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1.
Annals of Intensive Care ; 12(1):1-2, 2022.
Article in English | Academic Search Complete | ID: covidwho-2038917

ABSTRACT

Jordi became naturally involved with the Spanish Society, but also the American Thoracic Society (where he was one of the few Europeans to lead the Critical Care program Committee);he also helped many programs in Portugal, and in South America to develop their academic missions. Thanks to the collaboration between Francois Lemaire and Salvador Benito, Jordi spent two periods of sabbatical in Henri Mondor Hospital in Creteil, early in his career, at the end of the 1980s and in the 1990s. Albert Camus i Graph Jordi Mancebo, graduated in Medicine in 1980 and was made Doctor of Medicine in 1991 from the Autonomous University of Barcelona. [Extracted from the article] Copyright of Annals of Intensive Care is the property of Springer Nature 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.)

2.
Respir Res ; 23(1):256, 2022.
Article in English | PubMed | ID: covidwho-2038756

ABSTRACT

BACKGROUND: During the COVID-19 pandemic in The Netherlands, critically ill ventilated COVID-19 patients were transferred not only between hospitals by ambulance but also by the Helicopter Emergency Medical Service (HEMS). To date, little is known about the physiological impact of helicopter transport on critically ill patients and COVID-19 patients in particular. This study was conducted to explore the impact of inter-hospital helicopter transfer on vital signs of mechanically ventilated patients with severe COVID-19, with special focus on take-off, midflight, and landing. METHODS: All ventilated critically ill COVID-19 patients who were transported between April 2020 and June 2021 by the Dutch 'Lifeliner 5' HEMS team and who were fully monitored, including noninvasive cardiac output, were included in this study. Three 10-min timeframes (take-off, midflight and landing) were defined for analysis. Continuous data on the vital parameters heart rate, peripheral oxygen saturation, arterial blood pressure, end-tidal CO(2) and noninvasive cardiac output using electrical cardiometry were collected and stored at 1-min intervals. Data were analyzed for differences over time within the timeframes using one-way analysis of variance. Significant differences were checked for clinical relevance. RESULTS: Ninety-eight patients were included in the analysis. During take-off, an increase was noticed in cardiac output (from 6.7 to 8.2 L min(-1);P < 0.0001), which was determined by a decrease in systemic vascular resistance (from 1071 to 739 dyne·s·cm(-5), P < 0.0001) accompanied by an increase in stroke volume (from 88.8 to 113.7 mL, P < 0.0001). Other parameters were unchanged during take-off and mid-flight. During landing, cardiac output and stroke volume slightly decreased (from 8.0 to 6.8 L min(-1), P < 0.0001 and from 110.1 to 84.4 mL, P < 0.0001, respectively), and total systemic vascular resistance increased (P < 0.0001). Though statistically significant, the found changes were small and not clinically relevant to the medical status of the patients as judged by the attending physicians. CONCLUSIONS: Interhospital helicopter transfer of ventilated intensive care patients with COVID-19 can be performed safely and does not result in clinically relevant changes in vital signs.

3.
Anaesthesist ; 71(5): 333-339, 2022 05.
Article in German | MEDLINE | ID: covidwho-2035018

ABSTRACT

The controversy surrounding ventilation in coronavirus disease 2019 (COVID-19) continues. Early in the pandemic it was postulated that the high intensive care unit (ICU) mortality may have been due to too early intubation. As the pandemic progressed recommendations changed and the use of noninvasive respiratory support (NIRS) increased; however, this did not result in a clear reduction in ICU mortality. Furthermore, large studies on optimal ventilation in COVID-19 are lacking. This review article summarizes the pathophysiological basis, the current state of the science and the impact of different treatment modalities on the outcome. Potential factors that could undermine the benefits of noninvasive respiratory support are discussed. The authors attempt to provide guidance in answering the difficult question of when is the right time to intubate?


Subject(s)
COVID-19 , Noninvasive Ventilation , Respiratory Insufficiency , Humans , Intensive Care Units , Pandemics , Respiration, Artificial , Respiratory Insufficiency/therapy
4.
Clin Chest Med ; 43(3):529-538, 2022.
Article in English | PubMed | ID: covidwho-2035814

ABSTRACT

The concept of telecritical care has evolved over several decades. ICU Telemedicine providers using both the hub-and-spoke ICU telemedicine center and consultative service delivery models offered their services during the COVID-19 pandemic. Telemedicine center responses were more efficient, timely, and widely used than those of the consultative model. Bedside nurses, physicians, nurse practitioners, physician assistants, and respiratory therapists incorporated the use of ICU telemedicine tools into their practices and more frequently requested critical care specialist telemedicine support.

