ABSTRACT
Timely, effective, and safe antiviral therapy in COVID-19 patients reduces complications, disability and mortality rates. The greatest concern with remdesivir is the risk of drug-induced liver injury, including in patients whose liver function is compromised by COVID-19. The aim of the study was to investigate the efficacy and safety of remdesivir in patients with confirmed SARSCoV-2 infection who had been admitted to an infectious diseases hospital in the Volgograd region in March 2022. Materials and methods: the authors carried out an open, non-randomised, single-arm study using medical records of 234 patients who had been diagnosed with "U07.1 COVID-19, virus identified” and prescribed remdesivir upon admission. The effectiveness of therapy was evaluated using two criteria: the need for oxygen supplementation or ventilatory support, or mortality. The authors conducted the evaluation on days 7, 14, and 28 using the six-point ordinal severity scale by Y. Wang et al. The safety of therapy was assessed on the basis of complaints and changes in laboratory findings. Results: for the patients prescribed remdesivir at admission, the 7-day mortality rate was 3.0%, the 14-day mortality rate was 5.6%, and the 28-day mortality rate was 7.3%. With the exception of a patient with myocardial infarction, all the patients who had been hospitalised with mild COVID-19 and prescribed remdesivir did not require oxygen therapy and/or transfer to intensive care and were discharged following recovery. The patients with moderate to severe COVID-19 had the 14-day mortality rate of 6.4% and the 28-day mortality rate of 8.6%. 17 patients (7.2%) discontinued remdesivir prematurely for various reasons, including adverse drug reactions. Remdesivir therapy of 5-10 days was associated with an increase in ALT activity by 2.7 ± 0.8 times in 15.9% of patients with mild COVID-19, by 3.8 ± 1.8 times in 20.4% of patients with moderately severe COVID-19, and by 4.8 ± 2.7 times in 24% (12/50) of patients with severe COVID-19. In two patients (0.9%), the increase exceeded 10-fold the upper limit of normal. Conclusions: the obtained results support recommending remdesivir to patients with mild, moderate and severe COVID-19, including those with moderately elevated baseline activity of hepatic transaminases.
ABSTRACT
Objective: Lung ultrasound is a point-of-care diagnostic work-up tool used extensively in emergency departments. The COVID-19 Lung Ultrasound in Emergency Department (CLUE) protocol has shown initial promise in aiding emergency clinicians to make rapid and appropriate bedside clinical decisions. Its primary objective is to assess the performance of the lung ultrasound scoring system (LUSS) in determining SARS-CoV-2 pneumonia severity so that the patients can be moved to their designated ICUs, wards, or facility quarantine center from the emergency department. Methods: A cross-sectional study was undertaken among adult patients with a confirmed diagnosis of SARS-CoV-2 infection who were admitted/referred to the All India Institute of Medical Sciences, Rishikesh, Uttarakhand. The data were descriptively analyzed using Graphpad Prism (vs. 9.2.0). Results: Out of 197 patients included in this study, 74.6% were men with a mean age of 45.3 ± 15.5 years. The men to women ratio was 2.9:1. The most frequent symptoms on presentation were fever (59.9% of cases), cough (54.3%), dyspnea (36%), and 16.2% of the patients were asymptomatic. The mean LUSS score of the patients with invasive support was 24.3 ± 4.5, as compared to 15.7 ± 5.9 in the non-invasive group. Overall, 64.4% patients did not require any respiratory support with a mean LUSS score of 2.3 ± 3.5. Out of 197 patients, 5 (2.5%) died during hospital stay. The mean LUSS score of survivors was 7.1 ± 8.2, as compared to 22.2 ± 4.3 of the deceased. Conclusion: The CLUE protocol can help in triaging the patients in the mild and moderate severity group and discharging them directly from the emergency department itself to either a facility quarantine center or to home isolation. It ultimately helps in avoiding unnecessary referrals, eliminating contamination, and optimum utilization of health resources.
