Efficacy and safety of high-flow nasal cannula therapy in elderly patients with acute respiratory failure.

INTRODUCTION: To assess the efficacy and safety of high-flow nasal cannula (HFNC) in elderly patients with acute respiratory failure (ARF) not due to COVID-19, refractory to treatment with conventional oxygen therapy and/or intolerant to noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) and without criteria for admission to intensive care units (ICU). METHODS: Prospective observational study of patients with ARF treated with HFNC who presented clinical and arterial blood gas deterioration after 24 h of medical treatment and oxygenation by conventional systems. The degree of dyspnoea, gas exchange parameters (arterial O2 pressure/inspired O2 fraction ratio (PaO2/FiO2); oxygen saturation measured by oximetry/ inspired fraction of oxygen (Sp02/Fi02), ROX index), degree of patient tolerance and mortality were evaluated. These were measured at discharge from the emergency department (ED), 24 h after treatment with conventional oxygenation and 60, 120 min and 24 h after initiation of HFNC. The results were analyzed for all patients as a whole and for patients with hypercapnia (arterial carbon dioxide tension (PaCO2) < 45 mmHg) separately. RESULTS: 200 patients were included in the study between November 2019 and November 2020, with a mean age of 83 years, predominantly women (61.9%), obese (Body Mass Index (BMI) 31.1), with high comorbidity (Charlson index 4) and mild-moderate degree of dependence (Barthel 60). A number of 128 patients (64%) were hypercapnic. None had respiratory acidosis (pH 7.39). Evaluation at 60 min, 120 min and 24 h showed significant improvement in all patients and in the subgroup of hypercapnic patients with respect to baseline parameters in respiratory rate (RR), dyspnoea, ROX index, PaO2/FiO2, SpO2/FiO2 and patient comfort. No changes in PaCO2 or level of consciousness were observed. HFNC was well tolerated. Ten patients (5%) died due to progression of the disease causing ARF. CONCLUSIONS: HFNC is an effective and safe alternative in elderly patients with ARF not due to COVID-19, refractory to treatment with conventional oxygen therapy and/or intolerant to NIV or CPAP and without criteria for admission to ICU.

EDI-CAT: quality strategy for pediatric covid-19 research in Catalonia

Ground. The sudden outbreak of the covid-19 pandemic resulted in a need to start coordinated research projects on the disease. The creation of the COPEDI-CAT group (July 2020;more than 170 professionals) to study pediatric covid-19 in Catalonia represents a good example of this effort. Objective. To disseminate the results of the COPEDI-CAT group to show the feasibility of a quality muftidisciplinary research strategy with wide participation of primary care (PC). Method. Review of the scientific production of the COPEDI-CAT group generated by a muftidisciplinary team. The group reviewed ongoing studies and collected data, proposed new projects, implemented interventions recommended by expert professionals (local, national, and international), and created a space for debate and monitoring of the pandemic. Results. The main questions about the symptoms, transmissibility, severity, and main complications of covid-19 in pediatrics (multisystem inflammatory syndrome and long covid-19) have been addressed. This research has generated papers at national and international conferences, high-impact scientific publications, recommended clinical guidelines for the management of long covid-19, clinical prediction models, research grants (Prandi and Marató TV3 scholarship) and the participation in the «Escoles Sen-tinella» project. Conclusions. The covid-19 pandemic has represented a unique opportunity to carry out quality multidisciplinary research in pediatrics at PC. COPEDI-CAT can be a model for future research on diseases that affect children and adolescents in our country.

CURVE4COVID: Comprehensive understanding via representative variable exploration for COVID-19

Coronavirus disease 2019 (COVID-19) has been one of the most severe global pandemics in the 21st century. By the end of 2020, more than 83 million cases were confirmed, and more than 1.6 million deaths were reported globally. Understanding how COVID-19 spreads across diverse communities is key to public health surveillance and management for such a devastating and highly infectious disease. Current studies mainly analyze either non-human factors or human factors, focusing on a limited number of variables that can influence COVID-19 transmission. However, in a real-world context, these factors interact with each other and collectively shape the infection rate curve. Therefore, a comprehensive study based on both non-human and human factors on a large scale is required to fully understand disease transmission. Here, we propose a research framework named Comprehensive Understanding via Representative Variable Exploration for COVID-19 (CURVE4COVID). With the accessibility of various data online, including COVID-19-related Google Trends (e.g., human search behavior) and government-managed data (e.g., weather, air pollution, economic indicators), we conduct a large-scale and multi-variable analysis of the critical factors for COVID-19 transmission, which can shed light on the complexity of infectious disease management. The results demonstrate that combining non-human and human factors provides better predictive power for infection rates than non-human factors or human factors alone. This study's findings can provide new insights into disease transmission and help policymakers enhance preventative measures and healthcare management, thus having a far-reaching impact on society. © AMCIS 2021.

