Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 62
Filter
1.
European Psychiatry ; 65(Supplement 1):S713-S714, 2022.
Article in English | EMBASE | ID: covidwho-2154150

ABSTRACT

Introduction: Clozapine is a drug that can cause several side effects. Among the less commonly described is a drug-induced lung disease. Due to its non-specific clinical presentation, it represents a diagnostic challenge. The diagnosis is made based on: 1. Association of exposure to the agent and development of symptoms, 2. Pulmonary infiltration, 3. Exclusion of other causes, 4. Withdrawal of symptoms when the agent is excluded from therapy. To date, there have been only a few descriptions of this condition. Objective(s): Case report of rare side effect of clozapine. Method(s): Case report Results: Case report: male patient (37) with schizophrenia, was hospitalized after a brutal suicide attempt. The PCR test for COVID-19 that was routinely performed on admission was negative. After the introduction of clozapine into therapy, the patient became febrile. There was a drop in oxygen saturation, a Lung CT scan showed inflammatory changes (ground-glass opacities ), and COVID-19 pneumonia was suspected. Due to the worsening of the mental state, the dose of clozapine was increased. The physical condition further deteriorated: febrile, sO2 declining. After repeated PCR tests for COVID-19 (all negative), interstitial pneumonia caused by clozapine was suspected, and clozapine was excluded from therapy. The physical condition started to improve. Quetiapine was introduced, and occasional episodes of agitation were relieved with intramuscular diazepam. In the following days, the patient's mental state improved and he was discharged. Conclusion(s): Despite its superiority over other antipsychotics, clozapine was with good rationale ranked third in treatment guidelines for schizophrenia.

2.
European Psychiatry ; 65(Supplement 1):S427-S428, 2022.
Article in English | EMBASE | ID: covidwho-2153944

ABSTRACT

Introduction: The COVID-19 pandemic has disrupted numerous fundamental systems ranging from businesses to education system. The long-term consequences of the Pandemic, namely virtual learning and prolonged social isolation are coming to fruition in Child/Adolescent-Psychiatric Emergency-Rooms (CAP-ER). Discontinuity of in-person attendance of schools has poorly impacted the mental health of children and adolescents (C&A) of lowsocioeconomic areas, who often rely on schools for meals, physical activity, and mental-health support. An increase in agitation, suicidal ideation, and a declining school performance has been observed in such situations. Objective(s): The primary objective of this study is to explore the increase in these symptoms as the presenting complaint in the psychiatric ER. Method(s): Between April to June 2021 a cross-sectional quality improvement (QI) study was done on children presenting to CAP-ER BronxCare-Hospital NY with psychiatric complaints. Concomitant substance use disorder was determined using CRAFT questionnaire. Result(s): Our data comprised 209 patients (84 M/125 F) with 79 children and 130 adolescents. Ethnicity: 116 Hispanics (56%), 84 African Americans (40%), and 9 others. The most common presenting complaints were aggression (111, 53%), suicidal ideation/ suicide attempt (50, 24%), acute exacerbation of chronic illness (7, 3.3%), accidental overdosage (5, 2.3%) and others (36, 17.4). Marijuana was the most used substance (34 patients). Conclusion(s): There has been a surge in severity of presentation of psychiatric disorders among children and adolescents, aggression so far, the most prevalent. Further studies are needed to delineate the social links with this high emergent load and pandemic.

3.
European Psychiatry ; 65(Supplement 1):S28, 2022.
Article in English | EMBASE | ID: covidwho-2153780

ABSTRACT

Introduction: The infection caused by the SARS-CoV-2 virus called COVID-19 may affect not only the respiratory system but also the central nervous system (CNS). Delirium is a frequent and serious condition in COVID-19 patients and may be caused by the direct invasion of the CNS or the induction of CNS inflammatory mediators or by indirect effects due to the systemic inflammatory status, other organ failure, prolonged mechanical ventilation time, immobilization but also social isolation. We aim to critically review literature reporting this syndrome in patients infected by the SARSCoV-2 virus with a particular emphasis on reported clinical, laboratorial and neuroimaging findings. Method(s): A state-of-the-art literature review was performed using PubMed, Embase and Web of Knowledge using the following keywords: delirium, COVID-19, SARS-Cov-2, neuroimaging, laboratorial findings. Result(s): More than 50% of patients with COVID-19 may present with delirium and in about 20% of the cases this is the primary presentation of the disorder. Previous data suggests that these patients may show a higher frequency of certain symptoms such as agitation, myoclonus, abulia, and alogia. Some distinct neuroinflammatory syndromes have been identified in patients presenting with delirium associated with the virus, namely, autoimmune encephalitis, Acute Disseminated Encephalomyelitis (ADEM) and stroke showing its potential for CNS involvement. Many of these patients present normal brain imaging, EEG and CSF findings but others have more specific laboratorial changes such as elevated creatinine kinase, elevated D-dimer levels, abnormal coagulation parameters and positive SARS-Cov-2 PCR in CSF or meningeal enhancement, ischemic stroke and perfusion changes in MRI imaging.

