Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 14 de 14
Filter
1.
Deutsches Arzteblatt International ; 119(4):A125-A128+A4, 2022.
Article in German | Scopus | ID: covidwho-1842659
2.
Atemwegs- und Lungenkrankheiten ; 46(4):245, 2020.
Article in German | ProQuest Central | ID: covidwho-1710725
3.
Anaesthesist ; 70(Suppl 1): 19-29, 2021 12.
Article in English | MEDLINE | ID: covidwho-1574765

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 immense challenges for clinicians and hospitals as well as the strain on many healthcare systems has been unprecedented.The majority of patients present with mild symptoms of coronavirus disease 2019 (COVID-19); however, 5-8% become critically ill and require intensive care treatment. Acute hypoxemic respiratory failure with severe dyspnea and an increased respiratory rate (>30/min) usually leads to intensive care unit (ICU) admission. At this point bilateral pulmonary infiltrates are typically seen. Patients often develop a severe acute respiratory distress syndrome (ARDS).So far, remdesivir and dexamethasone have shown clinical effectiveness in severe COVID-19 in hospitalized patients. The main goal of supportive treatment is to ascertain adequate oxygenation. Invasive mechanical ventilation and repeated prone positioning are key elements in treating severely hypoxemic COVID-19 patients.Strict adherence to basic infection control measures (including hand hygiene) and correct use of personal protection equipment (PPE) are essential in the care of patients. Procedures that lead to formation of aerosols should be carried out with utmost precaution and preparation.


Subject(s)
COVID-19 , Critical Illness , Humans , SARS-CoV-2
4.
Deutsches Arzteblatt International ; 118(27-28), 2021.
Article in German | Scopus | ID: covidwho-1344794
6.
Deutsches Arzteblatt International ; 117(48):A2340-A2345, 2020.
Article in German | EMBASE | ID: covidwho-1175998
7.
Deutsches Arzteblatt International ; 117(48):A2321-A2323, 2020.
Article in German | EMBASE | ID: covidwho-1175976
8.
Deutsches Arzteblatt International ; 117(48):A2340-A2345, 2020.
Article in German | Scopus | ID: covidwho-1161434
9.
Transplant International ; 33(SUPPL 2):20, 2020.
Article in English | EMBASE | ID: covidwho-1093813

ABSTRACT

Introduction: On March 11, 2020, the WHO declared COVID-19 as global pandemic. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a new strain of coronavirus. By 20May 2020 there have been nearly five million confirmed cases with COVID-19 and more than 320.000 deaths worldwide. There is still limited data about the course of the disease in transplant patients. Some reports suggest that immunosuppression can have a protective role in patients with COVID-19, however other reports suggest an increased mortality in transplant patients. The specificity and sensitivity of diagnostic tests for SARSCoV-2 in immunosuppressed patients are also unclear at this point. Methods: We present a case report of diagnostic difficulties of SARS-CoV-2 in a female AB0-incompatible kidney transplant patient with severe COVID-19 pneumonia requiring intubation and mechanical ventilation. Results: Albeit she presented with typical symptoms for at least two weeks, PCR of two nasopharyngeal swabs and one throat wash were negative. Ultimately, typical findings on CT scans and positive stool samples confirmed the diagnosis before bronchoscopy was done and BAL tested positive. Despite immunosuppressive therapy was reduced her condition worsened. Mechanical ventilation was necessary for 17 days, however she was able to recover and could be discharged. Kidney function remained stable without renal replacement therapy. Conclusion: Our findings suggest that-especially in areas or situations where bronchoscopy and CT scans might not be available-stool testing for SARSCoV-2 might be of additional value to identify, isolate and treat COVID-19 patients. Taken together, this case highlights the importance of different diagnostic approaches when dealing with transplant patients to reach a proper diagnosis of COVID-19. Invasive procedures bear the potential of worsening the clinical course. Non-invasive stool testing might be an interesting supplemental diagnostic method. Moreover, at this point there is only scarce information published in relation to the extent of COVID-19 in transplant patients. Our case shows that reduced immunosuppression and IVIg-therapy was sufficient for a complete recovery with functioning graft.

