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1.
Best Pract Res Clin Anaesthesiol ; 35(3): 267-268, 2021 10.
Article in English | MEDLINE | ID: covidwho-1433002
2.
Best Pract Res Clin Anaesthesiol ; 35(3): 437-448, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1116288

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, emerged in late 2019 in Wuhan, China. The World Health Organization declared the virus a pandemic on March 11, 2020. Disease progression from COVID-19 infection has shown significant symptom manifestations within organ systems beyond the respiratory system. The literature has shown increasing evidence of cardiovascular involvement during disease course and an associated increase in mortality among infected patients. Although the understanding of this novel virus is continually evolving, it is currently proposed that the mechanism by which the SARS-CoV-2 virus contributes to cardiovascular manifestations involves the ACE2 transmembrane protein. The protein ACE2 is highly expressed in blood vessel pericytes, and infection can result in microvascular dysfunction and subsequent acute coronary syndromes. Complications involving the cardiovascular system include myocardial infarction, arrhythmias, shock, and heart failure. In this evidence-based review, we discuss risk factors of cardiovascular involvement in COVID-19 infection, pathophysiology of COVID-19-related cardiovascular infection, and injury, COVID-19 effects on the cardiovascular system and corresponding treatments, and hematologic effects of COVID-19 and COVID-19 in heart transplant patients. Clinicians managing COVID-19 patients should appreciate the potential cardiovascular effects related to the disease process.


Subject(s)
COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/virology , Cardiovascular System/virology , Evidence-Based Practice/methods , COVID-19/therapy , Cardiovascular Diseases/therapy , Delivery of Health Care/methods , Delivery of Health Care/standards , Evidence-Based Practice/standards , Humans , Risk Factors
3.
Best Pract Res Clin Anaesthesiol ; 35(3): 449-459, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1116287

ABSTRACT

Coronavirus disease (COVID-19) causes many deleterious effects throughout the body. Prior studies show that the incidence of acute kidney injury in COVID-19 patients could be as high as 25%. There are also autopsy reports showing evidence of viral tropism to the renal system. In this regard, COVID-19 can damage the kidneys and increase a patient's risk of requiring dialysis. Available evidence suggests that renal involvement in COVID-19 infection is not uncommon, and there has been an increased incidence of chronic kidney disease related to the pandemic. In this literature analysis, we address COVID-19 and its effects on the renal system, including the pathophysiologic mechanisms. We also address current studies on the causes of injury to the renal system, the cause of kidney failure, its effect on mortality, the impact on dialysis patients, and the impact on renal transplant patients. COVID-19 disease may have unique features in individuals on chronic dialysis and kidney transplant recipients, requiring increased vigilance in limiting viral transmission in perioperative, in-patient, and dialysis center settings.


Subject(s)
COVID-19/physiopathology , Kidney Diseases/physiopathology , Kidney/physiopathology , COVID-19/epidemiology , COVID-19/therapy , Humans , Kidney/virology , Kidney Diseases/epidemiology , Kidney Diseases/therapy , Kidney Diseases/virology , Renal Dialysis/methods , Renal Dialysis/trends , Treatment Outcome
4.
Best Pract Res Clin Anaesthesiol ; 35(3): 351-368, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1049749

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces coronavirus-19 disease (COVID-19) and is a major health concern. Following two SARS-CoV-2 pandemic "waves," intensive care unit (ICU) specialists are treating a large number of COVID19-associated acute respiratory distress syndrome (ARDS) patients. From a pathophysiological perspective, prominent mechanisms of COVID19-associated ARDS (CARDS) include severe pulmonary infiltration/edema and inflammation leading to impaired alveolar homeostasis, alteration of pulmonary physiology resulting in pulmonary fibrosis, endothelial inflammation (endotheliitis), vascular thrombosis, and immune cell activation. Although the syndrome ARDS serves as an umbrella term, distinct, i.e., CARDS-specific pathomechanisms and comorbidities can be noted (e.g., virus-induced endotheliitis associated with thromboembolism) and some aspects of CARDS can be considered ARDS "atypical." Importantly, specific evidence-based medical interventions for CARDS (with the potential exception of corticosteroid use) are currently unavailable, limiting treatment efforts to mostly supportive ICU care. In this article, we will discuss the underlying pulmonary pathophysiology and the clinical management of CARDS. In addition, we will outline current and potential future treatment approaches.