4.
Archives of Clinical Infectious Diseases ; 17(3), 2022.
Article in English | EMBASE | ID: covidwho-2067096

ABSTRACT

SARS-CoV-2, the pathogen responsible for COVID-19, has infected hundreds of millions since its emergence in late December 2019. Recently, concern has been raised due to the increased prevalence of co-infections with opportunistic pathogens among these pa-tients. Though not common, co-infections may be associated with adverse outcomes and increased risk of morbidity and mortality among patients suffering from COVID-19. Cytomegalovirus (CMV) infection is a serious problem among immunocompromised and critically ill patients. So far, few cases of co-infection with COVID-19 and CMV have been reported. Here, we report the co-infection with COVID-19 and CMV in a young woman presenting with sudden, progressive fever, delusion, agitation, bizarre behavior, seizure, and loss of consciousness leading to death despite receiving appropriate anti-viral treatment. To the best of our knowledge, this is the first case of coexisting SARS-CoV-2 and CMV infection presenting with severe, progressive meningoencephalitis in the era of COVID-19.

5.
Chest ; 162(4):A893, 2022.
Article in English | EMBASE | ID: covidwho-2060718

ABSTRACT

SESSION TITLE: Cases of Overdose, OTC, and Illegal Drug Critical Cases Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Hydroxychloroquine (HCQ) is commonly prescribed for the management of connective tissue disorders such as systemic lupus erythematosus and rheumatoid arthritis. Despite its widespread use, there are limited case reports describing HCQ intoxication and management. HCQ toxicity presents predominantly with cardiovascular manifestations, including hypotension, arrhythmias, and QT interval prolongation on electrocardiogram (EKG). Other findings include visual disturbances, altered mental status, and hypokalemia. CASE PRESENTATION: We present the case of a 60-year-old female with a history of rheumatoid arthritis and depression. She presented to the emergency department (ED) after ingesting 10-15 tablets of HCQ 200 mg in a suicide attempt. In the ED, she was noted to be lethargic and tachycardic. EKG revealed sinus tachycardia with a heart rate of 127 beats per minute and prolonged QTc of 680msec. The diagnostic evaluation also revealed hypokalemia with potassium 3.7mmol/l. Initial management in the ED included administration of activated charcoal, potassium supplementation, and intravenous bicarbonate infusion. The patient was admitted to the ICU for monitoring and supportive care. Serum electrolyte panel and EKG were monitored. The patient made an uneventful recovery after 2-3 days. The QT interval normalized, and hypokalemia improved. She was subsequently discharged to an inpatient psychiatric unit. DISCUSSION: Although HQC is commonly prescribed, there is limited data describing overdose. Our case of HCQ overdose presented as changes in mental status, QT interval prolongation, and hypokalemia. Similar findings have been reported in previous case reports. Management includes early gastric decontamination with activated charcoal, potassium supplementation, and supportive care. Intravenous bicarbonate infusion has been utilized for prolonged QT intervals, and benzodiazepines have been used for agitation and sedation. CONCLUSIONS: Although rare, HCQ toxicity can be life-threatening. It is a commonly prescribed agent, and therefore the clinician should be aware of its toxicity profile and management. Reference #1: Bakhsh HT. Hydroxychloroquine Toxicity Management: A Literature Review in COVID-19 Era. J Microsc Ultrastruct. 2020;8(4):136-140. Published 2020 Dec 10. doi:10.4103/JMAU.JMAU_54_20 Reference #2: McKeever R. Chloroquine/hydroxychloroquine overdose. Vis J Emerg Med. 2020;21:100777. doi:10.1016/j.visj.2020.100777 Reference #3: Lebin JA, LeSaint KT. Brief Review of Chloroquine and Hydroxychloroquine Toxicity and Management. West J Emerg Med. 2020;21(4):760-763. Published 2020 Jun 3. doi:10.5811/westjem.2020.5.47810 DISCLOSURES: No relevant relationships by Priyaranjan Kata No relevant relationships by Wajahat Khan No relevant relationships by Pratiksha Singh