ABSTRACT
Introduction: COVID-19 can lead to acute respiratory failure (ARF) requiring admission to intensive care unit (ICU). This study analyzes COVID-19 patients admitted to the ICU, according to the initial respiratory support. Its main aim is to determine if the use of combination therapy: high-flow oxygen system with nasal cannula (HFNC) and non-invasive ventilation (NIV), is effective and safe in the treatment of these patients. Methods: Retrospective observational study with a prospective database. All COVID-19 patients, admitted to the ICU, between March 11, 2020, and February 12, 2022, and who required HFNC, NIV, or endotracheal intubation with invasive mechanical ventilation (ETI-IMV) were analyzed. HFNC failure was defined as therapeutic escalation to NIV, and NIV failure as the need for ETI-IMV or death in the ICU. The management of patients with non-invasive respiratory support included the use of combined therapy with different devices. The study period included the first six waves of the pandemic in Spain. Results: 424 patients were analyzed, of whom 12 (2.8%) received HFNC, 397 (93.7%) NIV and 15 (3.5%) ETI-IMV as first respiratory support. PaO2/FiO2 was 145 ± 30, 119 ± 26 and 117 ± 29 mmHg, respectively (p = 0.003). HFNC failed in 11 patients (91.7%), who then received NIV. Of the 408 patients treated with NIV, 353 (86.5%) received combination therapy with HFNC. In patients treated with NIV, there were 114 failures (27.9%). Only the value of SAPS II index (p = 0.001) and PaO2/FiO2 (p < 0.001) differed between the six analyzed waves, being the most altered values in the 3rd and 6th waves. Hospital mortality was 18.7%, not differing between the different waves (p = 0.713). Conclusions: Severe COVID-19 ARF can be effectively and safely treated with NIV combined with HFNC. The clinical characteristics of the patients did not change between the different waves, only showing a slight increase in severity in the 3rd and 6th waves, with no difference in the outcome. © 2022 Elsevier Ltd
ABSTRACT
The COVID-19 (COronaVIrus Disease 2019) caused more than 3.5 million deaths all over the world. Patients who have underlying comorbidity, such as cardiovascular and pulmonary diseases have shown worse prognosis. In view of this, undivided attention was focused on patients with such rare conditions as pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). There is currently limited data available regarding COVID-19 infection in CTEPH patients. The available data are mostly case studies or small case series. The aim of this publication was to describe the course of COVID-19 in patients with previously diagnosed CTEPH. Methods. The study included 92 patients with an established diagnosis of CTEPH, who were managed in the Federal State Budgetary Institution National medical research center of cardiology named after academician E.I.Chazov, Ministry of Health of the Russian Federation. 62 patients with CTEPH and confirmed COVID-19 were enrolled, including 62% women. The mean age was 55.8 ± 14.8 years. Results. The duration of COVID-19 was 14 [10;30] days. The fever, general weakness, anosmia, and dyspnea were the most frequent presentations at diagnosis of COVID-19 in CTEPH patients. According to the multispiral computed tomography (CT) chest scans, more than half of the patients (54.2%) had mild disease (category CT-1). Most of the patients were under specific therapy (92%), mainly riociguat at an average daily dose of 5.75 ± 2.2 mg/day. All patients received anticoagulants. No need for long-term respiratory support and no lethal outcomes were registered in the study group. Conclusion. Small pilot studies demonstrated favorable clinical course of COVID-19 in CTEPH patients. This finding could be explained by the protective effect of anticoagulation and specific treatment.
ABSTRACT
Objective: To describe a case of SARS-CoV-19-associated encephalitis in a neonate. Method(s): Case report. Report: A 9-day-old term neonate presented with two focal motor seizures (right upper limb jerking and facial twitching). He had a 1-day history of coryzal illness with reduced feeding, but was afebrile. Antenatal course was uneventful. He was born at term via vaginal delivery. He did not require resuscitation or admission to SCBU. Maternal history was notable for symptomatic SARS-CoV-19 infection at time of delivery. Two siblings subsequently tested positive for SARS-CoV-19. He had further seizures in the emergency department and was loaded with phenobarbitone. The infant was stabilised locally and transferred to a tertiary paediatric hospital for the management of neonatal sepsis. He never required respiratory support. However, he was diffusely hypotonic with poor suck, necessitating nasogastric feeding. Nasopharyngeal PCR was positive for SARS-CoV-19. Lumbar puncture microscopy was negative (WCC 6). All CSF bacterial and viral investigations were negative. CSF testing of SARS-CoV-19 was not available. Brain MRI revealed bilateral asymmetric areas of reduced diffusivity involving the subcortical white matter, medulla and the corpus callosum with frontal lobe predominance. He made a full neurologic recovery with supportive therapies and was discharged following a 9-day admission. He had no further clinical seizures and phenobarbitone was successfully weaned pre-discharge. Conclusion(s): In the absence of another aetiology or antenatal risk factor, SARS-CoV-19 infection was presumed causative in this case of focal seizures and white matter changes in this term neonate. White matter abnormalities on MRI imaging are reported in neonates with seizures in the context of other viral infections. Single case reports have been published of SARS-CoV-19 infection with associated abnormal MRI brain findings, particularly diffusion abnormalities of the corpus callosum, as seen in our case.