10.
Med Klin Intensivmed Notfmed ; 116(5): 431-439, 2021 Jun.
Article in German | MEDLINE | ID: covidwho-1064439

ABSTRACT

BACKGROUND: Hospitalized coronavirus disease 2019 (COVID-19) patients have a high morbidity and mortality and are often dependent on intensive care, especially mechanical ventilation. Little is as yet known about COVID-19 patient allocation. OBJECTIVES: Analysis of the structures of German hospital care for COVID-19 patients up to July 2020 in terms of number of beds and previous ventilation experience. DATA AND METHODS: For the analysis of the care structures, only completed COVID-19 cases in which the virus was detected by a PCR test were evaluated. Claims data from the German Local Health Care Funds (Allgemeine Ortskrankenkassen, AOK) were analysed. The sample includes 17,094 COVID-19 cases that were treated in 1082 hospitals. RESULTS: A total of 77% of all hospitals participated in the treatment COVID-19 patients and 48% of all hospitals provided intensive care for these patients. One half of the hospitals that treated COVID-19 cases cared for 88% of all cases. Although this suggests a centralization effect of COVID-19 cases in specific hospitals, the remaining 12% of the cases were distributed among many hospitals with often very small numbers of cases. Furthermore, 23% of the ventilated COVID-19 cases were treated in hospitals with below-average ventilation experience. CONCLUSIONS: In the context of increasing numbers of infections, it is both necessary to improve the allocation of hospitalized, and therefore potentially ventilated, COVID-19 cases by means of clearly defined and centrally controlled pyramid-type concepts and to continue to care for patients without COVID-19. For Germany, a comprehensive pyramid-type concept with a greater concentration in the best-qualified hospitals seems reasonable for the care of these patients with complex diseases.


Subject(s)
COVID-19 , Germany , Hospitals , Humans , Respiration, Artificial , SARS-CoV-2
11.
Med Klin Intensivmed Notfmed ; 117(3): 218-226, 2022 Apr.
Article in German | MEDLINE | ID: covidwho-1061156

ABSTRACT

BACKGROUND: Forecasting models for intensive care occupancy of coronavirus disease 2019 (COVID-19) patients are important in the current pandemic for strategic planning of patient allocation and avoidance of regional overcrowding. They are often trained entirely on retrospective infection and occupancy data, which can cause forecast uncertainty to grow exponentially with the forecast horizon. METHODOLOGY: We propose an alternative modeling approach in which the model is created largely independent of the occupancy data being simulated. The distribution of bed occupancies for patient cohorts is calculated directly from occupancy data from "sentinel clinics". By coupling with infection scenarios, the prediction error is constrained by the error of the infection dynamics scenarios. The model allows systematic simulation of arbitrary infection scenarios, calculation of bed occupancy corridors, and sensitivity analyses with respect to protective measures. RESULTS: The model was based on hospital data and by adjusting only two parameters of data in the Aachen city region and Germany as a whole. Using the example of the simulation of the respective bed occupancy rates for Germany as a whole, the loading model for the calculation of occupancy corridors is demonstrated. The occupancy corridors form barriers for bed occupancy in the event that infection rates do not exceed specific thresholds. In addition, lockdown scenarios are simulated based on retrospective events. DISCUSSION: Our model demonstrates that a significant reduction in forecast uncertainty in occupancy forecasts is possible by selectively combining data from different sources. It allows arbitrary combination with infection dynamics models and scenarios, and thus can be used both for load forecasting and for sensitivity analyses for expected novel spreading and lockdown scenarios.


Subject(s)
COVID-19 , Bed Occupancy , Communicable Disease Control , Humans , Intensive Care Units , Retrospective Studies
12.
Pneumologie ; 75(2): 88-112, 2021 Feb.
Article in German | MEDLINE | ID: covidwho-1033360

ABSTRACT

Since December 2019, the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome - Corona Virus-2) has been spreading rapidly in the sense of a global pandemic. This poses significant challenges for clinicians and hospitals and is placing unprecedented strain on the healthcare systems of many countries. The majority of patients with Coronavirus Disease 2019 (COVID-19) present with only mild symptoms such as cough and fever. However, about 6 % require hospitalization. Early clarification of whether inpatient and, if necessary, intensive care treatment is medically appropriate and desired by the patient is of particular importance in the pandemic. Acute hypoxemic respiratory insufficiency with dyspnea and high respiratory rate (> 30/min) usually leads to admission to the intensive care unit. Often, bilateral pulmonary infiltrates/consolidations or even pulmonary emboli are already found on imaging. As the disease progresses, some of these patients develop acute respiratory distress syndrome (ARDS). Mortality reduction of available drug therapy in severe COVID-19 disease has only been demonstrated for dexamethasone in randomized controlled trials. The main goal of supportive therapy is to ensure adequate oxygenation. In this regard, invasive ventilation and repeated prone positioning are important elements in the treatment of severely hypoxemic COVID-19 patients. Strict adherence to basic hygiene, including hand hygiene, and the correct wearing of adequate personal protective equipment are essential when handling patients. Medically necessary actions on patients that could result in aerosol formation should be performed with extreme care and preparation.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Humans , Inpatients , Pandemics , Practice Guidelines as Topic , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL