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1.
Crit Care ; 26(1): 200, 2022 07 05.
Article in English | MEDLINE | ID: covidwho-2038844

ABSTRACT

In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A-F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a 'home-like' (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care.


Subject(s)
COVID-19 , Pandemics , Critical Care , Critical Illness , Humans , Intensive Care Units
2.
J Clin Lab Anal ; 36(5): e24378, 2022 May.
Article in English | MEDLINE | ID: covidwho-2034807

ABSTRACT

BACKGROUND: The purpose of this study was to investigate whether platelet count was associated with mortality in acute respiratory distress syndrome (ARDS) patients. METHODS: We analyzed patients with ARDS from Multi-parameter Intelligent Monitoring in Intensive Care Database III (MIMIC-III). Platelet count was measured at the time of intensive care unit (ICU) admission. The cox proportional hazard model and subgroup analysis were used to determine the relationship between the platelet count and mortality of ARDS, as well as the consistency of its association. The primary outcome of this study was 365-day mortality from the date of ICU admission. RESULT: This study enrolled a total of 395 critically ill patients with ARDS. After adjustment for age, gender and ethnicity, the multivariate cox regression model showed that the hazard ratios (HRs) (95% confidence intervals [CIs]) of platelet count <192 × 109 /L and >296 × 109 /L were 2.08 (1.43, 3.04) and 1.35 (0.91, 2.01), respectively, compared with the reference (192-296 ×109 /L). After adjusting for confounding factors, lower platelet count (<192 × 109 /L) was associated with increased mortality (adjusted HR, 1.71; 95% CI 1.06-2.76, p = 0.0284). However, there was no similar trend in the 30-day (adjusted HR,1.02; 95% CI 0.54-1.94) or 90-day (adjusted HR, 1.65; 95% CI 0.94-2.89) mortality. In the subgroup analysis, lower platelet count showed significant interactions with specific populations (p interaction = 0.0413), especially in patients with atrial fibrillation. CONCLUSION: Taken together, our analysis showed that platelet count is an independent predictor of mortality in critically ill patients with ARDS.


Subject(s)
Critical Illness , Respiratory Distress Syndrome , Cohort Studies , Humans , Intensive Care Units , Platelet Count , Risk Factors
3.
Aust Crit Care ; 2022.
Article in English | PubMed | ID: covidwho-2035775

ABSTRACT

OBJECTIVE: Reliable and accurate temperature assessment is fundamental for clinical monitoring;noninvasive thermometers of various designs are widely used in intensive care units, sometimes without a specific assessment of their suitability and interchangeability. This study evaluated agreement of four noninvasive thermometers with a pulmonary artery catheter temperature. METHODS: This prospective method comparison study was conducted in an Australian adult intensive care unit. One hundred postoperative adult cardiothoracic surgery patients who had a pulmonary artery catheter (Edwards Lifescience) in situ were identified. The temperature reading from the pulmonary artery catheter was compared to contemporaneous measurements returned by four different thermometers-temporal Artery (TA, Technimed), Per Axilla (Axilla, Welch Allyn), Tympanic (Tymp, Covidien), and the NexTemp® (NEXT, Medical Indicators [used per axilla]). The time required to obtain each noninvasive temperature measurement was recorded. RESULTS: Agreements between each noninvasive temperature and the pulmonary artery catheter standard were assessed using summary statistics and the Bland-Altman method comparison approach. A clinically acceptable maximum difference from the standard was defined as ±0.5 °C. Temperature agreement with the pulmonary artery standard (mean difference °C [95% limits of agreement °C]) was greatest for Tymp (-0.20 [-0.92 to 0.52]), intermediate for AXILLA (-0.37 [-1.3 to 0.59]) and NEXT (-0.71 [-1.7 to 0.27]), and least for TA (-0.60 [-2.0 to 0.81]). The proportion of measurements within ±0.5 °C of the standard were TYMP (81%), AXILLA (63%), TA (45%), and NEXT (30%). The time to obtain measurements varied, with the Tymp and TA estimates immediate, the AXILLA a mean of 40 s (standard deviation = 11 s), while NEXT results were at the manufacturer-recommended 3-min point. CONCLUSIONS: Tympanic thermometers showed closest agreement with the pulmonary artery standard. Deviations by more than 0.5 °C from that standard were relatively common with all noninvasive devices.