ABSTRACT
Objective: To determine the effect of disease activity on the clinical outcome of SARS CoV 2 in patients with underlying rheumatic diseases. Method(s): This multicentric cross sectional study was performed under grant received from GRA/ILAR from 1st June 2021 till 31st December 2021. Online survey form was disseminated through platform of PSR to collect the data. Data included demographic details as well as underlying rheumatic and medications. Course of SARS CoV2 was noted for the patients as either (1) need for hospitalization, intensive care unit (ICU) admission;(2) need for respiratory support or (3) recovery or death. Data was analysed using SPSSv23. Result(s): A total of 100 patients fulfilling the inclusion criteria were enrolled. 78 (78%) were females with a mean age of 45.60 +/- 13.7 years. The clinical and demographic characteristics at baseline are as shown in Table 1. The most common rheumatic disorders were RA, SLE and AS seen in 52 (52%) 20 (20%) and 8 (8%) respectively. The mean duration of rheumatic disorders was 7.54 +/- 7.66 years. Common medications were NSAIDS and glucocorticoids (GC) each in 55 (55%) patients, HCQ in 42 (42%) and MTX in 48 (48%).Mean duration of COVID-19 symptoms was 16 +/- 12.7 days. Overall, 33 (33%) patients needed hospitalization;out of whom only 21 (21%) needed ICU care. Mean duration of hospital stay was 10.69 +/- 11.6 days. Complaint of dyspnea predicted the hospitalization. There was no association between ongoing rheumatic disease treatment and need for hospitalization. Similarly, disease activity status of RA, SLE and AS had no association with hospitalization, need for invasive ventilation or mortality. Conclusion(s): In patients with underlying rheumatic disorders, more than two thirds survived the SARs-CoV 2 infection. Rheumatic disease activity and medications had no impact on patient outcomes. (Table Presented).
ABSTRACT
Background/Purpose: MIS-C is uncommon and yet potentially life threatening disorder associated with COVID-19 infection. MIS-C Malaysia Study Group had reported 174 cases, mostly affecting children < 12 years old (93.7%). The fatality rate was 4%. Hereby, we report a case of MIS-C at our adult rheumatology centre. Method(s): Patient's admission note and electrical medical information were reviewed. Result(s): This is a 17 year-old adolescent with underlying obesity (BMI 42 kg/m2). He completed COVID-19 vaccination (Pfizer-BioNTech x 2 doses) in October 2021. In end-February 2022, he presented acutely with recurrent seizures associated with fever (40.3degreeC) and headache. The COVID-19 RTK antigen and PCR tests were positive, and COVID-19 IgM & IgG were negative. At emergency room, he developed haemodynamic instability, needing ventilatory support for respiratory failure and inotropic therapy on Day 1 of illness. The initial diagnosis was severe COVID-19 infection with encephalitis and secondary bacterial infection. Subsequent investigations showed evidence of systemic inflammation with organ dysfunction involving neurological (seizures, CNS vasculitis), cardiac (myocarditis), renal (acute kidney injury) and gastrointestinal (acute livery injury) systems. MIS-C was then diagnosed with early initiation of immunomodulatory treatment (IVIg 2 g/kg and IV methylprednisolone 1-2 mg/kg/day) according to ACR recommendation. Low dose aspirin and high intensity prophylactic SC enoxaparin were prescribed but were discontinued soon due to bleeding tendency. Antimicrobial therapy was continued until microbiological study was proven sterile. With the immunomodulatory treatment, he had rapid clinical and laboratory improvement within first week and was transferred out from ICU on Day 10 of illness. The organ dysfunction was mostly resolved with no sequelae except for high blood pressure requiring antihypertensive. Inflammatory markers were markedly reduced;Serum ferritin reduced from 22,339 to 565.8 mug/L, procalcitonin decreased from 26.7 ng/ml to 1.5 ng/ml and CRP normalised (<5 mg/L). Home discharge was made on Day 16 of illness with oral prednisolone 60 mg daily without antiplatelet. During clinic visit after D30 of illness, he remained asymptomatic with good effort tolerance and normal blood pressure readings. He subsequently completed the high school examination in April 2022 and even enrolled at college later. Oral prednisolone was eventually tapered off at 3rd month of illness with appointments for MRI cardiac and brain scheduled for further assessment. Conclusion(s): MIS-C is a hyperinflammatory syndrome which requires high clinical suspicion as many patients response well to early immunodulatory treatment without sequelae. Long term follow up maybe needed for those with cardiac involvement. (Table Presented).