Subject(s)
COVID-19/therapy , Critical Care/standards , Health Knowledge, Attitudes, Practice , Intensive Care Units/standards , Respiratory Distress Syndrome/therapy , Adrenal Cortex Hormones/administration & dosage , Anticoagulants/administration & dosage , COVID-19/diagnosis , COVID-19/physiopathology , Critical Care/trends , Humans , Immunologic Factors/administration & dosage , Intensive Care Units/trends , Respiration, Artificial/standards , Respiration, Artificial/trends , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/physiopathology
5.
Best Pract Res Clin Anaesthesiol ; 35(3): 321-332, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1039303

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has potentiated the need for implementation of strict safety measures in the medical care of surgical patients - and especially in cardiac surgery patients, who are at a higher risk of COVID-19-associated morbidity and mortality. Such measures not only require minimization of patients' exposure to COVID-19 but also careful balancing of the risks of postponing nonemergent surgical procedures and providing appropriate and timely surgical care. We provide an overview of current evidence for preoperative strategies used in cardiac surgery patients, including risk stratification, telemedicine, logistical challenges during inpatient care, appropriate screening capacity, and decision-making on when to safely operate on COVID-19 patients. Further, we focus on perioperative measures such as safe operating room management and address the dilemma over when to perform cardiovascular surgical procedures in patients at risk.


Subject(s)
COVID-19/prevention & control , Cardiac Surgical Procedures/standards , Patient Safety/standards , Perioperative Care/standards , COVID-19/epidemiology , COVID-19/surgery , Cardiac Surgical Procedures/trends , Humans , Pandemics/prevention & control , Perioperative Care/trends , Risk Factors
6.
Best Pract Res Clin Anaesthesiol ; 35(3): 389-404, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-967096

ABSTRACT

The increase in interconnectedness of the global population has enabled a highly transmissible virus to spread rapidly around the globe in 2020. The COVID-19 (Coronavirus Disease 2019) pandemic has led to physical, social, and economic repercussions of previously unseen proportions. Although recommendations for pandemic preparedness have been published in response to previous viral disease outbreaks, these guidelines are primarily based on expert opinion and few of them focus on acute care staffing issues. In this review, we discuss how working in acute care medicine during a pandemic can affect the physical and mental health of medical and nursing staff. We provide ideas for limiting staff shortages and creating surge capacity in acute care settings, and strategies for sustainability that can help hospitals maintain adequate staffing throughout their pandemic response.


Subject(s)
COVID-19/epidemiology , Critical Care/standards , Health Personnel/standards , Workforce/standards , COVID-19/therapy , Critical Care/trends , Health Personnel/trends , Humans , Leadership , Pandemics/prevention & control , Workforce/trends
7.
Best Pract Res Clin Anaesthesiol ; 35(3): 333-349, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-966663

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can lead to severe pneumonia and multiorgan failure. While most of the infected patients develop no or only mild symptoms, some need respiratory support or even invasive ventilation. The exact route of transmission is currently under investigation. While droplet exposure and direct contact seem to be the most significant ways of transmitting the disease, aerosol transmission appears to be possible under circumstances favored by high viral load. Despite the use of personal protective equipment (PPE), this situation potentially puts healthcare workers at risk of infection, especially if they are involved in airway management. Various recommendations and international guidelines aim to protect healthcare workers, although evidence-based research confirming the benefits of these approaches is still scarce. In this article, we summarize the current literature and recommendations for airway management of COVID-19 patients.


