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1.
Yonsei Medical Journal ; 63(5):422-429, 2022.
Article in English | MEDLINE | ID: covidwho-1834347

ABSTRACT

PURPOSE: We previously developed learning models for predicting the need for intensive care and oxygen among patients with coronavirus disease (COVID-19). Here, we aimed to prospectively validate the accuracy of these models. MATERIALS AND METHODS: Probabilities of the need for intensive care [intensive care unit (ICU) score] and oxygen (oxygen score) were calculated from information provided by hospitalized COVID-19 patients (n=44) via a web-based application. The performance of baseline scores to predict 30-day outcomes was assessed. RESULTS: Among 44 patients, 5 and 15 patients needed intensive care and oxygen, respectively. The area under the curve of ICU score and oxygen score to predict 30-day outcomes were 0.774 [95% confidence interval (CI): 0.614-0.934] and 0.728 (95% CI: 0.559-0.898), respectively. The ICU scores of patients needing intensive care increased daily by 0.71 points (95% CI: 0.20-1.22) after hospitalization and by 0.85 points (95% CI: 0.36-1.35) after symptom onset, which were significantly different from those in individuals not needing intensive care (p=0.002 and <0.001, respectively). Trends in daily oxygen scores overall were not markedly different;however, when the scores were evaluated within <7 days after symptom onset, the patients needing oxygen showed a higher daily increase in oxygen scores [1.81 (95% CI: 0.48-3.14) vs. -0.28 (95% CI: 1.00-0.43), p=0.007]. CONCLUSION: Our machine learning models showed good performance for predicting the outcomes of COVID-19 patients and could thus be useful for patient triage and monitoring.

2.
Annals of the American Thoracic Society ; 19(5):717-719, 2022.
Article in English | MEDLINE | ID: covidwho-1833701
3.
Crit Care ; 26(1):130, 2022.
Article in English | PubMed | ID: covidwho-1833333

ABSTRACT

BACKGROUND: The detection of coinfections is important to initiate appropriate antimicrobial therapy. Molecular diagnostic testing identifies pathogens at a greater rate than conventional microbiology. We assessed both bacterial coinfections identified via culture or the BioFire® FilmArray® Pneumonia Panel (FA-PNEU) in patients infected with SARS-CoV-2 in the ICU and the concordance between these techniques. METHODS: This was a prospective study of patients with SARS-CoV-2 who were hospitalized for no more than 48 h and on mechanical ventilation for no longer than 24 h in 8 ICUs in Medellín, Colombia. We studied mini-bronchoalveolar lavage or endotracheal aspirate samples processed via conventional culture and the FA-PNEU. Coinfection was defined as the identification of a respiratory pathogen using the FA-PNEU or cultures. Serum samples of leukocytes, C-reactive protein, and procalcitonin were taken on the first day of intubation. We analyzed the empirical antibiotics and the changes in antibiotic management according to the results of the FA-PNEUM and cultures. RESULTS: Of 110 patients whose samples underwent both methods, FA-PNEU- and culture-positive samples comprised 24.54% versus 17.27%, respectively. Eighteen samples were positive in both techniques, 82 were negative, 1 was culture-positive with a negative FA-PNEU result, and 9 were FA-PNEU-positive with negative culture. The two bacteria most frequently detected by the FA-PNEU were Staphylococcus aureus (37.5%) and Streptococcus agalactiae (20%), and those detected by culture were Staphylococcus aureus (34.78%) and Klebsiella pneumoniae (26.08%). The overall concordance was 90.1%, and when stratified by microorganism, it was between 92.7 and 100%. The positive predictive value (PPV) was between 50 and 100% and were lower for Enterobacter cloacae and Staphylococcus aureus. The negative predictive value (NPV) was high (between 99.1 and 100%);MecA/C/MREJ had a specificity of 94.55% and an NPV of 100%. The inflammatory response tests showed no significant differences between patients whose samples were positive and negative for both techniques. Sixty-one patients (55.45%) received at least one dose of empirical antibiotics. CONCLUSIONS: The overall concordance was 90.1%, and it was between 92.7% and 100% when stratified by microorganisms. The positive predictive value was between 50 and 100%, with a very high NPV.

4.
Critical Care (London, England) ; 26(1):89, 2022.
Article in English | MEDLINE | ID: covidwho-1833332

ABSTRACT

Description of all consecutive critically ill COVID 19 patients hospitalized in ICU in University Hospital of Guadeloupe and outcome according to delay between steroid therapy initiation and mechanical ventilation onset. Very late mechanical ventilation defined as intubation after day 7 of dexamethasone therapy was associated with grim prognosis and a high mortality rate of 87%.