6.
Ymer ; 21(7):382-400, 2022.
Article in English | Scopus | ID: covidwho-2057148

ABSTRACT

People are thriving towards perfection, performance, and profit in the society which inturn is leading to disturbances among them both mentally and physically. One issue faced by most of the people irrespective of the age groups is "Stress". With the onset of Covid-19 pandemic, Stress has become a disastrous disorder faced by most of the people today. Most of the people are unaware that they are suffering from such a disorder. Stress lays in the hands of at-most all people either knowingly or unknowingly. There are numerous methods to detect stress manually. People don't come forward to take up treatments for stress. This disorder peeps out of humans through various symptoms like irritation, loss of appetite, agitation, depression, anxiety, reduced performance, sleep disturbance, etc. Among the afore mentioned symptoms, sleep disturbance is the major and most influential parameter in detecting and predicting stress. The SaYo Pillow is the "Smart-Yoga Pillow" which assists in concerning the relationship pertaining to sleep and stress. Although there are other methods to track sleep like Fitbit trackers to track sleeping patterns, SaYo Pillow stands out as it detects the psychological behaviors that occurs during sleep. This tracking of psychological behavior is lacking in case of other devices like Fitbit used for sleep pattern detection. The data obtained from this pillow can be used to study how stress can affect sleep. Machine Learning methods are applied to the data to detect if the person is stressed or not. Thereby adding to it, prediction is also done to understand will the person be stressed in near future. Machine Learning algorithms such as Support Vector Machine (SVM), Random Forest Classifier and Gradient Boosting Classifier was used to detect and predict stress among the individuals. The performance of these algorithms was compared to identify the best performing algorithms. After identifying the best performing algorithm, the same was applied to the data to detect and predict the occurrence of stress. In addition to that, an application was developed which suggests some activities to the candidate to overcome stress. © 2022 University of Stockholm. All rights reserved.

7.
Tijdschrift voor Geneeskunde en Gezondheidszorg ; 78(8), 2022.
Article in Dutch | EMBASE | ID: covidwho-2044392

ABSTRACT

An 11-year-old boy with juvenile neuronal ceroid lipofuscinosis (JNCL) is admitted because of acute agitation and hallucinations. Upon admission, the patient takes lorazepam, which does not induce the expected rest. A PCR-test had a positive result for SARS-CoV-2. Juvenile neuronal ceroid lipofuscinosis (JNCL) is a rare neurodegenerative disease in children and adolescents. Hallucinations are a known symptom in the course of the disease. In the case discussed in this article, however, the pronounced hallucinations fit within a broader clinical picture of a hyperactive delirium. A delirium is by definition provoked by a physical cause. In the presented case, JNCL was an existing risk factor for a delirium, the SARS-CoV-2 infection and lorazepam were presumably the triggering factors. Recent literature shows that an asymptomatic or mildly symptomatic SARS-CoV-2 infection can also trigger a delirium. Treatment consists of treating the physical cause (if possible), supportive measures for the patient and context, as well as medication. The antipsychotics risperidone and haloperidol are recommended. Within the context of JNCL, cautious initiation of a second-generation antipsychotic, such as risperidone, along with great alertness to possible side effects, such as extrapyramidal symptoms and neuroleptic malignant syndrome, are advised. For the young patient in the discussed case risperidone was started, supplemented with olanzapine as rescue medication. The medication had a good effect and no side effects were observed.

8.
Journal of the Intensive Care Society ; 23(1):143-144, 2022.
Article in English | EMBASE | ID: covidwho-2042974

ABSTRACT

Introduction: Due to the COVID-19 pandemic there has been an unprecedented number of hospital and Intensive Care Unit (ICU) admissions for respiratory failure. This has required a significant and sudden increase in ICU capacity. 1,2 Due to severe pulmonary infection and inflammation, patients have presented with acute respiratory distress syndrome (ARDS) with an associated inability to ventilate lungs with poor compliance. This has led to an increased requirement for extra corporeal membrane oxygenation (ECMO) support. This is only available in six commissioned centres across the United Kingdom.3 Objectives: The objective of this is to present a case study of a long-term patient in ICU with a prolonged duration on ECMO. This highlights the complex, mutli-dimensional physiological and psychological impact of recovery and rehabilitation in patients following a severe physical illness. Methods: Figure 1 shows the timeline of significant events during the patient's hospitalisation and admission at the ECMO centre. Due to the nature of a long ICU admission, the patient's condition fluctuated throughout their stay. Rehabilitation was impacted physically by the patient's limited ventilatory reserve caused by lung damage due to COVID. A severe sacral moisture lesion also limited their ability to sit in a chair for longer than one hour and perform sustained sitting on the edge of the bed activities. Psychologically the patient was limited due to significant anxiety and agitation. There were a number of barriers and challenges to rehabilitation whilst the patient was on ECMO as well as post ECMO decannulation. These challenges are detailed in Figure 2. Results: Despite the challenges, the patient was able to participate in physical rehabilitation and was provided psychological support by the psychology team. At their peak ability, the patient was able to perform 12 steps with maximal assistance of three staff. The patient's Chelsea Critical Care Physical Assessment Tool (CPAx) scores can be seen in Figure 3. There was marked difference in the patient's ability to meet the physiological demand of rehabilitation with the ECMO support and without. Following ECMO decannulation the patient struggled with fatigue, hypercapnia and increasing dependency on the ventilator. These issues led to a decline in ability and longer periods of tachypnoea and recovery. Conclusion: Supporting patients after a critical illness requires physical and psychological rehabilitation from the whole MDT. This example of a patient's recovery both during and post ECMO support due to COVID-19 shows the complex relationships affecting the patient's ability to improve and progress.

