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1.
Front Immunol ; 13: 879686, 2022.
Article in English | MEDLINE | ID: covidwho-1903014

ABSTRACT

Neutrophils play a significant role in determining disease severity following SARS-CoV-2 infection. Gene and protein expression defines several neutrophil clusters in COVID-19, including the emergence of low density neutrophils (LDN) that are associated with severe disease. The functional capabilities of these neutrophil clusters and correlation with gene and protein expression are unknown. To define host defense and immunosuppressive functions of normal density neutrophils (NDN) and LDN from COVID-19 patients, we recruited 64 patients with severe COVID-19 and 26 healthy donors (HD). Phagocytosis, respiratory burst activity, degranulation, neutrophil extracellular trap (NET) formation, and T-cell suppression in those neutrophil subsets were measured. NDN from severe/critical COVID-19 patients showed evidence of priming with enhanced phagocytosis, respiratory burst activity, and degranulation of secretory vesicles and gelatinase and specific granules, while NET formation was similar to HD NDN. COVID LDN response was impaired except for enhanced NET formation. A subset of COVID LDN with intermediate CD16 expression (CD16Int LDN) promoted T cell proliferation to a level similar to HD NDN, while COVID NDN and the CD16Hi LDN failed to stimulate T-cell activation. All 3 COVID-19 neutrophil populations suppressed stimulation of IFN-γ production, compared to HD NDN. We conclude that NDN and LDN from COVID-19 patients possess complementary functional capabilities that may act cooperatively to determine disease severity. We predict that global neutrophil responses that induce COVID-19 ARDS will vary depending on the proportion of neutrophil subsets.


Subject(s)
COVID-19 , Extracellular Traps , Extracellular Traps/metabolism , Humans , Neutrophils/metabolism , Respiratory Burst , SARS-CoV-2
2.
J Cardiothorac Vasc Anesth ; 36(8 Pt B): 2927-2934, 2022 08.
Article in English | MEDLINE | ID: covidwho-1684146

ABSTRACT

OBJECTIVES: Electrocardiographic (ECG) changes have been associated with coronavirus disease 2019 (COVID-19) severity. However, the progression of ECG findings in patients with COVID-19 has not been studied. The purpose of this study was to describe ECG features at different stages of COVID-19 cardiovascular (CV) events and to examine the effects of specific ECG parameters and cardiac-related biomarkers on clinical outcomes in COVID-19. DESIGN: Retrospective, cohort study. SETTING: Major tertiary-care medical centers and community hospitals in Louisville, KY. PARTICIPANTS: A total of 124 patients with COVID-19 and CV events during hospitalization. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twelve-lead ECG parameters, biomarkers of cardiac injuries, and clinical outcomes were analyzed with Spearman correlation coefficients and Kruskal-Wallis 1-way analysis of variance. Atrial fibrillation/atrial flutter was more frequent on the ECG obtained at the time of the CV event when compared with admission ECG (9.5% v 26.9%; p = 0.007). Sinus tachycardia was higher in the last available hospital ECG than the CV event ECG (37.5% v 20.4%; p = 0.031). Admission ECG-corrected QT interval was significantly associated with admission troponin levels (R = 0.52; p < 0.001). The last available hospital ECG showed nonsurvivors had longer QRS duration than survivors (114.6 v 91.2 ms; p = 0.026), and higher heart rate was associated with longer intensive care unit length of stay (Spearman ρ = 0.339; p = 0.032). CONCLUSIONS: In hospitalized patients with COVID-19 and CV events, ECGs at various stages of COVID-19 hospitalization showed significantly different features with dissimilar clinical outcome correlations.


Subject(s)
COVID-19 , Cardiovascular Diseases , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cohort Studies , Electrocardiography , Humans , Retrospective Studies
3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-292433

ABSTRACT

Patients diagnosed with COVID-19 infection undergoing surgical procedures have been reported to have increased post-operative complications and mortality. These findings are important when considering cardiac surgical procedures, specifically coronary artery bypass grafting (CABG). This case series describes the clinical course following a CABG procedure in two patients that went on to develop COVID-19 infection post-operatively, having previously tested negative. We aim to illustrate the similarities in clinical presentation, but differences in eventual outcomes for both patients and hypothesize the reasons for the differences. Patients with comorbidities such as advanced age, diabetes mellitus, obesity, hypertension, and COPD are possibly at increased risk of adverse outcomes should they contract the infection, and special care should be taken in this population. Early institution of VV-ECMO may be beneficial, but further studies are needed in this matter.

