Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 15 de 15
Filter
2.
Intensive Care Med ; 48(6): 690-705, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1899123

ABSTRACT

PURPOSE: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. METHODS: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. RESULTS: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. CONCLUSIONS: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality.


Subject(s)
Acute Kidney Injury , COVID-19 , Adult , Critical Illness , Humans , Intensive Care Units , Respiration, Artificial , SARS-CoV-2
4.
Critical Care Medicine ; 50:62-62, 2022.
Article in English | Academic Search Complete | ID: covidwho-1596169

ABSTRACT

There has been a significant recent increase in the amount of pre-print articles, given the need for rapid dissemination of data needed to treat COVID-19. The purpose of this study was to compare pre-print and published articles to evaluate for similarities and differences to determine the utility of pre-print articles to inform clinical practice. B Introduction: b Pre-print articles are open-access versions of manuscripts available prior to peer-review. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

5.
Ultrasound ; : 1742271X211047945, 2021.
Article in English | Sage | ID: covidwho-1480318

ABSTRACT

ObjectivesBedside lung ultrasound has been indispensable during the coronavirus disease 2019 (COVID-19) pandemic, allowing us to rapidly assess critically unwell patients. We demonstrate the unique application of contrast-enhanced ultrasound with the aim of further understanding this disease.MethodsPatient demographics were recorded alongside recent cross-sectional imaging and inflammatory markers. Ultrasound was conducted by experienced operators in a portable setting. Conventional six-point lung ultrasound method was used to evaluate B-lines, small (subpleural) consolidation and the pleura. Areas of small consolidation were targeted after intravenous administration of ultrasound contrast.ResultsThe areas of small consolidations, a potential sign of pneumonia on B-mode lung ultrasound, usually enhance on contrast-enhanced ultrasound. Our study revealed these areas to be avascular, indicating an underlying thrombotic/infarction process. Findings were present in 100% of the patients we examined. We have also shown that the degree of infarction correlates with CT severity (r?=?0.4) and inflammatory markers, and that these areas improve as patients recover.ConclusionsWe confirmed the theory of immune thrombus by identifying the presence of microthrombi in the lungs of 100% of our patients, despite 79% having had a recent negative CT pulmonary angiogram study. contrast-enhanced ultrasound can be utilised to add confidence to an uncertain COVID-19 diagnosis and for prognosticating and monitoring progress in confirmed COVID-19 patients. Contrast-enhanced ultrasound is clearly very different to CT, the gold standard, and while there are specific pathologies that can only be detected on CT, contrast-enhanced ultrasound has many advantages, most notability the ability to pick up microthrombi at the periphery of the lungs.

6.
Chin Med J (Engl) ; 134(2): 143-150, 2021 01 05.
Article in English | MEDLINE | ID: covidwho-1307571

ABSTRACT

ABSTRACT: Age-related sporadic cerebral small vessel disease (CSVD) has gained increasing attention over the past decades because of its increasing prevalence associated with an aging population. The widespread application of and advances in brain magnetic resonance imaging in recent decades have significantly increased researchers' understanding in the in vivo evolution of CSVD, its impact upon the brain, its risk factors, and the mechanisms that explain the various clinical manifestation associated with sporadic CSVD. In this review, we aimed to provide an update on the pathophysiology, risk factors, biomarkers, and the determinants and spectrum of the clinical manifestation of sporadic CSVD.


Subject(s)
Cerebral Small Vessel Diseases , Pandemics , Aged , Aging , Brain/diagnostic imaging , Cerebral Small Vessel Diseases/diagnostic imaging , Cerebral Small Vessel Diseases/epidemiology , Humans , Magnetic Resonance Imaging
7.
Anaesthesiol Intensive Ther ; 53(3): 265-270, 2021.
Article in English | MEDLINE | ID: covidwho-1234880

ABSTRACT

The COVID-19 pandemic has tested the very elements of human factors and ergonomics (HFE) to their maximum. HFE is an established scientific discipline that studies the interrelationship between humans, equipment, and the work environment. HFE includes situation awareness, decision making, communication, team working, leadership, managing stress, and coping with fatigue, empathy, and resilience. The main objective of HF is to optimise the interaction of humans with their work environment and technical equipment in order to maximise patient safety and efficiency of care. This paper reviews the importance of HFE in helping intensivists and all the multidisciplinary ICU teams to deliver high-quality care to patients in crisis situations.