5.
Clin Chest Med ; 43(3):471-488, 2022.
Article in English | PubMed | ID: covidwho-2035813

ABSTRACT

In this article, we discuss some of the more common obstetric-related conditions that can lead to critical illness and require management in an ICU. These include the hypertensive disorders of pregnancy, postpartum hemorrhage, hemolysis, elevated liver enzymes, and low platelet syndrome, acute fatty liver of pregnancy, amniotic fluid embolism, and peripartum cardiomyopathy. We also discuss pulmonary embolism and Covid-19. Despite not being specific to obstetric patients, pulmonary embolism is a common, life-threatening diagnosis in pregnancy with particular risks and management aspects. Covid-19 does not seem to occur with higher frequency in pregnant women, but it leads to higher rates of ICU admissions and mechanical ventilation in pregnant women than in their nonpregnant peers. Its prevalence during our current global pandemic makes it important to discuss in this article. We provide a basis for critical care physicians to be engaged in informed conversations and management in a multidisciplinary manner with other relevant providers in the care of critically ill pregnant and postpartum women.

6.
Boletin de Malariologia y Salud Ambiental ; 62(2):227-232, 2022.
Article in Spanish | CAB Abstracts | ID: covidwho-2034474

ABSTRACT

Introduction: The COVID-19 disease is complicated by severe acute respiratory syndrome (ARDS), which is considered the main cause of mortality within intensive care units, despite providing early and optimal ventilatory support. However, it is necessary to identify the factors associated with mortality in these patients.

7.
IJC Heart & Vasculature ; : 101116, 2022.
Article in English | ScienceDirect | ID: covidwho-2031332

ABSTRACT

Background Due to the coronavirus disease 2019 (COVID-19) pandemic, the first state of emergency had been declared from April 7 to May 25, 2020, in Japan. This pandemic might affect the management for patients with acute myocardial infarction (AMI). Method and Results: To evaluate the critical care and outcomes of AMI patients during the COVID-19 outbreak, we examined the patients with AMI hospitalized in 2020 (n=1,186) and those in 2017-2019 (n=4877) using a database of the Miyagi AMI Registry Study. The door-to-device time under the emergency declaration became longer as compared with that of the same period in 2017-2019 [83(65-111) vs. 74(54-108) min, p=0.04]. Importantly, the time delay was noted in only patients with Killip class I on arrival, but not in those with Killip class II-IV. Meanwhile, there were no significant changes in the duration from the symptom onset to hospital arrival, the use rate of ambulance and the performance rate of primary percutaneous coronary intervention before and after the COVID-19 outbreak. Eventually, in-hospital mortality had not deteriorated under the state of emergency (6.7 vs 7.8%, P=0.69). Conclusion: The emergence of the COVID-19 outbreak seemed to affect AMI management and highlight understanding the barriers to cardiovascular critical care.

9.
Aust Crit Care ; 2022.
Article in English | ScienceDirect | ID: covidwho-2031142

ABSTRACT

BACKGROUND: Intensive care units (ICUs) are emotionally demanding workplaces. Exposure to stress can negatively impact ICU staff members' emotional resilience, health, and capacity to provide care. Despite recognition of the benefits of promoting "healthy workplaces", there are limited interventional studies aimed at improving the well-being of ICU staff. AIM: The aim of this study was to assess the effectiveness of a multifaceted intervention for improving well-being of staff working in a tertiary ICU. METHODS: A before-and-after interventional study was conducted over a 2-year period, between 2019 and 2021. Interventions included social activities, fitness, nutrition, and emotional support. An electronic version of the PERMA-Profiler questionnaire was used to assess the well-being of a convenience sample of ICU staff before (n = 96) and after (n = 137) the intervention. Ten focus groups (each involving 12-18 nurses) were held to explore nurses' perceptions of the intervention's effectiveness. RESULTS: After the intervention, a significantly greater proportion of participants described their work week as draining (32% vs 19%, chi(2) = 4.4 df + 1, P = 0.03) and at least a bit harder than normal (38% vs 22%, chi(2) = 6.4 df + 1, p = 0.01) compared to baseline surveys. However, well-being scores after the intervention (mean = 6.95, standard deviation = 1.28) were not statistically different (p = 0.68) from baseline scores (mean = 7.02, standard deviation = 1.29). Analysis of focus groups data revealed three key categories: boosting morale and fostering togetherness, supporting staff, and barriers to well-being. CONCLUSIONS: After the intervention, there was a preserved level of well-being from baseline despite a statistically significant increase in staff reporting the work week as draining and at least a little bit harder than normal. These findings must be considered in light of the COVID-19 pandemic, which started after baseline data collection and continues to impact the community, including staff workload and pressures in intensive care. The study findings may inform strategies for improving ICU staff members' well-being.