4.
Rev. gastroenterol. Perú ; 41(4): 227-232, 20211001. tab
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-2033618

ABSTRACT

ABSTRACT Liver transplantation is the major treatment for end-stage liver disease. Postoperative care is a great challenge to reduce morbidity and mortality in patients. In this sense, management in the liver ICU allows hemodynamic management, coagulation monitoring, renal support, electrolyte disturbances, respiratory support and early weaning from mechanical ventilation and evaluation of the liver graft. Objective: The present study shows the results of the management of liver transplant patients in 20 years of experience in a transplant center in a low- to middle-income country. Materials and methods: The medical records of 273 adult patients in the ICU in the immediate postoperative liver transplant were reviewed, from March 20, 2000 to November 30, 2020, including the effect of the pandemic caused by COVID-19. Liver-kidney, retransplanted, SPLIT, and domino transplant patients were excluded. Results: The most frequent etiology for LTx was NASH (35%), the mean age was 49 years, MELD Score ranged 15 - 20 (47.5%), 21 - 30 (46%) > 30 (6.2%). ICU pre transplant stay 7%, average ICU stay: 7.8 days. APACHE average admission: 14.9 points. Weaning extubation of 91.8% patients in ICU and Fast Track in 8.2%. The most frequent respiratory complication was atelectasis 56.3%, pneumonia (31.3%); AKI 1 (60.9%), and 11.1% with hemodyalisis support (AKI3). Immunosuppression: Tacrolimus (8.9%). Post-operative ICU mortality was 6.2%. Conclusions: The management of liver transplantation in the ICU is essential to achieve optimal results in patients who present advanced liver disease and require advanced life support in the immediate postoperative period and thus optimize graft survival.


RESUMEN El trasplante de hígado es el principal tratamiento para la enfermedad hepática en etapa terminal. El cuidado postoperatorio es un gran desafío para disminuir la morbimortalidad en los pacientes. En este sentido, el manejo en la UCI hepática permite manejo hemodinámico, monitoreo de coagulación, soporte renal, alteraciones electrolíticas, soporte respiratorio y destete temprano de ventilación mecánica y evaluación del injerto hepático. Objetivo: El presente estudio muestra los resultados del manejo de pacientes trasplantados de hígado en 20 años de experiencia en un centro de trasplante en un país de ingresos bajos a medios. Materiales y métodos: Se revisaron las historias clínicas de 273 pacientes adultos en UCI en el posoperatorio inmediato de trasplante hepático, desde el 20 de marzo de 2000 hasta el 30 de noviembre de 2020, incluyendo el efecto de la pandemia provocada por el COVID-19. Se excluyeron los pacientes con trasplante de hígado-riñón, retrasplantados, SPLIT y dominó. Resultados: La etiología más frecuente para LTx fue NASH (35%), la edad promedio fue de 49 años, MELD Score varió 15 - 20 (47,5%), 21 - 30 (46%) > 30 (6,2%). Estancia pretrasplante en UCI 7%, estancia media en UCI: 7,8 días. Admisión media APACHE: 14,9 puntos. Extubación weaning del 91,8% de los pacientes en UCI y Fast Track en el 8,2%. La complicación respiratoria más frecuente fue atelectasia 56,3%, neumonía (31,3%); FRA 1 (60,9%) y 11,1% con soporte de hemodiálisis (FRA 3). Inmunosupresión: Tacrolimus (8,9%). La mortalidad postoperatoria en la UCI fue del 6,2%. Conclusiones: El manejo del trasplante hepático en UCI es fundamental para lograr resultados óptimos en pacientes que presentan enfermedad hepática avanzada y requieren soporte vital avanzado en el postoperatorio inmediato y así optimizar la supervivencia del injerto.

5.
Anales de la Real Academia Nacional de Farmacia ; 88(2):123-130, 2022.
Article in English | EMBASE | ID: covidwho-2033626

ABSTRACT

Objetive: Description of the different isolated microorganisms and their prevalence in infections associated with health care, in addition to determining their patterns of resistance to antibiotics in patients admitted with a confirmed or suspected diagnosis of COVID-19 in the Intensive Care Unit, during a third-level medical center with hospital reconversion. Method: Patient demographic data was obtained from the clinical record, with defined criteria. Antibiotic resistance patterns were evaluated as well as the identification of isolated bacteria in cultures of expectoration, pleural fluid, catheter tips. For bacterial identification and resistance mechanisms, automated equipment and phenotypic tests were used, following the CLSI (Clinical & Laboratory Standards Institute) criteria. Results: A total of 100 patients with bacterial infection added to the main COVID-19 picture were obtained, representing pneumonia, urinary tract infection, catheter infections and bacteremia. A total of 100 strains were isolated, of which 84 are Extremely Drug Resistant, 12 Multidrug Resistant and only 4 variable sensitivity. The bacteria with the highest prevalence is Staphylococcus aureus with, followed by Pseudonomas aeruginosa and Stenotrophomonas maltophilia. 100% of the patients admitted to the ICU (Intensive Care Unit) had death. Conclusion: The increase in resistance to antibiotics in the COVID-19 pandemic has set off alarms due to the complication that this brings, and the improper use of drugs as prophylaxis or attempted treatment only generates selective pressure that leads to an increase in resistance as observed in the isolated strains in this study, where the vast majority present enzymes as well as other resistance mechanisms that confer them to be XDR (Extremely Drug Resistant).