9.
Journal of the Intensive Care Society ; 23(1):167-168, 2022.
Article in English | EMBASE | ID: covidwho-2042973

ABSTRACT

Introduction: Patients in the intensive care (ICU) commonly receive analgesics and sedatives to facilitate mechanical ventilation. Recommendations suggest patients are kept as lightly sedated as feasible. Studies report an inconsistent association between deep sedation, prolonged ventilation and ICU stay.1 Opinions around patients 'wakefulness' include discomfort and the potential increased prevalence of psychological morbidity.2 Alpha-2-agonists (clonidine and dexmedetomidine) are agents used in ASD management and reported to produce lighter sedation. The aim of this project was to explore ICU pharmacist's perspective on ASD practice over UK. Objectives: • Explore ICU pharmacist's views on: ASD practices, sedation research priority, importance of A2B clinical trial and the impact of Covid19. • Determine the prevalence of clonidine and dexmedetomidine prescribing. Methods: An online survey was devised on SurveyMonkey. The survey was designed in 2 sections: -1. Respondents provided responses based on a 'point prevalence' of clonidine and dexmedetomidine prescriptions, on day of completion. 2. Their local ICU sedation practice, their views on priority of sedation research, the A2B study and whether they believed ASD was more challenging during the Covid19 pandemic. The online survey was distributed via the UK Clinical Pharmacy Association Critical Care Group (UKCPA CCG), the NIHR Critical Care National Speciality Group (NSG), the UK Critical Care Research Group and Twitter. The survey remained active for 12 weeks from 30.3.2021 with reminders sent for completion every fortnight. Results: There were 121 respondents, all but 1 were ICU pharmacists. There are approximately 243 ICU pharmacist posts in the UK, this represents a response rate of approximately 50%. 37 (30%) of respondent reported clonidine (but not dexmedetomidine) was prescribed in their ICU;7 (6%) described dexmedetomidine only;and 76 (63%) reported both. In describing ASD during Covid-19 pandemic, 107 (88%) respondents reported it had become more challenging. 83 (69%) of respondents stated that clonidine usage increased during the pandemic (27 (22%) no change). 46 (39%) stated that dexmedetomidine usage increased during the pandemic (50 (42%) no change). Among the respondents 98 (81%) 'strongly agreed', and 20 (17%) 'agreed' that research involving ASD is a priority. A2B is set to compare clinical and cost effectiveness of propofol, clonidine, and dexmedetomidine as primary sedative for ICU patients. 49 (40%) of respondents reported participating in A2B. 65 (54%) respondents felt that A2B was a 'very important', and 63 (52%) said it was an 'important' research question. Conclusion: This survey reported widespread use of alpha-2-agonists in ASD practice. Almost two-thirds of ICUs report using both agents. Clonidine use is the most prevalent. Given the paucity of high quality clinical effectiveness and safety data for this drug, clinical trials which assess clinical effectiveness, including ASD are a priority. Respondents endorsed that ASD research is a priority, with ASD management much more challenging during the Covid19 pandemic. Limitations include that the design was a brief online survey;although had a high pharmacist response it did not incorporate the views of other members of the ICU team.