4.
Journal of Cardiothoracic and Vascular Anesthesia ; 34(6):1397-1401, 2020.
Article in English | CAB Abstracts | ID: covidwho-1409855

ABSTRACT

The outbreak of a new coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) in China in December 2019 has brought serious challenges to disease prevention and public health. Patients with severe coronavirus disease 2019 (COVID-19) who undergo cardiovascular surgery necessitate extremely high demands from anesthesia personnel, and face high risks of mortality and morbidity. Based on the current understanding of COVID-19 and the clinical characteristics of cardiovascular surgical patients, the authors provide anesthesia management guidelines for cardiovascular surgery along with the prevention and control of COVID-19.

6.
Heart & Lung ; 50(4):567-568, 2021.
Article in English | ScienceDirect | ID: covidwho-1252956

ABSTRACT

Background Between 25%-50% of patients hospitalized with (COVID-19) suffer cardiovascular events. Limited information is available to identify those at greatest risk for cardiac complications. Objectives Objectives were to analyze risk factors associated with cardiovascular events (CE);analyze whether risk factors and outcomes were influenced by race;and analyze survival differences among various groups. Methods This retrospective cohort study of 700 inpatients with COVID-19 was conducted at nine hospitals within a large urban midwestern city. Data was collected from March 9, 2020, to June 20, 2020. Inclusion criteria included all COVID-19 inpatients and excluded non-inpatients. Predictor variables included demographics, comorbidities, and current clinical data. The outcomes were heart failure (HF), deep-vein thrombosis, myocardial infarction, pulmonary edema, stroke, cardiomyopathy, myocarditis, reduced ejection fraction, cardiac arrhythmias, cardiogenic shock, and cardiac arrest. Pearson's correlation coefficients were used to evaluate the correlation between different variables. Multiple logistics regression analyses were conducted to examine which variables predict cardiovascular events for the entire cohort, African American patients, and white patients, respectively. Mann-Whitney U, Chi-square, or Fisher's exact tests were used to examine differences in groups with and without CE and Kaplan-Meier was conducted for survival comparisons between groups. Results Of 700 COVID-19 positive inpatients, 126 experienced cardiovascular events and 574 did not. The incidence of cardiovascular events in our sample population was 18%. As shown in Table 1, we found the following factors were highly associated with the odds of new-onset of CEs: advanced age in years, males, non-Hispanic African American, presence of comorbidities, and decreased saturation levels. Numerous laboratory values were significantly associated with the risk of CEs (Table 1). African Americans had greater odds of CEs in the presence of diabetes and cardiovascular comorbidities (p=0.008, p=0.014, respectively). However, multiple logistics analysis was used to examine the joint effect of the risk factors which suggested that lower serum albumin and neoplastic/immune compromised diseases count were highly associated with CEs for African American COVID-19 inpatients (p=0.001, p=0.044, respectively). SaO2/FiO2 ratio and cardiovascular comorbidities were significantly associated with CEs for white inpatients (p=<0.001, p=0.007, respectively). As shown in Figure 1, Kaplan-Meier survival analysis revealed inpatients with CEs had a much higher mortality rate than those without CEs (45.2% vs. 8.7%). Median survival for patients with CEs was 18 days as opposed to 100 days for those that did not experience CEs. African Americans with CEs experienced higher mortality than those without CEs (43.9% vs. 7.8%). White COVID-19 inpatients' mortality rates were 46.3% and 9.0% for those with and without CEs, respectively. Of the 126 COVID-19 inpatients who had a CE, 14.3% had cardiac arrhythmias and 8.7% had new onset of HF diagnoses, and 4.8% had acute myocardial infarctions. Conclusion Multiple risk factors for CEs and death were identified in this sample of hospitalized patients with COVID-19, and mortality was increased significantly in those inpatients who had CEs. HF, cardiac arrhythmia, and acute myocardial infarction were the most frequently cited CEs implicating the need for long-term follow-up.

