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Considering the commonality of the pathogenetic links of the critical forms of COVID-19 and influenza AH1N1pdm09 (cytokine over-release syndrome), the question arises: will the predictors of an unfavorable outcome in patients on mechanical ventilation and, accordingly, the universal tactics of respiratory support in these diseases be identical? Objective. In a comparative aspect, to characterize patients with influenza AH1N1pdm09 and COVID-19 who were on mechanical ventilation, to identify additional clinical and laboratory risk factors for death, to determine the degree of influence of respiratory support (RP) tactics on an unfavorable outcome in the studied category of patients. Patients and methods. Patients treated on the basis of resuscitation and intensive care departments of the State Budgetary Healthcare Institution "SKIB" in Krasnodar and the State Budgetary Healthcare Institution "IB No 2" in Sochi were studied: group 1 - 31 people with influenza AH1N1pdm09 (21 people died - subgroup 1A;10 people survived - subgroup 1B) and group 2 - 50 people with COVID-19 (29 patients died - subgroup 2A;21 people survived - subgroup 2B). All patients developed hypoxemic ARF. All patients received step-by-step tactics of respiratory support, starting with oxygen therapy and ending with the use of "traditional" mechanical ventilation. Continuous variables were compared in subgroups of deceased and surviving patients for both nosologies at the stages: hospital admission;registration of hypoxemia and the use of various methods of respiratory therapy;development of multiple organ dysfunctions. With regard to the criteria for which a statistically significant difference was found (p < 0.05), we calculated a simple correlation, the relative risk of an event (RR [CI 25-75%]), the cut-off point, which corresponded to the best combination of sensitivity and specificity. Results. Risk factors for death of patients with influenza AH1N1pdm09 on mechanical ventilation: admission to the hospital later than the 8th day of illness;the fact of transfer from another hospital;leukocytosis >=10.0 x 109/l, granulocytosis >=5.5 x 109/l and LDH level >=700.0 U/l at admission;transfer of patients to mechanical ventilation on the 9th day of illness and later;SOFA score >=8;the need for pressor amines and replacement of kidney function. Predictors of poor outcome in ventilated COVID-19 patients: platelet count <=210 x 109/L on admission;the duration of oxygen therapy for more than 4.5 days;the use of HPNO and NIV as the 2nd step of RP for more than 2 days;transfer of patients to mechanical ventilation on the 14th day of illness and later;oxygenation index <=80;the need for pressors;SOFA score >=8. Conclusion. When comparing the identified predictors of death for patients with influenza and COVID-19 who needed mechanical ventilation, there are both some commonality and differences due to the peculiarities of the course of the disease. A step-by-step approach to the application of respiratory support methods is effective both in the case of patients with influenza AH1N1pdm09 and patients with COVID-19, provided that the respiratory support method used is consistent with the current state of the patient and his respiratory system, timely identification of markers of ineffectiveness of the respiratory support stage being carried out and determining the optimal moment escalation of respiratory therapy.Copyright © 2022, Dynasty Publishing House. All rights reserved.
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Objective. The prognosis value of fibrosis-4 score (FIB-4) in COVID-19 is controversial. Hence, we conducted a systematic review and meta-analysis to investigate the association between the FIB-4 index and COVID-19 disease progression. Methods. We performed meta-analysis using the PubMed, Embase, and Cochrane databases. A fixed- or random-effects model was used for evaluating heterogeneity. Results. Thirteen studies were included. The meta-analysis of unadjusted results showed that compared to lower FIB-4 index, patients with higher FIB-4 index had increased odds of mortality (OR=5.1, 95%CI 3.67-7.09;P<0.001), ICU admission (OR=2.32, 95%CI: 1.65-3.25, P<0.00001) and need for mechanical ventilator support (OR=3.51, 95%CI: 2.1-5.85, P<0.001). In addition, the meta-analysis of adjusted results showed patients with higher FIB-4 index was associated with increased risk of mortality (OR=3.01, 95%CI: 2.21-4.09, P<0.001) and need for mechanical ventilator support (OR=3.76, 95%CI: 2.08-6.82, P<0.001) compared to patients with lower FIB-4 index. Conclusion. This meta-analysis indicated that high FIB-4 index score was associated with the severity and mortality in COVID-19 infected patients.Copyright © 2022 by the Association of Clinical Scientists, Inc.