10.
Journal of the Intensive Care Society ; 23(1):156-157, 2022.
Article in English | EMBASE | ID: covidwho-2042971

ABSTRACT

Introduction: Clinical pharmacists specialising in critical care have become integrated into the critical care workforce providing valuable contributions to patient care.1 These findings are supported through the inclusion of clinical pharmacy services within national professional and commissioned standards for critical care.2,3 On admission to critical care, clinical focus changes from management of any chronic conditions to that of immediate preservation of life. This is inherently associated with acute changes in prescribed medicines.Medicines reconciliation on admission to and discharge from critical care is included specifically within the commissioning standards3 and aims to address any discrepancies generated by this change in focus. Unprecedented pressures experienced during the COVID-19 pandemic have resulted in stretched staff to patient ratios and mobilisation of less experienced staff. This has negatively impacted the end-to-end reconciliation process causing patients to be discharged home with unresolved medicines discrepancies. In line with recent NICE4 and Intensive Care Society guidance,5 rehabilitation of patients, post-critical care is important in completing unresolved actions and optimising care. Consequently, in September 2020 a carousel rehab clinic was introduced. All professional groups were invited to contribute. Objectives: To embed a pharmacist within the rehabilitation clinic to focus on any unresolved medicines reconciliation issues. Methods: Five senior critical care pharmacists (band 8a or above) participated in service provision to the clinic, which ran on two days a week. For consistency and structure, a local SOP and electronic note template was produced. All interventions recommended were discussed with the patient at the time and for GPs to review and action as appropriate in the context of their responsibility for ongoing care. Data collection for this service evaluation was retrospective and performed by one of the critical care pharmacists who had participated in the clinic. Historic clinic dates for September - November 2020 (inclusive) were reviewed on the electronic scheduling system to identify patients who attended clinic;these were then filtered for pharmacist entries to ascertain: • Number of patients reviewed • Number of medication-related interventions made • Intervention type and medication(s) involved Results: Over the 3-month period 51 patients were reviewed with a total of 59 medicine interventions made. The average number of interventions per patient was 1.2, with a range of 0 - 7. Eight intervention categories were identified (see Figure 1);the top three of which recommended stopping a medication (27%), reviewing a medication's need (19%) or restarting a medication (17%). The drugs most frequently intervened on were lansoprazole (12%) and bisoprolol (7%). Examples of significant clinical interventions made include: • Stopping acutely initiated bisoprolol (resolution of acute AF secondary to acute sepsis/dehydration on ICU) • Stopping of acutely started olanzapine for ICU-related agitation/delirium • Dose optimisation of bisporolol (post recent NSTEMI) • Re-initiation of atorvastatin (for secondary prevention of IHD) Conclusion: Medication interventions made by pharmacists in the post ICU rehabilitation clinic setting are clinically significant and add value to patient care both in terms of morbidity and mortality. Our results demonstrate a reduction in polypharmacy burden in line with wider healthcare initiatives.

11.
Journal of the Intensive Care Society ; 23(1):147-148, 2022.
Article in English | EMBASE | ID: covidwho-2042959

ABSTRACT

Introduction: The COVID-19 pandemic caused a sudden and unprecedented surge in ICU admissions for severe acute respiratory failure. Whilst there is a wealth of knowledge surrounding risk factors for developing critical care myopathy and effects of prolonged ICU stay on functional outcomes,1,2 little was known about the pathophysiology, treatment or physical outcomes of patients admitted to ICU with COVID-19. In our organisation, patients recovering from the acute phase of COVID-19 demonstrated a range of presentations impacting rehabilitation whist in ICU. Objective: To explore whether time taken to wake post sedation hold impacts on functional outcomes of patients surviving ICU admission for COVID-19. Methods: A retrospective review of patients admitted to ICU with a primary diagnosis of COVID-19 between March-April 2020 was conducted at a large London NHS Foundation Trust. Electronic clinical notes were reviewed and the following data extracted: age, ethnicity, sex, BMI, pre-admission clinical frailty score, duration of sedation, days taken to wake from sedation, duration of mechanical ventilation (MV), ICU length of stay (LOS) and hospital LOS. Functional outcomes were defined using the Intensive Care Unit Mobility Score (ICUMS). Data were analysed using descriptive statistics, reported as absolute numbers, percentages (%) and median (range). Results: 203 patients were identified, 137 were excluded as 58 died, 3 were incidental findings of COVID-19, 67 had missing data due to paper notes or transfers in/out of the Trust and 9 were duplicate records. Sixty-six patients were included in the final analysis (Table 1). Patients could be categorised into four rehabilitation groups: 1 = Never requiring sedation and MV, 2 = Woke from sedation (defined as RASS ≥-1) within 72 hours with preserved muscle power (defined as ICUMS ≥5 on ICU discharge), 3 = Woke from sedation within 72 hours but myopathic (defined as ICUMS ≤4 on ICU discharge), 4 = Slow to wake (> 72 hrs). Those slow to wake following sedation hold (group 4) had an increased age, BMI, and higher proportion of nonwhite ethnicity. Neuromuscular blocking agents (NMBA) and steroid use was more prevalent in group 4 compared to the other groups. There was also increased midazolam administration and higher number of total sedative agents received by these patients. Those slow to wake had a lower ICUMS at ICU discharge than those waking with preserved strength or never sedated (3, 6, 9 respectively). Those who were slow to wake were ventilated for longer than the other groups. Time taken to wake from sedation also resulted in longer ICU and hospital LOS. Similar functional outcomes at hospital discharge were noted between all 4 groups (Table 1). Conclusion: Patients slow to wake from sedation following ICU admission for a primary diagnosis of COVID-19 had a longer ICU LOS, reduced functional ability at ICU discharge and a longer hospital LOS. These preliminary observational clinical data support the testable hypothesis that within in the ICU, COVID rehabilitation phenotypes may exist which warrants further investigation.

13.
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.