6.
GERMS ; 12(2):253-261, 2022.
Article in English | EMBASE | ID: covidwho-2033512

ABSTRACT

Introduction Prior evidence found that bloodstream infections (BSIs) are common in viral respiratory infections and can lead to heightened morbidity and mortality. We described the incidence, risk factors, and outcomes of BSIs in patients with COVID-19. Methods This was a single-center retrospective cohort study of adults consecutively admitted from March to June 2020 for COVID-19 with BSIs. Data were collected by electronic medical record review. BSIs were defined as positive blood cultures (BCs) with a known pathogen in one or more BCs or the same commensal organism in two or more BCs. Results We evaluated 290 patients with BCs done;39 (13.4%) had a positive result. In univariable analysis, male sex, black/African American race, admission from a facility, hemiplegia, altered mental status, and a higher Charlson Comorbidity Index were positively associated with positive BCs, whereas obesity and systolic blood pressure (SBP) were negatively associated. Patients with positive BCs were more likely to have severe COVID-19, be admitted to the intensive care unit (ICU), require mechanical ventilation, have septic shock, and higher mortality. In multivariable logistic regression, factors that were independent predictors of positive BCs were male sex (OR=2.8, p=0.030), hypoalbuminemia (OR=3.3, p=0.013), ICU admission (OR=5.3, p<0.001), SBP<100 mmHg (OR=3.7, p=0.021) and having a procedure (OR=10.5, p=0.019). Patients with an abnormal chest X-ray on admission were less likely to have positive BCs (OR=0.3, p=0.007). Conclusions We found that male sex, abnormal chest X-ray, low SBP, and hypoalbuminemia upon hospital admission, admission to ICU, and having a procedure during hospitalization were independent predictors of BSIs in patients with COVID-19.

7.
Acta Medica Iranica ; 60(6):384-386, 2022.
Article in English | EMBASE | ID: covidwho-2033506

ABSTRACT

Safety monitoring of COVID-19 vaccination is paramount of importance. There are limited reports of Guillain-Barré syndrome (GBS) associated with the COVID-19 vaccination. The present study reported a case of GBS following the first dose of the Oxford-AstraZeneca SARS-CoV-2 vaccine. A 32-year-old man presented a history of progressive descending weakness and autonomic features within a month after receiving the Oxford-AstraZeneca SARS-CoV-2 vaccine. The neurological examination was consistent with acute polyneuropathy. The para-clinical investigations were in favor of acute demyelinating polyneuropathy. The patient was diagnosed with GBS, and IVIG was initiated as an acute treatment, which led to significant clinical recovery. We reported a case of GBS after receiving the Oxford-AstraZeneca vaccine. However, our findings dose not conclude a causal association between GBS and COVID-19 vaccination.

8.
Acta Medica Iranica ; 60(6):338-344, 2022.
Article in English | EMBASE | ID: covidwho-2033505

ABSTRACT

Dyspnea and decreased O2 saturation are the most common causes of hospitalization in noncritical COVID-19 patients. Breathing exercises and chest physiotherapy are used for managing the patients. These treatments are, however, not well supported by scientific evidence. In a randomized controlled trial, 80 patients were randomly assigned to planned breathing exercises (n=40) and control groups (n=40). The participants in the intervention group were instructed to blow into a balloon five times a day while lying down. Other therapies were similar in both groups. The severity of dyspnea at rest/after activity and peripheral oxygen saturation (SpO2) with/without O2 therapy were compared between the two groups on the first, second, and third days. The study findings showed no statistically significant difference in SpO2 with/without O2 therapy on the first, second, and third days between the two groups. Although the severity of dyspnea showed no significant difference between the two groups, the mean score of dyspnea at rest (2.72±2.25 vs. 1.6±1.21, P=0.007) and after activity (4.53±2.04 vs. 3.52±1.66, P=0.017) improved in the intervention group on the third day. Balloon-blowing exercise improves dyspnea in noncritical Covid-19 patients, but it does not significantly improve oxygenation.

