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1.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-335564

ABSTRACT

Background: The antiviral efficacy of remdesivir is still controversial. We aimed at evaluating its clinical effectiveness in hospitalised patients with COVID-19, with indication of oxygen and/or ventilator support. Following prior publication of preliminary results, here we present the final results after completion of data monitoring. Methods: In this European multicentre, open-label, parallel-group, randomised, controlled trial (DisCoVeRy, NCT04315948;EudraCT2020-000936-23), participants were randomly allocated to receive usual standard of care (SoC) alone or in combination with remdesivir, lopinavir/ritonavir, lopinavir/ritonavir and IFN-β-1a, or hydroxychloroquine. Adult patients hospitalised with COVID-19 were eligible if they had clinical evidence of hypoxemic pneumonia, or required oxygen supplementation. Exclusion criteria included elevated liver enzyme, severe chronic kidney disease, any contra-indication to one of the studied treatments or their use in the 29 days before randomization, or use of ribavirin, as well as pregnancy or breast-feeding. Here, we report results for remdesivir + SoC versus SoC alone. Remdesivir was administered as 200 mg infusion on day 1, followed by once daily infusions of 100 mg up to 9 days, for a total duration of 10 days. It could be stopped after 5 days if the participant was discharged. Treatment assignation was performed via web-based block randomisation stratified on illness severity and administrative European region. The primary outcome was the clinical status at day 15 measured by the WHO 7-point ordinal scale, assessed in the intention-to-treat population. Findings: Between March 22nd, 2020 and January 21st, 2021, 857 participants were randomised to one of the two arms in 5 European countries and 843 participants were included for the evaluation of remdesivir (control, n=423;remdesivir, n=420). At day 15, the distribution of the WHO ordinal scale was as follow in the remdesivir and control groups, respectively: Not hospitalized, no limitations on activities: 62/420 (14.8%) and 72/423 (17.0%);Not hospitalized, limitation on activities: 126/420 (30%) and 135/423 (31.9%);Hospitalized, not requiring supplemental oxygen: 56/420 (13.3%) and 31/423 (7.3%);Hospitalized, requiring supplemental oxygen: 75/420 (17.9%) and 65/423 (15.4%);Hospitalized, on non-invasive ventilation or high flow oxygen devices: 16/420 (3.8%) and 16/423 (3.8%);Hospitalized, on invasive mechanical ventilation or ECMO: 64/420 (15.2%) and 80/423 (18.9%);Death: 21/420 (5%) and 24/423 (5.7%). The difference between treatment groups was not statistically significant (OR for remdesivir, 1.02, 95% CI, 0.62 to 1.70, P=0.93). There was no significant difference in the occurrence of Serious Adverse Events between treatment groups (remdesivir, n=147/410, 35.9%, versus control, n=138/423, 32.6%, p=0.29). Interpretation: Remdesivir use for the treatment of hospitalised patients with COVID-19 was not associated with clinical improvement at day 15.

