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1.
J Clin Sleep Med ; 18(8): 2023-2027, 2022 08 01.
Article in English | MEDLINE | ID: covidwho-1835536

ABSTRACT

STUDY OBJECTIVES: The impact of direct mail order sales of positive airway pressure (PAP) devices, accentuated by the coronavirus disease 2019 (COVID-19) pandemic, on PAP adherence in patients with obstructive sleep apnea remains unclear. In this study we compared the impact of different modes of continuous positive airway pressure delivery on adherence and daytime symptoms. We hypothesized that adherence would not be affected by remote PAP setup, aided by telehealth technology. METHODS: Three groups were studied: 1) standard group PAP setup (3-4 people); 2) direct home shipment of PAP, followed by telehealth interactions; 3) direct home shipment of PAP, during the COVID-19 pandemic where delivery choice was removed. Demographics, sleepiness, PAP data, and insurance information were also compared. RESULTS: A total of 666 patients were studied in 3 groups. 1) Standard group PAP setup had 225 patients and adherence with PAP (% of nights used more than 4 hours) was 65.3 ± 2.1%. 2) Direct home shipment of PAP group had 231 patients, and adherence was 54.2 ± 2.4%. 3) Direct mailed PAP units during the COVID-19 pandemic group had 210 patients, and adherence was 55.9 ± 2.5%. Adherence was lower in both groups receiving home shipments compared to those in groups in-center (analysis of variance, Tukey, P = .002). Discontinuation of PAP was less in the in-center group setup patients (χ2 = 10.938 P ≤ .001). CONCLUSIONS: Patients receiving direct home PAP shipments had lower adherence and were more likely to discontinue PAP compared to standard in-person setup. CITATION: Stanchina M, Lincoln J, Prenda S, et al. The impact of different CPAP delivery approaches on nightly adherence and discontinuation rate in patients with obstructive sleep apnea. J Clin Sleep Med. 2022;18(8):2023-2027.


Subject(s)
COVID-19 , Sleep Apnea, Obstructive , Continuous Positive Airway Pressure , Humans , Pandemics , Patient Compliance , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/therapy
3.
Chest ; 158(6): 2511-2516, 2020 12.
Article in English | MEDLINE | ID: covidwho-1108121

ABSTRACT

Lung ultrasonography (LUS), an imaging modality quickly performed, interpreted, and integrated by the treating physician at the bedside, is a particularly useful tool for acutely ill patients. In the evaluation of a patient with respiratory failure in the ICU or ED, LUS is superior to chest radiograph and generally comparable with CT imaging and reduces the need for patient transport and radiation exposure. This article will provide a concise review of LUS as it pertains to respiratory failure in general and will include examples of relevant ultrasound images and video clips from critically ill patients.


Subject(s)
Critical Illness/therapy , Lung/diagnostic imaging , Point-of-Care Testing , Respiratory Insufficiency/diagnosis , Ultrasonography/methods , Acute Disease , Comparative Effectiveness Research , Humans
4.
Chest ; 159(1): 205-211, 2021 01.
Article in English | MEDLINE | ID: covidwho-1064920

ABSTRACT

Given the general utility of lung ultrasound for the evaluation of respiratory failure in acutely ill patients, it is logical to consider its specific advantages in coronavirus disease 2019-related pulmonary disease. The authors, representing the extensive experience of the North American and European coronavirus disease 2019 epicenters, present an ultrasound scanning protocol and report on the common associated ultrasound findings.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Clinical Protocols , Humans , Male , Middle Aged , Ultrasonography/methods
5.
J Intensive Care Med ; 35(8): 818-824, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-634271