ABSTRACT
Background: Covid-19 infection appeared as rapidly spreading cases of acute respiratory disease in Wuhan city of China that became pandemic. It was brought to the notice of WHO on December 31, 2019. Diabetes mellitus is one of the biggest health problems and fast growing emergencies of the 21st century. Diabetic patients with who got infected with Covid-19 have more chance of in hospital treatment need, intensive care unit care requirement, intubation and death. Objective(s): The objective of this study was to know the severity and mortality of covid-19 in patients with diabetes mellitus. Study Design: This was a descriptive case series study. Study Setting: It was done in the Covid-19 isolation and ICU unit of Ayub Teaching Hospital Abbottabad from May 2020 to October 2021. Method(s): Using non-probability consecutive sampling, 189 diabetic patients were enrolled. Sample included all covid-19 patients having diabetes that received indoor treatment during this period. All patients from both genders with age > 18 years were included. Patients with malignancy or on immunosuppressants for more than 1 month were excluded. Patients who were maintaining oxygen saturation at room air/facemask/nasal prongs were labelled as having non-severe disease while patient who needed CPAP or assisted ventilation were labelled as having severe covid-19 disease. All patients who died during admission were documented as covid-19 related mortality. Patients were labelled as diabetic who were known diabetic and taking diabetes treatment. Data was collected on a structured pro forma. Statistical program SPSS version 16.0 was used for the analysis of data. Result(s): In this study, mean age was 61.29 +/- 11.73 years. There were 40.2% male and 59.8% female patients. 86.2% patients were not-vaccinated, 3.7% patients were partially vaccinated and 10.1% patients were fully vaccinated. Hypertension was most common comorbidity (42.3%) and only CKD was significantly associated with increased mortality. 43.92%patients had non-severe illness while 56.08% patients had severe illness. The overall mortality of illness was 48.15% while it was 84.9% in patients with severe illness. Practical implication: These published publications provide a variety of various estimations and impact amounts due to the numerous different study designs and demographics. A comprehensive and methodical study is required because of the unpredictability of the situation. So that we conducted this study to assess the severity and mortality of covid-19 in patients with diabetes mellitus Conclusion(s): Our study concluded that severity and mortality of covid-19 was high in diabetic patients with high fasting & random sugar levels, pack smoking years and low oxygen saturation. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
ABSTRACT
Objective: Pneumonia is an important disease that causes sepsis in newborns and constitutes the majority of deaths due to infections, especially in developing countries. Pulse oximeters that are widely used in clinics, can determine heart rate, arterial oxygen saturation, additionally perfusion index (PI). In this study, the role of PI in determining the severity and prognosis of the disease in newborns with late-onset pneumonia (LOP);the relationship between PI and respiratory support need and Silverman Anderson Retraction Score (SAS) were aimed to determine. Material(s) and Method(s): In this prospective study, 30 term newborns diagnosed with late-onset pneumonia (LOP) were at the time of hospitalization,at the 24th hours of their treatment, and discharge;in the control group, PI measurements were made from the right upper extremity every 10 seconds for 3 minutes at the discharge of 30 term healthy newborns between December 2017 and June 2018. By comparing the data, it was aimed to determine the relationship of PI with the severity of the disease, prognosis, need for respiratory support and Silverman Anderson Retraction Score (SAS). Result(s): Their mean birth weights was 2000 - 4600 g the mean was 3570 g in the study, 2800 - 4100 g the mean was 3610 g in the control group and there was no significant difference (p>0.05);Gestational ages were 365/7 - 413/7, mean 392/7 in the study group, 373/7 - 405/7 in the control group, mean 396/7 weeks, and the statistical difference between the groups was not significant (p>0.05). The ratio of female/male was similar in the groups. Their median age was 9.5 days (3-27) in the control, 21 days (5-28) in the study group, and higher in the study group (p<0.05). The median capillary refill time was 1.7 seconds in the control, 1.6 seconds in the study group, and