2.
BMJ : British Medical Journal (Online) ; 368, 2020.
Article in English | ProQuest Central | ID: covidwho-1837197

ABSTRACT

ObjectiveTo delineate the clinical characteristics of patients with coronavirus disease 2019 (covid-19) who died.DesignRetrospective case series.SettingTongji Hospital in Wuhan, China.ParticipantsAmong a cohort of 799 patients, 113 who died and 161 who recovered with a diagnosis of covid-19 were analysed. Data were collected until 28 February 2020.Main outcome measuresClinical characteristics and laboratory findings were obtained from electronic medical records with data collection forms.ResultsThe median age of deceased patients (68 years) was significantly older than recovered patients (51 years). Male sex was more predominant in deceased patients (83;73%) than in recovered patients (88;55%). Chronic hypertension and other cardiovascular comorbidities were more frequent among deceased patients (54 (48%) and 16 (14%)) than recovered patients (39 (24%) and 7 (4%)). Dyspnoea, chest tightness, and disorder of consciousness were more common in deceased patients (70 (62%), 55 (49%), and 25 (22%)) than in recovered patients (50 (31%), 48 (30%), and 1 (1%)). The median time from disease onset to death in deceased patients was 16 (interquartile range 12.0-20.0) days. Leukocytosis was present in 56 (50%) patients who died and 6 (4%) who recovered, and lymphopenia was present in 103 (91%) and 76 (47%) respectively. Concentrations of alanine aminotransferase, aspartate aminotransferase, creatinine, creatine kinase, lactate dehydrogenase, cardiac troponin I, N-terminal pro-brain natriuretic peptide, and D-dimer were markedly higher in deceased patients than in recovered patients. Common complications observed more frequently in deceased patients included acute respiratory distress syndrome (113;100%), type I respiratory failure (18/35;51%), sepsis (113;100%), acute cardiac injury (72/94;77%), heart failure (41/83;49%), alkalosis (14/35;40%), hyperkalaemia (42;37%), acute kidney injury (28;25%), and hypoxic encephalopathy (23;20%). Patients with cardiovascular comorbidity were more likely to develop cardiac complications. Regardless of history of cardiovascular disease, acute cardiac injury and heart failure were more common in deceased patients.ConclusionSevere acute respiratory syndrome coronavirus 2 infection can cause both pulmonary and systemic inflammation, leading to multi-organ dysfunction in patients at high risk. Acute respiratory distress syndrome and respiratory failure, sepsis, acute cardiac injury, and heart failure were the most common critical complications during exacerbation of covid-19.

3.
British Journal of Nursing ; 31(8):422-428, 2022.
Article in English | CINAHL | ID: covidwho-1835945

ABSTRACT

The term ‘shock’ is used to describe a complex, life-threatening clinical condition that arises from acute circulatory failure. Shock is a pathological state that results when the circulation is unable to deliver sufficient oxygen and nutrients to the cells and tissues. The resulting hypoxia, tissue hypoperfusion and cellular dysfunction can lead to multi-organ failure;if this is not treated in a timely and appropriate manner, it can lead to death. This article gives an introduction to shock with an overview of the condition and its physiological impact on patients. Focusing on the aetiology and underlying causes, discussion will highlight the different types, stages and general pathophysiology of shock, as well as providing a guide to treatment options and nursing interventions.

4.
Complexity ; 2022, 2022.
Article in English | ProQuest Central | ID: covidwho-1832701

ABSTRACT

In recent years, precise high flow oxygen therapy as a new type of oxygen therapy machine has gradually attracted people’s attention and has been widely used in hospital emergency and clinical treatment of respiratory diseases;especially in recent years, severe coronavirus disease (COVID-19) has played an important role in the treatment of patients. This paper presents a new type of precise high flow oxygen therapy machine with electromagnetic pneumatic flow valve as the core control element. A sliding mode control strategy based on the system is proposed to realize the accurate control of oxygen concentration and output flow of oxygen therapy mixture. The physical equipment of the precision high flow system is established, and its working performance is verified through the test platform. The optimization design goal of the precision high flow equipment is achieved.

5.
Annals of Medicine and Surgery ; : 103709, 2022.
Article in English | ScienceDirect | ID: covidwho-1821117

ABSTRACT

The impact on mortality associated with covid-19 today exceeds five million deaths worldwide, and the number of deaths continues to rise. The complications of the survivors, socio-economic implications at a global level, economic limitations in the health systems, and physical and emotional exhaustion of health personnel are detrimental. Therapeutic strategies are required to limit the evolution of the disease, improve the prognosis of critically ill patients, and, in countries with low purchasing power, create affordable alternatives that can help contain the evolution towards the severity of infected people with mild to moderate symptoms. The misinformation and myths that today are more frequent on social networks and the implementation of practices without scientific support is a problem that aggravates the general panorama. This review aims to concentrate on the best evidence for treating SARS-CoV-2 infection in a simple and summarized manner, addressing therapies from their bases to the most innovative alternatives available today.