Secondary infections in mechanically ventilated patients with COVID-19: An overlooked matter?

OBJECTIVE: The susceptibility to infection probably increases in COVID-19 patients due to a combination of virusand drug-induced immunosuppression. The reported rate of secondary infections was quite low in previous studies. The objectives of our study were to investigate the rate of secondary infections, risk factors for secondary infections and risk factors for mortality in COVID-19 critically ill patients. METHODS: We performed a single-center retrospective study in mechanically ventilated critically ill COVID-19 patients admitted to our Critical Care Unit (CCU). We recorded the patients' demographic data; clinical data; microbiology data and incidence of secondary infection during CCU stay, including ventilator-associated pneumonia (VAP) and nosocomial bacteremia (primary and secondary). RESULTS: A total of 107 patients with a mean age 62.2 ± 10.6 years were included. Incidence of secondary infection during CCU stay was 43.0% (46 patients), including nosocomial bacteremia (34 patients) and VAP (35 patients). Age was related to development of secondary infection (65.2 ± 7.3 vs. 59.9 ± 12.2 years, p=0.007). Age ≥ 65 years and secondary infection were independent predictors of mortality (OR=2.692, 95% CI 1.068-6.782, p<0.036; and OR=3.658, 95% CI 1.385- 9.660, p=0.009, respectively). The hazard ratio for death within 90 days in the ≥ 65 years group and in patients infected by antimicrobial resistant pathogens was 1.901 (95% CI 1.198- 3.018; p= 0.005 by log-rank test) and 1.787 (95% CI 1.023-3.122; p= 0.036 by log-rank test), respectively. CONCLUSIONS: Our data suggest that the incidence of secondary infection and infection by antimicrobial resistant pathogens is very high in critically ill patients with COVID-19 with a significant impact on prognosis.

Acceptability and preferences for a smartphone intervention among liver transplant recipients: Prototype for the liveright transplant app

Background: Smartphone applications are on the rise;yet it is unclear whether liver transplant (LT) recipients would use or benefit from this technology. We aimed to understand baseline smartphone practices and identify preferences for an app-based intervention to guide the development of the LiveRightTM Transplant app among LT recipients Methods: Twenty in-depth, in-person interviews were conducted from 2019-2020 among adults 3 to 6 months after LT at the University of North Carolina We evaluated baseline use of smartphone technology, as well as acceptability of and preferences for a LT app Interviews were conducted by trained qualitative experts and analyzed in an iterative fashion using a thematic content approach to identify relevant themes Coded transcripts were analyzed using Dedoose qualitative software Results: Among 20 LT recipients, median age was 61 years (range 28-68);65% were male;60% Caucasian;40% underwent LT for non-alcoholic fatty liver disease, 20% for viral hepatitis, and 10% for alcohol-associated liver disease Patients lived 76 miles (range 14-270) from the hospital A majority (90%) of patients owned smartphones In addition to calls, text, and email, smartphone users engaged in social media including Facebook (55%), sought information through search engines (50%), and played games or watched videos (30%) on their phones Most (65%) used EPIC MyChart to communicate with the transplant team and set phone alarms for medication reminders A majority (80%) were interested in a LT app that enabled: 1) anonymous and secure ways to connect with other LT recipients, 2) logging biometric data, 3) medication reminders including real time updates of dosages, 4) virtual communication with the medical team (after hours or early in post-LT recovery when difficult to travel to clinic), and 5) vetted educational materials especially on medication side effects/symptoms, diet, and physical activity (Figure 1) Conclusion: LT recipients want a smartphone app to aid in their recovery Most important to them is connecting with other LT recipients for peer support, educational resources related to expectations, symptoms and medication side effects, and easy options to log biometric data to be shared with their transplant team With the advent of COVID-19, using smartphone interventions will be critical to improving transplant outcomes These data informed the development of the LiveRightTM app with pilot testing underway. (Table Presented).