STUDY ON OUTCOMES OF NONINVASIVE VENTILATION IN PATIENTS WITH RESPIRATORY FAILURE AND FACTORS DETERMINING OUTCOME

SESSION TITLE: Late Breaking Posters in Critical Care SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Respiratory failure is a life threatening emergency and the management of respiratory failure includes invasive or non-invasive ventilation based on the various clinical parameters. Hence the present study was conducted to assess the outcome of NIV in patients with respiratory failure and to determine the factors predicting the outcome. METHODS: This Prospective observational study had included a total of 104 subjects.The demographic details, clinical examination,vitals and arterial blood gas levels at 0,1, 4 and 24 hours were analyzed among study subjects. Descriptive analysis was carried out, that include mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Parametric statistics used were paired t test and ANOVA.Non parametric statistics used were Chisquare test.At 95% Confidence interval, p value of <0.05 was considered to be statistically significant. Multivariate Regression analysis was done to predict the factors determining outcome of NIV. The data was entered in excel sheet and analyzed using SPSS (Version 16). RESULTS: The mean age of the study population was 52.88±16.58 years.70.78% success rate was found among males and 29.23% success rate was found among females. The difference between gender and outcome was not statistically significant.There was no statistical significant association observed between BMI and outcome of NIV ( p value 0.84).Higher rate of success was seen among subjects with COPD (43.37%) followed by COVID 19 patients (18.07%), acute pulmonary edema and pneumonia (9.64% each), ARDS (8.43%).In our study, the difference between etiological diagnosis and outcome was found to be statistically significant in ARDS (P value 0.02), pneumonia (P value 0.04) and COPD (P value 0.007). Patients with GCS < 8, 12% were successful and GCS >8, 78.48% were successful. The difference between GCS and outcome was found to be statistically significant (P value <0.0001). All ABG parameters at 0, 1, 4 and 24 hours (except PaCo2 at 4 and 24 hours) were statistically significant to predict outcome of NIV. CONCLUSIONS: A successful outcome of 62.5% was observed in the subjects initiated on NIV for respiratory failure, COPD being the major etiological diagnosis and the factors determing NIV were based on etiological diagnosis, GCS and Arterial Blood gas parameters. CLINICAL IMPLICATIONS: Though studies on outcome of NIV are available involving multiple variables including sociodemographic data, clinical and ABG parameters, there are only limited Indian studies to determine NIV outcome based on etiological diagnosis, comorbidities, GCS and ABG parameters at different time intervals affecting outcome of NIV in respiratory failure.Thus, the present study was conducted to study the outcome of non-invasive ventilation in patients with respiratory failure and to determine the above factors that affect the outcome of non-invasive ventilation DISCLOSURES: No relevant relationships by Sahana K No relevant relationships by SURESH SAGADEVAN

Clinical and laboratory profile of children with COVID-19 admitted at a tertiary care hospital in Karnataka, Southern India

We like to share some ideas on the publication “Clinical and laboratory profile of children with COVID-19 admitted at a tertiary care hospital in Karnataka, Southern India”1. Sahana KS, et al1 concluded that “Presence of undernutrition and elevated C-reactive protein were associated with severe illness”. In this study, some laboratory parameters were studied and there might be important confounding effects. As Sahana KS, et al1 noted, some children have nutritional problems which might affect some laboratory parameters such as ferritin and haemoglobin. Additionally, a nutrition risk screening (NRS) score should be applied. In a previous report, NRS score was a good predictor for clinical outcome in cases with sepsis and it might be applicable to cases with COVID-192. Finally, the treatment given to different children might be different and it can result in different clinical outcomes. Those cases with atypical presentation may have received additional medications and it can affect both clinical outcome and clinical parameters. For example, steroids can affect the platelet count and might help to improve the clinical outcome. © 2018. Intertax. All rights reserved.

Clinical and laboratory profile of children with COVID-19 admitted at a tertiary care hospital in Karnataka, Southern India

Objectives: To assess the clinical characteristics, laboratory parameters and outcomes in paediatric patients with COVID-19. Method: Case records of all paediatric patients admitted with COVID-19 were included in the study. Data regarding mode of presentation, presence of comorbid conditions, severity of COVID-19, laboratory investigations and management were noted. Results: A total of 32 children was admitted with COVID-19 infection in our institute. COVID-19 infection was mild in 16 (50%) patients, moderate in 6 (18.8%) and severe in 10 (31.3%). Ages of the children ranged from 6 months to 16 years with a mean age of 10.75 years. Of them 17 (53%) were boys and 15 (47%) were girls. Pre-existing comorbidities were present in 8 (25%) children. Respiratory symptoms were the commonest presenting complaints, being observed in 18 (59%) cases. Atypical presentation of COVID-19 (other than respiratory) was seen in 31% of cases. Presence of undernutrition and elevated C-reactive protein (CRP) were associated with severe Covid-19 illness (p<0.05). Eleven (34%) cases required intensive care and mechanical ventilation was required in 2 (6.3%) cases. Out of the 32 cases only 1 patient expired giving a case fatality rate of 3.1%. Conclusions: Atypical presentation of COVID-19 with varied manifestations involving systems other than respiratory was observed in children as a separate entity from hyper-inflammatory syndrome. Presence of undernutrition and elevated CRP was associated with severe illness. © 2021,Sri Lanka Journal of Child Health. All rights reserved.