14.
Cureus ; 14(8): e27621, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2025408

ABSTRACT

Multisystem inflammatory syndrome in children (MIS-C) is a rare hyperinflammatory syndrome that mainly affects children after a primary infection with coronavirus disease 2019 (COVID-19), with the possibility of severe and lethal complications. We report a case of a unique presentation of MIS-C in a four-year-old boy who presented with severe agitation, muscle spasms, and two days of fever. Other findings consistent with MIS-C were revealed later, and he was managed with intravenous immunoglobulin (IVIG) and steroids. He showed a dramatic response of improvement and was discharged. This case report aimed to raise health professionals' awareness about the atypical presentations of MIS-C and the importance of early diagnosis, treatment, and follow-up MIS-C cases to avoid complications affecting children's lives.

15.
Virol J ; 19(1): 145, 2022 09 10.
Article in English | MEDLINE | ID: covidwho-2021311

ABSTRACT

BACKGROUND: A growing body of evidence reports that agitation and encephalopathy are frequent in critically ill Covid-19 patients. We aimed to assess agitation's incidence and risk factors in critically ill ARDS patients with Covid-19. For that purpose, we compared SARS-CoV-2 acute respiratory distress syndrome (ARDS) patients with a population of influenza ARDS patients, given that the influenza virus is also known for its neurotropism and ability to induce encephalopathy. METHODS: We included all the patients with laboratory-confirmed Covid-19 infection and ARDS admitted to our medical intensive care unit (ICU) between March 10th, 2020 and April 16th, 2021, and all the patients with laboratory-confirmed influenza infection and ARDS admitted to our ICU between April 10th, 2006 and February 8th, 2020. Clinical and biological data were prospectively collected and retrospectively analyzed. We also recorded previously known factors associated with agitation (ICU length of stay, length of invasive ventilation, SOFA score and SAPS II at admission, sedative and opioids consumption, time to defecation). Agitation was defined as a day with Richmond Agitation Sedation Scale greater than 0 after exclusion of other causes of delirium and pain. We compared the prevalence of agitation among Covid-19 patients during their ICU stay and in those with influenza patients. RESULTS: We included 241 patients (median age 62 years [53-70], 158 males (65.5%)), including 146 patients with Covid-19 and 95 patients with Influenza. One hundred eleven (46.1%) patients had agitation during their ICU stay. Patients with Covid-19 had significantly more agitation than patients with influenza (respectively 80 patients (54.8%) and 31 patients (32.6%), p < 0.01). After matching with a propensity score, Covid-19 patients remained more agitated than influenza patients (49 (51.6% vs 32 (33.7%), p = 0.006). Agitation remained independently associated with mortality after adjustment for other factors (HR = 1.85, 95% CI 1.37-2.49, p < 0.001). CONCLUSION: Agitation in ARDS Covid-19 patients was more frequent than in ARDS influenza patients and was not associated with common risk factors, such as severity of illness or sedation. Systemic hyperinflammation might be responsible for these neurological manifestations, but there is no specific management to our knowledge.


Subject(s)
Brain Diseases , COVID-19 , Influenza, Human , Respiratory Distress Syndrome , COVID-19/complications , Critical Illness , Humans , Influenza, Human/complications , Influenza, Human/epidemiology , Male , Middle Aged , Propensity Score , Retrospective Studies , SARS-CoV-2
16.
Southern African Journal of Anaesthesia and Analgesia ; 28(1), 2022.
Article in English | EMBASE | ID: covidwho-2006764

ABSTRACT

The proceedings contain 23 papers. The topics discussed include: petroleum jelly as an alternative coupling medium in focus assessed transthoracic echocardiography;perspectives on desflurane;use of high-flow nasal oxygenation outside COVID-19: a rural hospital experience;fitness for purpose of South African anesthesiologists;the effect of caregiver's recorded voice on emergence delirium in children undergoing dental surgery;perioperative outcomes of mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital;comparison of a novel low-cost hyperangulated optic intubation stylet with the Bonfils fiberscope: a simulated difficult airway manikin study;the awareness of local anaesthetic systemic toxicity amongst registrars from surgical disciplines in a tertiary hospital, South Africa;and SARS-CoV-2 infection prevalence in healthcare workers, administrative and support staff: the first wave experience at three academic hospitals in the Tshwane District of Gauteng.