7.
JCI Insight ; 6(9)2021 05 10.
Article in English | MEDLINE | ID: covidwho-1228934

ABSTRACT

SARS coronavirus 2 (SARS-CoV-2) is a novel viral pathogen that causes a clinical disease called coronavirus disease 2019 (COVID-19). Although most COVID-19 cases are asymptomatic or involve mild upper respiratory tract symptoms, a significant number of patients develop severe or critical disease. Patients with severe COVID-19 commonly present with viral pneumonia that may progress to life-threatening acute respiratory distress syndrome (ARDS). Patients with COVID-19 are also predisposed to venous and arterial thromboses that are associated with a poorer prognosis. The present study identified the emergence of a low-density inflammatory neutrophil (LDN) population expressing intermediate levels of CD16 (CD16Int) in patients with COVID-19. These cells demonstrated proinflammatory gene signatures, activated platelets, spontaneously formed neutrophil extracellular traps, and enhanced phagocytic capacity and cytokine production. Strikingly, CD16Int neutrophils were also the major immune cells within the bronchoalveolar lavage fluid, exhibiting increased CXCR3 but loss of CD44 and CD38 expression. The percentage of circulating CD16Int LDNs was associated with D-dimer, ferritin, and systemic IL-6 and TNF-α levels and changed over time with altered disease status. Our data suggest that the CD16Int LDN subset contributes to COVID-19-associated coagulopathy, systemic inflammation, and ARDS. The frequency of that LDN subset in the circulation could serve as an adjunct clinical marker to monitor disease status and progression.


Subject(s)
Blood Coagulation Disorders/blood , Blood Coagulation Disorders/etiology , COVID-19/blood , COVID-19/complications , Neutrophils/immunology , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Blood Coagulation Disorders/immunology , COVID-19/immunology , Cytokines/blood , Female , GPI-Linked Proteins/blood , Hospitalization , Humans , Inflammation Mediators/blood , Male , Middle Aged , Neutrophils/classification , Pandemics , Phagocytosis , Platelet Activation , Receptors, IgG/blood , Respiratory Distress Syndrome/blood , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/immunology , Severity of Illness Index
8.
J Cardiothorac Vasc Anesth ; 35(12): 3581-3593, 2021 12.
Article in English | MEDLINE | ID: covidwho-1157926

ABSTRACT

OBJECTIVE: To analyze outcomes and risk factors of cardiovascular events in a metropolitan coronavirus disease 2019 (COVID-19) database, and to perform a subgroup analysis in African American populations to determine whether outcomes and risk factors are influenced by race. DESIGN: Retrospective cohort analysis from March 9, 2020 to June 20, 2020. SETTING: Population-based study in Louisville, KY, USA. PARTICIPANTS: Seven hundred adult inpatients hospitalized with COVID-19. INTERVENTIONS: N/A. MEASUREMENTS AND MAIN RESULTS: This cohort consisted of 126 patients (18%) with cardiovascular events and 574 patients without cardiovascular events. Patients with cardiovascular events had a much higher mortality rate than those without cardiovascular events (45.2% v 8.7%, p < 0.001). There was no difference between African American and white patients regarding mortality (43.9% v 46.3%, p = 1) and length of stay for survivors (11 days v 9.5 days, p = 0.301). Multiple logistics regression analysis suggested that male, race, lower SaO2/FIO2, higher serum potassium, lower serum albumin, and number of cardiovascular comorbidities were highly associated with the occurrence of cardiovascular events in COVID-19 patients. Lower serum albumin and neoplastic and/or immune-compromised diseases were highly associated with cardiovascular events for African American COVID-19 patients. SaO2/FIO2 ratio and cardiovascular comorbidity count were significantly associated with cardiovascular events in white patients. CONCLUSIONS: Cardiovascular events were prevalent and associated with worse outcomes in hospitalized patients with COVID-19. Outcomes of cardiovascular events in African American and white COVID-19 patients were similar after propensity score matching analysis. There were common and unique risk factors for cardiovascular events in African American COVID-19 patients when compared with white patients.


Subject(s)
COVID-19 , Cardiovascular Diseases , Adult , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Comorbidity , Hospitalization , Humans , Male , Retrospective Studies , Risk Factors , SARS-CoV-2
11.
Front Med (Lausanne) ; 7: 571542, 2020.
Article in English | MEDLINE | ID: covidwho-874497