5.
BMC Infectious Diseases ; 22(319), 2022.
Article in English | CAB Abstracts | ID: covidwho-1833284

ABSTRACT

Background: Since the first official report of SARS-CoV-2 infection in Iran on 19 February 2020, our country has been one of the worst affected countries by the COVID-19 epidemic in the Middle East. In addition to demographic and clinical characteristics, the number of hospitalized cases and deaths is an important factor for evidence-based decision-making and disease control and preparing the healthcare system to face the future challenges of COVID-19. Therefore, this cohort study was conducted to determine the demographics, clinical characteristics, and outcomes of hospitalized COVID-19 patients in Kermanshah Province, west of Iran.

6.
BMC Anesthesiology ; 22(1):91, 2022.
Article in English | MEDLINE | ID: covidwho-1833281

ABSTRACT

BACKGROUND: The ABO and RhD blood group represent antigens on the surface of erythrocytes. The ABO blood group antigens are also present on multiple other cells. Interestingly, previous studies have demonstrated associations between the blood group and many types of disease. The present study aimed to identifying associations between the ABO blood group, the RhD blood group, and morbidity and mortality in a mixed cohort and in six pre-defined subgroups of critically ill patients. METHODS: Adult patients admitted to any of the five intensive care units (ICUs) in the Scania Region, Sweden, between February 2007 and April 2021 were eligible for inclusion. The outcomes were mortality analysed at 28- and 90-days as well as at the end of observation and morbidity measured using days alive and free of (DAF) invasive ventilation (DAF ventilation) and DAF circulatory support, including vasopressors or inotropes (DAF circulation), maximum Sequential Organ Failure Assessment score (SOFAmax) the first 28 days after admission and length of stay. All outcomes were analysed in separate multivariable regression models adjusted for age and sex. In addition, in a sensitivity analysis, five subgroups of patients with the main diagnoses sepsis, septic shock, acute respiratory distress syndrome, cardiac arrest and trauma were analysed using the same separate multivariable regression models. RESULTS: In total, 29,512 unique patients were included in the analyses. There were no significant differences for any of the outcomes between non-O blood groups and blood group O, or between RhD blood groups. In the sensitivity analysis of subgroups, there were no differences in mortality between non-O blood groups and blood group O or between the RhD blood groups. AB was the most common blood group in the COVID-19 cohort. CONCLUSIONS: The ABO and RhD blood group do not influence mortality or morbidity in a general critically ill patient population.

7.
American Journal of Respiratory & Critical Care Medicine ; 205(9):1116-1118, 2022.
Article in English | MEDLINE | ID: covidwho-1832821
8.
BMJ Open ; 12(4):e055679, 2022.
Article in English | MEDLINE | ID: covidwho-1832448

ABSTRACT

OBJECTIVE: To understand the experiences and perceived benefits of virtual visiting from the perspectives of intensive care unit (ICU)-experienced clinicians and non-ICU-experienced family liaison team members. DESIGN: Qualitative descriptive study. SETTING: Adult intensive care setting across 14 hospitals within the UK National Health Service. PARTICIPANTS: ICU-experienced clinicians and non-ICU-experienced family liaison team members deployed during the first wave of the COVID-19 pandemic. METHODS: Semistructured telephone/video interviews were conducted with ICU clinicians. Analytical themes were developed inductively following a standard thematic approach, using 'family-centred care' and 'sensemaking' as sensitising concepts. RESULTS: We completed 36 interviews, with 17 ICU-experienced clinicians and 19 non-ICU-experienced family liaison team members. In the context of inperson visiting restrictions, virtual visiting offered an alternative conduit to (1) restoring the family unit, (2) facilitating family involvement, and (3) enabling sensemaking for the family. Virtual visits with multiple family members concurrently and with those living in distant geographical locations restored a sense of family unit. Family involvement in rehabilitation, communication and orientation activities, as well as presence at the end of life, highlighted how virtual visiting could contribute to family-centred care. Virtual visits were emotionally challenging for many family members, but also cathartic in helping make sense of their own emotions and experience by visualising their relatives in the ICU. Being able to see and interact with loved ones and their immediate care providers afforded important cues to enable family sensemaking of the ICU experience. CONCLUSIONS: In this UK qualitative study of clinicians using virtual ICU visiting, in the absence of inperson visiting, virtual visiting was perceived positively as an alternative that promoted family-centred care through virtual presence. We anticipate the perceived benefits of virtual visiting may extend to non-pandemic conditions through improved equity and timeliness of family access to the ICU by offering an alternative option alongside inperson visiting.