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Introduction: It is thought of as a necessary service to provide high-quality care during pregnancy, labour, and the postpartum period. The fields of obstetrics/midwifery and neonatology, which are generally referred to as perinatology, have reduced maternal and newborn mortality and morbidity globally, but the COVID-19 pandemic brought on by the SARS-CoV-2-related COVID-19 virus posed a threat to the security of healthcare. Material(s) and Method(s): A prospective comparative study was conducted in a tertiary care hospital, Bisha city. I want to compare the outcome for 2 years (July 2020-June 2022) after shifting to the new unit with previous 2 years before shifting (July 2018-June 2020) in different aspect: The days on the mechanical ventilation, The IVH rate, The Mortality rate. In this study, I want to compare neonatal services outcomes (for preterm babies less than 37 weeks gestational age) after developing the infrastructure, manpower, Supplies and Policies after the shifting to the new department. Result(s): This is a prospective comparative study conducted in the department of neonatology, in a tertiary care hospital, Bisha city. Mean gestational age in before shifting to new unit, after shifting were 31, 33.34 respectively. Average weight were 1496, 1565 in before shifting to new unit, after shifting respectively. In our study, Average days on the mechanical ventilation were 14.78 days in before shifting to new unit group. Average days on the mechanical ventilation were 4.33 days in after shifting to new unit group. Conclusion(s): The provision of high quality and evidence-based perinatal care must remain a priority, even in the face of a pandemic. Restructuring in health care facility with New advance mechanical ventilators supporting Volume-targeted ventilation, 9 single rooms isolation for septic babies, T-piece resuscitator (in all OR suits, Delivery suits and ER), Total parental nutrition and also the all NICU policies updated especially for Caffeine citrate and fluconazole administration to preterm babies according to the AAP guidelines. Also all the department stuff completed the NRP and STABLE provider course as mandatory requirement to work in the NICU department. IVH rate, mortality rate was drastically reduced after shifting to the new unit than before shifting to new unit. Hence hospital restructuring in neonatology plays a crucial role to reduce mortality rate.Copyright © 2021 Muslim OT et al.
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant has recently emerged and spread globally. An outbreak of coronavirus disease 2019 (COVID-19) caused by the Delta variant occurred in Southern Taiwan in June 2021 and has been eliminated [1]. However, in April 2022, there was an outbreak of the Omicron variant in Taiwan. Fifteen patients with Omicron variant were admitted to our hospital from April 26 to May 1, 2022. We compared the clinical characteristics of the patients with the Delta variant in June 2021 and the Omicron variant in April 2022 (Table 1). These laboratory data were the first laboratory data at admission, and no anti-COVID-19 therapy was prescribed before these data. There were no differences in age (59.9 vs. 57.1 years, P = 0.96), male gender (63.6 vs. 60.0%, P = 1.00), diabetes ratio (27.3 vs. 35.7%, P = 1.00), body mass index (25.0 vs. 26.0 kg/m2, P = 1.00), pneumonia ratio (18.2 vs. 40.0%, P = 0.40) between the Delta and Omicron variants. There were also no differences in serum levels of aspartate aminotransferase (AST) (40.1 vs. 25.8 IU/L, P = 0.24) and alanine aminotransferase (ALT) (26.3 vs. 27.2 IU/L, P = 0.64) between the two groups. All the patients with the Omicron variant were symptomatic. The most common symptoms were upper respiratory tract infections (60.0%) (Supplementary Table 1). Six patients developed pneumonia without mechanical ventilator support requirement during admission (40.0%). Remdesivir, Paxlovid, or Molnupiravir were prescribed to patients according to their clinical conditions. Among the patients with the Omicron variant, nine (60.0%) had past medical history of diabetes, four (26.7%) had hypertension, three had chronic kidney disease (20.0%), and three had malignancy history (20.0%). COVID-19 might cause liver injury and lead to a more unfavorable prognosis [2]. In this study, about one-fifth of the patients suffered from liver injury, which was similar to previous studies [3]. There was no difference in liver injury between the Delta and Omicron variants in our study, which echoes previous research [4]. COVID-19 vaccination might protect against symptomatic diseases caused by the Omicron variant [5]. Vaccination rates have increased since 2021. In the study, over ninety percent of the patients have received at least two doses of vaccination. In conclusion, we demonstrated no difference in liver injury ratio between the Delta and Omicron variants. To our knowledge, this is the first report that compares the Delta and Omicron variants in Taiwan.
