Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 18 de 18
Filter
1.
Dtsch Med Wochenschr ; 147(20): 1297-1298, 2022 10.
Article in German | MEDLINE | ID: covidwho-2050604

Subject(s)
COVID-19 , Humans , Pandemics , SARS-CoV-2
3.
Infection ; 50(1): 93-106, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1661756

ABSTRACT

PURPOSE: This executive summary of a national living guideline aims to provide rapid evidence based recommendations on the role of drug interventions in the treatment of hospitalized patients with COVID-19. METHODS: The guideline makes use of a systematic assessment and decision process using an evidence to decision framework (GRADE) as recommended standard WHO (2021). Recommendations are consented by an interdisciplinary panel. Evidence analysis and interpretation is supported by the CEOsys project providing extensive literature searches and living (meta-) analyses. For this executive summary, selected key recommendations on drug therapy are presented including the quality of the evidence and rationale for the level of recommendation. RESULTS: The guideline contains 11 key recommendations for COVID-19 drug therapy, eight of which are based on systematic review and/or meta-analysis, while three recommendations represent consensus expert opinion. Based on current evidence, the panel makes strong recommendations for corticosteroids (WHO scale 5-9) and prophylactic anticoagulation (all hospitalized patients with COVID-19) as standard of care. Intensified anticoagulation may be considered for patients with additional risk factors for venous thromboembolisms (VTE) and a low bleeding risk. The IL-6 antagonist tocilizumab may be added in case of high supplemental oxygen requirement and progressive disease (WHO scale 5-6). Treatment with nMABs may be considered for selected inpatients with an early SARS-CoV-2 infection that are not hospitalized for COVID-19. Convalescent plasma, azithromycin, ivermectin or vitamin D3 should not be used in COVID-19 routine care. CONCLUSION: For COVID-19 drug therapy, there are several options that are sufficiently supported by evidence. The living guidance will be updated as new evidence emerges.


Subject(s)
COVID-19 , COVID-19/therapy , Hospitalization , Humans , Immunization, Passive , Practice Guidelines as Topic , SARS-CoV-2
4.
PLoS One ; 17(1): e0262315, 2022.
Article in English | MEDLINE | ID: covidwho-1622359

ABSTRACT

BACKGROUND: The role of non-invasive ventilation (NIV) in severe COVID-19 remains a matter of debate. Therefore, the utilization and outcome of NIV in COVID-19 in an unbiased cohort was determined. AIM: The aim was to provide a detailed account of hospitalized COVID-19 patients requiring non-invasive ventilation during their hospital stay. Furthermore, differences of patients treated with NIV between the first and second wave are explored. METHODS: Confirmed COVID-19 cases of claims data of the Local Health Care Funds with non-invasive and/or invasive mechanical ventilation (MV) in the spring and autumn pandemic period in 2020 were comparable analysed. RESULTS: Nationwide cohort of 17.023 cases (median/IQR age 71/61-80 years, 64% male) 7235 (42.5%) patients primarily received IMV without NIV, 4469 (26.3%) patients received NIV without subsequent intubation, and 3472 (20.4%) patients had NIV failure (NIV-F), defined by subsequent endotracheal intubation. The proportion of patients who received invasive MV decreased from 75% to 37% during the second period. Accordingly, the proportion of patients with NIV exclusively increased from 9% to 30%, and those failing NIV increased from 9% to 23%. Median length of hospital stay decreased from 26 to 21 days, and duration of MV decreased from 11.9 to 7.3 days. The NIV failure rate decreased from 49% to 43%. Overall mortality increased from 51% versus 54%. Mortality was 44% with NIV-only, 54% with IMV and 66% with NIV-F with mortality rates steadily increasing from 62% in early NIV-F (day 1) to 72% in late NIV-F (>4 days). CONCLUSIONS: Utilization of NIV rapidly increased during the autumn period, which was associated with a reduced duration of MV, but not with overall mortality. High NIV-F rates are associated with increased mortality, particularly in late NIV-F.