10.
Physiological Reports ; 10(17), 2022.
Article in English | ProQuest Central | ID: covidwho-2030378

ABSTRACT

Split ventilation (using a single ventilator to ventilate multiple patients) is technically feasible. However, connecting two patients with acute respiratory distress syndrome (ARDS) and differing lung mechanics to a single ventilator is concerning. This study aimed to: (1) determine functionality of a split ventilation system in benchtop tests, (2) determine whether standard ventilation would be superior to split ventilation in a porcine model of ARDS and (3) assess usability of a split ventilation system with minimal specific training. The functionality of a split ventilation system was assessed using test lungs. The usability of the system was assessed in simulated clinical scenarios. The feasibility of the system to provide modified lung protective ventilation was assessed in a porcine model of ARDS (n = 30). In bench testing a split ventilation system independently ventilated two test lungs under conditions of varying compliance and resistance. In usability tests, a high proportion of naïve operators could assemble and use the system. In the porcine model, modified lung protective ventilation was feasible with split ventilation and produced similar respiratory mechanics, gas exchange and biomarkers of lung injury when compared to standard ventilation. Split ventilation can provide some elements of lung protective ventilation and is feasible in bench testing and an in vivo model of ARDS.

11.
PLoS One ; 17(9), 2022.
Article in English | ProQuest Central | ID: covidwho-2029790

ABSTRACT

Introduction Shortages of human resources in radiation emergency medicine (REM) caused by the anxiety and stress of due to working in REM, are a major concern. The present study aimed to quantify stress and identify which tasks involved in REM response are most stressful to help educate (human resource development) and effectively reduce stress in workers. Furthermore, the final goal was to reduce the anxiety and stress of medical personnel in the future, which will lead to sufficient human resources in the field of REM. Methods In total, 74 nurses who attended an REM seminar were asked to answer a questionnaire (subjective) survey and wear a shirt-type electrocardiogram (objective survey). Then, informed consent was obtained from 39 patients included in the analysis. In the objective survey, average stress values of participants for each activity during the seminar were calculated based on heart rate variability (HRV). The average stress value was output as stress on a relative scale of 0–100, based on the model which is the percentile of the low-frequency/high-frequency ratio derived from HRV at any point in time obtained over time. Results A total of 35 (89.7%) participants answered that they had little or no knowledge of nuclear disaster and 33 (84.6%) had more than moderate anxiety. Stress values observed during the decontamination process were significantly higher than those observed when wearing and removing protective gear and during the general medical treatment process (P = 0.001, 0.004, and 0.023, respectively). Stress values did not increase during general medical treatment performed in protective clothing, but increased during the decontamination process, which is the task characteristic of REM. Discussion Stress felt by medical personnel throughout the entire REM response may be effectively reduced by providing careful education/training to reduce stress during the decontamination process. Reducing stress during REM response effectively could contribute to resolving the shortage of human resources in this field.

13.
DIVI ; 13(3):124-129, 2022.
Article in German | CINAHL | ID: covidwho-2026855
14.
Ulusal Travma ve Acil Cerrahi Dergisi = Turkish Journal of Trauma & Emergency Surgery: TJTES ; 28(9):1229-1237, 2022.
Article in English | MEDLINE | ID: covidwho-2025732

ABSTRACT

BACKGROUND: The COVID-19 pandemic affects the whole world, causing high mortality. Some clinical parameters have already been implemented to be followed up to prevent mortality, but there is still a need for further information about optimum follow-up parameters and cutoff values. We aimed to investigate the reliability of the parameters used in patient follow-up by comparing survivors and non-survivors. METHODS: Patients were divided into two groups as survivors and non-survivors. The parameters used in the follow-up of patients were evaluated for their prognostic value in the course of COVID-19. RESULTS: Of the 144 patients evaluated in our study, 57 patients were non-survivors (39.7%). Non-survivors were older with an average age of 67.8 years. Of the non-survivors, 59.6% were men. Male gender was found out to be associated with an increased risk concerning prognosis and mortality. The most common accompanying diseases were hypertension, diabetes mellitus, cardiac disease, and chronic obstructive pulmonary disease. In our study, it has been found that lymphocyte counts and levels of troponin, D-dimer, ferritin, and lactate dehydrogenase are important prognostic predictors in estimating mortality risk. CONCLUSION: The use of prognostic markers appears to provide benefitsin estimating mortality in COVID-19 patients.