ABSTRACT

Background: COVID-19 has spread rapidly worldwide. Many patients require mechanical ventilation. The goal of this study was to investigate the clinical course and outcomes of patients with COVID-19 undergoing mechanical ventilation and identify factors associated with death. Methods: Eighty-three consecutive critically ill patients with confirmed COVID-19 undergoing invasive mechanical ventilation were included in this retrospective, single-center, observational study from January 31 to March 15, 2020. Demographic, clinical, laboratory, radiological, and mechanical ventilation data were collected and analyzed. The primary outcome was 28-day mortality after endotracheal intubation. The secondary outcomes included the incidences of SARS-CoV-2-related cardiac, liver, and kidney injury. Results: Seventy-four out of 83 (89.2%) patients achieved oxygen saturation above 93% after intubation. Forty-nine out of 83 (59%) patients died and 34 (41%) patients survived after 28 days of observation. Multivariable regression showed increasing odds of death associated with cardiac injury (odds ratio 15.60, 95% CI 4.20-74.43), liver injury (5.40, 1.46-23.56), and kidney injury (8.39, 1.63-61.41), and decreasing odds of death associated with the higher PaO2/FiO2 ratio before intubation (0.97, 0.95-0.99). PaO2/FiO2 ratio before intubation demonstrated a positive linear correlation with platelet count (r = 0.424, P = 0.001), and negative linear correlation with troponin I (r = -0.395, P = 0.008). Conclusions: Cardiac, liver, and kidney injury may be associated with death for critically ill patients with COVID-19 undergoing invasive mechanical ventilation. The severity of pre-intubation hypoxia may be associated with a poorer outcome of patients with COVID-19 undergoing invasive mechanical ventilation. Larger, multi-institutional, prospective studies should be conducted to confirm these preliminary results.

12.
Front Cardiovasc Med ; 7: 150, 2020.
Article in English | MEDLINE | ID: covidwho-807173

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) is rapidly spreading and resulting in a significant loss of life around the world. However, specific information characterizing cardiovascular changes in COVID-19 is limited. Methods: In this single-centered, observational study, we enrolled 38 adult patients with COVID-19 from February 10 to March 13, 2020. Clinical records, laboratory findings, echocardiography, and electrocardiogram reports were collected and analyzed. Results: Of the 38 patients enrolled, the median age was 68 years [interquartile range (IQR), 55-74] with a slight female majority (21, 55.3%). Nineteen (50.0%) patients had hypertension. Seven (33.3%) had ST-T segment and T wave changes, and four (19%) had sinus tachycardia. Twenty (52.6%) had an increase in ascending aorta (AAO) diameter, 22 (57.9%) had an increase in left atrium (LA) size, and 28 (73.7%) presented with ventricular diastolic dysfunction. Correlation analysis showed that the AAO diameter was significantly associated with C-reactive protein (r = 0.4313) and creatine kinase-MB (r = 0.0414). LA enlargement was significantly associated with C-reactive protein (r = 0.4377), brain natriuretic peptide (r = 0.7612), creatine kinase-MB (r = 0.4940), and aspartate aminotransferase (r = 0.2947). Lymphocyte count was negatively associated with the AAO diameter (r = -0.5329) and LA enlargement (r = -0.3894). Conclusions: Hypertension was a common comorbidity among hospitalized patients with COVID-19, and cardiac injury was the most common complication. Changes in cardiac structure and function manifested mainly in the left heart and AAO in these patients. Abnormal AAO and LA size were found to be associated with severe inflammation and cardiac injury. Alternatively, ascending aortic dilation and LA enlargement might be present before infection but characterized the patient at risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

13.
J Cardiothorac Vasc Anesth ; 35(2): 389-397, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-807039

ABSTRACT

OBJECTIVE: To explore special coagulation characteristics and anticoagulation management in extracorporeal membrane oxygenation (ECMO)-assisted patients with coronavirus disease 2019 (COVID-19). DESIGN: Single-center, retrospective observation of a series of patients. PARTICIPANTS: Laboratory-confirmed severe COVID-19 patients who received venovenous ECMO support from January 20-May 20, 2020. INTERVENTIONS: This study analyzed the anticoagulation management and monitoring strategies, bleeding complications, and thrombotic events during ECMO support. MEASUREMENTS AND MAIN RESULTS: Eight of 667 confirmed COVID-19 patients received venovenous ECMO and had an elevated D-dimer level before and during ECMO support. An ECMO circuit pack (oxygenator and tubing) was replaced a total of 13 times in all 8 patients, and coagulation-related complications included oxygenator thrombosis (7/8), tracheal hemorrhage (5/8), oronasal hemorrhage (3/8), thoracic hemorrhage (3/8), bleeding at puncture sites (4/8), and cannulation site hemorrhage (2/8). CONCLUSIONS: Hypercoagulability and secondary hyperfibrinolysis during ECMO support in COVID-19 patients are common and possibly increase the propensity for thrombotic events and failure of the oxygenator. Currently, there is not enough evidence to support a more aggressive anticoagulation strategy.