Subject(s)
COVID-19/therapy , Noninvasive Ventilation , Respiration, Artificial , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/mortality , Female , Hospital Mortality , Humans , Intubation, Intratracheal/statistics & numerical data , Length of Stay , Male , Middle Aged , Noninvasive Ventilation/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Treatment Outcome , Young Adult
5.
2021.
Preprint in English | Other preprints | ID: ppcovidwho-295101

ABSTRACT

Rationale The role of non-invasive ventilation (NIV) in severe COVID-19 remains a matter of debate. Objectives To determine the utilization and outcome of NIV in COVID-19 in an unbiased cohort. Methods Observational study of confirmed COVID-19 cases of claims data of the Local Health Care Funds comparing patients with non-invasive and invasive mechanical ventilation (IMV) between spring versus autumn period 2020. Measurements and Main Results Nationwide cohort of 7490 cases (median/IQR age 70/60–79 years, 66% male) 3851 (51%) patients primarily received IMV without NIV, 1614 (22%) patients received NIV without subsequent intubation, and 1247 (17%) patients had NIV failure (NIV-F), defined by subsequent endotracheal intubation. The proportion of patients who received invasive MV decreased from 74% to 39% during the second period. Accordingly, the proportion of patients with NIV exclusively increased from 10% to 28%, and those failing NIV increased from 9% to 21%. Median length of hospital stay decreased from 26 to 22 days, and duration of MV decreased from 11.6 to 7.6 days. The NIV failure rate decreased from 49% to 42%. Overall mortality remained unchanged (51% versus 53%). Mortality was 39% with NIV-only, 52% with IMV and 66% with NIV-F with mortality rates steadily increasing from 58% in early NIV-F (day 1) to 75% in late NIV-F (>4 days). Conclusion Utilization of NIV rapidly increased during the autumn period, which was associated with a reduced duration of MV, but not with overall mortality. High NIV-F rates are associated with increased mortality, particularly in late NIV-F. Funding Institutional support and physical resources were provided by the University Witten/Herdecke and Kliniken der Stadt Köln and the Federal Association of the Local Health Care Funds. At a Glance Commentary Scientific Knowledge on the Subject Current management of ventilatory support in COVID-19 patients with respiratory failure is heterogeneous. Despite increasing use of non-invasive ventilation (NIV), defining intubation criteria still remains a matter of uncertainty and discussion, especially with regard to the balance between the NIV benefits and the risk of NIV failure. In addition, robust data concerning the influence of the duration and failure of NIV on intubation and mortality rates are still missing, although the time span between initiation of NIV and subsequent intubation in case of respiratory failure progression is suggested to influence patient outcome. What This Study Adds to the Field This is the first large observational study describing differences of ventilatory strategies between the spring and autumn period of the SARS-CoV-2 pandemic in Germany and provides the in-hospital mortality rate of 7,490 patients who received mechanical ventilation. The increased utilization of NIV from 10% (first period) to 29% (second period) was associated with overall reduced durations of mechanical ventilation and length of hospital stay, but overall mortality remained comparably high and reached 51%, 53% respectively. Patients succeeding with NIV had lower mortality rates than those getting intubated without preceding NIV attempts, but those failing NIV had higher mortality rates, respectively, and this became even more predominant in late NIV failure. The present observational study shows the increasing role of NIV in the concert of ICU medicine related to COVID-19, but also clearly addresses its risks in addition to its benefits, both impacting on mortality.

8.
Med Klin Intensivmed Notfmed ; 116(5): 421-430, 2021 Jun.
Article in German | MEDLINE | ID: covidwho-1193128

ABSTRACT

BACKGROUND: The vaccinations against the "severe acute respiratory syndrome coronavirus type 2" (SARS-CoV­2) play a decisive role in the global fight against the coronavirus pandemic. In the population, but also among health care workers (HCWs), there were concerns and skepticism about vaccinations even before the corona pandemic. METHODS: An online survey on the attitude of HCWs to vaccination against SARS-CoV­2 was carried out in December (December 3rd-December 12th, 2020) before and in February (February 1st-February 10th, 2021) after the start of the vaccinations. Members of the German Society for Internal Intensive Care Medicine and Emergency Medicine (DGIIN) and the German Interdisciplinary Association for Intensive Care Medicine and Emergency Medicine (DIVI) were invited by email and on Facebook. RESULTS: In December 2305 and in February 3501 people took part. The approval rate for vaccination increased from 85.2% to 92.1% (p < 0.001). There was also an increase in willingness to vaccinate (63.8% vs. 75.9%; p < 0.001). The female gender, membership of the professional group nursing staff and age < 45 years were significantly associated with a restricted willingness to vaccinate. There was also a decrease in concerns about efficacy, side effects and long-term damage. There was clear skepticism about the vaccine from AstraZeneca (Cambridge, United Kingdom). Before and after the introduction of vaccinations against SARS-CoV­2, an increase in the willingness to vaccinate against SARS-CoV-2 can be shown in German HCWs. Technical experts must bring objectivity into the currently controversial debate through precise and transparent information and thus counteract vaccination skepticism, not only among HCWs.


