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1.
Critical Care Medicine ; 51(1 Supplement):271, 2023.
Article in English | EMBASE | ID: covidwho-2190572

ABSTRACT

INTRODUCTION: Medical complications among pregnant peripartum patients are not common. However, certain disease such as obstetric hemorrhage or respiratory failure could be associated with poor outcome among obstetric patients whose biological systems are already stretched. When a peripartum patients encounter a severe medical condition, they are frequently transferred to a tertiary center for management of these patients' complex conditions. Our study investigated the outcomes of the peripartum patients who were transferred from other hospitals (Interhospital transfer [IHT]) to the Intensive Care Unit at an academic quaternary center. METHOD(S): We retrospectively analyzed all adult IHT peripartum patients to our institution's ICU between Jan. 2017 to Dec. 2021. We presented descriptive analysis for our patients and used multivariable ordinal regressions for association between demographic, clinical factors, and patients' length of stay (LOS) in the ICU (ICULOS), hospital (HLOS). RESULT(S): Among 1794 IHT peripartum patients, 59 patients were transferred directly to an ICU, 8 (13.6%) to Medical ICU, 2 (3.4%) Neuro ICU, 2 (3.4%) Surgical ICU and 47 (79.7%) to our Critical Care Resuscitation Unit. Patients' mean (Standard Deviation) age was 32 (6) years, SOFA score 3 (3), APACHE II 8 (4), median Respiratory Oxygenation (ROx) index was 13 [Interquartile Range 4-22], and serum lactate 11 [9-15] mmol/L. Respiratory failure occurred in 19 (32%), postpartum hemorrhage 9 (15%), sepsis 8 (14%) patients. 16 (27%) patients were infected with COVID-19. 24 (41%) needed intubation, 13 (22%) vasopressor, 4 (7%) Extracorporeal Membrane Oxygenation. Median ICULOS and HLOS was 5 [2-12], 8 [5-17] days. Only 1 (1.7%) died, while 45 (76.3%) were discharged home directly. Having COVID-19 infection was associated with both ICULOS (Correlation Coefficient -2,23, OR 0.06, 95%CI 0.02-0.65, P = 0.016) and HLOS (Corr. Coeff. -2.75, OR 0.06, 95%CI 0.01-0.37, P = 0.002). CONCLUSION(S): Although severe medical conditions were uncommon among interhospital transferred peripartum patients, they could be severe, especially during the COVID-19 pandemic. Fortunately, the mortality rate for peripartum patients in our study was very low. Further studies with larger sample sizes are needed to confirm our observation.

2.
ASAIO Journal ; 68:61-62, 2022.
Article in English | EMBASE | ID: covidwho-2032179

ABSTRACT

Background: Patients with severe COVID-19 related respiratory failure may require veno-venous extracorporeal membrane oxygenation (VV ECMO). After decannulation, patients on VV ECMO have historically had high percentages of cannula-associated deep vein thrombosis (CaDVT). Due to their hypercoagulable state and prolonged course on VV ECMO, we hypothesized that patients with COVID-19 would experience a higher rate of CaDVT when compared to their non-COVID-19 counterparts. We also described the association between location and size of cannula in the development of CaDVTs. Methods: This was a single center retrospective review of patients ≥ 18 years old who were treated with VV ECMO and decannulated from January 1, 2014, to January 10, 2022. Patients who were placed on VV ECMO due to trauma and patients who were cannulated for veno-arterial ECMO were excluded. Patients were managed in a dedicated Lung Rescue Unit and anticoagulated with a heparin infusion at a goal partial thromboplastin time (aPTT) of 45-55 or 60-80 depending on the presence of clotting complications. Post-decannulation venous duplexes were performed 24 hours after decannulation and if positive for DVT, performed again in 2 weeks. Univariate and multivariate analyses were conducted to analyze our primary outcome of the development of CaDVT. Results: A total of 291 patients met our inclusion criteria: 76 COVID-19 VV ECMO patients and 215 non-COVID-19 VV ECMO patients. Decannulated COVID-19 VV ECMO patients had a significantly higher body mass index (BMI) (35.8, 32.9, p= 0.03) and length of ECMO run (hours) (660, 312, p< 0.001) than their non-COVID-19 counterparts. Most decannulated patients in both groups received post-decannulation duplexes (96%, 99%, p= 0.45). COVID-19 and non-COVID-19 patients decannulated from VV ECMO both experienced high incidences of CaDVT on initial post-decannulation ultrasound (95%, 88%, p= 0.13). COVID-19 patients were more likely to have multiple CaDVTs (32%, 11%, p< 0.001). Patients with COVID- 19 experienced a higher rate of right common femoral CaDVT (47%, 17%, p< 0.001) and a higher percentage of 25 French drainage cannula CaDVT (48%, 18%, p< 0.001). COVID-19 VV ECMO patients had a significantly higher incidence of persistent CaDVT on repeat ultrasound (78%, 56%, p= 0.03). A logistic regression was performed with all decannulated patients. Age, BMI, hours on ECMO, COVID-19 status, and size and location of ECMO cannulas did not predict the presence of DVT. Conclusion: Both COVID-19 and non-COVID-19 VV ECMO patients had high rates of CaDVTs. The utilization of VV ECMO in COVID-19 respiratory failure was associated with a higher incidence of CaDVTs on repeat ultrasound as compared to patients with non-COVID-19 related respiratory failure. Regular post-decannulation screening, treatment, and follow up imaging should be performed. Further investigation into the effect of anticoagulation strategy is needed. (Table Presented).