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Introduction: To maximise the input of intensivists onto the management of ventilated patients during the COVID pandemic, we have developed and implemented telemetry system VentConnect [1]. The aim of this study is to identify stakeholder's expectations and experience from this technology. Method(s): The telemetry device VentConnect (scheme at Fig. 1) enabled transmission of HDMI signal from mechanical ventilators to a password protected interface on any web browser. We implemented it between December 2020 and March 2021 on a total of 31 beds where patients were treated during COVID Pandemic. Afterwards, we performed Structured User Interviews with ICU doctors. Questionnaire responses we clustered and calculated. Result(s): Eight doctors were interviewed, 4 fully qualified intensivists, and 4 in training. By far the most demanded was the ability to see flow curve or flow pattern (100%), followed by inspiratory pressures (75%) and check tidal volume (63%). Other parameters were mentioned less frequently such as driving pressure (25%) and interferences (38%). With regards users experience, answers were overwhelmingly positive, highlighting mostly the ability to continuously monitor the progress of patients without the need to donning personal protective equipment. In some, however, curiosity was the only motivator for use. Three juniors expressed apprehension that their supervisors might criticise their ventilator setting which would otherwise had gone unnoticed. Two participants thought that the temptation to check patient 24/7 would impair their ability to rest and relax during their off time. Conclusion(s): Telemetry system that enabled clinicians to remotely check ventilator screen met the expectation of clinicians, who mainly demanded to check flow patterns, tidal volumes and pressures. Concerns were mainly about psychological impact of using this technology. These need to be addressed.
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Objectives: The aim of this study is to evaluate the effect of coronavirus disease 2019 (COVID-19) diagnosed in the third trimester of pregnancy on maternal, fetal, and obstetric outcomes. Method(s): This retrospective study included 109 pregnant women hospitalized with a diagnosis of COVID-19 during the third trimester of pregnancy (28-40 weeks) in a tertiary center between March 1 and December 31, 2020. Demographic characteristics, clinical signs, and obstetric outcomes of the patients were searched for analysis. Laboratory and x-ray results were reported, and treatment methods were summarized. Finally, mother-newborn results were recorded. Result(s): We included one hundred nine pregnant women in this study. We divided the patients into two groups as those with positive PCR test (n = 59) and negative PCR test and possible covid patients (n = 50) whose symptoms and histories meet the covid criteria. The mean age of the patients was 28.90 +/- 6.21 years, and the mean week of gestation was 37.45 +/- 2.29 weeks. Half of the patients were asymptomatic (n = 57, 47.7%), and 69% of all patients were delivered by cesarean section. The hospitalization time of antigen-positive cases was between 2-9 days. The mean lymphocyte count was 1.37 +/- 0.45 x103/mL in the PCR positive patient group, and this value was 1.67 +/- 0.54 103/mL in the PCR negative patients (p = 0.007). While the mean neutrophil count was 8.13 +/- 3.16 x 103/mL in the PCR positive patient group, this value was 10.99 +/- 4.14 x 103/mL in the PCR negative patients (p < 0.001). Fifteen patients required intensive care unit follow-up, and 2 of them died while receiving mechanical ventilator support. Conclusion(s): COVID-19 infection in the third trimester of pregnancy does not affect fetal and maternal outcomes if the disease is under control at an early stage. In hospitalized patients, symptoms are more precious than antigen testing.Copyright © 2023 by Prusa Medical Publishing.
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Objective: To report the clinical features of pulmonary hypertension diagnosed by echocardiography in 5 patients with novel coronavirus pneumonia (COVID-19) in order to understand the special clinical manifestations of COVID-19 and explore the possible mechanism. Method(s): The echocardiographic data and clinical characteristics of COVID-19 patients complicated with pulmonary hypertension diagnosed by echocardiography in Beijing Ditan Hospital, Capital Medical University were analyzed descriptively from February 5 to March 31, 2020. Result(s): A total of 15 patients with severe and critical COVID-19 patients underwent echocardiography. Of them, 7 patients were diagnosed with pulmonary hypertension, 5 of which were confirmed as complications of COVID-19. Among the 5 patients, 4 were female and 1 was male, aged 62-78 years;4 were with hypertension, 3 were with diabetes, and 1 was with coronary atherosclerotic heart disease. All 5 critically ill patients with COVID-19 were given ventilator-assisted breathing, 2 of which were given extracorporeal membrane oxygenation at the same time. According to echocardiography, the systolic pressure of pulmonary artery in 5 patients was 43-65 mmHg, with an average of 54 mmHg. The severity of pulmonary hypertension was graded as mild in 1 patient and moderate in 4 patients. During the follow-up, pulmonary artery systolic pressure gradually decreased to normal in 4 patients, and then ventilator and ECMO were withdrawn;1 patient died due to respiratory failure and persistent pulmonary hypertension. Conclusion(s): Patients with COVID-19 may be complicated by pulmonary hypertension, which is often found in the critical patients. Echocardiography is an important imagingdiagnostic method for pulmonary hypertension in patients with COVID-19.Copyright © 2020 by the Chinese Medical Association.
