ABSTRACT
Background: Geriatric patients with COVID-19 have had poor clinical outcomes globally, especially during the first wave of the pandemic. In Taiwan, the first wave of the COVID-19 pandemic occurred from May to July 2021. This retrospective study aimed to compare the characteristics and outcomes between geriatric and younger patients with COVID-19 infection. Methods: A total of 257 confirmed COVID-19 cases who were hospitalized from May to June 2021 were included. Their characteristics and outcomes, including in-hospital mortality, use of mechanical ventilation, and hospital stay, were collected for analysis. Results: There were 98 elderly patients (aged >= 65 years, median, 72.5 (interquartile range, 69.0-78.0) years) and 159 younger patients (aged < 65 years, median 55.0 (46.0-60.0) years). The elderly patients had a significantly higher Charlson comorbidity score (4.0 (3.0-5.0) vs. 1.0 (1.0-2.0), p < 0.001), and significantly higher D-dimer, procalcitonin, ferritin, and creatinine levels, but lower albumin level than the younger patients. The elderly group also had higher in-hospital mortality (7.1% vs. 1.9%, p < 0.05), were more likely to develop severe disease (83.7% vs. 67.9%, p < 0.01), and had a longer hospital stay (15.0 (11.0-23.0) vs. 12.0 (9.0-16.5) days, p < 0.001). Nevertheless, the elderly patients did not have a higher risk of using high-flow nasal cannulas (17.3% vs. 15.1%, p = 0.63) or mechanic ventilation (23.5% vs. 17.0%, p = 0.20). Conclusion: Elderly COVID-19 patients had significant higher risks of severe disease, mortality, and lon-ger duration of hospitalization, possible due higher rates of comorbidities and pro-inflammatory status. Copyright (c) 2022, Taiwan Society of Geriatric Emergency & Critical Care Medicine.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) can cause acute respiratory failure and acute respiratory distress syndrome (ARDS). The prone position (PP) is widely used in patients with severe hypoxemia due to ARDS as it improves oxygenation. The aim of this study was to investigate whether improvements in gas exchange and lung mechanics with the PP were associated with survival in ventilated COVID-19 patients. Methods: Fourteen ventilated patients who were placed in the PP were included from May to June 2021. Clinical manifestations and lung mechanics parameters were collected. Results: The overall intensive care unit (ICU) mortality rate was 42.9%. Nonsurvivors were older (p = 0.014) and had higher Charlson comorbidity index (2.1 +/- 1.5 vs. 4.8 +/- 2.4, p = 0.035) and Sepsis-related Organ Failure Assessment (SOFA) (3.3 +/- 1.0 vs. 7.3 +/- 3.5, p = 0.019) scores compared to survivors. There was no difference in PaO2/FiO(2) (P/F ratio) at baseline between the survivors and nonsurvivors. The improvement in P/F ratio (p = 0.0037) and reduction in driving pressure (Pdrive) (p = 0.046) on the second day after first PP were correlated with lower mortality. Significant predictors of successfully stopping prone treatment included a reduction in Pdrive at the first hour, lower tidal volume (Vt) at the fourth hour, and P/F ratio improvement on the second day after PP. Conclusion: Improvement in P/F ratio and reduction in driving pressure on the second day after PP were correlated with reduced mortality. Three parameters could predict successful resumption of the supine position. Copyright (c) 2022, Taiwan Society of Geriatric Emergency & Critical Care Medicine.
ABSTRACT
Background: A 19-year-old gentleman, with past history of sinusitis, aseptic meningitis upon birth & subsequent epilepsy, came back from the UK presenting with fever, sore throat, chills with myalgia, as well as pleuritic chest pain. Case: COVID-19 was ruled out. Despite appropriate medications, his chest pain worsened together with epigastric pain. Fever persisted. Urgent CT was arranged for him showing findings suspicious of pericarditis. Serial ECG after admission revealed the classical findings compatible with pericarditis. He was taken over to CCU with treatment for pericarditis started. Unfortunately, despite empirical broad spectrum antibiotics & anti-inflammatories, his symptoms worsened with borderline blood pressure, increasing tachypnoea & persistent fever. Blood tests showed sky high white cell count up to 50 with neutrophil predominance. Serial echocardiograms showed a gradual increase in posteriorly-loculated pericardial effusion with fibrin, with striking findings of constriction physiology. Significant respirophasic changes in mitral & tricuspid inflow were demonstrated. Right-sided cardiac chambers were not collapsed, rather, the RA & the IVC were dilated. CT was repeated for deteriorating hemodynamics showing a rim-enhancing pericardial effuision. Decision making: In view of the constrictive physiology demonstrated in echocardiograms, surgical intervention was deemed necessary for the patient & he was sent immediately to Queen Elizabeth Hospital Cardiothoracic Surgery team for emergency surgery. Conclusion: The classical teaching of constrictive pericarditis describes patients with prior insult to the pericardium such as surgery, previous tuberculosis infection, prior radiotherapy exposure, etc, such that the pericardium is calcified as a cage hindering the expansion of the heart. However, with the presence of purulent and fibrin-rich effusion, constrictive physiology can become evident and life-thereatening (Effusive-constrictive pericarditis) as well.