Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 4 de 4
Filter
1.
J Crit Care ; 71: 154122, 2022 Jul 28.
Article in English | MEDLINE | ID: covidwho-2015609

ABSTRACT

PURPOSE: In the absence of recent international recommendations supported by scientific societies like Anesthesiology or Intensive Care Medicine, healthcare professionals (HCP) knowledge on IV fluid is expected to vary. We undertook a cross-sectional survey, aiming to assess prescription patterns and test the knowledge of HCP for IV fluid use in the operating room (OR) and intensive care unit (ICU). METHODS: An online international cross-sectional survey was conducted between October 20, 2019, and November 27, 2021. The survey included multiple-choice questions on demographics, practice patterns and knowledge of IV fluids, and a hemodynamically unstable patient assessment. RESULTS: 1045 HCP, from 97 countries responded to the survey. Nearly three-quarters reported the non-existence of internal hospital or ICU-based guidelines on IV fluids. The respondents' mean score on the knowledge assessment questions was 46.4 ± 14.4. The cumulative mean scores were significantly higher among those supervising trainees (p = 0.02), specialists (p < 0.001) and those working in high-income (p < 0.001) countries. Overall performance of respondents on the knowledge testing for IV fluid was unsatisfactory with only 6.5% respondents performed above average. CONCLUSION: There is a wide difference in the knowledge and prescription of IV fluids among the HCP surveyed. These findings reflect the urgent need for education on IV fluids.

2.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-335706

ABSTRACT

Background: The systemic inflammatory response following severe coronavirus infection (COVID-19) is associated with poor outcome. Several anti-inflammatory medications were studied in COVID-19 patients. Xanthohumol (Xn), a natural extract from hop cones, possesses strong anti-inflammatory and antioxidative properties. The aim of this study was to analyse the effect of Xn on the inflammatory response and the clinical outcome of COVID-19 patients. Methods Adult patients treated for acute respiratory failure (PaO 2 /FiO 2 less than 150) were studied. Patients were randomized into two groups: Xn – patients receiving adjuvant treatment with Xn at a daily dose of 4.5 mg/kg body weight for 7 days, and C – controls (patients receiving placebo – NaCl 0.9%). Observations were performed at four time points: immediately after admission to the ICU and on the 3rd, 5th and 7th days of treatment. The inflammatory response was assessed based on the plasma IL-6 concentration, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP) and D-dimer levels. The mortality rate was determined 28 days after admission to the ICU. Results Seventy-two patients were eligible for the study, and 50 were included in the final analysis. The mortality rate was significantly lower and the clinical course was shorter in the Xn group compared to controls (20% vs. 48%, p < 0.05, and 9 ± 3 days vs. 22 ± 8 days, p < 0.001). Treatment with Xn decreased plasma IL-6 concentration (p < 0.01), D-dimer levels (p < 0.05) and NLR (p < 0.01) more significantly compared to standard treatment. Conclusion Adjuvant therapy with Xn appears to be a promising anti-inflammatory treatment in COVID-19 patients.

3.
Crit Care ; 25(1): 106, 2021 03 16.
Article in English | MEDLINE | ID: covidwho-1136238

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. METHODS: Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ2) test (p < 0·05 was considered as unstable). RESULTS: Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16-24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment. CONCLUSION: Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. TRIAL REGISTRATION: The study was registered with Clinical trials.gov Identifier: NCT04534569.


Subject(s)
COVID-19/complications , Consensus , Delphi Technique , Respiratory Insufficiency/therapy , Respiratory Insufficiency/virology , Humans
4.
J Infect Chemother ; 27(6): 826-833, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1046303

ABSTRACT

INTRODUCTION: Severe coronavirus 2019 disease (CoViD-19) may lead to respiratory failure and mechanical ventilation. Therefore, ventilator associated pneumonia (VAP) may complicate the course of the disease. The aim of the current article was to investigate possible predictive factors for bacterial VAP on a retrospective manner, in a cohort of mechanically ventilated CoViD-19 patients. Additionally, determinant factors of lethality were analyzed. METHODS: Medical records of patients hospitalized in the intensive care units (ICU) at the university hospital UZ Brussel during the epidemic were reviewed. VAP was defined following the National Healthcare Safety Network 2017 criteria. Univariate and multivariate logistic regressions analyses were performed. RESULTS: Among the 39 patients included in the study, 54% were diagnosed with bacterial VAP. Case fatality rate was 44%, but 59% of the deceased patients had a do-not-resuscitate status. Multivariate logistic regression for prediction of VAP showed significant differences in duration of ICU hospitalization and in minimal lung compliance. Additional analyses were performed on CoViD-19 patients who were affected by bacterial respiratory superinfection. The responsible pathogens correspond to the commonly found bacteria in VAP. However, 71% of the isolated germs were multi-drug resistant and bacteraemia was reported in 38%. Multivariate analyses for prediction of lethality found significant difference in SOFA score. CONCLUSIONS: Mechanically ventilated CoViD-19 patients might frequently develop VAP. Longer ICU hospitalization was associated with pulmonary superinfection in the current cohort. Moreover, decreased minimal lung compliance was correlated to VAP and higher SOFA score at VAP diagnosis was associated with lethality.


Subject(s)
COVID-19 , Pneumonia, Bacterial , Pneumonia, Ventilator-Associated , Aged , COVID-19/epidemiology , Female , Humans , Intensive Care Units , Male , Middle Aged , Pneumonia, Bacterial/epidemiology , Pneumonia, Bacterial/mortality , Pneumonia, Ventilator-Associated/epidemiology , Pneumonia, Ventilator-Associated/microbiology , Pneumonia, Ventilator-Associated/mortality , Respiration, Artificial , Retrospective Studies , Ventilators, Mechanical
SELECTION OF CITATIONS
SEARCH DETAIL