17.
Indian Journal of Critical Care Medicine ; 26:S120-S123, 2022.
Article in English | EMBASE | ID: covidwho-2006411

ABSTRACT

Aim: To prevent endotracheal intubations in the COVID wards with early awake proning, allowing time for lung to recover, and decrease mortality in COVID-19 patients. Objectives: 1. To assess the effect of prone positioning on the requirement for invasive mechanical ventilation. 2. To calculate PaO2/FiO2 before prone position. 3. To measure PaO2/FiO2 after prone position. 4. To assess how much increase in PaO2 during prone. 5. To assess the length of time tolerating prone positioning. Materials and methods: Inclusion criteria: (1) Age >18 years. (2) Patient with confirmed COVID with or without chest X-ray infiltrates. (3) Isolated hypoxemic respiratory failure without substantial dyspnea (the paradoxically well appearing hypoxemic patient). Requiring >2 L of O2 to maintain SpO2 >92%. A reasonable candidate might meet the following criteria: • not in multi-organ failure, • expectation that patient has a fairly reversible lung injury and may avoid intubation, • no hypercapnia or substantial dyspnea, • normal mental status, able to communicate distress, • no anticipation of difficult airway. (4) Patients who do not wish to be intubated (DNI). The main risk of awake proning is that it could cause excessive delays in intubation. In the DNI patient who is failing other modes of ventilation, there is little to be lost by trialing awake proning. Exclusion criteria: (1) Signs of respiratory fatigue (RR > 40/minute, PaCO2 > 50 mm Hg/pH< 7.30, and obvious accessory respiratory muscle use), (2) immediate need for intubation (PaO2/FiO2 < 50 mm Hg, unable to protect airway or change of mental status), (3) unstable hemodynamic status, and (4) inability to collaborate with prone position with agitation or refusal. Also, it is observed that the mean O2 requirement is slightly higher in females (Baseline-7.74 L) as compared to males (Baseline-6.06 L), however, this difference is not statistically significant when observed using an independent sample t test (t value = -1.728, df = 48, p > 0.05). The mean reduction of O2 requirement from baseline to Day 3 post proning amongst male patients is 4.53 L, while in females it is 5.16 L. There is no statistically significant mean reduction of O2 requirement in males and females which was observed using independent sample t-test (t value = -0.675, df = 47, p > 0.05). SpaO2 increase after awake proning Overall, a total of 21 patients were followed up until Day 3 post proning and an increase in SpaO2 was observed in these patients. It is seen that the Mean Baseline SpaO2 in these 21 patients was 68.43 ± 2 (14.172) and after 3 days of awake proning it increased to 77.24 + 2 (17.023). However, this difference is not statistically significant using the paired sample t-test (t value = -1.819, df = 20, p > 0.05). Conclusion: It can be concluded from the study that 3 out of 50 patients (6.0%) required NIV or intubation after giving awake proning. The SpaO2 increases after awake proning but the increase is not statistically significant. However, the O2 requirement is reduced 4 to 6 times after awake proning and this reduction is statistically very highly significant. Thus, awake proning significantly helps in the reduction of the requirement of O2.

18.
BMJ Supportive and Palliative Care ; 12:A21, 2022.
Article in English | EMBASE | ID: covidwho-2005499

ABSTRACT

Introduction The COVID-19 pandemic created new challenges due to the high numbers and the high symptom burden of end-of-life patients on respiratory support. Methods We conducted an audit of end-of-life patients on the respiratory HDU wards at Whipps Cross Hospital between 17/09/2020-30/01/2021. Results 84 patients receiving respiratory support (in the form of CPAP and HFNT) died during that time at a mean age of 77 (95% CI 67-87) and median of 79 years. All but one death, which followed a cardiac arrest, were expected. The most common clinical indicator for a patient approaching end-of-life was hypoxia on respiratory support, which was documented in 36 (43%) patients, followed by terminal agitation in 27 (32%) patients. Objections to the medical assessment of terminal illness were raised by 3 families and in 1 case the patient had conflicting wishes. The average time between recognition of a terminal deterioration and death was 1.4 days with a median of 2 days. 29 (35%) patients did not have a specialist palliative care review primarily due to the rapid patient deterioration. 25 (30%) patients were not visited by a relative due to the infection risk. 72 (86%) patients were weaned off respiratory support and those who continued did so due to a medical or patient decision. Despite most patients (82%) receiving continuous subcutaneous infusions with an opiate and benzodiazepine most patients had persistent terminal symptoms: 51 (74%) on infusions had agitation and 38 (55%) were persistently breathlessness. Discussion This data highlights some of the major difficulties faced in caring for patients with COVID on respiratory support and approaching end of life. With the inevitably persisting nature of this pandemic and the possibility of future pandemics still present, it is vital to be able to offer guidance and multidisciplinary input to ensure comfort and dignity for these patients.