A case of secondary hemophagolymphohistiocytosis post sars cov2 infection

Aims & Objectives: Introduction. Coronavirus SARS-CoV-2, has been associated with a hyperinflammatory state. This has been described as a form of secondary haemophagocyticlymphohistiocytosis that may contribute to increased mortality and is characterised by a fulminant and fatal hypercytokinaemia with multiorgan failure. In adults, HLH is most commonly triggered by viral infections and sepsis. Cardinal features of HLH include unremitting fever, cytopenias, and hyperferritinaemia;pulmonary involvement (including ARDS).We report a case where secondary HLH was noted in a patient with COVID19 infection. Patients/Materials & Methods: Case Report. A 6 year old female child was admitted to the hospital with complaints of fever since3 days. Fever was high grade in nature and of sudden onset with no previous respiratory symptoms. During her stay she developed nonproductive cough. The patient also had an episodeofhematemesis followed by 2 episodes offres hblood perrectum and 1 episode of seizure.Onphysicalexaminationpatient had tachypnea with pallor andhepatomegaly. Hematological parameters were estimated using Automated Sysmex XN-1000 and Biochemical parameters using Vitros 5600 fully automated chemistry analyzer. Results: Hb was 5.1 gm/dl, TLC was 21.2 × 103 and platelet count was 11 × 103. Peripheral smear examination showed normocyticnormo chromicanemia with neutrophilicleucocytosis and thrombocytopenia.Clotting profile and creatinine levels were with in normal range. LFT was deranged with an elevated ESR, LDH,D- Dimer and serumferritin levels.USG showed mildascites and bilateralminimalpleuraleffusion. MDCT revealed Bilateralconsolidation with airbronchogram. Dengue SPOT and IgG for SARSCoV2 was interpreted as positive. Bone marrow showed few large foamyhistiocytesexhibitingphagocytosis of blood cells. Hence the cytopenias were presumed to be due to increased peripheral destruction. Weilfelix reaction showed decreased titre and the patient was diagnosed to have Rickettsialfever. Patient was transfused with packed RBCS and platelets. She was started on antiepileptics, antibiotics and exoxaparinprophylactically. Dexamethasone was also given for 11 days for the management. Discussion & Conclusion: Conclusion: Mortality is increased in patients with Secondary HLHin COVID19. Screening for HLHis recommended in COVID19 patients presenting with bicytopeniaorpancytopenia.

Molecular screening of antimalarial, antiviral, anti-inflammatory and HIV protease inhibitors against spike glycoprotein of coronavirus.

Coronavirus outbreak in December 2019 (COVID-19) is an emerging viral disease that poses major menace to Humans and it's a crucial need to find the possible treatment strategies. Spike protein (S2), a envelop glycoprotein aids viral entry into the host cells that corresponds to immunogenic ACE2 receptor binding and represents a potential antiviral drug target. Several drugs such as antimalarial, antibiotic, anti-inflammatory and HIV-protease inhibitors are currently undergoing treatment as clinical studies to test the efficacy and safety of COVID-19. Some promising results have been observed with the patients and also with high mortality rate. Hence, there is a need to screen the best CoV inhibitors using insilico analysis. The Molecular methodologies applied in the present study are, Molecular docking, virtual screening, drug-like and ADMET prediction helps to target CoV inhibitors. The results were screened based on docking score, H-bonds, and amino acid interactions. The results shows HIV-protease inhibitors such as cobicistat (-8.3kcal/mol), Darunavir (-7.4kcal/mol), Lopinavir (-9.1kcal/mol) and Ritonavir (-8.0 kcal/mol), anti-inflammatory drugs such as Baricitinib (-5.8kcal/mol), Ruxolitinib (-6.5kcal/mol), Thalidomide (-6.5kcal/mol), antibiotic drugs such as Erythromycin(-9.0kcal/mol) and Spiramycin (-8.5kcal/mol) molecules have good affinity towards spike protein compared to antimalarial drugs Chloroquine (-6.2kcal/mol), Hydroxychloroquine (-5.2kcal/mol) and Artemisinin (-6.8kcal/mol) have poor affinity to spike protein. The insilico pharmacological evaluation shows that these molecules exhibit good affinity of drug-like and ADMET properties. Hence, we propose that HIVprotease, anti-inflammatory and antibiotic inhibitors are the potential lead drug molecules for spike protein and preclinical studies needed to confirm the promising therapeutic ability against COVID-19.