Oral mucosal lesions in moderate-to-severe COVID-19 Disease - An Indian critical care unit experience

Severe acute respiratory syndrome coronavirus 2 is a widespread worldwide public health malady due to a viral COVID-19 infection. The World Health Organization has affirmed this malady as a pandemic and Public Health Emergency of International Concern. A wide array of oral lesions has been reported in patients with COVID-19. Oral lesions can be an initial sign of COVID-19 or an alarming sign of peripheral thrombosis. However, there is a scarcity of published literature on the oral manifestations of COVID-19 in hospitalized patients. We present four different types of oral lesions in hospitalized patients with moderate-to-severe COVID-19 disease. This article proposes that a detailed examination of the oral cavity in patients admitted to COVID-19 intensive care unit/high dependency units will help to understand the significance of the oral lesions in the management of the disease. Dental professionals should be a part of the multidisciplinary treatment protocol, thus, emphasizing a detailed and meticulous oral examination and oral health amelioration of COVID-19 patients. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Helmet niv in hypoxemic respiratory failure due to severe COVID-19 pneumonia: A descriptive study

Introduction: The utility of HELMET-noninvasive ventilation (NIV) for severe COVID-19 pneumonia-related hypoxemic respiratory failure remains unclear. Materials and methods: This is an observational descriptive study conducted at a tertiary care hospital in Noida, India. We included adult patients (aged >19 years) with hypoxemic respiratory failure due to severe COVID-19 pneumonia, who were treated with HELMET-NIV. The primary outcome was the proportion of patients who were successfully weaned from HELMET-NIV, while failure comprised of patients who required intubation. Results: Total of 30 patients were included (mean (±SD) age 57.1±11.9 years). 25 (83.3%) patients were male. Mean baseline PaO2-FiO2 ratio (PFR) was 150.1±57.4 mm of Hg in 30 patients. 19 (63.3%) patients could be successfully weaned from HELMET-NIV. Invasive mechanical ventilation was required in 9 (30%) patients out of which 8 (26.7%) patients died. Total of 22 (73.3%) patients could be discharged home. Receiver operative characteristic (ROC) curve to find optimum cut off PFR at 24 hours (PFR-24) was plotted to predict NIV success: a cut off point that maximized sensitivity and specificity (youdens index) was at PFR 170 with sensitivity and specificity of 71.4% and 88.9% for NIV success, respectively. 7 patients observed complications, of which 5 had mask deflation, 1 complained of noise and 1 patient had barotrauma. Discussions: The role of NIV in hypoxemic respiratory failure is getting more and more recognition. HELMET interface is a new method of applying NIV. In the setting of the COVID-19 pandemic, the HELMET interface can be an effective method of delivering NIV. It has been described as an aid to decrease virus spread by decreasing aerosol generation. Also, higher pressures can be applied as compared to face mask NIV. In our study, more than 50% of patients could be successfully weaned from NIV. The rate of any major complications was low: only 1 patient had barotrauma (subcutaneous emphysema). However, it is an observational and single-center study. Larger and multicenter studies are needed to support the above findings. Conclusion: HELMET-NIV for severe COVID-19 pneumonia-related hypoxemic respiratory failure is feasible. The rate of any major complications is low.