Persistent P Plateau Pressure Elevation Versus Sporadic: Which Is a Better Indicator of Mortality?

INTRODUCTION: ARDS net trial recommends keeping low tidal volumes (6-8 cc/IBW) and plateau pressures less than 30 cm H20. However, it is not well studied if sporadic elevation or continuous elevation of plateau pressures results in poor outcomes. We hypothesize that persistent elevation of p plat for >24 hrs. or > 6 times (measured 4 hrs. apart) continuously is associated with increased mortality. METHOD(S): Retrospective chart review of patients admitted with COVID-19 during the surge of August to September 2021 at Houston Methodist Baytown hospital. Inclusion Criteria- COVID-19 patients with respiratory failure, ards and intubated. Plateau pressures are recorded every 4 hrs. Data obtained from EPIC ICU flowsheet. Persistent elevation was defined as all the plateau pressures measured for > 24 hrs. and are continuously elevated. Exclusion criteria - patients admitted to ICU with cardiac arrest, patients who are covid negative and covid positive, but no ARDS are excluded. Tidal volume recorded is when the first highest p plateau pressure was documented. Descriptive statistics and t-tests were used to interpret the results. RESULT(S): Out of a total of 48 patients, only 12 patients survived, and 36 patients died. Mortality rate- 75%. Survivors vs. non survivors average Age(y) 42 vs.55 (p< 0.05), Tidal volume 5.98 ml/PBW vs.6.03 ml/PBW (p=0.105), Normal elastance 4.06 vs. 4.07(p=0.44), Delta P 22 vs.23(p=0.27) and ventilatory ratio 84 vs. 98(p< 0.05) were calculated during maximum plateau pressures. In patients with continuous p plat >30, 29 (85%) patients died and 5 (15%) survived. OR- 5.8 (P< 0.05). Out of the 5 patients that survived 2 went on ECMO. Intermittent p plat elevation was noted in 11 out of 14 patients who did not have continuous p plat elevation. CONCLUSION(S): Ventilatory ratio, a simple index of impaired ventilation and physiological dead space was higher in nonsurvivors compared with survivors. Continuous p plat elevation for more than 24 hrs. that is resistant to intervention might be an indirect indicator of worsening lung ventilation and increasing mortality. Rather than a single-time daily measurement of variables like delta P or p plateau pressure multiple measurements and trends might be helpful to prognosticate patients that might have poor outcomes and indicate worsening lung function.

Descriptive Study Evaluating Protocol-Driven Spontaneous Breathing Trials Pre-Covid and during Covid

INTRODUCTION: Spontaneous breathing trials are a part of the ABCDEF bundle to improve outcomes like decreasing mechanical ventilator days, hospitalization, and ICU LOS. Protocol-guided SBT has been shown to help in this process successfully. There is not much data comparing pre-Covid-19 to during Covid -19 years in terms of ability to meet the protocol-driven SBT trial and outcomes after meeting the criteria. We sought to compare the above through our study. METHOD(S): We reviewed the ventilator-related data at Houston Methodist Baytown hospital from 2018 to 2021. 2018-2019 Pre Covid-19 compared to 2020-2021 Covid -19 years. SBT protocol that the Houston Methodist system has approved has been used for evaluating patients. Descriptive statistics and t-test were used to compare the groups. RESULT(S): Comparing pre-covid-19 to covid-19 years data, the number of ventilator days doubled during the COVID period 5664 vs.10705 (p < 0.05). There were fewer patients meeting protocol-guided SBT criteria and less percentage of daily SBTs being performed (31 % vs. 18%,p< 0.05). % of SBTs passed (44% vs. 32%, p< 0.05) pre COVID-19 compared to COVID years. Once SBTs passed, the number of patients receiving liberation orders was the same (78% vs. 79 %, p=0.37). CONCLUSION(S): There were more ventilator days during the covid years of 2020-2021. Following the protocol, there were a lesser number of SBTs performed and passed during the COVID-19 years. This is most likely due to COVID -19 related lung injury, prolonged use of medications like a neuromuscular blockade, higher sedation that might have caused diaphragmatic weakness, prolonged ventilator days, and inability to meet the SBT criteria. Other factors like healthcare workers shortage or increased patient-to-nursing, Respiratory therapist shortage, and physician ratios might have also contributed. Patients might be harder to wean with COVID -19, and early tracheostomies and disposition might be considered in COVID-19 patients.