Subject(s)
Anticoagulants/therapeutic use , COVID-19/therapy , Extracorporeal Membrane Oxygenation , Adult , Aged , Aged, 80 and over , Anticoagulants/administration & dosage , COVID-19/complications , COVID-19/diagnostic imaging , Critical Care , Extracorporeal Membrane Oxygenation/adverse effects , Female , Fibrin Fibrinogen Degradation Products/analysis , Hemorrhage/chemically induced , Hemorrhage/epidemiology , Humans , Male , Middle Aged , Monitoring, Physiologic , Respiratory Insufficiency/diagnostic imaging , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Retrospective Studies , Thrombosis/epidemiology , Tomography, X-Ray Computed , Trachea/injuries
14.
ASAIO J ; 66(8): e111, 2020 08.
Article in English | MEDLINE | ID: covidwho-706039
15.
J Cardiothorac Vasc Anesth ; 34(6): 1402-1405, 2020 06.
Article in English | MEDLINE | ID: covidwho-175909

ABSTRACT

Severe acute respiratory syndrome coronavirus-2 is still active in Wuhan, China, and is spreading to the rest of the world. Recently, perioperative anesthetic management in patients with suspected or confirmed coronavirus-2 has been reported. However, little has been reported on the anesthetic management of patients undergoing aortic dissection repair in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. During the outbreak in Wuhan, the authors' team completed 4 cases of aortic dissection repair successfully in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. The purpose of the present report is to summarize current knowledge and experiences on anesthetic management in this patient population and to provide clinical practice guidelines on anesthetic management and infection prevention and control in these critically ill patients.


Subject(s)
Anesthetics/therapeutic use , Aneurysm, Dissecting/surgery , Coronavirus Infections/complications , Pneumonia, Viral/complications , Anesthesiology/methods , Aneurysm, Dissecting/virology , COVID-19 , Coronavirus Infections/transmission , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/transmission
16.
ASAIO J ; 66(5): 475-481, 2020 05.
Article in English | MEDLINE | ID: covidwho-142784

ABSTRACT

Severe cases of coronavirus disease 2019 (COVID-19) cannot be adequately managed with mechanical ventilation alone. The role and outcome of extracorporeal membrane oxygenation (ECMO) in the management of COVID-19 is currently unclear. Eight COVID-19 patients have received ECMO support in Shanghai with seven with venovenous (VV) ECMO support and one veno arterial (VA) ECMO during cardiopulmonary resuscitation. As of March 25, 2020, four patients died (50% mortality), three patients (37.5%) were successfully weaned off ECMO after 22, 40, and 47 days support, respectively, but remain on mechanical ventilation. One patient is still on VV ECMO with mechanical ventilation. The partial pressure of oxygen/fractional of inspired oxygen ratio before ECMO initiation was between 54 and 76, and all were well below 100. The duration of mechanical ventilation before ECMO ranged from 4 to 21 days. Except the one emergent VA ECMO during cardiopulmonary resuscitation, other patients were on ECMO support for between 18 and 47 days. In conclusion, ensuring effective, timely, and safe ECMO support in COVID-19 is key to improving clinical outcomes. Extracorporeal membrane oxygenation support might be an integral part of the critical care provided for COVID-19 patients in centers with advanced ECMO expertise.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Extracorporeal Membrane Oxygenation , Pneumonia, Viral/therapy , Adult , Aged , Aged, 80 and over , COVID-19 , China , Female , Humans , Male , Middle Aged , Pandemics , Respiration, Artificial , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
18.
J Cardiothorac Vasc Anesth ; 34(7): 1727-1732, 2020 07.
Article in English | MEDLINE | ID: covidwho-45999

ABSTRACT

The COVID-19 pandemic is spreading globally. COVID-19 has an effect on the systemic state, cardiopulmonary function and primary disease of patients undergoing surgery. COVID-19's high contagiousness makes anesthesia and intraoperative management more difficult. This expert consensus aims to comprehensively introduce the application of perioperative ultrasound in COVID-19 patients, including pulmonary ultrasound and anesthesia management, ultrasound and airway management, ultrasound-guided regional anesthesia and echocardiography for COVID-19 patients.


