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1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-324254

ABSTRACT

Background: Our study aimed to find symptoms unique in pregnancy and to help the early diagnosis in pregnant women and to evaluate the impact of COVID-19 in postpartum women and their newborns. Methods Clinical data were reviewed and collected for 11 pregnant women with laboratory-confirmed COVID-19 who were consecutively admitted to Zhongnan Hospital of Wuhan University and Women and Children’s Hospital of Hubei Province, from Jan 26 to Feb 26, 2020. Results All the confirmed women didn’t have any exposure history and their early symptoms were mildly elevated temperate and fatigue. The chest CT scans of confirmed women can be atypical manifestations, such as bilateral pleural effusions and slightly increased densities. Eight of eleven confirmed women did not feel anything unusual until abnormalities were found on chest CT scans on admission screening test. All three groups had elevated white blood cell count, neutrophil count and lactate dehydrogenase, and reduced total protein.The infection did not increase the risk for premature delivery, premature rupture of membrane, or comorbidities in pregnancy. Conclusions Pregnant women were often asymptomatic and accidentally detected abnormalities on chest CT scan on admission which emphasize the importance of CT scan in prevalent areas of the COVID-19. Even after the laboratory confirmation, the manifestation of the CT scan could be atypical, which alerted the necessity of protection for healthcare workers. The COVID-19 did not increase the risk of complications in pregnant women and their neonates. Trial registration: This case series was approved by the institutional ethics board of Zhongnan Hospital of Wuhan University (No. 2020020) and Women and Children’s Hospital of Hubei Province(NO. LW035).

2.
Journal of Intensive Medicine ; 2022.
Article in English | ScienceDirect | ID: covidwho-1665214

ABSTRACT

Background The coronavirus disease 2019 (COVID-19) is an ongoing pandemic since December 2019. Invasive mechanical ventilation (IMV) is essential for the management of COVID-19 with acute respiratory distress syndrome (ARDS). We aimed to assess the impact of compliance with a respiratory decision support system on the outcomes of patients with COVID-19-associated ARDS who required IMV. Methods In this retrospective, single-center, case series, 46 patients with COVID-19-associated ARDS who required IMV at Zhongnan Hospital of Wuhan University, China, from January 8, 2020, to March 24, 2020, with the final follow-up date of April 20, 2020, were included. Demographic, clinical, laboratory, imaging, and management information were collected and analyzed. Compliance with the respiratory support decision system was documented, and its relationship with 28-day mortality was evaluated. Results The median age of the 46 patients with COVID-19-associated ARDS requiring IMV was 68.5 years, and 31 were men. The partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio at intensive care unit (ICU) admission was 104 mmHg. The median total length of IMV was 12.0 (interquartile range [IQR], 6.0–27.3) days, and the median respiratory support decision score was 11.0 (IQR, 7.8–16.0). To 28 days after ICU admission, 18 (39.1%) patients died. Survivors had a significantly higher respiratory support decision score than non-survivors (15.0 [10.3–17.0] vs. 8.5 (6.0–10.3), P = 0.001). Using receiver operating characteristic (ROC) curve to assess the discrimination of respiratory support decision score to 28-day mortality, the area under the curve (AUC) was 0.796 (95% confidence interval [CI]: 0.657–0.934, P = 0.001) and the cut-off was 11.5 (sensitivity = 0.679, specificity = 0.889). Patients with a higher score (>11.5) were more likely to survive at 28 days after ICU admission (log-rank test, P < 0.001). Conclusions For severe COVID-19-associated ARDS with IMV, following the respiratory support decision and assessing completion would improve the progress of ventilation. With a decision score of >11.5, the mortality at 28 days after ICU admission showed an obvious decrease.

3.
Shock ; 56(2): 200-205, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1316852

ABSTRACT

PURPOSE: We used lung ultrasonography to identify features of COVID-19 pneumonia and to evaluate the prognostic value. PATIENTS AND METHODS: We performed lung ultrasonography on 48 COVID-19 patients in an intensive care unit (ICU) (Wuhan, China) using a 12-zone method. The associations between lung ultrasonography score, PaO2/FiO2, APACHE II, SOFA, and PaCO2 with 28-day mortality were analyzed and the receiver operator characteristic curve was plotted. RESULTS: 25.9% areas in all scanning zones presented with B7 lines and 23.5% with B3 lines (B-pattern) on lung ultrasonography; 13% areas with confluent B lines (B-pattern), 24.9% in areas with consolidations, and 9.9% in areas with A lines. Pleural effusion was observed in 2.8% of areas. Lung ultrasonography score was negatively correlated with PaO2/FiO2 (n = 48, r = -0.498, P < 0.05) and positively correlated with APACHE II (n = 48, r = 0.435, P < 0.05). Lung ultrasonography score was independently associated with 28-day mortality. The areas under receiver operator characteristic curves of lung ultrasonography score were 0.735 (95% CI: 0.586-0.844). The sensitivity, specificity, and cutoff values were 0.833, 0.722, and 22.5, respectively. CONCLUSIONS: Lung ultrasonography could be used to assess the severity of COVID-19 pneumonia, and it could also reveal the pathological signs of the disease. The lung ultrasonography score on ICU admission was independently related to the ICU 28-day mortality.