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Mechanical ventilators are advanced life-supporting machines in this century. The ventilator needs to be safe, flexible, and easy for competent clinicians to use. Since ventilators supply the patient with gas, they need pneumatic components to be present. First technology ventilators were typically powered by pneumatic energy. Gas pressure is used to power ventilators as well as ventilate patients. Nowadays, ventilators are operated electronically with the useful microprocessor tool. This proposal aims to design a simple portable mechanical ventilator that includes measuring some important physiological variables such as respiratory rate, heart rate, and O2 saturation, which can be utilized in hospital and at home. The proposed system includes Arduino, Raspberry pi4, touch screen, and graphical user interface. This study showed a significant individual performance for measuring some important parameters such as flow rate, tidal volume, and minute ventilation. The accuracy of measuring the flow rate was 72%. The Cohen's kappa (CK) was estimated to be 0.61. The accuracy of calculated the tidal volume was estimated at 83% with 0.80 CK. The accuracy of measuring the O2 saturation was estimated at 99% with 0.99 CK. The advantages of the proposed design are cost-effective, safe, flexible, and easy to use. Also, this system is smart and can control its transactions, so it can be used at home without the need for professional help. The operating parameters can also be set by the user with a simple user interface.Copyright © 2022 by ASME.
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Introduction: COVID-19 became a global pandemic in 2020 and currently, there is no definitive treatment. Severe and critically ill COVID-19 patients are admitted due to respiratory illness and failure leading to multiple-organ dysfunction syndrome. Cytokine release syndrome (CRS) is prevalent among these patients. Hemoperfusion is a form of extracorporeal therapy that effectively removes the inflammatory cytokines that lead to lung damage. This study was conducted to determine the clinical outcomes of patients diagnosed with Severe and Critical COVID-19 who underwent hemoperfusion at the University and Santo Tomas Hospital. Method(s): This retrospective study included 135 severe and critical COVID-19 patients who underwent hemoperfusion using an HA330 cartridge. Demographic, clinical data, and outcomes were described. APACHE II score, Hemoglobin, platelet count, leukocytes, neutrophils, lymphocytes, serum creatinine, inflammatory markers such as serum ferritin, hs-CRP, IL-6, LDH, procalcitonin, D-dimer, PaO2/FiO2 (PF) ratio were compared pre and post hemoperfusion (HP) among those survivors and non-survivors. The effects of the timing of hemoperfusion on different clinical parameters and outcomes were described. Result(s): The most common cause of death is respiratory (20%). There were 98 patients (73%) who survived. Mortality rates were elevated among chronic kidney disease and cancer patients. APACHE II score was lower post hemoperfusion compared to baseline levels among survivors. After 4 sessions of hemoperfusion, hemoglobin and platelet counts were lower among non-survivors. WBC levels were increased for all patients. Neutrophils increased compared to baseline among those who expired. Lymphocytes were decreased compared to baseline among non-survivors. There is no significant change in creatinine levels compared to baseline. Post HP ferritin, LDH, and D-dimer were elevated among non-survivors. Among survivors, hs-CRP and procalcitonin were lower compared to baseline. Post HP ferritin and D-dimer increased among survivors. IL-6 levels showed no significant difference post-HP from baseline but we reported higher levels among non-survivors versus survivors. PF ratio was higher post hemoperfusion among patients who survived compared to those who died. The effect of timing of hemoperfusion was divided into 14 days versus more than 14 days of illness. The APACHE II score for those who underwent hemoperfusion within 14 days showed a lower score. There was no significant difference in the baseline levels of hematologic counts, inflammatory markers, and PF ratio among those who underwent hemoperfusion beyond 14 days. For those who underwent hemoperfusion within 14 days, hemoglobin, hs-CRP, IL-6, and procalcitonin were lower compared to baseline while neutrophils, ferritin, d-dimer, and PF ration had increased levels. Most patients who underwent hemoperfusion within 14 days of illness required high flow O2 supplementation than an invasive mechanical ventilator. Conclusion(s): Hemoperfusion results in lower APACHE II score, hemoglobin, HsCRP, and procalcitonin levels. There was no significant difference from baseline clinical parameters among those who underwent hemoperfusion beyond 14 days of illness. Those who underwent hemoperfusion within 14 days of illness required less invasive mechanical O2 support. This was also submitted for the ISN Frontiers, New Delhi but was not presented. No conflict of interestCopyright © 2023
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Introduction: Since 2019, COVID-19 pneumonia caused by SARS-CoV-2 virus has led to a worldwide pandemic. Since then, various neurological manifestations of COVID-19 pneumonia have been reported. Neurological manifestations include headache, anosmia, seizures, and altered mental status. In some cases, it presents as stroke, encephalitis, and neuropathy. Artery of Percheron (AOP) is a variant in the posterior circulation. Here, a single artery arises from the posterior cerebral artery p1 segment. It supplies bilateral thalamus with or without midbrain. Thrombosis in this artery leads to clinical symptoms like reduced level of consciousness, altered mental status, and memory impairment. Case Report: Here, we present a case who presented with fever and altered sensorium without any focal neurological deficits and without known risk factors for stroke. His COVID-19 PCR was positive. He was initially diagnosed as COVID-19 pneumonia with encephalitis and was started on treatment for the same. His initial CT brain and lumbar puncture were normal. The next day, when MRI brain with and without contrast was done, the thalamic stroke due to AOP infarction was diagnosed and appropriate treatment for stroke was initiated. Discussion(s): Many patients miss the window for thrombolysis because of variable presentation in clinical symptoms with negative imaging. It is also difficult to assess the time of onset of stroke in this varied presentation. Our patient had fever and cough for 2 days and had altered mental status since the morning of admission. During hospital stay, he developed bilateral third nerve palsy. This case also highlights the importance of detailed evaluation in COVID-19 patients with neurological complaints. This helps to avoid delays in treatment and to improve clinical outcomes. As our knowledge of COVID-19 and its varied neurological manifestations evolve, we need to be prepared for more atypical presentation to facilitate timely interventions.Copyright © 2022 The Author(s). Published by S. Karger AG, Basel.