Subject(s)
COVID-19 , SARS-CoV-2 , Female , Hospitals , Humans , Middle Aged , United Kingdom , Vaccination
9.
Dtsch Arztebl Int ; 118(Forthcoming)2021 01 11.
Article in English | MEDLINE | ID: covidwho-1097290

ABSTRACT

BACKGROUND: Since identification of the first cases in December 2019, COVID-19, caused by the novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome-coronavirus-2) has spread across the world, giving rise to a global pandemic. METHODS: A literature search was carried out in PubMed, using search terms defined by the authors. Questions important for the management of patients with COVID-19 were identified and discussed, and recommendations or statements on these topics were formulated in a structured consensus process. RESULTS: Determination of the indication for the admission of COVID-19 patients to the hospital should involve consideration of age, comorbidities, respiratory rate, and oxygen saturation. Every patient admitted without a recent PCR test should be tested immediately. It is recommended that any COVID-19 patient with hypoxemia (SpO2 <90%) despite being given oxygen, dyspnea, or a high respiratory rate be admitted to intensive care. In the case of hypoxemic respiratory insufficiency, an attempt at treatment with high-flow oxygen or non-invasive ventilation is suggested, while patients with severe hypoxemia/high respiratory rate should undergo intubation and invasive ventilation. In the presence of additional risk factors (such as obesity, known thrombophilia, intensive care treatment, or elevated D-dimers), intensified prophylaxis against thromboembolism may be indicated. Treatment with dexamethasone decreases the mortality among patients with severe or critical COVID-19. The important personal protection measures are attention to hygiene and the correct wearing of personal protective equipment. CONCLUSION: The principal treatment measures are maintenance of adequate oxygenation, pharmacological prevention of thrombosis, and, in severe cases, administration of dexamethasone.

11.
Med Klin Intensivmed Notfmed ; 115(Suppl 3): 115-122, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1029344

ABSTRACT

In view of the globally evolving coronavirus disease (COVID-19) pandemic, German hospitals rapidly expanded their intensive care capacities. However, it is possible that even with an optimal use of the increased resources, these will not suffice for all patients in need. Therefore, recommendations for the allocation of intensive care resources in the context of the COVID-19 pandemic have been developed by a multidisciplinary group of authors with the support of eight scientific medical societies. The recommendations for procedures and criteria for prioritisations in case of resource scarcity are based on scientific evidence, ethicolegal considerations and practical experience. Medical decisions must always be based on the need and the treatment preferences of the individual patient. In addition to this patient-centred approach, prioritisations in case of resource scarcity require a supraindividual perspective. In such situations, prioritisations should be based on the criterion of clinical prospect of success in order to minimize the number of preventable deaths due to resource scarcity and to avoid discrimination based on age, disabilities or social factors. The assessment of the clinical prospect of success should take into account the severity of the current illness, severe comorbidities and the patient's general health status prior to the current illness.


Subject(s)
COVID-19 , Coronavirus , Critical Care , Humans , Methacrylates , Pandemics , Resource Allocation , SARS-CoV-2
12.
Med Klin Intensivmed Notfmed ; 115(8): 654-667, 2020 Nov.
Article in German | MEDLINE | ID: covidwho-932492

ABSTRACT

Lung and chest ultrasound are further examination modalities in addition to computed tomography and laboratory diagnostics in patients with COVID-19. It extends the clinical-physical examination because it can examine lung surface sensitively. Lung surface pattern changes have been found in sonograms of patients with COVID-19 pneumonia and during the course of the disease. German specialist societies of clinical acute, emergency and intensive care medicine as well as imaging, which are concerned with the care of patients with SARS-CoV­2 infection and COVID-19, have coordinated recommendations for lung and thorax sonography. This document has been created within a transparent process, led by the German Society of Interdisciplinary Emergency and Acute Medicine e. V. (DGINA), and worked out by an expert panel and delegates from the societies. Sources of the first 200 cases were summarized. Typical thorax sonographic findings are presented. International sources or standards that were available in PubMed until May 24, 2020 were included. Using case studies and multimedia content, the document is intended to not only support users but also demonstrate quality features and the potential of chest and lung sonography. The German Society for Ultrasound in Medicine (DEGUM) is carrying out a multicenter study (study coordination at the TU Munich).


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , COVID-19 , Humans , Lung/diagnostic imaging , SARS-CoV-2 , Ultrasonography
13.
Dtsch Med Wochenschr ; 145(16): 1152-1156, 2020 08.
Article in German | MEDLINE | ID: covidwho-713562

ABSTRACT

In view of dramatically increasing patient numbers worldwide in the face of the corona pandemic and scarce resources in intensive care medicine in many countries, some of which are dramatically undersupplied, concerns and fears have spread among the population in Germany. Healthcare workers didn't know how to deal with an overload of the healthcare system. Numerous inquiries from concerned physicians as well as ethics committees prompted the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) together with seven other medical associations to work out a clinical-ethical recommendation on "Decisions on resource allocation in emergency and intensive care in the context of the COVID-19 pandemic".


