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1.
Anesthesiol Clin ; 39(2): 255-264, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1077760

ABSTRACT

This article documents experiences from frontline anesthesia providers in Wuhan, China, mainly from the anesthesiologists in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. Those experiences offer valuable insight into the processes used to optimize the emergency response system, and the medical resources and emergency allocation, as well as providing information on the role anesthesiologists played in managing the pandemic.


Subject(s)
Anesthesiology/trends , COVID-19 , Pandemics , Anesthesiology/education , China , Clinical Competence , Humans , Personal Protective Equipment
2.
Anesthesiology ; 132(6): 1333-1338, 2020 06.
Article in English | MEDLINE | ID: covidwho-960598

ABSTRACT

The coronavirus disease 2019, named COVID-19 officially by the World Health Organization (Geneva, Switzerland) on February 12, 2020, has spread at unprecedented speed. After the first outbreak in Wuhan, China, Chinese anesthesiologists encountered increasing numbers of infected patients since December 2019. Because the main route of transmission is via respiratory droplets and close contact, anesthesia providers are at a high risk when responding to the devastating mass emergency. So far, actions have been taken including but not limited to nationwide actions and online education regarding special procedures of airway management, oxygen therapy, ventilation support, hemodynamic management, sedation, and analgesia. As the epidemic situation has lasted for months (thus far), special platforms have also been set up to provide free mental health care to all anesthesia providers participating in acute and critical caring for COVID-19 patients. The current article documents the actions taken, lesson learned, and future work needed.


Subject(s)
Anesthesiology/standards , Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Infection Control/standards , Pandemics , Pneumonia, Viral , Anesthesiology/trends , COVID-19 , China/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Forecasting , Humans , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission
3.
Immunity ; 53(5): 1108-1122.e5, 2020 11 17.
Article in English | MEDLINE | ID: covidwho-880509

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic is a global public health crisis. However, little is known about the pathogenesis and biomarkers of COVID-19. Here, we profiled host responses to COVID-19 by performing plasma proteomics of a cohort of COVID-19 patients, including non-survivors and survivors recovered from mild or severe symptoms, and uncovered numerous COVID-19-associated alterations of plasma proteins. We developed a machine-learning-based pipeline to identify 11 proteins as biomarkers and a set of biomarker combinations, which were validated by an independent cohort and accurately distinguished and predicted COVID-19 outcomes. Some of the biomarkers were further validated by enzyme-linked immunosorbent assay (ELISA) using a larger cohort. These markedly altered proteins, including the biomarkers, mediate pathophysiological pathways, such as immune or inflammatory responses, platelet degranulation and coagulation, and metabolism, that likely contribute to the pathogenesis. Our findings provide valuable knowledge about COVID-19 biomarkers and shed light on the pathogenesis and potential therapeutic targets of COVID-19.


Subject(s)
Coronavirus Infections/blood , Coronavirus Infections/pathology , Plasma/metabolism , Pneumonia, Viral/blood , Pneumonia, Viral/pathology , Adult , Aged , Aged, 80 and over , Betacoronavirus , Biomarkers/blood , Blood Proteins/metabolism , COVID-19 , Coronavirus Infections/classification , Coronavirus Infections/metabolism , Female , Humans , Machine Learning , Male , Middle Aged , Pandemics/classification , Pneumonia, Viral/classification , Pneumonia, Viral/metabolism , Proteomics , Reproducibility of Results , SARS-CoV-2
5.
Risk Manag Healthc Policy ; 13: 1253-1260, 2020.
Article in English | MEDLINE | ID: covidwho-732247

ABSTRACT

BACKGROUND: The rapid spread of COVID-19 has expanded into a pandemic, for which the main containment strategies to reduce transmission are social distancing and isolation of ill persons. Thousands of medical staff have been infected worldwide. Coronavirus testing kits have been in short supply, and early diagnostic reagents did not have high sensitivity. The aim of this study was to describe the characteristics of patients requiring emergency surgery in a COVID-19 outbreak area. METHODS: We assessed medical data regarding all patients who underwent emergency surgery at the main campus of Wuhan Union Hospital from January 23, 2020, to February 15, 2020. We classified patients based on suspicion of COVID-19 infection (suspected vs not suspected) before they were admitted to the operating room. We used descriptive statistics to analyze the data. Outcomes included the incidence of confirmed COVID-19 infection and length of stay, which were followed until March 25, 2020. RESULTS: Among the 88 emergency patients included in this study, the mean age was 37 years. Twenty-five patients presented with abnormalities observed on chest CT scans and 16 presented with fever. The median wait time for surgery was one day. The median preparation time and median time until short orientation memory concentration test (SOMCT) recovery from anesthesia were 44.0 min and 23.0 min, respectively. The median postoperative length of stay was five days. Compared with patients not suspected of COVID-19 infection, six patients were confirmed to be infected with COVID-19 in the suspected group. No health care workers were infected during this study period. CONCLUSION: Simple identification using temperature screening of patients, respiratory symptoms, and chest CT scans before being admitted for emergency surgery was rapid and effective. Shortened contact times might reduce the risk of infection. Additional investigations with larger samples and improved designs are needed to confirm these observations.