9.
Acta Medica Iranica ; 60(6):329-337, 2022.
Article in English | EMBASE | ID: covidwho-2033504

ABSTRACT

Solid-organ transplantation recipients were assumed highly vulnerable to coronavirus disease 2019 (COVID-19). However, the results of previous studies in patients with orthotopic heart transplantation (OHT) under immunosuppressive therapy are contradictory. Therefore, we aimed to assess the prevalence of COVID-19 infection and associated risk factors, along with the six-month outcomes in COVID-19 positive OHT patients. This single-center telephone-based survey was conducted on OHT patients. Using a detailed questionnaire, exposure to COVID-19, related symptoms, and preventive self-care measures were collected. Outcomes of COVID-19-positive patients were reassessed using another survey six months later. 118 OHT patients (male: n=87, 73.7%) were included with a mean age of 45.3±13.1 years. Sixteen patients (13.5%) reported one or more symptoms compatible with COVID-19, of whom 12 (10.2%) tested positive. Our results indicated no statistically significant association between COVID-19 and comorbidities. Poor adherence to self-care measures and contact with positive index cases were both significantly associated with COVID-19 infection (P<0.001). A later six months follow-up showed that two out of 12 (16.6%) COVID-19 positive OHT patients died. There was no statistically significant difference between the prevalence of COVID-19 in our patients compared to Iran’s general population (P=251.0). Non-compliance with personal protective protocols and a history of contact with COVID-19 cases were the most risk factors for COVID-19 infection in OHT patients.

10.
Pulmonologiya ; 31(6):701-709, 2021.
Article in Russian | EMBASE | ID: covidwho-2033500

ABSTRACT

Although antibiotics (ABs) are ineffective against COVID-19, they are often prescribed to patients with the new coronavirus infection. Many of these prescriptions are uncalled for. The aim of the work is to assess the frequency of prescribing antibiotics to hospitalized patients with confirmed COVID-19, identify the most commonly prescribed ABs, and determine the significance of various biomarkers for the diagnosis of bacterial infection. Methods. A retrospective analysis of 190 inpatient cases with confirmed COVID-19 was carried out. The records of COVID-19 patients who were admitted to the intensive care unit were excluded from the analysis. Two groups were formed: 30 patients (group 1) with COVID-19, emergency or elective surgery, and exacerbation of chronic infectious diseases, and 160 patients (group 2) with manifestations of COVID-19 only. Results. ABs were prescribed to 189 patients upon admission to the hospital. The most frequently prescribed ABs included macrolides (63.5%), respiratory fluoroquinolones (49.7%), and third or fourth-generation cephalosporins (57.1%). ABs were administered starting from the first day of admission and until the discharge. The patients in group 2 were more often prescribed respiratory fluoroquinolones and, less often, III – IV generation cephalosporins. Moreover, macrolides were used in the treatment regimens of both groups. Longer administration of respiratory fluoroquinolones to patients in group 2 than patients in group 1 (p < 0,05) was noted. Group 2 also tended to receive longer therapy with macrolides. On admission, the patients with signs of bacterial infection had more significant leukocytosis with a neutrophilic shift, a more common increase in ESR of more than 20 mm/h and an increase in the level of procalcitonin ≥ 0,5 ng/ml. Conclusion. ABs were administered to the overwhelming majority of hospitalized patients in the absence of clear therapeutic indications. The ABs are likely to have a minimal benefit as empirical treatment of COVID-19 and are associated with unintended consequences, including adverse effects and increased antibiotic resistance. According to our data, the most informative markers of a secondary bacterial infection in patients with COVID-19 are leukocytosis with a neutrophilic shift, an increase in ESR of more than 20 mm/h, and a procalcitonin level of more than 0,5 ng/ml.

11.
NeuroQuantology ; 20(10):5508-5516, 2022.
Article in English | EMBASE | ID: covidwho-2033485

ABSTRACT

Hypovitaminosis D was shown to be prevalent in this research of 124 people who were COVID-19 positive. With a p-value of 0.001, greater serum concentrations of inflammatory markers like COVID-19 were significantly related with lower vitamin D levels (D-dimer, CRP, and ferritin). One way to gauge the severity of COVID-19 infection is by looking at the serum vitamin D level. An increased risk of acute respiratory infection is linked to vitamin D deficiency. The processes through which vitamin D influences the immune system are complex. The usual immunomodulatory activity appears to be inhibited with reduced serum vitamin D concentrations, favoring a pro-inflammatory phase. Less effective macrophage activity and antigen presentation may be caused by insufficient vitamin D levels. As a result, low vitamin D levels may potentially contribute to a delayed or dysregulated response to the body's initial contact with SARS-CoV-2 or prevent the construction of an effective defense in cases of established SARS-CoV-2 infection. Inflammation and the biological functions of the innate and adaptive immune systems are linked to vitamin D. Coronavirus illness risk or severity have been observed to be inversely correlated with blood 25-hydroxyvitamin D (25(OH)D) levels in observational studies (COVID-19). The significance of vitamin D in COVID-19 has been attributed to a number of pathways, such as the modulation of immunological and inflammatory responses, control of the renin-angiotensin-aldosterone systems, and participation in glucose metabolism and the cardiovascular system. Patients with COVID-19 may be more likely to experience catastrophic consequences if their 25(OH)D levels are low, not only because of the hyperinflammatory state that is often present but also because it aggravates cardiovascular disease and impaired glucose metabolism that already exist. Some randomized controlled trials have demonstrated that supplementing with vitamin D is helpful for lowering coronavirus 2 RNA positivity in SARS, but not for lowering intensive care unit admission or all-cause death in patients with moderate-to-severe COVID-19. According to the most recent research, taking a vitamin D supplement to keep your serum 25(OH)D level at or above 30 ng/mL (recommended range: 40–60 ng/mL) may help lower your risk of developing COVID-19 and its serious consequences, such as death. According to worldwide recommendations, it is prudent to suggest vitamin D supplements to those who have vitamin D shortage or insufficiency during the COVID-19 pandemic, even though additional well-designed research are necessary.

12.
Flora ; 27(2):317-323, 2022.
Article in Turkish | EMBASE | ID: covidwho-2033380

ABSTRACT

Introduction: Although there is limited data on the frequency of nosocomial infections in patients followed up in the intensive care unit due to COVID-19, the rate of empirical antibiotic use in these patients is quite high. In our study, it was planned to determine the frequency of nosocomial infections in patients hospitalized in intensive care units due to COVID-19, the pathogens isolated in nosocomial infections, and to investigate the characteristics of these infections. Materials and Methods: Our study is a retrospective study in which the records of 590 adult patients hospitalized in the COVID-19 intensive care unit and followed prospectively between April 1, 2020 and December 31, 2021 were examined. Results: In our study, nosocomial infection developed in 7.28% of patients hospitalized in the intensive care unit due to COVID-19, and mortality was 93% in patients who developed nosocomial infections. Of these infections, 67.44% were lower respiratory tract infections, 25.58% were bloodstream infections, and 6.97% were urinary tract infections. While the median number of toatl hospital stay was 20 days, the median time since admission to infection was 12 days. Infections often developed with a single microorganism, and the most frequently isolated microorganisms are A. baumannii and K. pneumoniae. Conclusion: Nosocomial infections that develop in patients followed in the intensive care unit due to COVID-19, are seen in approximately 7% of patients, but are mortal. In this patient group, regular microbiological follow-up and implementation of strict infection control measures especially for the prevention of ventilator-associated pneumonia;It is recommended to review the antibiotics frequently used in the follow-up and treatment of COVID-19 and to be selective in the decision to start empirical antibiotics in order to prevent the development of antimicrobial resistance.

13.
Flora ; 27(2):286-295, 2022.
Article in Turkish | EMBASE | ID: covidwho-2033379

ABSTRACT

Introduction: Aspergillus species have begun to cause invasive pulmonary aspergillosis (IPA) with increasing frequency in patients with known risk factors in intensive care units (ICU). An international multicenter cohort study (AspICU) established criteria for diagnosis of invasive pulmonary aspergillosis (IPA) in intensive care units. In our study, patients with Aspergillus spp. growth in deep tracheal aspirate (DTA) samples in ICU were evaluated according to AspICU criteria. Materials and Methods: This study is a retrospective study. DTA samples were collected from the Pandemic and Reanimation ICU and performed in the Medical Microbiology Laboratory by separated two periods;pre-pandemic (1 March 2019-31 December 2019) and post-pandemic (1 March 2020-31 December 2020). Cases with Aspergillus spp. growth in the DTA samples in the Pandemic ICU were evaluated as COVID 19 associated pulmonary aspergillosis (CAPA) according to AspICU criteria. Results: While Aspergillus spp. was grown in the DTA of three patients in 2019 and five patients in 2020 in the Reanimation ICU, and 11 patients in the Pandemic ICU. Growths belonging to one patient from both Reanimation (2019) and Pandemic ICUs were considered as colonization. Other growths were interpreted as IPA according to AspICU criteria. When the incidence rates according to 10000 patient days were compared, the incidence rate increased significantly in 2020 (19.1) (p< 0.001) compared to 2019 (3.4);In 2020, it was determined that it increased significantly in the Pandemic ICU (40.4) (p< 0.001) compared to Reanimation ICU (9.2). Conclusion: It should not be forgotten that intensive care patients are also at risk for IPA, especially after viral infections (such as COVID-19, Influenza). Although the incidence of IPA was not very high, it was observed that it tended to increase according to our study. The diagnosis of IPA is problematic, therefore it is necessary to increase awareness and sample diversity and to use biomarkers more widely other than hematology patients.