Subject(s)
Airway Management/standards , COVID-19/prevention & control , Health Personnel/standards , Hospitalization , Personal Protective Equipment/standards , Practice Guidelines as Topic/standards , Aerosols , Airway Management/trends , COVID-19/epidemiology , Health Personnel/trends , Hospitalization/trends , Humans , Pandemics/prevention & control , Personal Protective Equipment/trends
8.
Best Pract Res Clin Anaesthesiol ; 35(3): 307-319, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-956948

ABSTRACT

Telemedicine is the medical practice of caring for and treating patients remotely. With the spread of the coronavirus disease-2019 (COVID-19) pandemic, telemedicine has become increasingly prevalent. Although telemedicine was already in practice before the 2020 pandemic, the internet, smartphones, computers, and video-conferencing tools have made telemedicine easily accessible and available to almost everyone. However, there are also new challenges that health care providers may not be prepared for, including treating and diagnosing patients without physical contact. Physician adoption also depends upon reimbursement and education to improve the telemedicine visits. We review current trends involving telemedicine, how pandemics such as COVID-19 affect the remote treatment of patients, and key concepts important to healthcare providers who practice telemedicine.


Subject(s)
COVID-19/prevention & control , Health Personnel/trends , Practice Patterns, Physicians'/trends , Telemedicine/trends , COVID-19/diagnosis , COVID-19/epidemiology , Humans , Pain Management/methods , Pain Management/trends , Pandemics/prevention & control , Substance-Related Disorders/epidemiology , Substance-Related Disorders/therapy , Telemedicine/methods
9.
Best Pract Res Clin Anaesthesiol ; 35(3): 405-414, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-927468

ABSTRACT

The current COVID-19 pandemic is testing political leaders and healthcare systems worldwide, exposing deficits in crisis communication, leadership, preparedness and flexibility. Extraordinary situations abound, with global supply chains suddenly failing, media communicating contradictory information, and politics playing an increasingly bigger role in shaping each country's response to the crisis. The pandemic threatens not just our health but also our economy, liberty, and privacy. It challenges the speed at which we work, the quality of our research, and the effectiveness of communication within the scientific community. It can impose ethical dilemmas and emotional stress on healthcare workers. Nevertheless, the pandemic also provides an opportunity for healthcare organizations, leaders, and researchers to learn from their mistakes and to place their countries and institutions in a better position to face future challenges.


Subject(s)
COVID-19/epidemiology , Crew Resource Management, Healthcare/standards , Health Personnel/standards , Leadership , COVID-19/therapy , Communication , Crew Resource Management, Healthcare/methods , Delivery of Health Care/methods , Delivery of Health Care/standards , Humans , Pandemics
10.
Anesth Analg ; 131(4): 993-999, 2020 10.
Article in English | MEDLINE | ID: covidwho-760675

ABSTRACT

BACKGROUND: The cellular immune system is of pivotal importance with regard to the response to severe infections. Monocytes/macrophages are considered key immune cells in infections and downregulation of the surface expression of monocytic human leukocyte antigen-DR (mHLA-DR) within the major histocompatibility complex class II reflects a state of immunosuppression, also referred to as injury-associated immunosuppression. As the role of immunosuppression in coronavirus disease 2019 (COVID-19) is currently unclear, we seek to explore the level of mHLA-DR expression in COVID-19 patients. METHODS: In a preliminary prospective monocentric observational study, 16 COVID-19-positive patients (75% male, median age: 68 [interquartile range 59-75]) requiring hospitalization were included. The median Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score in 9 intensive care unit (ICU) patients with acute respiratory failure was 30 (interquartile range 25-32). Standardized quantitative assessment of HLA-DR on monocytes (cluster of differentiation 14+ cells) was performed using calibrated flow cytometry at baseline (ICU/hospital admission) and at days 3 and 5 after ICU admission. Baseline data were compared to hospitalized noncritically ill COVID-19 patients. RESULTS: While normal mHLA-DR expression was observed in all hospitalized noncritically ill patients (n = 7), 89% (8 of 9) critically ill patients with COVID-19-induced acute respiratory failure showed signs of downregulation of mHLA-DR at ICU admission. mHLA-DR expression at admission was significantly lower in critically ill patients (median, [quartiles]: 9280 antibodies/cell [6114, 16,567]) as compared to the noncritically ill patients (30,900 antibodies/cell [26,777, 52,251]), with a median difference of 21,508 antibodies/cell (95% confidence interval [CI], 14,118-42,971), P = .002. Reduced mHLA-DR expression was observed to persist until day 5 after ICU admission. CONCLUSIONS: When compared to noncritically ill hospitalized COVID-19 patients, ICU patients with severe COVID-19 disease showed reduced mHLA-DR expression on circulating CD14+ monocytes at ICU admission, indicating a dysfunctional immune response. This immunosuppressive (monocytic) phenotype remained unchanged over the ensuing days after ICU admission. Strategies aiming for immunomodulation in this population of critically ill patients should be guided by an immune-monitoring program in an effort to determine who might benefit best from a given immunological intervention.