Subject(s)
Coronavirus Infections/therapy , Critical Care/ethics , Pandemics/ethics , Pneumonia, Viral/therapy , Advance Care Planning/ethics , COVID-19 , Critical Care/statistics & numerical data , Emergency Medicine/ethics , Emergency Medicine/statistics & numerical data , Germany/epidemiology , Health Priorities/ethics , Humans
14.
Med Klin Intensivmed Notfmed ; 115(6): 477-485, 2020 Sep.
Article in German | MEDLINE | ID: covidwho-700035

ABSTRACT

In view of the globally evolving Coronavirus Disease (COVID-19) pandemic, German hospitals rapidly expanded their intensive care capacities. However, it is possible that even with an optimal use of the increased resources, these will not suffice for all patients in need. Therefore, recommendations for the allocation of intensive care resources in the context of the COVID-19 pandemic have been developed by a multidisciplinary authors group with support of eight scientific medical societies. The recommendations for procedures and criteria for prioritisations in case of resource scarcity are based on scientific evidence, ethico-legal considerations and practical experience. Medical decisions must always be based on the need and the treatment preferences of the individual patient. In addition to this patient-centred approach, prioritisations in case of resource scarcity require a supra-individual perspective. In such situations, prioritisations should be based on the criterion of clinical prospect of success in order to minimize the number of preventable deaths due to resource scarcity and to avoid discrimination based on age, disabilities or social factors. Assessment of the clinical prospect of success should take into account the severity of the current illness, severe comorbidities and the patient's general health status prior to the current illness.


Subject(s)
Coronavirus Infections/epidemiology , Critical Care/ethics , Health Care Rationing/ethics , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Clinical Decision-Making , Humans , Pandemics/ethics , Practice Guidelines as Topic , SARS-CoV-2 , Societies, Medical
15.
Lancet Respir Med ; 8(9): 853-862, 2020 09.
Article in English | MEDLINE | ID: covidwho-698963

ABSTRACT

Background Nationwide, unbiased, and unselected data of hospitalised patients with COVID-19 are scarce. Our aim was to provide a detailed account of case characteristics, resource use, and outcomes of hospitalised patients with COVID-19 in Germany, where the health-care system has not been overwhelmed by the pandemic. METHODS: In this observational study, adult patients with a confirmed COVID-19 diagnosis, who were admitted to hospital in Germany between Feb 26 and April 19, 2020, and for whom a complete hospital course was available (ie, the patient was discharged or died in hospital) were included in the study cohort. Claims data from the German Local Health Care Funds were analysed. The data set included detailed information on patient characteristics, duration of hospital stay, type and duration of ventilation, and survival status. Patients with adjacent completed hospital stays were grouped into one case. Patients were grouped according to whether or not they had received any form of mechanical ventilation. To account for comorbidities, we used the Charlson comorbidity index. FINDINGS: Of 10 021 hospitalised patients being treated in 920 different hospitals, 1727 (17%) received mechanical ventilation (of whom 422 [24%] were aged 18-59 years, 382 [22%] were aged 60-69 years, 535 [31%] were aged 70-79 years, and 388 [23%] were aged ≥80 years). The median age was 72 years (IQR 57-82). Men and women were equally represented in the non-ventilated group, whereas twice as many men than women were in the ventilated group. The likelihood of being ventilated was 12% for women (580 of 4822) and 22% for men (1147 of 5199). The most common comorbidities were hypertension (5575 [56%] of 10 021), diabetes (2791 [28%]), cardiac arrhythmia (2699 [27%]), renal failure (2287 [23%]), heart failure (1963 [20%]), and chronic pulmonary disease (1358 [14%]). Dialysis was required in 599 (6%) of all patients and in 469 (27%) of 1727 ventilated patients. The Charlson comorbidity index was 0 for 3237 (39%) of 8294 patients without ventilation, but only 374 (22%) of 1727 ventilated patients. The mean duration of ventilation was 13·5 days (SD 12·1). In-hospital mortality was 22% overall (2229 of 10 021), with wide variation between patients without ventilation (1323 [16%] of 8294) and with ventilation (906 [53%] of 1727; 65 [45%] of 145 for non-invasive ventilation only, 70 [50%] of 141 for non-invasive ventilation failure, and 696 [53%] of 1318 for invasive mechanical ventilation). In-hospital mortality in ventilated patients requiring dialysis was 73% (342 of 469). In-hospital mortality for patients with ventilation by age ranged from 28% (117 of 422) in patients aged 18-59 years to 72% (280 of 388) in patients aged 80 years or older. INTERPRETATION: In the German health-care system, in which hospital capacities have not been overwhelmed by the COVID-19 pandemic, mortality has been high for patients receiving mechanical ventilation, particularly for patients aged 80 years or older and those requiring dialysis, and has been considerably lower for patients younger than 60 years. FUNDING: None.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Health Resources/statistics & numerical data , Hospitalization/statistics & numerical data , Hospitals/statistics & numerical data , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/therapy , Coronavirus Infections/virology , Female , Germany/epidemiology , Hospital Mortality , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Pandemics , Patient Acceptance of Health Care/statistics & numerical data , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Respiration, Artificial/statistics & numerical data , SARS-CoV-2 , Young Adult
16.
Clin Res Cardiol ; 109(12): 1511-1521, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-648791

