Utility of Pulse Oximetry Oxygen Saturation (SpO2) with Incorporation of Positive End-Expiratory Pressure (SpO2 ∗10/FiO2 ∗PEEP) for Classification and Prognostication of Patients with Acute Respiratory Distress Syndrome.

Background: Conventionally, PaO2/FiO2 (P/F ratio) has been used to categorize severity of acute respiratory distress syndrome (ARDS) and prognostication of outcome. Recent literature has shown that incorporation of positive end-expiratory pressure (PEEP) into the P/F ratio (PaO2 ∗10/FiO2 ∗PEEP or P/FP∗10) has a much better prognostic ability in ARDS as compared to P/F ratio. The aim of this study was to correlate SpO2 ∗10/FiO2 ∗PEEP (S/FP∗10) to PaO2 ∗10/FiO2 ∗PEEP (P/FP∗10) and evaluate the utility of S/FP∗10 as a reliable noninvasive indicator of oxygenation in ARDS to avoid repeated arterial blood sampling. Aim: To evaluate if pulse oximetry is a reliable indicator of oxygenation in ARDS patients by calculating SpO2 ∗10/FiO2 ∗PEEP (S/FP∗10). The primary objective was to determine the correlation of S/FP∗10 to P/FP∗10 ratio in ARDS patients. The secondary objective was to determine the cut-off value of S/FP∗10 ratio to predict severe ARDS and survival. Methods: Patients aged 18-80 years on invasive mechanical ventilation (MV) diagnosed with ARDS as defined by the Berlin definition were included. The values of PaO2, FiO2, and SpO2 were collected at three different time points. They were at baseline, i.e., after intubation and initiation of MV (within one hour of intubation), day one (1-24 hours of MV), and day three (48-72 hours of MV). The primary outcome was survival at the end of intensive care unit (ICU) stay. Results: A total of 85 patients with ARDS on invasive MV were included. The data points were obtained at baseline, day one, and day three of MV. S/FP∗10 ratio has an excellent correlation to P/FP∗10 ratio at baseline and day three of invasive MV (r = 0.831 and 0.853, respectively; p < 0.001) and has a strong correlation on day one of invasive MV (r = 0.733, p < 0.001). S/FP∗10 ratio ≤116 at baseline has excellent discriminant function to be categorized as severe ARDS as per Berlin definition (AUC: 0.925, p < 0.001, 90% sensitivity, 93% specificity, CI: [0.862-0.988]). The increase in S/FP∗10 ratio by ≥64.40 from baseline to day three of MV is a good predictor of survival (AUC: 0.877, p < 0.001, 73.5% sensitivity, 97% specificity, CI: [0.803-0.952]). Conclusion: S/FP∗10 has a strong correlation to P/FP∗10 in ARDS patients. S/FP∗10 ≤116 has an excellent discriminant function to be categorized as severe ARDS. The S/FP∗10 ratio on day three of MV and the change in S/FP∗10 ratio from baseline and day one to day three of MV are good predictors of survival in ARDS patients. This trial is registered with CTRI/2020/04/024940.

"Post-COVID-19 syndrome:" The New Pandemic Affecting Healthcare Workers and How the Frontline Warriors Are Battling it.

OBJECTIVES: "Post-COVID-19 syndrome," which may be the new pandemic, has affected various domains of quality of life; even among those who have recovered from mild COVID-19 disease. The aim of our study was to explore the health, social and psychological impact on healthcare workers (HCWs) who have recovered from active COVID-19 illness and highlight their needs post-recovery. MATERIALS AND METHODS: It was a web-based survey study. A total of 163 eligible consenting HCWs participated in this survey. The Institutional Ethical Committee approval was obtained before study recruitment and the study was registered with the Clinical Trial Registry of India. Each participant responded to 25 questions. RESULTS: Among those participated, 51% were doctors, 32% were nurses and others were allied health professionals and students. About 82% had mild COVID-19 illness and 40% required hospitalisation for COVID-19 treatment. In the post-recovery period, 66% experienced health issues and fatigue on mild exertion was the most common symptom (42.94%). It was followed by anosmia and ageusia (21.47%), headache and myalgia (15.34%) and breathlessness (8.59%). About 82% HCW felt the need for a post-COVID-19 recovery health care unit. Potential risk of infecting family members was the most common concern (53.46%) followed by the fear of contracting the virus again (46.54%). About 35% of HCW experienced the fear of developing post-COVID-19 complications. About 78% of HCW did not report any psychological concerns, but one-third were stressed due to the financial impact. CONCLUSION: Post-COVID-19 syndrome impacts all domains of quality of life. Fatigue, loss of taste and smell, headache, myalgia and breathlessness continue to persist beyond recovery of active illness. Most of the HCWs emphasised the need to set up post-COVID-19 care units. The fear of contracting the virus again and financial drain due to hospital expenses continued to distress HCWs.