Icu-Acquired Delirium in Covid Year of 2021 and Its Outcomes: A Retrospective Study

INTRODUCTION: ICU-acquired delirium results in increased LOS, duration of mechanical ventilation, and mortality. Patients with COVID are at increased risk. Current literature suggests that delirium without coma occurs in at least about 30 % of COVID patients admitted to ICU. In our ICU we use an EPIC EMR-based daily ICU checklist with ABCDEF bundle during our rounds and utilized virtual ICU during the daytime in addition to the nights with peak surges. With our study, we wanted to evaluate the incidence of Delirium during our COVID year of 2021 and its relation to Mortality rate and ICU Length of stay (LOS). METHOD(S): A retrospective evaluation of patients admitted to Houston Methodist Baytown ICU from January to December 2021. Patients with covid positive were included. Data were obtained from the EPIC and ICU dashboard. Compliance with the ABCDEF ICU checklist was reviewed by auditing 20 patient charts per month. Delirium screening compliance was evaluated on AM and PM shifts for all ICU patients. Hospital ICU acquired delirium % was defined as all patients discharged from the ICU unit in that month that didn't have a positive CAM-ICU in the first 48 hrs. and then had a positive CAM-ICU after 48 hrs. in the ICU. ICU Mortality rate is defined as the percentage of patients with ICU stays who expired during ICU stay. Descriptive statistics and linear regression were used to compare and correlate. RESULT(S): In 2021, we had 377 ICU patients with COVID positive, an Average CMI of 4.986, and a LOS index of 1.24. Compliance with the daily ABCDEF ICU Checklist was 98%. Compliance to am screening was 89.41% vs. pm screening 90.56%. Mean Incidence of ICU acquired Delirium in COVID patients was only 7.14 % (2.77- 15.22) with peaks occurring during COVID surges. Linear regression analysis predicted a strong direct relationship between Delirium % and ICU Mortality rate (P< 0.05), and ICU Length of Stay(P< 0.05). CONCLUSION(S): Our data from 2021 shows Delirium % that is significantly less than the incidence. The lower % might have been from continuing to adhere to the ABCDEF bundle, utilization of the ICU checklist, and effective use of virtual ICU. Hospital ICU acquired delirium % correlated with ICU mortality and ICU length of stay. Hence, it is important to continue to focus on ways to decrease ICU delirium.

Attenuated initial serum ferritin concentration in critically ill coronavirus disease 2019 geriatric patients with comorbid psychiatric conditions.

We examined the effects of psychiatric comorbidity, sex, and ICU admission on serum ferritin concentration in 628 elderly patients (79.7 ± 8.5 years) with positive SARS-CoV-2 PCR test. Hospitalization was required in 96% of patients and 17% required ICU admission. Patients with COVID-19 and psychiatric comorbidities (n = 212) compared to patients without psychiatric comorbidities (n = 416) had significantly lower ferritin concentration (570.4 ± 900.1 vs. 744.1 ± 965, P = 0.029), a greater incidence of delirium (22.6 vs. 14.4%, P = 0.013) and higher mortality (35.3 vs. 27.6%, P = 0.015). Furthermore, we found significant effects for sex (P = 0.002) and ICU admission (P = 0.007). Among patients without comorbid psychiatric conditions, males had significantly higher ferritin compared to females (1,098.3 ± 78.4 vs. 651.5 ± 94.4, P < 0.001). ICU patients without comorbid psychiatric conditions had significantly higher serum ferritin compared to ICU patients with comorbid psychiatric conditions: (1,126.6 ± 110.7 vs. 668.6 ± 156.5, P < 0.001). Our results suggest that the presence of comorbid psychiatric conditions in elderly patients with COVID-19 is associated with higher rates of delirium and mortality and lower ferritin levels during severe illness. Whether high serum ferritin is protective during severe infection requires further investigation.

Oil immersed lossless total analysis system for integrated RNA extraction and detection of SARS-CoV-2.