15.
Journal of Clinical Medicine ; 11(17):4997, 2022.
Article in English | ProQuest Central | ID: covidwho-2023793

ABSTRACT

Background: To explore the feasibility and effectiveness of multifaceted quality improvement intervention based on the clinical decision support system (CDSS) in VTE prophylaxis in hospitalized patients. Methods: A randomized, department-based clinical trial was conducted in the department of respiratory and critical care medicine, orthopedic, and general surgery wards. Patients aged ≥18 years, without VTE in admission, were allocated to the intervention group and received regular care combined with multifaceted quality improvement intervention based on CDSS during hospitalization. VTE prophylaxis rate and the occurrence of hospital-associated VTE events were analyzed as primary and secondary outcomes. Results: A total of 3644 eligible residents were enrolled in this trial. With the implementation of the multifaceted quality improvement intervention based on the CDSS, the VTE prophylaxis rate of the intervention group increased from 22.93% to 34.56% (p < 0.001), and the incidence of HA-VTE events increased from 0.49% to 1.00% (p = 0.366). In the nonintervention group, the VTE prophylaxis rate increased from 24.49% to 27.90% (p = 0.091), and the incidence of HA-VTE events increased from 0.47% to 2.02% (p = 0.001). Conclusions: Multifaceted quality improvement intervention based on the CDSS strategy is feasible and expected to facilitate implementation of the recommended VTE prophylaxis strategies and reduce the incidence of HA-VTE in hospital. However, it is necessary to conduct more multicenter clinical trials in the future to provide more reliable real-world evidence.

16.
Journal of Clinical Medicine ; 11(16):4705, 2022.
Article in English | ProQuest Central | ID: covidwho-2023785

ABSTRACT

Background: Medication Regimen Complexity (MRC) refers to the combination of medication classes, dosages, and frequencies. The objective of this study was to examine the relationship between the scores of different MRC tools and the clinical outcomes. Methods: We conducted a retrospective cohort study at Roger William Medical Center, Providence, Rhode Island, which included 317 adult patients admitted to the intensive care unit (ICU) between 1 February 2020 and 30 August 2020. MRC was assessed using the MRC Index (MRCI) and MRC for the Intensive Care Unit (MRC-ICU). A multivariable logistic regression model was used to identify associations among MRC scores, clinical outcomes, and a logistic classifier to predict clinical outcomes. Results: Higher MRC scores were associated with increased mortality, a longer ICU length of stay (LOS), and the need for mechanical ventilation (MV). MRC-ICU scores at 24 h were significantly (p < 0.001) associated with increased ICU mortality, LOS, and MV, with ORs of 1.12 (95% CI: 1.06–1.19), 1.17 (1.1–1.24), and 1.21 (1.14–1.29), respectively. Mortality prediction was similar using both scoring tools (AUC: 0.88 [0.75–0.97] vs. 0.88 [0.76–0.97]. The model with 15 medication classes outperformed others in predicting the ICU LOS and the need for MV with AUCs of 0.82 (0.71–0.93) and 0.87 (0.77–0.96), respectively. Conclusion: Our results demonstrated that both MRC scores were associated with poorer clinical outcomes. The incorporation of MRC scores in real-time therapeutic decision making can aid clinicians to prescribe safer alternatives.

17.
Frontiers in Medicine ; 9, 2022.
Article in English | Web of Science | ID: covidwho-2022775

ABSTRACT

BackgroundPrognostic tools developed to stratify critically ill patients in Intensive Care Units (ICUs), are critical to predict those with higher risk of mortality in the first hours of admission. This study aims to evaluate the performance of the pShock score in critically ill patients admitted to the ICU with SARS-CoV-2 infection. MethodsProspective observational analytical cohort study conducted between January 2020 and March 2021 in four general ICUs in Salvador, Brazil. Descriptive statistics were used to characterize the cohort and a logistic regression, followed by cross-validation, were performed to calibrate the score. A ROC curve analysis was used to assess accuracy of the models analyzed. ResultsSix hundred five adult ICU patients were included in the study. The median age was 63 (IQR: 49-74) years with a mortality rate of 33.2% (201 patients). The calibrated pShock-CoV score performed well in prediction of ICU mortality (AUC of 0.80 [95% Confidence Interval (CI): 0.77-0.83;p-value < 0.0001]). ConclusionsThe pShock-CoV score demonstrated robust discriminatory capacity and may assist in targeting scarce ICU resources during the COVID-19 pandemic to those critically ill patients most likely to benefit.

