ABSTRACT
Background: COVID-19 patients who develop hypoxemic respiratory failure despite conventional oxygen therapy usually require high flow nasal oxygen (HFNO) or non-invasive ventilation (NIV). Aim: To compare the effect of both in managing COVID- 19 induced respiratory failure and to determine whether HFNO decreases the rate of intubation when compared with NIV. Settings and design: Single centre, retrospective observational study. Materials and methods: Data collected from medical records. As per the inclusion criteria, patients who received either HFNO or NIV as initial therapy for at least 2 calendar days were analysed. Both the therapies were compared in around 200 patients (HFNO = 100, NIV = 100), with the rate of intubation at day 14 as the primary outcome and length of ICU stay, hospital stay, mortality at day 28, no. of ventilatory free days, complications during ICU stay and comfort score as secondary outcomes. Statistical analysis: Data analysis was done using SPSS software. p value < 0.05 was considered statistically significant. Results: The rate of intubation and mortality rates were higher in the NIV group (P = 0.001), whereas there was no difference in length of hospital or ICU stay among the both (P = 0.15, 0.75, respectively). HFNO group patients were more comfortable (P < 0.05). Conclusion: HFNO is effective in the management of COVID- 19 induced acute hypoxemic respiratory failure with a lower rate of intubation, lower mortality rate, and better tolerance compared to NIV though it does not reduce the duration of ICU or hospital stay.
ABSTRACT
The COVID-19 pandemic has ravaged populations across the globe. The toll taken is unprecedented in the modern age. Aside from this obvious morbidity and mortality, there is an under-appreciated pandemic of mental illness that is sweeping across the world. Mental health issues in health care professionals have long since been identified to be a significant problem. Our experiences during previous similar epidemics have shown that such situations take a huge toll on the physical as well as mental health of personnel affected, either directly by infection or indirectly by the social and economic consequences of the pandemic. The health care worker may find him/herself in a very challenging situation, dealing simultaneously with multiple sources of stress in an ever-changing environment. These manifest in the form of serious mental issues such as depression, anxiety, stress, sleep disturbances, and posttraumatic stress disorder, to name a few. These can have a longlasting impact on the psychological makeup of the victims. We conducted this survey-based study to assess the prevalence of depression and anxiety among a wide range of personnel involved in health care, in different settings, working in the front line and nonfront line scenarios. Aims and objectives: To assess the prevalence of developing anxiety and depression among health care workers during the COVID-19 pandemic and to compare the prevalence thereof based on various factors such as occupation, pre-existing health issues, level of work, social background, working directly with infected patients. Materials and methods: Survey-based, prospective, observational cohort study including data collection over 1 month. The online survey was circulated as a Google Form and made available to all healthcare workers pan India. The study included the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7) scale along with other personal information, gathered anonymously. The paired t-test and Mann- Whitney U-test were used to determine the statistical significance. Results: The mean age of the population was 39.9 years, with equal distribution among the sexes. 70% of subjects were married and 76% lived with their families. The commonest co-morbidities were hypertension (n = 66), obesity (n = 61), diabetes (n = 37). 60.4% had PG qualifications, 69.3% were treating physicians, and 49.4% were consultants. 90.3% worked in urban settings, 65.5% worked at the tertiary level. 37.4% worked directly with COVID-19 patients. 24.4% of respondents worked in ICU, 14.7% in OPD, 12% in ward settings. Gross prevalence of depression was 43% (mild: 22.6%, moderate 11.2%, moderate-severe 5.1%, severe: 3.9%). Prevalence of anxiety was 47% (mild 26%, moderate 13%, severe 7%). Depression was commoner among men (p = 0.04), those in a relationship (p = 0.00), those with children (p = 0.00) in older age groups, with higher positions and educational qualifications, and those with co-morbidities (p = 0.0). It was less prevalent in front-line workers, including physicians (p = 0.00). Among the front-line workers, depression and anxiety were more prevalent among physicians (p = 0.01). Depression was commoner in OPD and ED settings (p = 0.00), and less for people getting quarantine period (p = 0.00). Conclusion: Our survey shows a higher than average prevalence of anxiety and depression among health care workers in India as compared to non-pandemic periods. We have also identified groups that are at higher risk for mental health issues .
ABSTRACT
Aim and background: Mechanical Power in ARDS has predictive value for both VILI and mortality. Driving pressure and mechanical power are two new targets in the mechanical ventilation of ARDS patients. COVID-19 pneumonia has two different phenotypes H type and L type which have different lung compliance, elasticity, and recrutability with different ventilatory strategies. We want to observe how Mechanical Power behaves in H type COVID-19 ARDS and its correlation with compliance and driving pressure. Objective: To study the correlation of Mechanical Power with Driving Pressure and Compliance in H type of COVID-19 pneumonia. Materials and methods: It is a prospective observational study conducted in COVID-19 patients admitted to the Medical Intensive Care unit. We included 65 adult COVID-19 patients aged between 18 and 70 years requiring invasive mechanical ventilation for at least 24 hours. Patients who developed spontaneous pneumothorax and pneumomediastinum before initiation of mechanical ventilation were excluded. Patients were categorised to H type based on lung compliance (<40 mL/cmH2O), recrutability, and lung weight. The Mechanical Power was calculated using the following equation, MP = 0.098 × TV × RR (Paw-1/2 ΔP). Paw-peak airway pressure, ΔP-driving pressure, TV-tidal volume, RR-respiratory rate. The variables are taken at 3 different time intervals in the first 24 hours of invasive mechanical ventilation. All patients are ventilated according to ARDSNET protocol. The Driving pressure and compliance were recorded. The correlation of Mechanical Power with Driving pressure and Compliance were analysed using Pearson Correlation. Results: The mean age of the patients was 57.04 ± 13.96 years (mean ± SD), gender distribution 75% were males and 25% were females. A positive correlation was observed between Mechanical power and Driving pressure (Pearson correlation 0.245) which is statistically significant p = 0.049. A negative correlation was observed between Mechanical power and Compliance (Pearson correlation 0.183) which is not statistically significant. Conclusion: The Mechanical Power and Driving pressure the new targets of Ventilator-Induced Lung Injury (VILI) and also predictors of mortality in ARDS patients. The positive correlation between Mechanical Power and Driving pressure was observed in H type of COVID-19 patients which behaves similar to other ARDS and independent risk factors of mortality in H type of COVID-19 ARDS too.
ABSTRACT
In late 2019, China reported cases of respiratory illness in humans, which involved a novel Coronavirus SARS-CoV-2 (also known as 2019-nCoV). The World Health Organization (WHO) termed the disease COVID-19 (i.e., Coronavirus disease 2019). Most of the morbidity and mortality from COVID-19 is largely due to acute viral pneumonitis that leads to acute respiratory distress syndrome (ARDS). This article will discuss the clinical features of the multiorgan involvement in COVID-19 as well as the management of patients who become critically ill due to COVID-19.