3.
Int J Obstet Anesth ; 49: 103236, 2022 02.
Article in English | MEDLINE | ID: covidwho-1936547

ABSTRACT

BACKGROUND: We present the care of 17 consecutive pregnant patients who required mechanical ventilation for Coronavirus Disease 2019 (COVID-19) pneumonia at a quaternary referral center in the United States. We retrospectively describe the management of these patients, maternal and fetal outcomes, as well as the feasibility of prone positioning and delivery. METHODS: Between March 2020 and June 2021, all pregnant and postpartum patients who were mechanically ventilated for COVID-19 pneumonia were identified. Details of their management including prone positioning, maternal and neonatal outcomes, and complications were noted. RESULTS: Seventeen pregnant patients required mechanical ventilation for COVID-19. Thirteen patients received prone positioning, with a total of 49 prone sessions. One patient required extracorporeal membrane oxygenation. All patients in this series survived until at least discharge. Nine patients delivered while mechanically ventilated, and all neonates survived, subsequently testing negative for SARS-CoV-2. There was one spontaneous abortion. Four emergent cesarean deliveries were prompted by refractory maternal hypoxemia or non-reassuring fetal heart rate after maternal intubation. CONCLUSIONS: Overall, maternal and neonatal survival were favorable even in the setting of severe COVID-19 pneumonia requiring mechanical ventilation. Prone positioning was well tolerated although the impact of prone positioning or fetal delivery on maternal oxygenation and ventilation are unclear.


Subject(s)
COVID-19 , Female , Humans , Infant, Newborn , Pregnancy , Prone Position , Referral and Consultation , Respiration, Artificial , Retrospective Studies , SARS-CoV-2 , United States
4.
Frontiers in Communication ; 5:11, 2020.
Article in English | Web of Science | ID: covidwho-1339482

ABSTRACT

This paper introduces a crucial parameter to the novel coronavirus response in the United States, by shedding light on the early-warning role of intelligence agencies. It argues that the intelligence components of the federal government's Biological Defense Program offered actionable forewarning about an impending pandemic in the years leading to the COVID-19 outbreak. Yet, almost from the opening stages of the pandemic, senior US government officials, including President Donald Trump, have repeatedly claimed that the virus "came out of nowhere" and that "nobody saw it coming." We show that these assertions contradict more than 15 years of pandemic preparedness warnings by intelligence professionals, and disregard the existence of intelligence-led federal pandemic response strategies of every US administration in our time. However, rather than simply placing blame on the White House for discounting these warnings, we advance a conceptual analysis of what many in the US Intelligence Community view as a critical breakdown in strategic communication between intelligence professionals and key government decision-makers. This study agrees with those who suggest that the White House disregarded its own pandemic experts. However, it also posits that the means of strategic communication employed by intelligence experts to alert the White House to the threat were unproductive. These alerts were communicated largely through the President's Daily Brief, an archaic, and ineffectual method of communication that is not designed to facilitate the kind of laser-focused, unequivocal exchange of information needed when potentially catastrophic threats confront the world. This study suggests that the Intelligence Community must implement more direct, immediate and conclusive methods of communicating intelligence to decision-makers, and should seriously consider creating a new line of products that addresses existential challenges to national security. Lastly, we contend it is time to re-evaluate existing rules that prevent intelligence analysts from offering advice on policy. Although we agree that intelligence professionals should refrain from providing policy advice on routine matters, we question the value of preventing these highly knowledgeable experts from communicating strategic policy advice to decision-makers when it comes to threats of a catastrophic nature, which may prove potentially existential for the US, its allies, and the world.

5.
J Matern Fetal Neonatal Med ; : 1-7, 2020.
Article in English | PubMed | ID: covidwho-808188

ABSTRACT

BACKGROUND: In the last two decades, the world faced three epidemics caused by novel coronaviruses, namely, SARS CoV in 2002, MERS CoV in 2012, and the ongoing SARS-CoV-2 that started in late 2019. Despite a growing understanding of SARS-CoV-2 virology, epidemiology, and clinical management strategies, other aspects, such as mode of delivery, vertical transmission, and maternal bonding, remain controversial. The question we faced upon the decision to separate the neonates of SARS-CoV-2 positive mother is whether we follow the principle of "do no harm"? METHODS: This is a quality improvement project that analyzed all cases of SARS-CoV-2 positive pregnancies that delivered at a major health care system from 3 January 2020 to 6 January 2020. The article was prepared following Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines. Data were prospectively collected and entered into the Research Electronic Data Capture (REDCap). Maternal bonding was defined by events such as rooming-in, skin to skin contact (STSC), and breastfeeding. Descriptive analysis was performed using the same software platform. INTERVENTION: We compared neonatal transmission rates between those neonates who experienced bonding versus those who were separated. RESULTS: A total of 1989 women were screened for SARS-CoV-2, from which 86 tested positive. Out of 31 analyzed pregnancies, five women (16%) were admitted to ICU and required mechanical ventilation. From the remaining 26 (84%), 17 (65%) opted for rooming-in, 12 (46%) for STSC, and 16 (61%) fed the infants with breastmilk (11 direct breastfeedings and five pumped the breast milk). All neonatal tests for SARS-CoV-2 returned negative. CONCLUSION: Our results have illustrated that maternal bonding appears safe in neonates born to mothers that are SARS-CoV-2 positive.

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