Subject(s)
COVID-19/diagnosis , Lung/diagnostic imaging , Ultrasonography/methods , Aged , COVID-19/epidemiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pandemics , Prognosis , Prospective Studies , ROC Curve , SARS-CoV-2
4.
Radiol Cardiothorac Imaging ; 2(2): e200126, 2020 Apr.
Article in English | MEDLINE | ID: covidwho-1155978

ABSTRACT

PURPOSE: To compare radiologic characteristics of coronavirus disease 2019 (COVID-19) pneumonia at thin-section CT on admission between patients with mild and severe disease. MATERIALS AND METHODS: Seventy patients with COVID-19 pneumonia who were admitted to Zhongnan Hospital of Wuhan University between January 20, 2020 and January 27, 2020 were enrolled. On the basis of the World Health Organization guidelines, 50 patients were categorized with the mild form and 20 with the severe form based on clinical conditions. Imaging features, clinical, and laboratory data were reviewed and compared. RESULTS: Patients with the severe form (median age, 65 years; interquartile range [IQR]: 54.75-75.00 years) were older than those with the mild form of disease (median age, 42.5 years; IQR: 32.75-58.50 years) (P < .001). Patients with the severe form of disease had more lung segments involved (median number of segments: 17.5 vs 7.5, P ≤ .001) and also larger opacities (median number of segments with opacities measuring 3 cm to less than 50% of the lung segment: 5.5 vs 2.0, P = .006; ≥ 50% of lung segment: 7.5 vs 0.0, P < .001). They also had more interlobular septal thickening (75% vs 28%, P < .001), higher prevalence of air bronchograms (70% vs 32%, P = .004), and pleural effusions (40% vs 14%, P = .017). CONCLUSION: Ground-glass opacities with or without consolidation in a peripheral and basilar predominant distribution were the most common findings in COVID-19 pneumonia. Patients with the severe form of the disease had more extensive opacification of the lung parenchyma than did patients with mild disease. Interlobular septal thickening, air bronchograms, and pleural effusions were also more prevalent in severe COVID-19.© RSNA, 2020.

5.
Crit Care Med ; 48(9): 1289-1295, 2020 09.
Article in English | MEDLINE | ID: covidwho-317610

ABSTRACT

OBJECTIVES: Severe acute respiratory distress syndrome is complicated with coronavirus disease 2019 and extracorporeal membrane oxygenation support may be necessary in severe cases. This study is to summarize the clinical features, extracorporeal membrane oxygenation characteristics, and outcomes of patients with severe acute respiratory syndrome coronavirus 2 pneumonia received extracorporeal membrane oxygenation. DESIGN: Descriptive study from two hospitals. SETTING: The ICUs from university hospitals. PATIENTS: Patients with severe acute respiratory syndrome coronavirus 2 pneumonia received mechanical ventilation, including those underwent extracorporeal membrane oxygenation from Zhongnan Hospital of Wuhan University and Wuhan Pulmonary Hospital from January 8, 2020, to March 31, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Clinical records, laboratory results, ventilator parameters, and extracorporeal membrane oxygenation-related data were abstracted from the medical records. One-hundred twenty-nine critically ill patients with severe acute respiratory syndrome coronavirus 2 pneumonia were admitted to ICU of the two referral hospitals. Fifty-nine patients received mechanical ventilation and 21 of them received extracorporeal membrane oxygenation support (fourteen from Zhongnan hospital and seven from Wuhan pulmonary hospital). Compared to mechanical ventilation patients without extracorporeal membrane oxygenation support, there was a tendency of decline in mortality but with no significant difference (no-extracorporeal membrane oxygenation group 24/38 [63.2%] vs extracorporeal membrane oxygenation group 12/21 [57.1%]; p = 0.782). For those patients with extracorporeal membrane oxygenation, 12 patients died and nine survived by April 7, 2020. Among extracorporeal membrane oxygenation patients, the PaCO2 prior to extracorporeal membrane oxygenation was lower (54.40 mm Hg [29.20-57.50 mm Hg] vs 63.20 mm Hg [55.40-72.12 mm Hg]; p = 0.006), and pH prior to extracorporeal membrane oxygenation was higher (7.38 [7.28-7.48] vs 7.23 [7.16-7.33]; p = 0.023) in survivors than nonsurvivors. CONCLUSIONS: Extracorporeal membrane oxygenation might be an effective salvage treatment for patients with severe acute respiratory syndrome coronavirus 2 pneumonia associated with severe acute respiratory distress syndrome. Severe CO2 retention and acidosis prior to extracorporeal membrane oxygenation indicated a poor prognosis.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Extracorporeal Membrane Oxygenation , Pneumonia, Viral/therapy , Respiratory Distress Syndrome/therapy , Aged , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Extracorporeal Membrane Oxygenation/adverse effects , Extracorporeal Membrane Oxygenation/mortality , Female , Hospitals, University , Humans , Intensive Care Units , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Prognosis , Respiration, Artificial , Respiratory Distress Syndrome/etiology , Respiratory Function Tests , SARS-CoV-2
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