6.
Journal of Medical Virology ; n/a(n/a), 2022.
Article in English | Wiley | ID: covidwho-1819370

ABSTRACT

Hospital readmissions due to COVID-19 are one of the main concerns for the health system due to risks to the patient's life and increased use of health resources. Studies focusing on this issue are important to understand the risk factors and create strategies to avoid readmissions. We evaluated the readmission of patients with confirmed COVID-19 in a private hospital in southern Brazil, between March 2020 and 2021. Also, the characteristics and clinical outcomes of patients admitted to the intensive care unit (ICU) and nonadmitted were compared. Poisson regression models with prevalence ratio (PR) with 95% confidence intervals (95% CIs) were applied to confirm the association between variables and ICU admission. Of the 2084 hospitalized patients with COVID-19, 1806 were discharged alive. Among them, 106 were readmitted for unplanned reasons during one year. Early hospital readmission (≤30 days) occurred in 52.8% of the cases. The main reasons were respiratory, gastroenterological, kidney, and cardiac disease. The median age was 73.0 years old and women correspond to 52.8%. The presence of at least one comorbidity was detected in 87.7% of patients. Hypertension, diabetes, cardiac, and lung disease were more frequent. The ICU admitted patients (n?=?43;40.5%) mostly had 4?5 comorbidities, pulmonary involvement ≥50%, length of stay (LOS), and days between discharge and first readmission. Longer LOS (PR: 3.46;95% CI: 1.24?5.67), days between discharge/first readmission (PR: 2.21;95% CI: 1.15?5.88), and pulmonary involvement (≥50%; PR: 1.59;95% CI: 1.11?3.54) were independently associated with ICU admission. Longer LOS, longer days between discharge/first readmission, and pulmonary involvement (≥50%) were associated with ICU admission in readmitted patients. Readmissions evaluation is pivotal and may help in ensuring safe care transition and postdischarge follow-up.

7.
Asian Journal of Pharmaceutical and Clinical Research ; 15(4):118-121, 2022.
Article in English | EMBASE | ID: covidwho-1818973

ABSTRACT

Objective: The studies describing the clinicoepidemiological features of coronavirus disease-2019 (COVID-19) patients of first wave are available but about second wave, very few studies have documented. This study was aimed to describe the clinicoepidemiological features and the causes of mortality of COVID-19 patients of second wave admitted in our center. Methods: This retrospective, observational, and cross-sectional study was carried out among 200 randomly selected and confirmed COVID-19 indoor patients admitted between April 7, 2021 and July 3, 2021 in Dr. N. D. Desai Hospital, Nadiad. The demographic profile, clinical features, comorbidities, inflammatory markers, and causes of mortality in these patients were analyzed. Results: A total 200 patients of COVID-19 of second wave were analyzed. Majority of them were males (64.5%) and the patients between 18 and 60 years of age constituted 60%. Hypertension (70.93%) and diabetes mellitus (46.51%) were common comorbidities followed by ischemic heart diseases and chronic kidney disease. The most common presenting features were fever (75.7%), cough (68.8%), and shortness of breath (60%). The median duration of hospital stay was 7 days [interquartile range, 4-12]. The patients needed any kind of mode of oxygen therapy were 82.5%. The most common cause of death was cardiac arrest (70.58%) followed by severe acute respiratory distress syndrome (ARDS) (35.29%). Conclusions: In this retrospective study, most patients were young males with the age <60 years. The patients had one or more comorbidities, hypertension being the most common. Inflammatory markers were significantly higher in patients who died in our hospital.

8.
Indian Journal of Critical Care Medicine ; 26(4):528-530, 2022.
Article in English | Web of Science | ID: covidwho-1818519
9.
Lung India ; 39(2):191-194, 2022.
Article in English | EMBASE | ID: covidwho-1818451

ABSTRACT

Pulmonary veno-occlusive disease (PVOD) is an important cause of pulmonary arterial hypertension (PAH) and is classified under idiopathic cause of PAH. Over a period of time, PVOD has been studied in detail in the western countries and various diagnostic criteria are formulated. Being a rapidly progressive disease, early diagnosis is of utmost importance which helps to initiate appropriate treatment. Recent studies suggest that PVOD has a genetic predisposition and has an autosomal recessive pattern of inheritance. Here, we discuss the case of siblings diagnosed with PVOD to have such genetic predisposition for this disease.