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Objectives: Objective of the study was to examine the laboratory findings with clinical characteristics and treatments of patients who were hospitalized in a tertiary intensive care unit with the diagnosis of coronavirus disease 2019 (COVID-19) and developed pneumothorax and to determine epidemiology and risks of pneumothorax. Method(s): The study was conducted by retrospectively examining the electronic records of 681 COVID-19 patients who were followed up between 1 April 2020 and 1 January 2021 in 3 tertiary intensive care units (each was 24 beds). Patients demographic and clinical characteristics, laboratory findings, mechanical ventilator parameters and chest imaging were evaluated retrospectively. Result(s): Pneumothorax in 22 (3.2%) of 681 with COVID-19 patients was detected and acute respiratory distress syndrome (ARDS) in 481 (70.6). All the study patients met ARDS diagnostic criterias. Mortality rates were 43.4% (296/681) in all patients, 52.8% (254/481) in patients with ARDS, and 86.3% (19/22) in patients with pneumothorax. Pneumothorax occurred in the patients within a mean of 17.4+/-4.8 days. The computed tomographies of patients were observed common ground-glass opacities, heterogenic distribution with patch infiltrates, alveolar exudates, interstitial thickening in the 1st week of their symptom onset. Conclusion(s): We observed that pneumothorax significantly increased mortality in COVID-19 patients with ARDS. We believe that understanding and preventing the characteristics of pneumothorax will make an important contribution to mortality reduction.Copyright © 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.
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Introduction: At the end of April 2020 in Europe, some children with SARS-CoV-2 infections developed fever, abdominal pain, shock, myocardial insufficiency and the need for intensive care. This new disease has been called MIS-C. Although the pathogenesis of MIS-C is unclear, it progresses with signs of multi-organ involvement as a result of uncontrolled inflammation of the immune system and even causes death. Aim(s): We aimed to evaluate the pulmonary function tests(PFT) of patients diagnosed with MIS-C. Method(s): We retrospectively evaluated the complaints, clinical features, laboratory and radiographic findings and all therapies(during hospitalization and after) of the patients diagnosed with MIS-C, and we performed spirometry at the 3rd month after recovery. Result(s): A total of 40 patients were included in this study;however, spirometry could be performed only to 23 of them. Ten patients(43.5%) were girls and the median age was 9 years. Only four patients had chronic diseases such as asthma and immune deficiency. On the 3rd month after recovery, spirometric assessment of patients were as follows: FEV1:93.3% (75-109),FVC:90.04%(69-105),FEV1/FVC:101.3%(88-116), FEF2575:104.9%(72-138). Only two patients had mild restrictive pattern. One patient was lost due to MIS-C. The presence of chronic disease, pneumonic infiltration on X-rays, the need for intensive care, oxygen or non-invasive mechanical ventilator, and the treatments that received were not found to have any effect on the PFTs at the 3rd month. Conclusion(s): This is the first study about PFTs of MIS-C patients;and we did not find any impact on spirometric values. MIS-C in pediatric patients did not affect pulmonary functions on 3rd month evaluation;but we would like to emphasize the necessity of long-term follow-up of these patients.