14.
National Journal of Physiology, Pharmacy and Pharmacology ; 12(7):958-961, 2022.
Article in English | EMBASE | ID: covidwho-2033363

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) has rapidly become a worldwide concern ever since first being reported from Wuhan, China in December 2019. With no known cure, there is widespread fear-provoking interest in studying the factors contributing to mortality. Aim and Objectives: The current study was undertaken with a view to try to understand the cause of morbidity and mortality. Materials and Methods: A retrospective study done in our Institution on COVID-19 patients admitted over a course of 3 months after approval from Institutional Ethics Committee. Results: We had 17 deaths over the period under consideration whereas 73 patients improved (mortality = 19%, n = 90). Most of the patients were in the 41–80 years age group (>70%). No gender preponderance was found with mortality in each being around 20%. A clear correlation between co-morbidities and mortality was found with no person without any comorbidity succumbing to the disease. Respiratory and Heart conditions were found to contribute most to mortality with patients presenting with shortness of breath being most at risk. Similarly, a Neutrophil: Lymphocyte ratio greater than 12 was found to significantly increase the mortality. Conclusion: Patients with comorbidities need to be monitored closely with treatment being directed at improving the respiratory outcome.

15.
Revista do Colegio Brasileiro de Cirurgioes ; 49, 2022.
Article in English | EMBASE | ID: covidwho-2032681

ABSTRACT

Objective: COVID-19 pandemic required optimization of hospital institutional flow, especially regarding the use of intensive care unit (ICU) beds. The aim of this study was to assess whether the individualization of the indication for postoperative recovery from pulmonary surgery in ICU beds was associated with more perioperative complications. Method: retrospective analysis of medical records of patients undergoing anatomic lung resections for cancer in a tertiary hospital. The sample was divided into: Group-I, composed of surgeries performed between March/2019 and February/2020, pre-pandemic, and Group-II, composed of surgeries performed between March/2020 and February/2021, pandemic period in Brazil. We analyzed demographic data, surgical risks, surgeries performed, postoperative complications, length of stay in the ICU and hospital stay. Preventive measures of COVID-19 were adopted in group-II. Results: 43 patients were included, 20 in group-I and 23 in group-II. The groups did not show statistical differences regarding baseline demographic variables. In group-I, 80% of the patients underwent a postoperative period in the ICU, compared to 21% in group-II. There was a significant difference when comparing the average length of stay in an ICU bed (46 hours in group-I versus 14 hours in group-II-p<0.001). There was no statistical difference regarding postoperative complications (p=0.44). Conclusions: the individualization of the need for ICU use in the immediate postoperative period resulted in an improvement in the institutional care flow during the COVID-19 pandemic, in a safe way, without an increase in surgical morbidity and mortality, favoring the maintenance of essential cancer treatment.

16.
Anaesthesia ; 77:59, 2022.
Article in English | EMBASE | ID: covidwho-2032360

ABSTRACT

Tracheal obstruction due to build-up of dry secretions is a rare but life-threatening complication following laryngectomy. We report a case of near-total obstruction presenting as acute dyspnoea, initially attributed to COVID-19 infection. Description The intensive care unit (ICU) team was called to review a 52-year-old man urgently who was in extremis on the acute medical unit. He had undergone a total laryngectomy 3 months previously for advanced laryngeal cancer. On arrival, he was in severe respiratory distress with faint inspiratory sounds and silent prolonged expiratory phase. His vital signs showed sinus tachycardia;normal blood pressure and peripheral oxygen saturations (SpO2) of 80% despite 15 l.min-1 of oxygen via a tracheostomy mask. The patient had removed his Larytube and reinserting worsened his respiratory distress. Attempts made to pass a suction catheter through the stoma were met with resistance. The emergency intubation team was called to help;unfortunately, no ear, nose and throat (ENT) surgical services were available on site. We undertook urgent bedside bronchoscopy using an Ambu aScope 4, with a large 5.8/2.8 scope. Initial view revealed near-total obstruction of the trachea with a thick mucoid mass. Attempts at suctioning with the bronchoscope were unsuccessful due to its size and thickness. Boluses of sterile 0.9% saline were instilled to loosen the mass, without success. As a final attempt, paediatric Magill forceps were inserted about 3 cm into the stoma and removed the mass successfully, under direct vision. A 10 cm long mucosanguineous plug was removed and the patient was instantly relieved. The patient's SpO2 improved to 100% and good equal air entry was heard bilaterally. (Figure Presented) Discussion Following laryngectomy, patients lack the natural mechanism for warming, filtering and humidifying inspired air. Instead, it is essential that artificial methods of humidification are used. If properly cared for, the retention of life-threatening thick, tenacious secretions is rare [1]. Unfortunately, laryngectomy patients are still poorly managed at non-specialist centres due to a lack of both medical and nursing expertise [2]. This patient was in extremis and too unstable to be moved for further investigations or transfer to a different hospital with additional expertise. This case serves as a reminder that full systematic review and the application of well-timed basic initial management can save patients from lifethreatening emergencies.