9.
Heart & Lung ; 54:49-55, 2022.
Article in English | MEDLINE | ID: covidwho-1828556

ABSTRACT

BACKGROUND: COVID-19 patient experiences in the intensive care unit (ICU) are marked by family separation. Families understand the importance of isolation and hospital visiting policies, but they consider it necessary to visit their loved ones and use personal protective equipment. OBJECTIVE: To describe the lived experiences of family members in their first contact with a relative in a COVID-ICU. METHODS: A phenomenological study was conducted using Cohen's method. The subjects were interviewed using an open-question format to allow them full freedom of expression. Twelve family members were recruited between February and March 2021. RESULTS: Analysis of the qualitative data resulted in five major themes: (1) fear of contagion related to donning/doffing procedures, (2) positive emotions related to first contact with the hospitalized relative, (3) concern for the emotional state of the hospitalized relative, (4) impact of the COVID-ICU and comparisons between imagination and reality regarding the severity of the disease, and (5) recognition of and gratitude toward healthcare professionals. CONCLUSIONS: It has been confirmed that visits to the ICU reduce anxiety among family members. Our findings constitute an internationally relevant contribution to understanding of the needs of relatives who meet loved ones for the first time while wearing personal protective equipment.

10.
Heart & Lung ; 54:95-96, 2022.
Article in English | MEDLINE | ID: covidwho-1828551
11.
Annual Conference of the Canadian Society of Civil Engineering, CSCE 2021 ; 244:519-529, 2022.
Article in English | Scopus | ID: covidwho-1826333

ABSTRACT

Modular construction methods have been widely used in the civil engineering industry as they provide ease of assembly, convenience of design, and allowing for flexibility in terms of placement. With the increasing number of COVID-19 cases, hospitals’ capacity is decreasing as more intensive care units (ICU) rooms are allocated to those cases. The limited capacity can be overcome by using modular construction to provide field hospitals, to accommodate more patients. This paper adopts transient Lagrangian computational fluid dynamics simulations to investigate the importance of having an appropriate ventilation system in place to achieve containment of contaminants within a modular construction room. The model was validated using the results from the experimental simulation of aerosol in an airconditioned space. The performance of having 10, 20, and 40 air changes per hour (ACH) was examined for a room with a geometry of 6.1 × 2.5 × 3.0 m. It was observed that the rate at which the mouth-generated aerosols were filtered towards the ventilation system (outlet) increased by 137% by increasing the ACH from 10 to 40. Aerosol particles landing on equipment decreased by 25% when the rate was increased to 40 ACH. © 2022, Canadian Society for Civil Engineering.

12.
27th Brazilian Congress on Biomedical Engineering, CBEB 2020 ; 83:2143-2148, 2022.
Article in English | Scopus | ID: covidwho-1826147

ABSTRACT

The current health crisis caused by the new coronavirus (SARS-CoV-2) has created a great demand to widely explore the mechanisms of mechanical ventilation for life support in Intensive Care Unit (ICU). This work describes the basic concepts of the mechanical ventilation process and a brief technical description of both invasive and non-invasive ventilator. Additionally, describes the importance of this therapy as it is the main mechanism for assisting patients in a critical state of coronavirus disease (COVID-19). It also presents approaches that have been considered to meet the current demands and prevent the collapse of the health system. Finally, it presents the responsibilities of clinical engineers in this scenario. © 2022, Springer Nature Switzerland AG.

13.
Journal of the Association of Physicians of India ; 70(January):44-49, 2022.
Article in English | GIM | ID: covidwho-1824227

ABSTRACT

Objective: Though systemic corticosteroid is used for treatment of COVID 19, questions regarding the appropriate dose, duration and type of corticosteroid use still remain unanswered. This study aimed to address, whether choice of systemic corticosteroid significantly influences the clinical outcome of COVID 19 patients. Materials and Methods: Studies reporting the comparison between clinical outcome of dexamethasone and methylprednisolone in treatment of COVID 19 were searched from inception till April, 2021. Random-effect model was used. Odd's ratio (OR) and 95% confidence interval was expressed. I2 statistics used for test of heterogeneity. Result: Three studies with 373 patients (160 in dexamethasone group and 213 in methyl prednisolone group) were included. Though, statistically significant reduction in all-cause mortality with methyl prednisolone group in comparison to dexamethasone group (OR=1.80, 95%CI: 1.08 to 3.01, P=0.02) estimated, sub group analysis of observational studies did not support the finding (OR=1.60, 95% CI: 0.88 to 2.92, P=0.12). No significant difference in terms of need for invasive ventilator or intensive care unit (ICU) between the 2 groups. The grade of evidence was very low for both the outcomes. Conclusion and Relevance: In the present context, both dexamethasone and methyl prednisolone are equally effective in the management of COVID 19.

14.
Journal of the Association of Physicians of India ; 70(January):14-17, 2022.
Article in English | GIM | ID: covidwho-1824219

ABSTRACT

Importance: As there is no definitive treatment available for covid-19 pneumonia, with timed administration of tocilizumab as an adjuvant therapy in moderate to severe covid-19 pneumonia, we can reduce mortality due to cytokine storm.

16.
Enfermería Intensiva (English ed.) ; 2022.
Article in English | ScienceDirect | ID: covidwho-1819483

ABSTRACT

The COVID-19 pandemic has caused an unprecedented health crisis. Pressure on the National Health System has created unique demand particularly in certain services and care units like the critical care units. Objective To learn about the experience of nurses in caring for people with coronavirus in critical care units. Method A qualitative phenomenological study that constitutes the second phase of a mixed methodology project. We conducted interviews with 17 nurses caring for patients affected by COVID-19 in critical care units. The interviews were audio-recorded, transcribed, and analysed using thematic discourse analysis. Results This article shows the findings around the theme “the value of human resources” which is nuanced through sub-themes “it's not the beds, it's the expert staff”, “shouldering the patient's burden”, and suffering because “they have not cared well”. Discussion Expert nurses have emerged as leading professionals in the care of the critical patient during the COVID-19 pandemic. This leadership is executed from a profile framed in an inclusive philosophy where wisdom, agility and intuition are the key elements underpinning problem identification and solving in a creative way, while adapting to the needs of the patient and healthcare team as they emerge. Conclusions Expert nurses have played an advanced role in the management of care and human resources by exercising effective leadership in the clinical setting. Care has been hampered due to the crisis, which causes nurses moral distress because they have been unable to meet standards of quality and excellence in care. Resumen La pandemia por COVID-19 ha supuesto una crisis sanitaria sin precedentes. La presión asistencial sobre el Sistema Nacional de Salud ha generado escenarios insólitos de demanda especialmente llamativos en algunos servicios o unidades asistenciales como las Unidades de Cuidados Críticos. Objetivo Conocer la experiencia de los profesionales enfermeros referida a la atención de personas infectadas por coronavirus en las Unidades de Cuidados Críticos. Método Estudio cualitativo de carácter fenomenológico que constituye la segunda fase de un proyecto de metodología mixta. Se realizaron entrevistas a 17 enfermeras que prestaron cuidados en Unidades de Cuidados Críticos a pacientes afectados de COVID-19. Las entrevistas fueron audiograbadas, transcritas y analizadas mediante análisis temático del discurso. Resultados En este artículo se muestran los hallazgos en torno al tema «el valor del recurso humano» que matiza su significado a través de los subtemas «no son las camas, es el personal experto», «llevando la carga del paciente» y sufriendo por «no haber cuidado bien». Discusión Los profesionales enfermeros expertos se erigen como profesionales líderes en el cuidado del paciente crítico durante la pandemia por COVID-19. Este liderazgo se ejerce desde un perfil enmarcado en una filosofía integradora donde sabiduría, agilidad e intuición son los elementos clave que dan soporte a la identificación y resolución de problemas de forma creativa adaptándose a las necesidades emergentes de los pacientes y equipo de cuidados. Conclusiones Los profesionales enfermeros expertos han desempeñado un rol avanzado en la gestión de cuidados y de recursos humanos mediante el ejercicio de un liderazgo eficiente en el entorno clínico. Los cuidados se han visto mermados por la situación de crisis, circunstancia que les genera sufrimiento moral por no haber podido cumplir con los estándares de calidad y excelencia en el cuidado.

17.
Klimik Dergisi ; 35(1):14-20, 2022.
Article in Turkish | CAB Abstracts | ID: covidwho-1819127

ABSTRACT

Objective: The study aims to contribute to the literature by sharing the treatment process and results of patients who develop pneumothorax, pneumomediastinum, and subcutaneous emphysema, which are rarely seen in COVID-19 pneumonia, and to reveal the possible high mortality situation.