Subject(s)
COVID-19/therapy , Ergonomics , Intensive Care Units , SARS-CoV-2 , COVID-19/epidemiology , Communication , Humans , Leadership , Patient Safety , Resilience, Psychological
9.
Crit Care Res Pract ; 2021: 8832660, 2021.
Article in English | MEDLINE | ID: covidwho-1054737

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) had a significant impact on the National Health Service in the United Kingdom (UK), with over 35 000 cases reported in London by July 30, 2020. Detailed hospital-level information on patient characteristics, outcomes, and capacity strain is currently scarce but would guide clinical decision-making and inform prioritisation and planning. METHODS: We aimed to determine factors associated with hospital mortality and describe hospital and ICU strain by conducting a prospective cohort study at a tertiary academic centre in London, UK. We included adult patients admitted to the hospital with laboratory-confirmed COVID-19 and followed them up until hospital discharge or 30 days. Baseline factors that are associated with hospital mortality were identified via semiparametric and parametric survival analyses. RESULTS: Our study included 429 patients: 18% of them were admitted to the ICU, 52% met criteria for ICU outreach team activation, and 61% had treatment limitations placed during their admission. Hospital mortality was 26% and ICU mortality was 34%. Hospital mortality was independently associated with increasing age, male sex, history of chronic kidney disease, increasing baseline C-reactive protein level, and dyspnoea at presentation. COVID-19 resulted in substantial ICU and hospital strain, with up to 9 daily ICU admissions and 41 daily hospital admissions, to a peak census of 80 infected patients admitted in the ICU and 250 in the hospital. Management of such a surge required extensive reorganisation of critical care services with expansion of ICU capacity from 69 to 129 beds, redeployment of staff from other hospital areas, and coordinated hospital-level effort. CONCLUSIONS: COVID-19 is associated with a high burden of mortality for patients treated on the ward and the ICU and required substantial reconfiguration of critical care services. This has significant implications for planning and resource utilisation.

10.
J Intensive Care Soc ; 22(4): 328-334, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-901770

ABSTRACT

In the last 10 years, there has been increasing interest into the psychological wellbeing of healthcare providers. Within critical care, increasing attention is being paid to the concept of 'burnout' - a cluster of symptoms that adversely affect the health of critical care providers. Publications and statements from the major critical care societies have all addressed this syndrome and emphasised urgency in tackling it. The current COVID-19 pandemic has fundamentally changed the way we work, communicate and learn. Even before the pandemic, there have been growing concerns and acknowledgement that healthcare practitioners in intensive care are at increased risk of burnout and burnout syndrome. There has never been greater pressure on intensive care or indeed healthcare as a whole to look after so many patients during this pandemic and yet there is global acknowledgement that key to overcoming these challenges is to look after the care providers - both physically and psychologically. In this paper, we review the issue of burnout amongst healthcare practitioners during current pandemic. We present the impact of burnout on the individual and the system as a whole but perhaps most importantly, we provide a review of steps being taken to mitigate against these adverse outcomes in the short and longer term.

11.
J Intensive Care Soc ; 22(3): 255-260, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-885957

ABSTRACT

The use of social media as a tool for professional communication and education in healthcare has been increasing; pros and cons of such platforms were extensively debated in recent years with mixed results. During the COVID-19 pandemic, social media use has accelerated to the point of becoming a ubiquitous part of modern healthcare systems. As with any tool in healthcare, its risks and benefits need to be carefully considered. In this article, we review the use of social media in the current pandemic. Importantly, we will illustrate this using experiences from the perspective of large medical organisations and also identify the common pitfalls.

12.
Intensive Care Med ; 46(8): 1666, 2020 08.
Article in English | MEDLINE | ID: covidwho-621029

ABSTRACT

The original version of this article unfortunately contained two mistakes.

13.
Alzheimers Dement ; 16(11): 1571-1581, 2020 11.
Article in English | MEDLINE | ID: covidwho-713873

ABSTRACT

We have provided an overview on the profound impact of COVID-19 upon older people with Alzheimer's disease and other dementias and the challenges encountered in our management of dementia in different health-care settings, including hospital, out-patient, care homes, and the community during the COVID-19 pandemic. We have also proposed a conceptual framework and practical suggestions for health-care providers in tackling these challenges, which can also apply to the care of older people in general, with or without other neurological diseases, such as stroke or parkinsonism. We believe this review will provide strategic directions and set standards for health-care leaders in dementia, including governmental bodies around the world in coordinating emergency response plans for protecting and caring for older people with dementia amid the COIVD-19 outbreak, which is likely to continue at varying severity in different regions around the world in the medium term.


Subject(s)
Alzheimer Disease/complications , Coronavirus Infections/complications , Dementia/complications , Pneumonia, Viral/complications , Aged , Aged, 80 and over , Alzheimer Disease/therapy , Betacoronavirus , COVID-19 , Coronavirus Infections/therapy , Female , Humans , Male , Pandemics , Pneumonia, Viral/therapy , Risk Factors , SARS-CoV-2
14.
J Ultrasound ; 2020 Aug 04.
Article in English | MEDLINE | ID: covidwho-694852

ABSTRACT

Lung ultrasound has become an essential tool for rapid bedside assessment in critically unwell patients, proving helpful in assessment of COVID-19 due to logistics of cross-sectional imaging. Contrast enhanced ultrasound (CEUS) further characterizes sonographic features of COVID-19 as multiple areas of infarction, a finding not reproducible on other widely available imaging modalities. CEUS also has the benefit of being cheap, radiation-free, without risk of nephrotoxicity, and can be performed at the bedside. It is predicted that lung CEUS in COVID-19 may help guide prognosis and management. We describe three cases of CEUS in COVID-19.

SELECTION OF CITATIONS
SEARCH DETAIL