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Aim: Angiotensin-converting enzyme 2 (ACE2) acts not only as an enzyme but also as a thought to be central receptor by which severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) enters host cells. Angiotensin-converting enzyme inhibitors (ACEIs) are thought to $1 are central to SARS-CoV-2 progression. However, its effect on clinical outcomes is still not fully explained. In this study, we investigated the effects of ACEIs use on pulmonary computed tomography findings. Method(s): The data of the patients who were hospitalized for SARS-CoV-2 pneumonia and were using medications for the diagnosis of hypertension from 20th March to 20th June 2020 were evaluated retrospectively. Patients were divided into 2 groups patients using ACEIs and not using ACEIs. Result(s): The study was conducted with 107 patients. Mild cases without signs of pneumonia were excluded from this study. Moderate cases were accepted as patients with symptoms related to the respiratory system and pneumonia detected on imaging. SpO2<=93%, >=30 breaths/min respiratory rate, and patients who developed respiratory failure, mechanical ventilator need, shock, or multiorgan failure were included in the severe and critically ill cases group. Severe and critical cases were evaluated as a single group. When the radiological images of the patients were examined, it was remarkable that multilobar findings were less common in the ACEIs using group (p<0.001). At the clinical end point, mortality rates in patients using ACEIs (12.7%) were significantly lower than patients without using ACEIs (32.7%). Conclusion(s): In our study, we showed that SARS-CoV-2 progresses with less multilobar involvement in pulmonary computed tomography in patients using ACEI.Copyright © 2023 by The Medical Bulletin of Istanbul Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayinevi.
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Aim: During the first episodes of COVID-19 pandemic mostly affected population is elderly, but data about possible effects of the geriatric syndromes on clinical course and mortality are still conflicting. Method(s): Between April-June 2020 patients aged over 60 years, newly diagnosed as COVID-19 with a positive PCR test and need for hospitalization (ward or ICU) were prospectively enrolled to study. Demographics, whole blood analysis and laboratory results at the admission, computerized tomography findings, stage of the disease, need of oxygen, mechanical ventilation and intensive care unit were recorded. All patients were evaluated with a survey for sarcopenia, frailty and insufficient nutrutional status. Result(s): 65 patients were enrolled to study %41 (n:27) were females and the mean age was 69+/-8,4. Demographics were similiar in both gender, mean hospital stay was 9,2+/-4,3days. Respectively number of patients with frail, prefrail, risk of sarkopenia and insufficient nutrition were 6(%9,2), 16(%24,6), 7 (%10,8), 5 (%7,7). Advance age (>70 years) was a risk factor frailty (p>0,001). Risk factors for mortality advanced age (p<0.041), frail-prefrail (p<0,0042) chronic renal failure(p<0.001), arrhythmia (p<0.045), need of ICU (p<0.001), need of noninvasive mechanical ventilator (NIMV) (p<0.001) and intubation (p<0.002) Conclusion(s): Advanced age is highly correlated with frailty. Sarkopenia and insufficient nutritional status were also commonly with frailty. Comorbidities, need of ICU, NIMV and intubation were risk factors for mortality and common in prefrail patients. Not only frail but prefrail COVID-19 patients should follow up closely during hospitalization.
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Introduction: Patients on dialysis are a great risk of acquiring COVID-19 infection, with higher mortality rates. We compared the outcomes and mortality of first and second waves of COVID-19 in dialysis patients hospitalized in a Peruvian hospital Methods: This is an observational, analytic, retrospective cohort study of patients with ESKD on KTS hospitalized from March 2020 to June 2021. Peru's first pandemic wave started from March to August 2020 and the second wave began from December 2020 to June 2021. Patient demographics and clinical features were collected from the Hospital Nacional Alberto Sabogal Sologuren electronic medical record. We evaluated the survival in the first year post-COVID-19 of discharged patients Results: Out of the 310 ESKD patients who had COVID-19, 61.94% (192) were male, and the mean age was 63.75 years. The most frequent comorbidities were arterial hypertension in 86.8% (269), diabetes mellitus in 46.1% (143), obesity in 5.2% (16), and cardiovascular disease in 10.3% (32). There were 1.94% on peritoneal dialysis and 98.06% on hemodialysis. COVID-19 diagnosis was by molecular PCR in 16.1%, antigen swab test in 17.42%, serological test in 35.81%, and radiological clinical criteria in 30.65%. At admission, the average oxygen saturation was 88.94% (40-99) with a PaFi of 245.52% (38-681). 