ABSTRACT

AIMS: To assess the impact of the lockdown due to coronavirus disease 2019 (COVID-19) on key quality indicators for the treatment of ST-segment elevation myocardial infarction (STEMI) patients. METHODS: Data were obtained from 41 hospitals participating in the prospective Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) study, including 15,800 patients treated for acute STEMI from January 2017 to the end of March 2020. RESULTS: There was a 12.6% decrease in the total number of STEMI patients treated at the peak of the pandemic in March 2020 as compared to the mean number treated in the March months of the preceding years. This was accompanied by a significant difference among the modes of admission to hospitals (p = 0.017) with a particular decline in intra-hospital infarctions and transfer patients from other hospitals, while the proportion of patients transported by emergency medical service (EMS) remained stable. In EMS-transported patients, predefined quality indicators, such as percentages of pre-hospital ECGs (both 97%, 95% CI = - 2.2-2.7, p = 0.846), direct transports from the scene to the catheterization laboratory bypassing the emergency department (68% vs. 66%, 95% CI = - 4.9-7.9, p = 0.641), and contact-to-balloon-times of less than or equal to 90 min (58.3% vs. 57.8%, 95%CI = - 6.2-7.2, p = 0.879) were not significantly altered during the COVID-19 crisis, as was in-hospital mortality (9.2% vs. 8.5%, 95% CI = - 3.2-4.5, p = 0.739). CONCLUSIONS: Clinically important indicators for STEMI management were unaffected at the peak of COVID-19, suggesting that the pre-existing logistic structure in the regional STEMI networks preserved high-quality standards even when challenged by a threatening pandemic. CLINICAL TRIAL REGISTRATION: NCT00794001.


Subject(s)
COVID-19 , Cardiology Service, Hospital/trends , Delivery of Health Care, Integrated/trends , Hospitalization/trends , Outcome and Process Assessment, Health Care/trends , Percutaneous Coronary Intervention/trends , Regional Health Planning/trends , ST Elevation Myocardial Infarction/therapy , Aged , COVID-19/epidemiology , Cross-Sectional Studies , Female , Germany/epidemiology , Hospital Mortality/trends , Humans , Male , Middle Aged , Percutaneous Coronary Intervention/mortality , Prospective Studies , Quality Indicators, Health Care/trends , Registries , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/mortality , Time Factors , Time-to-Treatment/trends , Treatment Outcome
17.
Med Klin Intensivmed Notfmed ; 115(Suppl 3): 111-114, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-72019

ABSTRACT

Since December 2019, a novel coronavirus (severe acute respiratory syndrome-coronavirus 2, SARS-CoV-2) has rapidly spread around the world resulting in an acute respiratory illness pandemic. The majority of patients presents with mild symptoms of coronavirus disease 2019 (COVID-19). However, about 5% become critically ill and require intensive care treatment. Acute hypoxemic failure with severe dyspnea and an increased respiratory rate (>30/min) usually leads to ICU admission. At that point, bilateral pulmonary infiltrates are typically seen. Patients often develop a severe acute respiratory distress syndrome (ARDS). To date there is no specific treatment available-the main goal of supportive therapy is to ascertain adequate oxygenation. Early intubation and repeated prone positioning are key elements in treating hypoxemic COVID-19 patients. Strict adherence to basic infection control measures (including hand hygiene) and use of personal protection equipment (PPE) are essential in the care of patients. Procedures that lead to formation of aerosols should be avoided where possible and carried out with utmost precaution.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Critical Illness , Humans , Pandemics , Respiratory Distress Syndrome/therapy , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL