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2.
Clinical Research in Cardiology ; 110(2):292-301, 2021.
Article | WHO COVID | ID: covidwho-1064474

ABSTRACT

AIMS: During the COVID-19 pandemic, hospital admissions for cardiac care have declined However, effects on mortality are unclear Thus, we sought to evaluate the impact of the lockdown period in central Germany on overall and cardiovascular deaths Simultaneously we looked at catheterization activities in the same region METHODS AND RESULTS: Data from 22 of 24 public health-authorities in central Germany were aggregated during the pandemic related lockdown period and compared to the same time period in 2019 Information on the total number of deaths and causes of death, including cardiovascular mortality, were collected Additionally, we compared rates of hospitalization (n = 5178) for chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and out of hospital cardiac arrest (OHCA) in 26 hospitals in this area Data on 5,984 deaths occurring between March 23, 2020 and April 26, 2020 were evaluated In comparison to the reference non-pandemic period in 2019 (deaths: n = 5832), there was a non-significant increase in all-cause mortality of 2 6% [incidence rate ratio (IRR) 1 03, 95% confidence interval (CI) 0 99-1 06;p = 0 16] Cardiovascular and cardiac mortality increased significantly by 7 6% (IRR 1 08, 95%-CI 1 01-1 14;p = 0 02) and by 11 8% (IRR 1 12, 95%-CI 1 05-1 19;p < 0 001), respectively During the same period, our data revealed a drop in cardiac catherization procedures CONCLUSION: During the COVID-19-related lockdown a significant increase in cardiovascular mortality was observed in central Germany, whereas catherization activities were reduced The mechanisms underlying both of these observations should be investigated further in order to better understand the effects of a pandemic-related lockdown and social-distancing restrictions on cardiovascular care and mortality

6.
Atemwegs- und Lungenkrankheiten ; 46(7):408-413, 2020.
Article | WHO COVID | ID: covidwho-831141

ABSTRACT

Chronic consuming infectious diseases of the respiratory organs or chronic infectious complications of pre-existing lung diseases often mean a high, long-term symptom burden for the affected patients Nevertheless, the concepts and involvement of palliative care have so far not found any structured access to care for these patients Using tuberculosis, non-tuberculous mycobacteriosis, and non-specific clinical pictures as an example, this overview shows where palliative care can and should contribute to the treatment concept to the benefit of the patient As an acute infection, pneumonia is a common cause of death in patients with chronic, progressive underlying diseases and should give the physician a reason to address the therapeutic goal – possibly with the involvement of palliative care expertise The corona pandemic has clearly demonstrated the need for palliative care in infectiology © 2020 Dustri-Verlag Dr Karl Feistle

12.
Pneumologie ; 74(6): 337-357, 2020 Jun.
Article in German | MEDLINE | ID: covidwho-611131

ABSTRACT

Against the background of the pandemic caused by infection with the SARS-CoV-2, the German Society for Pneumology and Respiratory Medicine (DGP e.V.), in cooperation with other associations, has designated a team of experts in order to answer the currently pressing questions about therapy strategies in dealing with COVID-19 patients suffering from acute respiratory insufficiency (ARI).The position paper is based on the current knowledge that is evolving daily. Many of the published and cited studies require further review, also because many of them did not undergo standard review processes.Therefore, this position paper is also subject to a continuous review process and will be further developed in cooperation with the other professional societies.This position paper is structured into the following five topics:1. Pathophysiology of acute respiratory insufficiency in patients without immunity infected with SARS-CoV-22. Temporal course and prognosis of acute respiratory insufficiency during the course of the disease3. Oxygen insufflation, high-flow oxygen, non-invasive ventilation and invasive ventilation with special consideration of infectious aerosol formation4. Non-invasive ventilation in ARI5. Supply continuum for the treatment of ARIKey points have been highlighted as core statements and significant observations. Regarding the pathophysiological aspects of acute respiratory insufficiency (ARI), the pulmonary infection with SARS-CoV-2 COVID-19 runs through three phases: early infection, pulmonary manifestation and severe hyperinflammatory phase.There are differences between advanced COVID-19-induced lung damage and those changes seen in Acute Respiratory Distress Syndromes (ARDS) as defined by the Berlin criteria. In a pathophysiologically plausible - but currently not yet histopathologically substantiated - model, two types (L-type and H-type) are distinguished, which correspond to an early and late phase. This distinction can be taken into consideration in the differential instrumentation in the therapy of ARI.The assessment of the extent of ARI should be carried out by an arterial or capillary blood gas analysis under room air conditions and must include the calculation of the oxygen supply (measured from the variables of oxygen saturation, the Hb value, the corrected values of the Hüfner number and the cardiac output). In principle, aerosols can cause transmission of infectious viral particles. Open systems or leakage systems (so-called vented masks) can prevent the release of respirable particles. Procedures in which the invasive ventilation system must be opened, and endotracheal intubation must be carried out are associated with an increased risk of infection.The protection of personnel with personal protective equipment should have very high priority because fear of contagion must not be a primary reason for intubation. If the specifications for protective equipment (eye protection, FFP2 or FFP-3 mask, gown) are adhered to, inhalation therapy, nasal high-flow (NHF) therapy, CPAP therapy or NIV can be carried out according to the current state of knowledge without increased risk of infection to the staff. A significant proportion of patients with respiratory failure presents with relevant hypoxemia, often also caused by a high inspiratory oxygen fraction (FiO2) including NHF, and this hypoxemia cannot be not completely corrected. In this situation, CPAP/NIV therapy can be administered under use of a mouth and nose mask or a respiratory helmet as therapy escalation, as long as the criteria for endotracheal intubation are not fulfilled.In acute hypoxemic respiratory insufficiency, NIV should be performed in an intensive care unit or in a comparable unit by personnel with appropriate expertise. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring with readiness to carry out intubation must be ensured at all times. If CPAP/NIV leads to further progression of ARI, intubation and subsequent invasive ventilation should be carried out without delay if no DNI order is in place.In the case of patients in whom invasive ventilation, after exhausting all guideline-based measures, is not sufficient, extracorporeal membrane oxygenation procedure (ECMO) should be considered to ensure sufficient oxygen supply and to remove CO2.


Subject(s)
Continuous Positive Airway Pressure , Noninvasive Ventilation/methods , Positive-Pressure Respiration , Practice Guidelines as Topic , Pulmonary Edema/therapy , Respiratory Insufficiency/therapy , Berlin , Betacoronavirus , Continuous Positive Airway Pressure/standards , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Humans , Intubation, Intratracheal , Lung/physiopathology , Lung/virology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pulmonary Edema/etiology , Respiratory Insufficiency/prevention & control , Societies, Medical
13.
Pneumologie ; 74(6): 337-357, 2020 Jun.
Article in German | MEDLINE | ID: covidwho-108923

ABSTRACT

Against the background of the pandemic caused by infection with the SARS-CoV-2, the German Society for Pneumology and Respiratory Medicine (DGP e.V.), in cooperation with other associations, has designated a team of experts in order to answer the currently pressing questions about therapy strategies in dealing with COVID-19 patients suffering from acute respiratory insufficiency (ARI).The position paper is based on the current knowledge that is evolving daily. Many of the published and cited studies require further review, also because many of them did not undergo standard review processes.Therefore, this position paper is also subject to a continuous review process and will be further developed in cooperation with the other professional societies.This position paper is structured into the following five topics:1. Pathophysiology of acute respiratory insufficiency in patients without immunity infected with SARS-CoV-22. Temporal course and prognosis of acute respiratory insufficiency during the course of the disease3. Oxygen insufflation, high-flow oxygen, non-invasive ventilation and invasive ventilation with special consideration of infectious aerosol formation4. Non-invasive ventilation in ARI5. Supply continuum for the treatment of ARIKey points have been highlighted as core statements and significant observations. Regarding the pathophysiological aspects of acute respiratory insufficiency (ARI), the pulmonary infection with SARS-CoV-2 COVID-19 runs through three phases: early infection, pulmonary manifestation and severe hyperinflammatory phase.There are differences between advanced COVID-19-induced lung damage and those changes seen in Acute Respiratory Distress Syndromes (ARDS) as defined by the Berlin criteria. In a pathophysiologically plausible - but currently not yet histopathologically substantiated - model, two types (L-type and H-type) are distinguished, which correspond to an early and late phase. This distinction can be taken into consideration in the differential instrumentation in the therapy of ARI.The assessment of the extent of ARI should be carried out by an arterial or capillary blood gas analysis under room air conditions and must include the calculation of the oxygen supply (measured from the variables of oxygen saturation, the Hb value, the corrected values of the Hüfner number and the cardiac output). In principle, aerosols can cause transmission of infectious viral particles. Open systems or leakage systems (so-called vented masks) can prevent the release of respirable particles. Procedures in which the invasive ventilation system must be opened, and endotracheal intubation must be carried out are associated with an increased risk of infection.The protection of personnel with personal protective equipment should have very high priority because fear of contagion must not be a primary reason for intubation. If the specifications for protective equipment (eye protection, FFP2 or FFP-3 mask, gown) are adhered to, inhalation therapy, nasal high-flow (NHF) therapy, CPAP therapy or NIV can be carried out according to the current state of knowledge without increased risk of infection to the staff. A significant proportion of patients with respiratory failure presents with relevant hypoxemia, often also caused by a high inspiratory oxygen fraction (FiO2) including NHF, and this hypoxemia cannot be not completely corrected. In this situation, CPAP/NIV therapy can be administered under use of a mouth and nose mask or a respiratory helmet as therapy escalation, as long as the criteria for endotracheal intubation are not fulfilled.In acute hypoxemic respiratory insufficiency, NIV should be performed in an intensive care unit or in a comparable unit by personnel with appropriate expertise. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring with readiness to carry out intubation must be ensured at all times. If CPAP/NIV leads to further progression of ARI, intubation and subsequent invasive ventilation should be carried out without delay if no DNI order is in place.In the case of patients in whom invasive ventilation, after exhausting all guideline-based measures, is not sufficient, extracorporeal membrane oxygenation procedure (ECMO) should be considered to ensure sufficient oxygen supply and to remove CO2.


Subject(s)
Continuous Positive Airway Pressure , Noninvasive Ventilation/methods , Positive-Pressure Respiration , Practice Guidelines as Topic , Pulmonary Edema/therapy , Respiratory Insufficiency/therapy , Berlin , Betacoronavirus , Continuous Positive Airway Pressure/standards , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Humans , Intubation, Intratracheal , Lung/physiopathology , Lung/virology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pulmonary Edema/etiology , Respiratory Insufficiency/prevention & control , Societies, Medical
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