10.
Lung India ; 39(2):97-99, 2022.
Article in English | EMBASE | ID: covidwho-1818447
11.
Vaccines ; 10(3), 2022.
Article in English | EMBASE | ID: covidwho-1818226

ABSTRACT

The COVID-19 vaccination has been the subject of unprecedented misinformation, false news, and public concerns. This study presents a unique analysis comprising persons who were not vaccinated and became ill. It investigates reasons for not vaccinating and evaluates how the personal experience of COVID-19 affected further attitudes and decisions related to health. The study included 730 consecutive unvaccinated patients hospitalized in 12 centers in Poland during the autumn 2021 pandemic wave. The most frequent reason behind the refusal to receive the vaccine was concern over the adverse effects, disbelief that the vaccine was sufficiently tested, and one’s conviction that COVID-19 will not affect a patient. Online information, friends, spouse, children/grandchildren, and other family members were most often the source of discouragement from vaccination. Most individuals regretted their decision not to receive a vaccine (66.0%), declared to promote COVID-19 vaccination after discharge (64.0%), and to receive a COVID-19 vaccine in the time recommended for convalescents (69.5%). Individuals expressing no regrets of vaccine refusal more frequently revealed conspiracy beliefs. The study shows that personal experience with severe COVID-19 can influence the perception of vaccination, but approximately one-third of unvaccinated hospitalized patients still appear to express vaccine hesitancy.

12.
Journal of Clinical Medicine ; 11(9), 2022.
Article in English | EMBASE | ID: covidwho-1818163

ABSTRACT

Hyperglycemia is among the main risk factors for severe COVID-19. We evaluated the association of glycated albumin (GA) and GA/HbA1c ratio with progression of COVID-19 from mild to severe disease in patients with type 2 diabetes mellitus (T2DM). Our retrospective study included 129 patients aged over 18 years with COVID-19 and T2DM who did not have any need of oxygen supplement. Of these, 59 patients whose COVID-19 was aggravated and required oxygen supplementation eventually were classified as having severe disease. Clinical and laboratory data were compared between mild and severe cases. The median of GA (18.4% vs. 20.95%, p = 0.0013) and GA/HbA1c (2.55 vs. 2.68, p = 0.0145) were higher in severe disease than in mild disease and positively correlated with C-reactive protein (Kendal Tau coefficient 0.200 and 0.126, respectively;all p < 0.05). Multiple logistic regression analysis showed that GA (odds ratio (OR), 1.151;95% confidence interval (CI), 1.024–1.294) and GA/HbA1c (OR, 8.330;95% CI, 1.786–38.842) increased the risk of severe disease. Patients with GA 20% or higher were 4.03 times more likely to progress from mild to severe disease. GA and GA/HbA1c ratio predicted progression of COVID-19 from mild to severe disease in patients with T2DM.

13.
Frontiers in Medicine ; 9, 2022.
Article in English | EMBASE | ID: covidwho-1817974

ABSTRACT

Background: Severe COVID-19 pneumonia requiring intensive care treatment remains a clinical challenge to date. Dexamethasone was reported as a promising treatment option, leading to a reduction of mortality rates in severe COVID-19 disease. However, the effect of dexamethasone treatment on cardiac injury and pulmonary embolism remains largely elusive. Methods: In total 178 critically ill COVID-19 patients requiring intensive care treatment and mechanical ventilation were recruited in three European medical centres and included in the present retrospective study. One hundred thirteen patients (63.5%) were treated with dexamethasone for a median duration of 10 days (IQR 9–10). Sixty five patients (36.5%) constituted the non-dexamethasone control group. Results: While peak inflammatory markers were reduced by dexamethasone treatment, the therapy also led to a significant reduction in peak troponin levels (231 vs. 700% indicated as relative to cut off value, p = 0.001). Similar, dexamethasone resulted in significantly decreased peak D-Dimer levels (2.16 mg/l vs. 6.14 mg/l, p = 0.002) reflected by a significant reduction in pulmonary embolism rate (4.4 vs. 20.0%, p = 0.001). The antithrombotic effect of dexamethasone treatment was also evident in the presence of therapeutic anticoagulation (pulmonary embolism rate: 6 vs. 34.4%, p < 0.001). Of note, no significant changes in baseline characteristics were observed between the dexamethasone and non-dexamethasone group. Conclusion: In severe COVID-19, anti-inflammatory effects of dexamethasone treatment seem to be associated with a significant reduction in myocardial injury. Similar, a significant decrease in pulmonary embolism, independent of anticoagulation, was evident, emphasizing the beneficial effect of dexamethasone treatment in severe COVID-19.

