 to 2022 were reviewed. Patients with SP while on HFNC were included as cases. Age and gender-matched patients who received HFNC and did not develop SP were controls. Baseline characteristics between groups were compared using t-test for continuous variables and chi-square for categorical values. Longitudinal ROX scores were calculated until the last day (day of pneumomediastinum development for SP group, and death or MV commencement for controls). Nominal logistic regression was performed to identify variables associated with SP development. Parameter Estimates were used to construct a prediction model, and a ROC curve was implemented to assess the accuracy of the prediction of SP events. RESULTS: Total 61 patients enrolled, 52% (32/61) developed SP on HFNC and 48% (29/61) were control group (CG). No statistical significance found on baseline demographics. Median HFNC days-to-SP was 7 [standard deviation (SD), 6.8 days]. Median days from COVID-19 diagnosis-to-SP was 9 (SD, 5 days). Use of MV was greater in SP group (29 vs 3, p-value < 0.001) and use of vassopresor support (28 vs 3, p-value < 0.001). SP-group had an increased mortality compared to CG, with 88% (28/32) vs.12% (3) (p-value, <0.001). Median ROX scores on Day 1 were 5.45 for SP group and 18.2 for CG (p<0.001). Median ROX scores on last day (day-to-event) were 4.08 and 9.4 in CG (p<0.001). Nominal logistic regression identified number of days on HFNC, ROX score on day 1, and cumulative amount of Flow rate, as independent variables associated with SP development. ROC of the Prediction model using parameter estimates from these 3 variables had an AUC of 0.922. CONCLUSIONS: Development of SP is associated with increased mortality. Patients with lower ROX scores at initiation of therapy, prolonged days of HFNC and increased cumulative flow rates are associated with the development of SP. CLINICAL IMPLICATIONS: HFNC has the potential to cause alveolar damage, however a larger patient population size is needed to further analyze the relationship of HFNC use and the development of SP. DISCLOSURES: No relevant relationships by Sofia Durscki Vianna No relevant relationships by Cynthia Espinosa No relevant relationships by Hernando Garcia No relevant relationships by Ephraim Mansour No relevant relationships by Laura Mendez Morente No relevant relationships by Zuleikha Muzaffarr No relevant relationships by Sergio Poli No relevant relationships by Luisa Quesada No relevant relationships by Douglas Salguero No relevant relationships by Michelle Yousefzadeh
ABSTRACT
Virus infections belonging to the Coronaviridae family are causal agents of respiratory, hepatic, intestinal, and occasionally neurological pathologies. They can cause ischemic stroke and cerebral hemorrhage by various mechanisms. This article is observational, retrospective, cross-sectional, descriptive. Series of cases of ischemic and hemorrhagic stroke treated at the "1 de Octubre" Regional Hospital from May 2020 to August 2020 associated with SARS-CoV-2 infection with the use of CT imaging diagnostic aids based on the CO-RADS classification, RT-PCR, clinical and imaging correlation of the stroke, considering its location and time of evolution. A total of 9 patients with CVD and COVID-19 were found: 4 patients with a history of SAH and 4 patients without comorbidities who debuted with CVD during COVID-19 infection, 1 with heart valve disease, the neurological symptoms collected were: headache, disorientation, dysarthria, motor aphasia, seizures, facial paralysis, hemiparesis, and hemiplegia. 7 patients with ischemic presentation, one of them had a hemorrhagic transformation and 2 only had hemorrhagic events. The hypercoagulable state associated with the hyperinflammatory response triggered by COVID-19 could be considered a possible cause of stroke. COVID-19 is a pathology related to cerebral vascular disease, causing ischemic pathology, but it can also have hemorrhagic characteristics.
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Background and importance Remdesivir is currently included in clinical guidelines for COVID-19 treatment. Although safety data were published in ACTT-1, the toxicity of this drug in regular clinical practice is still unknown. Aim and objectives In this study we aimedd to describe remdesivir's toxicity in patients only requiring supplemental lowflow oxygen (no high-flow oxygen requirements or other noninvasive ventilation at start of treatment). Material and methods Retrospective cohort including patients treated with remdesivir following Spanish Medicines and Health Products Agency criteria (non-critical patients requiring low-flow oxygen) between August and October 2020 in a tertiary- level hospital. Exclusion criteria were being under 18 years of age and participation in clinical trials with remdesivir. The percentage of adverse reactions occurring in the 14 days following on from the beginning of treatment was the primary outcome. Secondly, the number of treatment discontinuations were assessed. Categorical variables were expressed as proportions while continuous values were formulated as median and interquartile range (IQR). Results 264 patients were included (59.2% men, mean age 66 years;IQR 54-82). In the 14 days following on from the beginning of treatment, an adverse reaction (AR) was reported in 146 (55.3%) patients. In 91 (34.5%) of them it was grade ≥2 AR, in 31 (11.7%) grade ≥3 and in 8 (3.0%) of them grade ≥4. Median of days until toxicity began was 3.5 days (IQR 1.2-9.0). The most common AR was an increase in transaminases, which happened in 114 (43.2%) patients, 29.1% of them being grade ≥3 and 3.9% grade ≥4. Regarding renal toxicity, an increase in serum creatinine occurred in 51 (19.8%) patients, 27.5% of them being grade ≥3 and 9.8% grade ≥4. One patient suffered a grade 3 anaphylactic reaction during infusion and another one developed hepatitis during the follow-up period. Two more patients suffered gastrointestinal toxicity (grade 1-2 nausea and diarrhoea). During the study period, 31 (12.1%) patients discontinued remdesivir treatment,12.5% of them due to AR or toxicity related to the drug. Conclusion and relevance Increased transaminases was the most common AR in this population, matching remdesivir's European Public Assessment Report (EPAR) specifications, followed by an increase in the serum creatinine levels (frequency not detailed on the EPAR). However, only 12.5% of treatment discontinuations were due to adverse reactions or toxicity linked to remdesivir. Further investigation is needed to unravel the degree of involvement of the drug in this toxicity.
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Due to the measures imposed to prevent the spread of the virus during the COVID-19 pandemic, how education and work communications are carried have changed. An increase in video conferencing and meeting applications is noticeable. In this research paper, we describe the results of a user experience evaluation of three widely used platforms: Discord, Microsoft Teams, and Zoom. Through the User Experience Questionnaire (UEQ) application, it was determined that Discord is better in aspects not related to tasks and provides an above-average UX. On the other hand, zoom excels when it comes to tasks, but in conjunction with Microsoft Teams, it delivers below-average UX. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.