17.
Anaesthesia ; 77:19, 2022.
Article in English | EMBASE | ID: covidwho-2032358

ABSTRACT

Sedation is integral to facilitating interventions on the intensive care unit (ICU), which would otherwise be intolerable;however, in excess it may prolong intubation and lead to brain dysfunction such as delirium [1]. This is a frequently under-diagnosed problem in the ICU, shown to result in worsened neurological outcomes [2]. The Critical Care Pain Observation Tool (CPOT), Richmond Agitation- Sedation Score (RASS), Confusion Assessment Method for the ICU (CAMICU) are validated to assess for pain, over-sedation and delirium, respectively. We explored how effectively these were used in a hospital in the Northeast of England to address over-sedation and delirium. Methods Adults intubated and ventilated on critical care were identified, and the most recent 24 h of bedside observation charts examined for completion of 4-h RASS, 4-h CPOT and 12-h CAM-ICU assessments. For those over-sedated during this time, we assessed whether sedation was appropriately titrated or held. Patients on neuromuscular blocking agents, with acute brain injury or with specific indication for deep sedation were excluded. Results Fifty-five patient-days were audited, during which sedation was utilised in 71% (n = 39). Overall, pain and RASS were monitored well, assessed at 88% and 91% of 4-h opportunities, respectively;however, CAM-ICU was recorded at only 15% of opportunities. Where documented, RASS scores were within target (-2 to 1) 45% of the time. Where out of range, this was almost exclusively due to oversedation (RASS ≤ -3). Eighty-five per cent (n = 33) of patients were over-sedated on at least one occasion in the last 24 h. Of these, 39% (n = 13) had their sedation neither titrated nor held during this time. Notably, this was the case for 55% (n = 11) of the 20 patients intubated for COVID-19, in contrast to only 15% (n = 2) of the 13 patients intubated for other reasons. Discussion Over-sedation in ICU remains prevalent despite adequate RASS surveillance. This is particularly true among COVID-19 patients. Further, infrequent CAM-ICU use may result in delirium being missed, carrying risk of adverse neurological outcomes and mortality [2]. We have implemented protocolled PAD pathways within each bed space, to empower nurses to titrate sedation and improve awareness of CAM-ICU. Additionally, we have disseminated education on the harms of over-sedation and unrecognised delirium, and we are evaluating re-audit data to ascertain if there has been a resulting improvement in PAD management for sedated patients.

18.
Anaesthesia ; 77:19, 2022.
Article in English | EMBASE | ID: covidwho-2032357

ABSTRACT

Intensive care unit (ICU) admission has significant long-term sequelae, affecting both physical and mental health [1]. Long-term respiratory outcomes in COVID- 19 ICU patients has been of concern and the British Thoracic Society recommends a post-hospital-discharge chest X-ray (CXR) and clinic follow-up [2]. We aimed to establish the long-term health outcomes of patients with COVID-19 following admission to ICU. Methods All patients admitted to ICU at University Hospital Crosshouse with COVID-19 from 01/03/2020-31/08/2021 were identified retrospectively. A comparator prepandemic dataset of patients admitted with pneumonia from 01/07/2018-31/12/ 2019 was also identified. Re-admissions were excluded in both cohorts. Electronic notes were interrogated for demographics, outcomes and follow-up. This included attendance at our post-ICU recovery programme, InS:PIRE. Statistical analysis was by Fisher's exact test and Mann-Whitney U-test. Results A total of 135 patients were admitted during the COVID-19 period, with 52 patients admitted in the pre-pandemic period. Comparisons between the groups are shown in Table 1. Of the 78 COVID-19 survivors, 48 (61.5%) had a CXR after hospital discharge. In 50%, this was abnormal. Thirty patients (38.5%) had evidence of outpatient respiratory follow-up, with four (13.3%) were now receiving long-term oxygen therapy. Of the 37% who had completed InS:PIRE by the time of data collection, most did not feel back to baseline, with best health scores averaging 66% of normal. Impairment in usual daily activities was the main issue. (Table Presented) Discussion We demonstrate admission to ICU with COVID-19 is associated with prolonged ventilation, high mortality and significant ongoing morbidity among survivors. Chest X-rays remain abnormal in half of patients after hospital discharge and many remain significantly functionally impaired. The low rates of respiratory follow- up is concerning and may mean our study underestimates the problem. Continued follow-up of survivors of severe COVID-19 is, therefore, crucial and will allow us to identify ongoing clinical and rehabilitation needs as well as enable access to appropriate support.