18.
PLoS One ; 17(9), 2022.
Article in English | ProQuest Central | ID: covidwho-2021957

ABSTRACT

Introduction Using respiratory virus rapid diagnostic tests in the emergency department could allow better and faster clinical management. Point-of-care PCR instruments now provide results in less than 30 minutes. The objective of this study was to assess the impact of the use of a rapid molecular diagnostic test, the cobas® Influenza A/B & RSV Assay, during the clinical management of emergency department patients. Methods Patients (adults and children) requiring admission or suffering from an underlying condition at risk of respiratory complications were prospectively recruited in the emergency department of four hospitals in the Brussels region. Physicians’ intentions regarding admission, isolation, antibiotic, and antiviral use were collected before and after performing the rapid molecular test. Additionally, a comparison of the analytical performance of this test against antigen rapid tests and viral culture was performed as well as a time-to-result evaluation. Results Among the 293 patients recruited, 90 had a positive PCR, whereas 44 had a positive antigen test. PCR yielded a sensitivity of 100% for all targets. Antigen tests yielded sensitivities ranging from 66.7% for influenza B to 83.3% for respiratory syncytial virus (RSV). The use of PCR allowed a decrease in the overall need for isolation and treatment by limiting the isolation of negative patients and antibiotic use for positive patients. Meanwhile, antiviral treatments better targeted patients with a positive influenza PCR. Conclusion The use of a rapid influenza and RSV molecular test improves the clinical management of patients admitted to the emergency department by providing a fast and reliable result. Their additional cost compared to antigen tests should be balanced with the benefit of their analytical performance, leading to efficient reductions in the need for isolation and antibiotic use.

19.
PLoS One ; 17(9), 2022.
Article in English | ProQuest Central | ID: covidwho-2021948

ABSTRACT

Background Influenza cause a clinical and economic burden for health systems and society. It is necessary to know the cost of the disease in order to perform cost-effectiveness assessments of preventive or treatment interventions. Objective Assess the costs of the care of children with influenza in a third level hospital in Mexico. Methods Longitudinal retrospective study based on the review of clinical files of children hospitalized with influenza. The use of resources used during their hospitalization in the emergency room, general ward, or PICU was logged, and the amount of supplies were multiplied by their corresponding prices to calculate the direct medical expenses. Descriptive statistics were used, and a GLM was adjusted in order to assess the effect of the clinical characteristics of the patients on the cost. Goodness of fit tests were performed. Results 132 files were reviewed, out of which 95% were of subjects who had comorbidities. Subjects admitted at the PICU generates the highest cost (mean $29,608.62 USD), when analyzing the total cost summarizing the three clinical areas (Emergency room, general ward and PICU) by age group, the highest cost was for patients over age 10 (mean $49,674.53 USD). Comorbidities increase the cost of hospitalization by $10,000.00 USD. Conclusions Influenza causes a significant financial burden on the health system. Children with comorbidities increase the costs and children over 10 years uses a significant amount of resources and they are not a priority in immunization program. It is necessary to perform studies on the use of resources in the first and second attention levels, which represent the highest incidence of the disease.

20.
PLoS Global Public Health ; 2(6), 2022.
Article in English | CAB Abstracts | ID: covidwho-2021484

ABSTRACT

Using three age-structured, stochastic SIRM models, calibrated to Australian data post July 2021 with community transmission of the Delta variant, we projected possible public health outcomes (daily cases, hospitalisations, ICU beds, ventilators and fatalities) and economy costs for three states: New South Wales (NSW), Victoria (VIC) and Western Australia (WA). NSW and VIC have had on-going community transmission from July 2021 and were in 'lockdown' to suppress transmission. WA did not have on-going community transmission nor was it in lockdown at the model start date (October 11th 2021) but did maintain strict state border controls. We projected the public health outcomes and the economic costs of 'opening up' (relaxation of lockdowns in NSW and VIC or fully opening the state border for WA) at alternative vaccination rates (70%, 80% and 90%), compared peak patient demand for ICU beds and ventilators to staffed state-level bed capacity, and calculated a 'preferred' vaccination rate that minimizes societal costs and that varies by state. We found that the preferred vaccination rate for all states is at least 80% and that the preferred population vaccination rate is increasing with: (1) the effectiveness (infection, hospitalization and fatality) of the vaccine;(2) the lower is the daily lockdown cost;(3) the larger are the public health costs from COVID-19;(4) the higher is the rate of community transmission before opening up;and (5) the less effective are the public health measures after opening up.

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