Subject(s)
Coronavirus Infections/immunology , Critical Illness , HLA-DR Antigens/biosynthesis , HLA-DR Antigens/immunology , Immune Tolerance/immunology , Pneumonia, Viral/immunology , APACHE , Aged , Antibodies/analysis , Antibodies/immunology , COVID-19 , Coronavirus Infections/therapy , Critical Care , Down-Regulation/immunology , Female , Humans , Immunotherapy , Lipopolysaccharide Receptors/immunology , Male , Middle Aged , Monocytes/immunology , Pandemics , Pneumonia, Viral/therapy , Prospective Studies , Respiratory Insufficiency/immunology , Respiratory Insufficiency/physiopathology
11.
Best Pract Res Clin Anaesthesiol ; 34(2): 345-351, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-325827

ABSTRACT

Limiting the spread of the disease is key to controlling the COVID-19 pandemic. This includes identifying people who have been exposed to COVID-19, minimizing patient contact, and enforcing strict hygiene measures. To prevent healthcare systems from becoming overburdened, elective and non-urgent medical procedures and treatments have been postponed, and primary health care has broadened to include virtual appointments via telemedicine. Although telemedicine precludes the physical examination of a patient, it allows collection of a range of information prior to a patient's admission, and may therefore be used in preoperative assessment. This new tool can be used to evaluate the severity and progression of the main disease, other comorbidities, and the urgency of the surgical treatment as well as preferencing anesthetic procedures. It can also be used for effective screening and triaging of patients with suspected or established COVID-19, thereby protecting other patients, clinicians and communities alike.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Preoperative Care/methods , Telemedicine/methods , Anesthesia , COVID-19 , Humans
12.
Anesth Analg ; 131(1): 24-30, 2020 07.
Article in English | MEDLINE | ID: covidwho-159435

ABSTRACT

BACKGROUND: Health care worker (HCW) safety is of pivotal importance during a pandemic such as coronavirus disease 2019 (COVID-19), and employee health and well-being ensure functionality of health care institutions. This is particularly true for an intensive care unit (ICU), where highly specialized staff cannot be readily replaced. In the light of lacking evidence for optimal staffing models in a pandemic, we hypothesized that staff shortage can be reduced when staff scheduling takes the epidemiology of a disease into account. METHODS: Various staffing models were constructed, and comprehensive statistical modeling was performed. A typical routine staffing model was defined that assumed full-time employment (40 h/wk) in a 40-bed ICU with a 2:1 patient-to-staff ratio. A pandemic model assumed that staff worked 12-hour shifts for 7 days every other week. Potential in-hospital staff infections were simulated for a total period of 120 days, with a probability of 10%, 25%, and 40% being infected per week when at work. Simulations included the probability of infection at work for a given week, of fatality after infection, and the quarantine time, if infected. RESULTS: Pandemic-adjusted staffing significantly reduced workforce shortage, and the effect progressively increased as the probability of infection increased. Maximum effects were observed at week 4 for each infection probability with a 17%, 32%, and 38% staffing reduction for an infection probability of 0.10, 0.25, and 0.40, respectively. CONCLUSIONS: Staffing along epidemiologic considerations may reduce HCW shortage by leveling the nadir of affected workforce. Although this requires considerable efforts and commitment of staff, it may be essential in an effort to best maintain staff health and operational functionality of health care facilities and systems.


Subject(s)
Coronavirus Infections , Critical Care/organization & administration , Epidemiologic Methods , Pandemics , Personnel Staffing and Scheduling/organization & administration , Pneumonia, Viral , Anesthesiology/organization & administration , COVID-19 , Computer Simulation , Health Workforce , Humans , Infectious Disease Transmission, Patient-to-Professional , Models, Organizational , Quarantine
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