14.
Geriatric Orthopaedic Surgery and Rehabilitation ; 12:22, 2021.
Article in English | EMBASE | ID: covidwho-1817114

ABSTRACT

Introduction: hip fractures in elderly patients have been associated with high morbidity and mortality rate and are dependent on the presence of associated comorbidities. SARS-CoV-2 disease (Covid-19) is nowadays considered to be an independent risk factor increasing mortality rates. The aim of our report was to analyse the management of a vaccinated versus a non-vaccinated elderly patient that were both diagnosed positive to SARS-CoV-2 after having sustained an intracapsular neck of femur fracture. Methods: Two patients (Patient A 91 and Patient B 88 years old, both female) were referred to our hospital after sustaining an intracapsular neck of femur hip fracture as a result of low energy trauma. Both patients tested positive for Covid-19 during their preoperative screening tests. Patient A had not been vaccinated against Covid-19 in contrast to patient B who had completed the 2 dose regimen of the Pfizer-BioNTech COVID-19 vaccine. Patient A presented on arrival Leukopenia (WBC: 1.2 μc/l, Neutrophils 0.4 mcL) and Thrombocytopenia (PLT 70.000). The Procalcitonin, C-Reactive Protein and Ferritin levels long as Arterial blood Gases were measured in both patients on arrival. Patient A required administration of Granulocyte colony stimulating factor and platelet transfusion prior to surgery. Results: Both patients underwent uncemented hip hemiarthroplasty. Patient A was operated 5 days after hospital admission as optimization of the patient's Covid-19 related Leukopenia and Thrombocytopenia was required and Patient B was operated within 24 hours after hospital admission. Patient A required transfusion of 4 blood Units (bleeding related to Thrombocytopenia) compared to 2 blood units that were administered in Patient B. Patient A developed Covid 19 related Pneumonia and Lung disease on the 6th post-operative day (PO2 SO2) and required high flow nasal cannula therapy for 7 days followed by oxygen therapy for 8 days delaying her mobilization and hospital discharge. Patient A was discharged on the 29th post-operative day and Patient B was discharged on the 6th post-operative day. Conclusion: Covid 19 related complications in elderly hip fracture patients are challenging and require multidisciplinary approach and hospital resources. However, Vaccination against covid-19 seems to prevent Covid related complications and can improve the outcome. Large series studies and further research is required to support our thesis.

15.
Blood Purification ; 50(SUPPL 1):18, 2021.
Article in English | EMBASE | ID: covidwho-1816951

ABSTRACT

Background: Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. which attacks the immune system causing an exaggerated and uncontrolled release of pro-inflammatory mediators (cytokine storm). On-pump cardiac surgery triggers a significant postoperative systemic inflammatory response and together it possible resulting in multiple-organ dysfunction associated with poor clinical outcome. Using haemoadsorption (Jafron HA330) device can improve cytokine elimination and promises better clinical outcome. Case presentation: The patient (58 age) received in Cardiovascular department University Clinical Center Sarajevo like urgent case with suspect disectio aortae Stanford A. He said that this afternoon he felt suddenly very strong pain in chest with weakness hands and legs. After examination, CT angiography and TTE (dimension of aorta ascendens 54 mm with visible disction flap, aortic regurgitation AR+4, no pericard effusion) it confirm diagnosis disectio aortae ascendens. Also, during examination it is stated that patient has fever 38,7 C. Preoperative fast cheking SARS-CoV-2 Ag-RDT confirm positive COVID infection. Bilateral pneumonia characteristic for Covid disease was found on CT. Urgent surgery, replacement of aortic valve (AVR Edwards Magna 23) and double sandwich tube replacement aortae ascendens was performed. Because of active COVID infection during extracorporeal circulation (220 minute) it used hemoperfuser Jafron HA330, cytokine adsorber. Jafron hemoperfuser HA330 was installed into the venous CPB, so that the blood was pumped into the reservoir. Postoperatively , the patient had hemodynamic stability with medium doses of inotrops and he was extubated 3 hours later. In consultation with an infectologist therapy for COVID disease was ordained. Intensive oxygen therapy was necessary for postoperative period (high flow nasal canila and mask) According to standard protocol drains removed. The patient was discharged on the thirteenth postoperative day in good condition. Conclusion: Reduction cytokine storm by using hemoperfuser Jafron HA330 during cardiac surgery can be therapeutic options for critically ill patients. .