The COVID-19 pandemic exposed difficulties in scaling current quantitative PCR (qPCR)-based diagnostic methodologies for large-scale infectious disease testing. Bottlenecks include lengthy multi-step processes for nucleic acid extraction followed by qPCR readouts, which require costly instrumentation and infrastructure, as well as reagent and plastic consumable shortages stemming from supply chain constraints. Here we report an Oil Immersed Lossless Total Analysis System (OIL-TAS), which integrates RNA extraction and detection onto a single device that is simple, rapid, cost effective, and requires minimal supplies and infrastructure to perform. We validated the performance of OIL-TAS using contrived SARS-CoV-2 viral particle samples and clinical nasopharyngeal swab samples. OIL-TAS showed a 93% positive predictive agreement (n = 57) and 100% negative predictive agreement (n = 10) with clinical SARS-CoV-2 qPCR assays in testing clinical samples, highlighting its potential to be a faster, cheaper, and easier-to-deploy alternative for infectious disease testing.

Parentage-based tagging combined with genetic stock identification is a cost-effective and viable replacement for coded-wire tagging in large-scale assessments of Canadian salmon fisheries

I present responses to arguments offered by coded-wire tag (CWT) proponents supposedly limiting the effectiveness of a genetic stock identification (GSI) and parentage-based tagging (PBT) fisheries assessment method. I demonstrate that a GSI-PBT-based assessment method is cheaper, more powerful, and more informative than traditional CWTs. Implementation of a GSI-PBT for Canadian fisheries assessment can provide information at least equivalent to that derived from the current CWT assessment program. Adoption of a GSI-PBT assessment program will facilitate mass-marking of Chinook salmon (Oncorhynchus tshawytscha) in British Columbia, has allowed for genetic tagging during the COVID pandemic while few Chinook salmon juveniles were marked with CWTs, has allowed for tagging of approximately six times more juveniles than traditionally tagged with CWTs, and at an estimated cost of 23 % of that associated with tagging with CWTs. GSI and PBT provide an alternate, cheaper, and more effective method in the assessment and management of Canadian-origin salmon relative to CWTs, and an opportunity for a genetic-based system to replace the current CWT system for salmon assessment. The time has arrived for agencies managing Pacific salmon fisheries to prepare for a transition from CWTs to a genetics-based fisheries assessment program.

Digital Therapeutics in Parkinson's Disease: Practical Applications and Future Potential.

Digital therapeutics, treatments delivered remotely and enabled by modern technology, facilitate the provision of personalized, evidence-based, interdisciplinary interventions to manage the complexities associated with Parkinson's disease. In the context of the COVID-19 pandemic, the need for digital therapeutics has arguably never been greater. However, despite new advances in technology and a heightened interest due to the pandemic, digital therapeutics remain underdeveloped and underutilized. In this paper, we briefly review practical applications and emerging advances in digital therapeutic platforms that target motor and non-motor signs and healthy lifestyle behaviors such as regular exercise, a healthful diet and optimal sleep hygiene habits. Future applications which could transform personalized self-management and patient care are presented. Opportunities, drawbacks and barriers to access are discussed.

Sex differences and psychological stress: responses to the COVID-19 pandemic in China.

BACKGROUND: About 83,000 COVID-19 patients were confirmed in China up to May 2020. Amid the well-documented threats to physical health, the effects of this public health crisis - and the varied efforts to contain its spread - have altered individuals' "normal" daily functioning. These impacts on social, psychological, and emotional well-being remain relatively unexplored - in particular, the ways in which Chinese men and women experience and respond to potential behavioral stressors. Our study investigated sex differences in psychological stress, emotional reactions, and behavioral responses to COVID-19 and related threats among Chinese residents. METHODS: In late February (2020), an anonymous online questionnaire was disseminated via WeChat, a popular social media platform in China. The cross-sectional study utilized a non-probabilistic "snowball" or convenience sampling of residents from various provinces and regions of China. Basic demographic characteristics (e.g., age and gender) - along with residential living arrangements and conditions - were measured along with psychological stress and emotional responses to the COVID-19 pandemic. RESULTS: Three thousand eighty-eight questionnaires were returned: 1749 females (56.6%) and 1339 males (43.4%). The mean stress level,as measured by a visual analog scale, was 3.4 (SD = 2.4) - but differed significantly by sex. Besides sex, factors positively associated with stress included: age (< 45 years), employment (unsteady income, unemployed), risk of infection (exposureto COVID-19, completed medical observation), difficulties encountered (diseases, work/study, financial, mental), and related behaviors (higher desire for COVID-19 knowledge, more time concerning on the COVID-19 outbreak). "Protective" factors included frequent contact with colleagues, calmness of mood comparing with the pre-pandemic, and psychological resilience. Males and females also differed significantly in adapting to current living/working, conditions, responding to run a fever, and needing psychological support services. CONCLUSIONS: The self-reported stress of Chinese residents related to the COVID-19 pandemic was significantly related to sex, age, employment, resilience and coping styles. Future responses to such public health threats may wish to provide sex- and/or age-appropriate supports for psychological health and emotional well-being to those at greatest risk of experiencing stress.