18.
African Journal of Infectious Diseases ; 15(2 Supplementary):31-37, 2021.
Article in English | GIM | ID: covidwho-1818937

ABSTRACT

Background: SARS COV-2 is the cause of the current outbreak of COVID-19. The infection of SARS COV-2 causes changes in the gutlung axis and the intestinal microbiota pro-inflammatory cytokines interaction which leads to the injury of the gastrointestinal tract. One of the symptoms of COVID-19 outside the respiratory system is a complaint in the GIT. Materials and Methods: We present a COVID-19 case report that begins with a complaint of abdominal pain.

19.
Asian Journal of Medical and Biological Research ; 8(1):16-23, 2022.
Article in English | CAB Abstracts | ID: covidwho-1817917

ABSTRACT

The severity of Coronavirus disease-2019 (COVID-19) varies among individuals and some influential factors leads to critical infections and death. This study aimed to assess various clinical data of hospitalized patients and identify the determinants of critical COVID-19 infection. This was a cross-sectional study among hospitalized COVID-19 patients confirmed by reverse transcription polymerase chain reaction (RT-PCR). Data was collected from a single Centre between January to April 2021 by experienced physicians of Ad-din Medical College Hospital. All of the laboratory tests were performed by technical experts and the data was analyzed by Statistical package for the social sciences software. Among the study participants 25% were Intensive care unit (ICU) patients and the mean age of them were higher (59 years) than non-ICU (55 years) patients. Our analysis has identified diabetes mellitus (AOR=2.5, 95%CI: 1.1-5.4) and ischemic heart disease (AOR=3.1, 95%CI: 1.1-8.9) as significant predictor of critical outcome (ICU admission). Anemia (AOR=3.3, 95%CI: 1.5-7.4), lymphopenia (AOR=2.9, 95%CI: 1.2-7.1), and thrombocytopenia (AOR=4.2, 95%CI: 2.7-12.9) was also associated critical outcome. Biomarkers of kidney injury (creatinine, blood urea nitrogen), liver damage (alanine transaminase, aspartate aminotransferase, fibrinogen) and electrolyte imbalance (sodium and potassium level) were also significantly associated with critical infection. A higher d-dimer level (2.5) was the most important predictor (AOR=11.5, 95%CI: 5.4-24.6) of critical COVID 19 infections. The study has revealed socio-demographic, comorbidity, and radiological risk factors of critical COVID-19 infections. The identified risk factors would be considered for decision making during the treatment process.

20.
BMJ Open ; 12(3):e050153, 2022.
Article in English | PubMed | ID: covidwho-1816761

ABSTRACT

INTRODUCTION: It is plausible that a longer duration of nutrition intervention may have a greater impact on clinical and patient-centred outcomes. The Intensive Nutrition care Therapy comparEd to usual care iN criTically ill adults (INTENT) trial will determine if a whole hospital nutrition intervention is feasible and will deliver more total energy compared with usual care in critically ill patients with at least one organ system failure. METHODS AND ANALYSIS: This study is a prospective, multicentre, unblinded, parallel-group, phase II randomised controlled trial (RCT) conducted in 23 hospitals in Australia and New Zealand. Mechanically ventilated critically ill adult patients with at least one organ failure who have been in intensive care unit (ICU) for 72-120 hours and meet all of the inclusion and none of the exclusion criteria will be randomised to receive either intensive or usual nutrition care. INTENT started recruitment in October 2018 and a sample size of 240 participants is anticipated to be recruited in 2022. The study period is from randomisation to hospital discharge or study day 28, whichever occurs first, and the primary outcome is daily energy delivery from nutrition therapy. Secondary outcomes include daily energy and protein delivery during ICU and in the post-ICU period, duration of ventilation, ventilator-free days, total bloodstream infection rate and length of hospital stay. All other outcomes are considered tertiary and results will be analysed on an intention-to-treat basis. ETHICS AND DISSEMINATION: Ethics approval has been received in Australia (Alfred Hospital Ethics Committee (HREC/18/Alfred/101) and Human Research Ethics Committee of the Northern Territory Department of Health (2019-3372)) and New Zealand (Northern A Health and Disability Ethics Committee (18/NTA/222). Results will be disseminated in an international peer-reviewed journal(s), at scientific meetings and via social media. TRIAL REGISTRATION NUMBER: NCT03292237.

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