16.
Pakistan Armed Forces Medical Journal ; 72(1):338, 2022.
Article in English | ProQuest Central | ID: covidwho-1813019
17.
Biochemical and Cellular Archives ; 21(2):1-2, 2021.
Article in English | EMBASE | ID: covidwho-1812557
18.
Journal of Clinical and Diagnostic Research ; 16(4):OC01-OC04, 2022.
Article in English | EMBASE | ID: covidwho-1798691

ABSTRACT

Introduction: Patients with history of past or active malignancy are at increased risk of contracting the virus and developing Coronavirus Disease 2019 (COVID-19) related complications. With the global prevalence of cancer and the high transmissibility of Severe Acute Respiratory Syndrome Corona Virus 2 (SARSCoV-2), an understanding of the disease course of COVID-19 and factors influencing clinical outcomes in patients with cancer is necessary and is largely unknown. Aim: To study the laboratory characteristics of patients with malignancy and COVID-19 infection and to evaluate the outcomes in terms of clinical features, severity of infection and mortality of patients with malignancy and COVID-19 infection. Materials and Methods: The present study was a cross-sectional study conducted at Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India after obtaining Institutional Ethical Committee (IEC) clearance, involving 72 subjects with COVID-19 infection. The duration of the study was from April-November 2020. Demographic details and data were collected in patients with active or previous malignancy and COVID-19 illness based on Indian Council of Medical Research (ICMR) criteria. Clinical outcome of the patients was measured based on need for Intensive Care Unit (ICU) admission, oxygen therapy and mortality. Descriptive statistics of the explanatory and outcome variables were calculated by mean, Standard Deviation (SD), median and Interquartile Range (IQR) for quantitative variables, frequency and proportions for qualitative variables. Inferential statistics like Chi-square test was applied for qualitative variables. Results: The mean age of the subjects was 52.10±14.512 years with 29 males, 43 females. Among 72 patients with malignancy, patients were classified as mild (23), moderate (22) and severe (27) according to ICMR case type respectively. Among the total patients, 21 (29.2%) were asymptomatic and 51 (70.8%) were symptomatic with 26 (36.1%) symptomatic patients having severe disease. Also, 30 (41.7%) had requirement of O2 and 28 (38.9%) were admitted to ICU. Most common was solid organ (66) lung carcinoma (13), breast (10), compared to haematological malignancies (6). A total of 22 (30.6%) patients had mortality with most common complication being Acute Respiratory Distress Syndrome (ARDS) (20.8%) followed by sepsis (4.2%). Conclusion: The results of present study revealed higher mortality and increased inflammatory markers in patients with severe COVID-19 infection and malignancy.

19.
European Heart Journal Cardiovascular Imaging ; 23(SUPPL 1):i606, 2022.
Article in English | EMBASE | ID: covidwho-1795302