ABSTRACT

It has been well known for decades that prone positioning (PP) improves oxygenation. However, it has gained widespread acceptance only in the last few years since studies have shown significant survival benefit. Many centers have established prone ventilation in their treatment algorithm for mechanically ventilated patients with severe acute respiratory distress syndrome (ARDS). Physiologically, PP should also benefit awake, non-intubated patients with acute hypoxemic respiratory failure. However, proning in non-intubated (PINI) patients did not gain any momentum until a few months ago when the Coronavirus disease 2019 (COVID-19) pandemic surged. A large number of sick patients overwhelmed the health care system, and many centers faced a dearth of ventilators. In addition, outcomes of patients placed on mechanical ventilation because of COVID-19 infection have been highly variable and often dismal. Hence, increased focus has shifted to using various strategies to prevent intubation, such as PINI. There is accumulating evidence that PINI is a low-risk intervention that can be performed even outside intensive care unit with minimal assistance and may prevent intubation in certain patients with ARDS. It can also be performed safely at smaller centers and, therefore, may reduce the patient transfer to larger institutions that are overwhelmed in the current crisis. We present a case series of 2 patients with acute hypoxemic respiratory failure who experienced significant improvements in oxygenation with PP. In addition, the physiology of PP is described, and concerns such as proning in obese and patient's anxiety are addressed; an educational pamphlet that may be useful for both patients and health care providers is provided.


Subject(s)
Anxiety , Coronavirus Infections , Obesity , Pandemics , Patient Positioning/methods , Pneumonia, Viral , Prone Position/physiology , Respiratory Insufficiency , Adult , Anxiety/physiopathology , Anxiety/prevention & control , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/metabolism , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Humans , Hypoxia/etiology , Hypoxia/therapy , Male , Obesity/epidemiology , Obesity/physiopathology , Oxygen Consumption , Oxygen Inhalation Therapy/methods , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/epidemiology , Pneumonia, Viral/etiology , Pneumonia, Viral/metabolism , Pneumonia, Viral/physiopathology , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , Respiration, Artificial/methods , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/psychology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Treatment Outcome
7.
J Am Soc Echocardiogr ; 33(8): 1040-1047, 2020 08.
Article in English | MEDLINE | ID: covidwho-342809

ABSTRACT

BACKGROUND: The COVID-19 pandemic has placed an extraordinary strain on healthcare systems across North America. Defining the optimal approach for managing a critically ill COVID-19 patient is rapidly changing. Goal-directed transesophageal echocardiography (TEE) is frequently used by physicians caring for intubated critically ill patients as a reliable imaging modality that is well suited to answer questions at bedside. METHODS: A multidisciplinary (intensive care, critical care cardiology, and emergency medicine) group of experts in point-of-care echocardiography and TEE from the United States and Canada convened to review the available evidence, share experiences, and produce a consensus statement aiming to provide clinicians with a framework to maximize the safety of patients and healthcare providers when considering focused point-of-care TEE in critically ill patients during the COVID-19 pandemic. RESULTS: Although transthoracic echocardiography can provide the information needed in most patients, there are specific scenarios in which TEE represents the modality of choice. TEE provides acute care clinicians with a goal-directed framework to guide clinical care and represents an ideal modality to evaluate hemodynamic instability during prone ventilation, perform serial evaluations of the lungs, support cardiac arrest resuscitation, and guide veno-venous ECMO cannulation. To aid other clinicians in performing TEE during the COVID-19 pandemic, we describe a set of principles and practical aspects for performing examinations with a focus on the logistics, personnel, and equipment required before, during, and after an examination. CONCLUSIONS: In the right clinical scenario, TEE is a tool that can provide the information needed to deliver the best and safest possible care for the critically ill patients.


Subject(s)
Coronavirus Infections/epidemiology , Critical Care/organization & administration , Cross Infection/prevention & control , Echocardiography, Transesophageal/methods , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , COVID-19 , Canada/epidemiology , Consensus , Coronavirus Infections/prevention & control , Female , Humans , Infection Control/methods , Male , North America/epidemiology , Pandemics/prevention & control , Patient Positioning , Pneumonia, Viral/prevention & control , Point-of-Care Systems , Risk Assessment , Safety Management
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