56.77% (176) used reservoir masks, 26.8% binasal cannulas, and 2.9% mechanical ventilators. The average hospitalization time was 11.67 days and the average number of dialysis sessions was 3.78 (0-25). Up to 25.81% (80) of the patients had an indication for ICU management, however, only 3.23% (10) received it. Up to 48.71% (151) died during hospitalization, of which 90% (9) were in the ICU and 75% (60) had an indication for ICU management but did not receive it. The risk of death of patients with an ICU indication is 1.9 higher than those who did not have an indication. (CI: 1.57 - 2.38) Patients were admitted with intermediate ISARIC4C scores of 8.1% (25), high 53.5% (166), and very high 37.7% (117). Of which 20% (5) died with an intermediate score, 39.2% (65) with a high score, and 68.4% (80) with a very high score. (p=0.001) 67.5% (102) of the deceased were male (p=0.047) and the risk of death for males versus females is 1.59 (CI: 1.004 - 2.536). In the first wave, 176 ESKD patients who had COVID-19 were registered between March and August 2020. In the second wave, 134 ESKD patients were registered between December 2020 and May 2021. Mortality between the first and second waves was 50% (88) in the first and 45.5% (61) in the second (p=0.43). Regarding the evolution after one year of patients who were discharged (159), mortality was 22% (35), with the main causes being cardiovascular diseases (28.5%), and acute respiratory failure (25.7%). and infectious (22.8%). [Formula presented] Conclusion(s): COVID-19 had devastating outcomes for vulnerable groups such as ESKD patients. In our study, we demonstrated higher mortality (48.1%), particularly in the male sex. The ISARIC4C score represented a higher mortality risk with a higher score level. No conflict of interestCopyright © 2023
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Risk factors for COVID-19 death in high-altitude populations have been scarcely described. This study aimed to describe risk factors for COVID-19 death in three referral hospitals located at 3399 m in Cusco, Peru, during the first 14 months of the pandemic. A retrospective multicenter cohort study was conducted. A random sample of ~50% (1225/2674) of adult hospitalized patients who died between 1 March 2020 and 30 June 2021 was identified. Of those, 977 individuals met the definition of death by COVID-19. Demographic characteristics, intensive care unit (ICU) admission, invasive respiratory support (IRS), disease severity, comorbidities, and clinical manifestation at hospital admission were assessed as risk factors using Cox proportional-hazard models. In multivariable models adjusted by age, sex, and pandemic periods, critical disease (vs. moderate) was associated with a greater risk of death (aHR: 1.27; 95%CI: 1.14-1.142), whereas ICU admission (aHR: 0.39; 95%CI: 0.27-0.56), IRS (aHR: 0.37; 95%CI: 0.26-0.54), the ratio of oxygen saturation (ROX) index ≥ 5.3 (aHR: 0.87; 95%CI: 0.80-0.94), and the ratio of SatO2/FiO2 ≥ 122.6 (aHR: 0.96; 95%CI: 0.93-0.98) were associated with a lower risk of death. The risk factors described here may be useful in assisting decision making and resource allocation.
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Introduction The Rothman Index (RI, PeraHealth, Inc. Charlotte, NC, USA) is a predictive model intended to provide continuous monitoring of a patient's clinical status. There is limited data to support its use in the risk stratification of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We hypothesized that low admission RI scores would correlate with higher rates of adverse outcomes in patients hospitalized for coronavirus disease 2019 (COVID-19). Methods Medical records of adult patients admitted to a single 1,200-bed tertiary academic center were retrospectively reviewed for demographic data, baseline characteristics, RI scores, admission to intensive care unit (ICU), need for mechanical ventilation, and inpatient mortality. Statistical analyses were performed using STATA statistical software, version 17 (Stata Corp LLC, College Station, TX, USA). Continuous variables were analyzed using the Mann-Whitney test, and categorical variables were analyzed using Fisher's exact test. Both univariate and multivariate analyses were performed. A p-value <0.05 was considered statistically significant. Results Median admission RI score for the entire cohort was 63.0 (IQR 45.0 - 77.1). The cohort was divided by admission RI into a low-risk group (RI ≥70; n=70) and a high-risk group (RI <70; n=107). Compared to patients with low-risk RI, patients with high-risk RI had higher mortality (95.2%, 95% CI: 85.8 - 105 vs 4.8%, 95% CI: -5 - 14.2, p < 0.01), were more likely to require ICU admission (90.2%, 95% CI: 81.9 - 98.5 vs 9.8%, 95% CI: 1.5 - 18.1, p < 0.01) and mechanical ventilation (89.7%, 95% CI: 78.3 - 101 vs 10.3%, 95% CI: -1 - 21.7, p < 0.01), and had a longer median hospital length of stay (12 days, 95% CI: 9 - 14 vs 5 days, 95% CI: 4 - 7, p < 0.01). Conclusions High-risk RI was associated with increased admission to the ICU, mechanical ventilation, and mortality. These results suggest that it may be used as a tool to aid provider judgment in the setting of COVID-19.