8.
J Perianesth Nurs ; 35(5): 453-456, 2020 10.
Article in English | MEDLINE | ID: covidwho-437274

ABSTRACT

As the backbone for the treatment of patients with coronavirus disease 2019 (COVID-19), nurses have been playing key roles in cabin hospitals, isolation wards, and intensive care units for critical cases. Anesthesia nurses have their own professional specialties, such as airway management, the use and maintenance of life support equipment, including ventilators, and the use of high-flow oxygen equipment. With rich experience in emergency responses and nursing, anesthesia nurses, along with emergency nurses and critical care nurses, play important roles during the treatment of patients with COVID-19. In our hospital, 27 of 34 anesthesia nurses participated in the front-line fight against COVID-19 and did an excellent job. Anesthesia care by nurses is relatively new in China, and the role of anesthesia nurses during a disaster response has not been fully appreciated. Given their specialty, anesthesia nurses have played important roles in the treatment of patients with COVID-19. We hope that authorities will consider including anesthesia nurses in national disaster response medical rescue teams.


Subject(s)
Coronavirus Infections/therapy , Nurse Anesthetists/organization & administration , Pneumonia, Viral/therapy , Airway Management/methods , COVID-19 , Coronavirus Infections/epidemiology , Humans , Nurse's Role , Pandemics , Pneumonia, Viral/epidemiology
9.
J Cardiothorac Vasc Anesth ; 34(6): 1402-1405, 2020 06.
Article in English | MEDLINE | ID: covidwho-175909

ABSTRACT

Severe acute respiratory syndrome coronavirus-2 is still active in Wuhan, China, and is spreading to the rest of the world. Recently, perioperative anesthetic management in patients with suspected or confirmed coronavirus-2 has been reported. However, little has been reported on the anesthetic management of patients undergoing aortic dissection repair in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. During the outbreak in Wuhan, the authors' team completed 4 cases of aortic dissection repair successfully in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. The purpose of the present report is to summarize current knowledge and experiences on anesthetic management in this patient population and to provide clinical practice guidelines on anesthetic management and infection prevention and control in these critically ill patients.


Subject(s)
Anesthetics/therapeutic use , Aneurysm, Dissecting/surgery , Coronavirus Infections/complications , Pneumonia, Viral/complications , Anesthesiology/methods , Aneurysm, Dissecting/virology , COVID-19 , Coronavirus Infections/transmission , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/transmission
10.
Br J Anaesth ; 125(1): e28-e37, 2020 07.
Article in English | MEDLINE | ID: covidwho-45870

ABSTRACT

Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (Sao2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (Sao2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Intubation, Intratracheal/methods , Personal Protective Equipment , Pneumonia, Viral/therapy , Aged , COVID-19 , China , Coronavirus Infections/complications , Coronavirus Infections/prevention & control , Female , Humans , Hypotension/etiology , Hypoxia/etiology , Male , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Pneumothorax/etiology , Practice Guidelines as Topic , Retrospective Studies , SARS-CoV-2
11.
J Cardiothorac Vasc Anesth ; 34(5): 1125-1131, 2020 05.
Article in English | MEDLINE | ID: covidwho-40445

ABSTRACT

OBJECTIVES: The aim of the present study was to prevent cross-infection in the operating room during emergency procedures for patients with confirmed or suspected 2019 novel coronavirus (2019-nCoV) by following anesthesia management protocols, and to document clinical- and anesthesia-related characteristics of these patients. DESIGN: This was a retrospective, multicenter clinical study. SETTING: This study used a multicenter dataset from 4 hospitals in Wuhan, China. PARTICIPANTS: Patients and health care providers with confirmed or suspected 2019-nCoV from January 23 to 31, 2020, at the Wuhan Union Hospital, the Wuhan Children's Hospital, The Central Hospital of Wuhan, and the Wuhan Fourth Hospital in Wuhan, China. INTERVENTIONS: Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in 4 hospitals in Wuhan. MEASUREMENTS AND MAIN RESULTS: Cross-infection in the operating rooms of the 4 hospitals was effectively reduced by implementing the new measures and procedures. The majority of patients with laboratory-confirmed 2019-nCoV infection or suspected infection were female (23 [62%] of 37), and the mean age was 41.0 years old (standard deviation 19.6; range 4-78). 10 (27%) patients had chronic medical illnesses, including 4 (11%) with diabetes, 8 (22%) with hypertension, and 8 (22%) with digestive system disease. Twenty-five (68%) patients presented with lymphopenia, and 23 (62%) patients exhibited multiple mottling and ground-glass opacity on computed tomography scanning. CONCLUSIONS: The present study indicates that COVID 19-specific guidelines for emergency procedures for patients with confirmed or suspected 2019-nCoV may effectively prevent cross-infection in the operating room. Most patients with confirmed or suspected COVID 19 presented with fever and dry cough and demonstrated bilateral multiple mottling and ground-glass opacity on chest computed tomography scans.


Subject(s)
Anesthesia , Coronavirus Infections , Cross Infection , Emergency Medical Services , Infection Control , Pandemics , Pneumonia, Viral , Adolescent , Adult , Aged , Anesthesia/methods , Anesthesia/standards , Betacoronavirus , COVID-19 , Child , Child, Preschool , China , Chronic Disease , Comorbidity , Coronavirus Infections/complications , Cross Infection/prevention & control , Emergency Medical Services/standards , Female , Humans , Infection Control/standards , Male , Middle Aged , Operating Rooms , Pneumonia, Viral/complications , Practice Guidelines as Topic , Retrospective Studies , SARS-CoV-2 , Young Adult
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