Subject(s)
Anesthesia/methods , Betacoronavirus , Coronavirus Infections/diagnostic imaging , Perioperative Care/methods , Pneumonia, Viral/diagnostic imaging , Ultrasonography/methods , Airway Management/methods , Anesthesia, Conduction/methods , COVID-19 , Cardiovascular Diseases/complications , Cardiovascular Diseases/diagnostic imaging , Coronavirus Infections/complications , Coronavirus Infections/transmission , Echocardiography/methods , Hemodynamics , Humans , Lung/diagnostic imaging , Lung Diseases/diagnostic imaging , Lung Diseases/microbiology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/transmission , SARS-CoV-2 , Tracheotomy/methods , Ultrasonography, Interventional/methods , Ventilator Weaning/methods
19.
J Cardiothorac Vasc Anesth ; 34(5): 1125-1131, 2020 05.
Article in English | MEDLINE | ID: covidwho-40445

ABSTRACT

OBJECTIVES: The aim of the present study was to prevent cross-infection in the operating room during emergency procedures for patients with confirmed or suspected 2019 novel coronavirus (2019-nCoV) by following anesthesia management protocols, and to document clinical- and anesthesia-related characteristics of these patients. DESIGN: This was a retrospective, multicenter clinical study. SETTING: This study used a multicenter dataset from 4 hospitals in Wuhan, China. PARTICIPANTS: Patients and health care providers with confirmed or suspected 2019-nCoV from January 23 to 31, 2020, at the Wuhan Union Hospital, the Wuhan Children's Hospital, The Central Hospital of Wuhan, and the Wuhan Fourth Hospital in Wuhan, China. INTERVENTIONS: Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in 4 hospitals in Wuhan. MEASUREMENTS AND MAIN RESULTS: Cross-infection in the operating rooms of the 4 hospitals was effectively reduced by implementing the new measures and procedures. The majority of patients with laboratory-confirmed 2019-nCoV infection or suspected infection were female (23 [62%] of 37), and the mean age was 41.0 years old (standard deviation 19.6; range 4-78). 10 (27%) patients had chronic medical illnesses, including 4 (11%) with diabetes, 8 (22%) with hypertension, and 8 (22%) with digestive system disease. Twenty-five (68%) patients presented with lymphopenia, and 23 (62%) patients exhibited multiple mottling and ground-glass opacity on computed tomography scanning. CONCLUSIONS: The present study indicates that COVID 19-specific guidelines for emergency procedures for patients with confirmed or suspected 2019-nCoV may effectively prevent cross-infection in the operating room. Most patients with confirmed or suspected COVID 19 presented with fever and dry cough and demonstrated bilateral multiple mottling and ground-glass opacity on chest computed tomography scans.


Subject(s)
Anesthesia , Coronavirus Infections , Cross Infection , Emergency Medical Services , Infection Control , Pandemics , Pneumonia, Viral , Adolescent , Adult , Aged , Anesthesia/methods , Anesthesia/standards , Betacoronavirus , COVID-19 , Child , Child, Preschool , China , Chronic Disease , Comorbidity , Coronavirus Infections/complications , Cross Infection/prevention & control , Emergency Medical Services/standards , Female , Humans , Infection Control/standards , Male , Middle Aged , Operating Rooms , Pneumonia, Viral/complications , Practice Guidelines as Topic , Retrospective Studies , SARS-CoV-2 , Young Adult
20.
J Cardiothorac Vasc Anesth ; 35(5): 1503-1508, 2021 05.
Article in English | MEDLINE | ID: covidwho-17607

ABSTRACT

Anesthesiologists have a high risk of infection with COVID-19 during perioperative care and as first responders to airway emergencies. The potential of becoming infected can be reduced by a systematic and integrated approach that assesses infection risk. The latter leads to an acceptable choice of materials and techniques for personal protection and prevention of cross-contamination to other patients and staff. The authors have presented a protocolized approach that uses diagnostic criteria to clearly define benchmarks from the medical history along with clinical symptoms and laboratory tests. Patients can then be rapidly assigned into 1 of 3 risk categories that direct the choice of protective materials and/or techniques. Each hospital can adapt this approach to develop a system that fits its individual resources. Educating medical staff about the proper use of high-risk areas for containment serves to protect staff and patients.


Subject(s)
Anesthesia , COVID-19 , Infection Control , Anesthesiologists , Humans , SARS-CoV-2
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