ABSTRACT

Myocardial dysfunction is common and associated with worse outcomes in patients with ARDS, pulmonary embolism or severe sepsis due to pulmonary hypoxic vasoconstriction. Thrombotic events, myocarditis and endothelial dysfunction may contribute to these effects in COVID- 19 infection. The evaluation of myocardial function can provide prognostic information regarding the severity of a current COVID-19 infection, but scarce data available on the role of Deformation Indices obtained by Speckle Tracking Analysis to describe unique features of myocardial dysfunction in COVID-19 pneumonitis. AIMS: to evaluate the value of ventricular and atrial Deformation Imaging in patients with COVID- 19 infection and hypoxia who had preserved systolic function in comparison with age-, gender-, BSA, hypoxia-matched control subjects with respiratory disease on oxygen therapy, thus excluding the effects of pulmonary vasoconstriction. We also assessed the impact of biochemical and inflammatory markers on the Echo-Indices. METHODS: 21 patients with PCR-confirmed COVID-pneumonitis (15 males, age:60.1 ± 16.1yrs, range:43-89) and 31 control, PCR-negative subjects (age:62.8 ± 15.5yrs, range:22-92) on oxygen with matched biometric data were compared. 2 examiners, blinded to the clinical data performed off-line standard Echocardiographic assessment and Deformation Imaging by 2D-Speckle Tracking Analysis with the TomTec Arena software package (Unterschleissheim, Germany) in both ventricles and atria. Plasma chemistry data were compared between the groups. RESULTS: No differences found in the biometric data and the cardiac chamber sizes between the groups. The global systolic strain indices were reduced in the COVID-group in the LV, but not the EF (LV-GLS -13.6 ± 2.9 vs -16 ± 1.1%, LV-GCS -24.8 ± 2.4 vs -28.9 ± 2.8%, p = 0.001, LVEF 61 ± 3.7 vs 60.7 ± 4.9%, p = NS), and these were reduced in the RV and RA, but not the TAPSE and TDI-S' when compared to the controls (RV-FWS -12.3 ± 2.9 vs -16.2 ± 1.5%, RV-GLS -14.6 ± 3.4 vs -17.1 ± 1.7%, RASr 18.5 ± 6 vs 22.3 ± 4.8% p = 0.005. Interestingly, the dispersion of contraction was increased in the COVID-patients in both the LV (LV-SD 416.2 ± 81.8 vs 309.8 ± 69.8ms, p < 0.001) and the RV and the RA (RV-SD 414.9 ± 117 vs 303.8 ± 61ms, RA-SD 33.5 ± 6.7 vs 26.1 ± 4.7ms, p < 0.001). The right heart indices correlated well with the biochemical data (RV-FWS and RV-SD with Ferritin r = 0.54 and -0.46, p = 0.003, RASr with GLS r = 0.64, p = 0.002, RA-SD with Troponin, p = 0.01 and with the RV-coupling Index r = 0.72, p = 0.02). CONCLUSIONS: Myocardial dysfunction is common among severely ill and hypoxic COVID-19 patients. The conventional Echo-parameters of systolic function or pulmonary pressures do not appear being specific but the Deformation Indices can provide tools to detect unique changes of the myocardial function and dys-synchrony imposed by the COVID-19 infection, independently from the impact of hypoxia or raised pulmonary pressures, hence they can predict outcome more accurately.

20.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793894

ABSTRACT

Introduction: Even if life-saving in most cases, excess O2 may have adverse effects. We described the prevalence of hyperoxemia and excess O2 administration in patients with severe acute respiratory syndrome due to novel coronavirus (SARS-CoV-2) and explored the association with mortality in the intensive care unit (ICU) or ventilatorassociated pneumonia (VAP). Methods: Retrospective single-centre study on 134 patients with SARS-CoV-2 requiring mechanical ventilation for ≥ 48 h. We calculated the excess O2 administered based on an ideal arterial O2 tension ( PaO2) target of 55-80 mmHg. We defined hyperoxemia as PaO2 > 100 mmHg and hyperoxia + hyperoxemia as an inspired O2 fraction (FiO2) > 60% + PaO2 > 100 mmHg. Risk factors for ICU-mortality and VAP were assessed with multivariate analyses. Results: Each patient received an excess O2 of 1121 [829-1449] l per day of mechanical ventilation. Hyperoxemia was found in 38 [27-55] % of arterial blood gases, hyperoxia + hyperoxemia in 11 [5-18] %. The FiO2 was not reduced in 69 [62-76] % of cases of hyperoxemia. Adjustments were more frequent with higher PaO2 or initial FiO2 levels. ICU-mortality was 32%. VAP was diagnosed in 48.5% of patients. Hyperoxemia (odds ratio [OR] 1.300 95% confidence interval [1.097- 1.542]) and hyperoxia + hyperoxemia (OR 1.144 [1.008-1.298]) were associated with higher risk for ICU-mortality, independently of age, Sequential Organ failure Assessment score at ICU-admission and mean PaO2/FiO2. Hyperoxemia (OR 1.033 [1.006-1.061]), hyperoxia + hyperoxemia (OR 1.038 [1.003-1.075]) and daily excess O2 (OR 1.001 [1.000- 1.001]) were identified as risk factors for VAP, independently of body mass index, blood transfusions, days of neuromuscular blocking agents before VAP, prolonged prone positioning and mean PaO2/FiO2 before VAP. Conclusions: Excess O2 administration and hyperoxemia were common in mechanically ventilated patients with SARS-CoV-2 and may be associated with ICU-mortality and greater risk for VAP.

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