New Insights on the Mobility of Viral and Host Non-Coding RNAs Reveal Extracellular Vesicles as Intriguing Candidate Antiviral Targets.

Intercellular communication occurring by cell-to-cell contacts and via secreted messengers trafficked through extracellular vehicles is critical for regulating biological functions of multicellular organisms. Recent research has revealed that non-coding RNAs can be found in extracellular vesicles consistent with a functional importance of these molecular vehicles in virus propagation and suggesting that these essential membrane-bound bodies can be highjacked by viruses to promote disease pathogenesis. Newly emerging evidence that coronaviruses generate non-coding RNAs and use extracellular vesicles to facilitate viral pathogenicity may have important implications for the development of effective strategies to combat COVID-19, a disease caused by infection with the novel coronavirus, SARS-CoV-2. This article provides a short overview of our current understanding of the interactions between non-coding RNAs and extracellular vesicles and highlights recent research which supports these interactions as potential therapeutic targets in the development of novel antiviral therapies.

Oil Immersed Lossless Total Analysis System (OIL-TAS): Integrated RNA Extraction and Detection for SARS-CoV-2 Testing (preprint)

The coronavirus disease 2019 (COVID-19) pandemic exposed difficulties in scaling current quantitative PCR (qPCR)-based diagnostic methodologies for large-scale infectious disease testing. Bottlenecks include the lengthy multi-step process of nucleic acid extraction followed by qPCR readouts, which require costly instrumentation and infrastructure, as well as reagent and plastic consumable shortages stemming from supply chain constraints. Here we report a novel Oil Immersed Lossless Total Analysis System (OIL-TAS), which integrates RNA extraction and detection onto a single device that is simple, rapid, cost effective, uses minimal supplies and requires reduced infrastructure to perform. We validated the performance of OIL-TAS using contrived samples containing inactivated SARS-CoV-2 viral particles, which show that the assay can reliably detect an input concentration of 10 copies/L and sporadically detect down to 1 copy/L. The OIL-TAS method can serve as a faster, cheaper, and easier-to-deploy alternative to current qPCR-based methods for infectious disease testing.

Psychological Stress and Gender Differences during COVID-19 Pandemic in Chinese Population (preprint)

About 83000 COVID-19 patients were confirmed in China up to May 2020. The effects of this public health crisis - and the varied efforts to contains its spread - have altered individuals "normal" daily functioning. This impact on social, psychological, and emotional well-being remain relatively unexplored, especially the ways in which Chinese men and women experience and respond to potential behavioral-related stressors. A cross-sectional study was conducted in late February 2020. Demographic characteristics and residential living conditions were measured along with psychological stress and behavior responses to the COVID-19 epidemic. 3088 questionnaires were received: 1749 females (56.6%) and 1339 males (43.4%). The mean level of stress, as measured by a visual analog scale, was 3.4 (SD=2.4) - but differed significantly by sex. Besides sex, factors positively associated with stress included: age ([≤]45 years), employment (unsteady income, unemployed), risk infection population (exposed to COVID-19, completed medical observation), difficulties encountered (diseases, work/study, financial, mental), behaviors(higher desire for COVID-19 knowledge, more time spent on the COVID-19). "Protective" factors included frequently contact with colleagues, calmness, and psychological resilience. Males and females also differed significantly in adapting to current living/working status, coping with heating, and psychological support service needs. Among Chinese, self-reported stress related to the COVID-19 epidemic were significantly related to sex, age, employment, resilience and coping styles. Future responses to such public health threats may wish to provide sex- and/or age-appropriate supports for psychological health and emotional well-being to those at greatest risk of experiencing stress.