19.
Anaesthesia ; 77:58, 2022.
Article in English | EMBASE | ID: covidwho-2032353

ABSTRACT

Airway safety is a cornerstone of anaesthetic practice. With the rise of intubations seen on wards or high-dependency areas during the COVID-19 pandemic, the importance of upholding safe practice and standards in all areas have been highlighted. Thorough and accessible airway procedure documentation is a key part of this. Oxford University Hospitals provide a high-acuity intensive care service with patients from a number of clinical areas. Initially, there was no standardised way of documenting intubation procedures. The majority were recorded on blank space electronic forms, making them difficult to identify in an emergency. Methods In the first 2 weeks of August 2020, we audited the current practice of airway documentation, including their location and content. We also recorded the time taken to find the airway documentation on electronic patient records. We then introduced a standardised intubation form (Fig. 1) in line with Difficult Airway Society (DAS) and Association of Anaesthetists guidelines [1] on 28 August 2020. The airway documentations were reaudited in October 2020 and in July 2021. Results In our initial audit, we captured 20 patients intubated on the intensive care unit (ICU). Of these, 95% had some form of documentation on their intubation but only five (25%) had all the above points documented. Our re-audit in October 2020 captured 23 patients, where 95.6% of patients had some form of airway documentation. Only nine (39%) had the new form, and within this subgroup, the completion of all the recommended variables was documented in seven patients (77.8%). We re-audited this in July 2021 where we captured 20 patients. Nine (45%) patients had the new form. Of those who did not, 63% had been intubated in theatre or during a crash call on the ward or had been transferred from another hospital. Using the pro forma had reduced the average time taken for identifying airway documentation from 93 to 19 s. Regarding the completeness of documentation, 78% of the standardised form and only 9% of non-standardised documentations contained full details of intubation. Discussion Introduction of a standardised electronic form had increased the quality and visibility of airway documentation in line with the quality recommended by NAP4 or DAS. The form was being used at increasing frequency in the ICU a year since its introduction, demonstrating its worth as a sustainable intervention;however, the practice was not so well followed when intubation occurred in theatres, wards and in pre-hospital environments. (Figure Presented).

20.
Anaesthesia ; 77:34, 2022.
Article in English | EMBASE | ID: covidwho-2032349

ABSTRACT

There have been at least three fires in intensive care units in the UK over the past 10 years, requiring full-scale evacuations. Fires have also occurred in operating theatres during the use of lasers, including in combination with high-flow nasal oxygen and as a result of diathermy reacting with chlorhexidine. In addition, the COVID-19 pandemic has brought increasing relevance to fire safety and the safe use of oxygen. As a result, the Association of Anaesthetists and Intensive Care Society have brought out new fire safety guidelines in May 2021, written by a multidisciplinary working group. Part of this guidance includes recommendations that all clinical staff have annual multidisciplinary training on the management of a fire and evacuation and biannual practical 'walk-through' training or simulation training. This should include where to find manual fire call points, evacuation aids, evacuation plans with routes and procedures and oxygen shut-off valves in their clinical areas. Methods We carried out a quality-improvement project, looking at qualitative data from surveying clinical staff at Newham University Hospital, before and after delivering our intervention. Our intervention consisted of delivering fire safety teaching, covering the national guidelines and local protocols on how to manage a fire and resulting patient evacuation. This was then followed by running a simulated practical session of a fire in an operating theatre at NUH and the evacuation of an anaesthetised patient down a set of stairs. This was delivered to anaesthetists of all grades, theatre staff including operating department practitioners and surgeons. This was achieved with the collaborative effort of the theatre department, the fire safety team and the simulation team. Results Our results highlight the necessity of this new guidance, as there was significant improvement reported in all categories of the survey after versus before our fire safety training and simulation, as well as positive feedback from colleagues. These categories included: (1) knowledge of where to find manual fire call points, patient evacuation aids, fire action cards and evacuation plans in your clinical area;(2) knowledge of the evacuation route from the operating theatres and (3) confidence in responding to a fire alarm and managing a patient evacuation. In addition, there was a lack of any similar organised fire safety teaching or simulation, as advised to occur bi-annually by the Association of Anaesthetists, prior to our quality-improvement project.

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