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Background: The effective SARS-CoV-2 infection prevention and control in any country depends on awareness and training of healthcare practitioners (HCPs) in addition to the preparedness and protective measures of healthcare settings. Purpose(s): The study aimed to measure the preparedness of public hospitals and healthcare providers to face COVID-19 pandemic in Iraq. Method(s): This was a cross-sectional study based on an electronic survey (Qualtrics) in English distributed among HCPs working in public hospitals across the country. The survey was distributed via two professional Facebook groups between March 22nd to April 7th 2020. The author adopted with modifications the survey items from previous studies of Middle East Respiratory Syndrome (MERS). Result(s): The authors received 347 completed surveys (52.2% pharmacists, 38.3% physicians and dentists 8.6%). All the seven items measuring HCP awareness of COVID-19 disease and preventive measures were above average with total mean of 27.91 (+/-4.21) out of 35 points. In contrast, 10 out of 12 items measuring the public hospital preparedness to COVID-19 were below average (between 1.73 and 2.7 out of 5) particularly those related to provide staff trainings and protective personal equipment (PPE). Additionally, 81.8% of the participants Conclusion(s): Iraqi HCPs have adequate levels of awareness of COVID-19;however, the public hospitals need to enhance staff training and protective measures in addition to providing adequate PPE to HCPs. The Ministry of Health needs to provide adequate numbers of mechanical ventilators to public hospitals to face COVID-19 pandemic.
ABSTRACT
Venovenous extracorporeal membrane oxygenation (VV-ECMO) is recommended for the treatment of acute respiratory distress syndrome (ARDS) with refractory hypoxemia or when lung protective ventilation cannot be applied. Coronavirus disease (COVID-19) pandemic led to the increase in the cases of ARDS requiring VV-ECMO. As a result, critical care respiratory therapists (RTs) are more frequently involved in the care of VV-ECMO patients. In this role, the RTs are not only required to have basic knowledge of ECMO technology, but they also must understand the complex interaction between a patient, a ventilator, and an ECMO machine. The objective of the presentation will be to provide RTs with the essential practical knowledge of modern VV-ECMO therapy required for the treatment of ARDS patents. The presentation will include perfusionist's and RT's perspectives from one of the largest academic health networks in North America. It will be demonstrated that the collaboration between two clinical fields of perfusion and respiratory therapy is required for the optimal care to the ARDS patients. The presentation will cover the main steps of therapeutic algorithm for VV-ECMO ARDS patients: 1. an optimization of mechanical ventilation before VV-ECMO consideration;2. VV-ECMO indications;3. start, maintenance and weaning phases of VV-ECMO;4. post decannulation. The complex interaction between a patient, a VV-ECMO machine, and a mechanical ventilator as well as challenges of respiratory monitoring will be discussed. The obtained knowledge will allow RTs to provide optimal respiratory care at each stage of VV- ECMO process.
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Objective: To address the issue of ventilator shortages due to the COVID-19 pandemic, our group developed the proof-of-concept of a low-cost and rapidly scalable open-source mechanical ventilator system for emergency use. Method(s): A simplified architecture of MiniVent was designed to meet the low-cost and easy-to-produce pre-established properties of our device. To carry out such an approach, we decided to use only components commonly available in the market or components of easy production with usual manufacturing techniques, such as 3D printing. The design of MiniVent comprises a pneumatic unit that controls the quality of the air and oxygen mixture and maintains the pressure on the patient's lungs at the desired preset value, along the respiratory cycle. The control unit was programmed on a microcontroller and is responsible for ensuring the respiratory rate and the inspiratory-expiratory ratio, selected by the user. To ensure the fulfilment of all the security and specification requirements of pandemic ventilators, we followed the mandatory specifications presented in the document - Rapidly Manufactured Ventilator System (RMVS) - published by the Medicines & Healthcare products Regulatory Agency (MHRA). A set of tests was performed using different ventilatory parameters for instrumental verification of MiniVent's physical and biological performance. A stability test was also carried out during 35 hours of uninterrupted operation to analyse whether the expected dynamics of the output pressure were maintained over this time. Result(s): The ventilator system developed allows prescribing different breathing rates, fractions inspired of oxygen (FiO2), inspiratory-expiratory ratios (I: E), positive inspiratory pressures (PIP) and positive end-expiratory pressures (PEEP), which can be easily adjustable to the patient's condition. The results of a set of tests assured the reliability of all the ventilatory parameters set by the user. Furthermore, MiniVent showed a good performance over 35 hours of uninterrupted operation, which pointed out the stability of this device. In addition, the device was tested in a porcine model showing good mechanical performance and adequate arterial blood gas throughout all test periods. When compared with commercial ventilators, MiniVent exhibited a similar performance of ventilation. Conclusion(s): MiniVent could be a reliable solution to overcome the shortage of commercial ventilators in emergencies, such as the recent COVID-19 pandemic. This device presents a production cost of under 1000 and does not need specialized technical assistance so it might be a viable solution even in lowerincome countries.