19.
Annales Medico-Psychologiques ; 2022.
Article in English | EMBASE | ID: covidwho-2003849

ABSTRACT

Depression is the most common psychiatric disorder in the general population, and emergency room visits for depression have been increasing for several years. In addition, the Covid-19 pandemic may lead to an explosion of psychiatric emergency room visits for this reason, with an overall prevalence of anxiety and depression that appears to be increasing since 2020. The Centre Psychiatrique d'Orientation et d'Accueil is a regional psychiatric emergency service located in Paris which records approximately 10,000 consultations per year. Among these consultations, the main symptoms are those of depression (depressive ideations, anxiety) and nearly 40 % are diagnosed with mood disorders, including depression. The management of the patient in the emergency room is based on a global evaluation, which should not be limited to the psychiatric interview. In the best case, and if compatible with the organization of the service, an initial evaluation by the nursing reception staff determines the context of the arrival of the patient, the reason and the degree of urgency of the consultation can thus be assessed from the outset. The request for care can come from the patient themself, but also from family and friends who are worried about a decline in the patient's previous condition. The consultation may also be triggered by the intervention of emergency services, particularly in the case of attempted suicide or agitation. The context of arrival, the environment, and the patient's entourage must be taken into account in order to achieve an optimal orientation. Particular attention must be paid to the first episodes (elimination of a differential diagnosis, screening for a possible bipolar disorder). The existence of an external causal factor or a comorbid personality disorder should not trivialize the consultation and lead to a faulty diagnosis of a characterized depressive episode. Drug treatment in the emergency room is usually symptomatic (anxiolytic treatment with benzodiazepines or neuroleptics, depending on the situation), and outpatient referral should always be preferred. Therapeutic adaptations can then be considered. The decision to hospitalize must always be justified, and consent for care must be rigorously evaluated. It is almost always necessary to take the patient's entourage into account as well as the potential support of the patient by the entourage. All these elements must be recorded in the file. Suicide risk assessment must be systematic for all patients consulting psychiatric emergencies, and the use of the RUD (Risk, Urgency, Dangerousness) grid can be useful. Any decision to release a patient with suicidal tendencies must be made strictly following certain conditions:a rapid psychiatric re-evaluation of the crisis, with for example the proposal of a post-emergency consultation, a supportive entourage, accepted symptomatic treatment. The registration of the suicidal patient in a monitoring system such as VigilanS can also be beneficial and reduce the risk of recidivism.

20.
Hong Kong Journal of Paediatrics ; 27(1):47, 2022.
Article in English | EMBASE | ID: covidwho-2003053

ABSTRACT

Background: Nowadays, noninvasive ventilation is the mainstay of the ventilation strategy in the neonatal intensive care units (NICUs) and most of infants, especially preterm infants, having respiratory problems, are provided noninvasive ventilation (NIV) upon their demands. Nevertheless, complication of NIV device-related pressure injury was common, the incidence of nasal injury ranged from 20% to 60%. Limited studies were found evaluating the nursing care of preterm infants receiving NIV. Aims: This study aimed to develop an evidence-based clinical practice guideline for preterm infants receiving NIV, implement the guideline in a NICU of a regional hospital, and evaluate infant outcomes including comfort, incidence of NIV device-related pressure injury. Besides, improvement on nurse's knowledge and practice for caring infants under NIV were assessed. Study Design and Methods: The Iowa Model-Revised was adopted as the theoretical framework to guide the study process. A multidisciplinary workgroup consists of eight stakeholders in NICU was formed for the process and acted as the champions for the new practice. A before and after study design was adopted and included the preimplementation and post-implementation phases. An integrative review was conducted to identify relevant studies from eight electronic databases before the study. All eligible studies were appraised using the Johns Hopkins University's evidence appraisal tool. Neonatal Pain, Agitation and Sedation Scale (N-PASS) for pain assessment and two self-developed NIV care bundle knowledge test and audit tool were used for the study. Results: Due to the COVID-19 pandemic in 2020, the study was extended for a month and ended in January 2021. A total of 74 infants in Pre-implementation phase (before group) and 67 infants in Post-implementation phase (after group) were recruited. Logistic regression model was used to compare the incidence of pressure injury between groups after adjusted for all substantial covariates in the study. Infants in after group had an 84% decreased odds of acquiring pressure injury (adjusted OR=0.149, 95% CI 0.045-0.495, p=0.002). Infant's comfort level whilst receiving NIV was not determined in the study as the after group having a significantly lesser mean time (p<0.001) in calm state but lower N-PASS score. Regarding nurse participants, 71 nurses received the training programme on NIV care bundle, and overall nurses' knowledge level improved immediately (adjusted p<0.001) and at 12 weeks after the programme. Three audits were conducted to evaluate nurses' practice, nurses' compliance rate to the care bundle significantly improved at 12 (p<0.001) and 24 weeks (p<0.001) in comparison with baseline compliance rate in the pre-implementation phase. However, nurses' knowledge retention at 12-week and compliance rate at 24-week after the training programme declined. Conclusion: The evidence-based clinical practice guideline aims to promote comfort and prevent injury in infants receiving NIV, and outcomes of the infants depend on vigilant nursing care and compliance to this clinical practice guideline. Declining of nurse's knowledge level and practice compliance found in the study indicates the needs of continuous education and audit on the practice to sustain the service quality and patient's safety.

SELECTION OF CITATIONS
SEARCH DETAIL