similar between the groups. The mean PI was 2.3+/-0.9 in the control group. In the study group, it was 3.6+/-1.2 on hospitalization, 3.2+/-1.2 on the first day, 3.4+/-0.7 at discharge. In the study group, PI values on hospitalization and first day were higher (p<0.05). There were reticular infiltration 50% bilateral, 30% right paracardiac, 10% left paracardiac, 3.3% right lower lobe. Alpha hemolytic streptococci in 1 (3.3%), Acinetobacter iwoffii in 1 (3.3%), Respiratory syncytial virus 6 (20%), Coronavirus 4 (13.3%), Rhinovirus 2 (6.7%) and Influenza A 1 (3.3%) patient were determined. We applied free flow oxygen 17 (56.7%), oxygen by hood 5 (16.7%), heated humidified high-flow nasal cannula 1 (3.3%), nasal continuous airway pressure 4 (13.3%), nasal intermittent positive pressure ventilation 4 (13.3%) cases. PI was higher in the patients needing positive pressure on admission (p<0.05). A positive correlation was found between SAS and PI on admission in the study group (p=0.008). The number of patients whose PI decreased during hospitalization increased over time. Conclusion(s): In the neonates with LOP, the severity of the disease, the need for respiratory support and prognosis cannot be predicted by PI. There was no relation between SAS and PI. It was concluded that more accurate results can be achieved by measuring PI using more patients, more sensitive probes and technically more advanced monitors. New studies should be conducted to determine the role of PI in demonstrating well-being and early detection of life-threatening conditions in the healthy newborns. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.
ABSTRACT
Studies reporting the clinical presentations of COVID-19 in children in sub-Saharan Africa are few, especially from resource-constrained countries. This case series reports the demographic and clinical characteristics and laboratory findings of confirmed cases of COVID-19 in children seen at a district hospital in Sierra Leone. This is a report of nine COVID-19 paediatric cases managed at a secondary level hospital in Kambia District, Northern Sierra Leone. Each child was detected by contact tracing after an infected adult was identified by the COVID-19 response team. The clinical symptoms at presentation, clinical courses, and treatments instituted and patient outcomes are discussed in the context of the facilities available at a typical West African district hospital. Nine out of 30 individuals with confirmed COVID-19 infection who presented to the hospital from 24 April to 20 September 2020 and who were admitted to the isolation center of the hospital were in the paediatric age group. The mean age (SD) and median (IQR) of the children were 69.0 +/- 51.7months and 84.0 (10.5, 108.0) months, respectively;five (55.6%) were males. The children were asymptomatic or only had mild illnesses and none required intranasal oxygen or ventilatory support. In the five symptomatic children, the most common symptoms were fever (40%) and cough (40%). All children had normal haemoglobin, platelet and white blood cell (WBC) count. Four children had a positive malaria test and were treated with a complete course of anti-malaria medications. No child received steroid or had specific anti-COVID-19 treatment. All children stayed in the isolation center for 14 days and were re-tested for COVID-19 two weeks after initial diagnosis. No complications have been reported in any of them since discharge. The proportion of children among COVID-19 infected cases seen in a rural community in Sierra Leone was 30%. Fever was the most common symptom and malaria was confirmed in 40% of the infected children. This has significant implication on the diagnosis of COVID-19 in malaria-endemic settings and on how best to manage children who present with fever during the COVID-19 pandemic. Copyright © Hammed Hassan Adetola et al.
ABSTRACT
Introduction: Sars-cov2 infection is commonly associated with acute kidney injury (AKI) which may be observed in up to 40% of cases. Pathogenesis of AKI during COVID-19 is yet not perfectly understood. Many risk factors have been proposed associated with AKI occurrence during COVID-19 infection. To date there is still limited data of AKI progression and long-term outcomes among these patients. We aim to describe risk factors for development of AKI and the progression of their renal function up to six months after hospital discharge. Methodology: This is a retrospective observational study in a tertiary car nephrology department in Barcelona, Spain. We evaluated data from 71 hospitalized patients with AKI occurrence during COVID-19 infection between 1st of March and 30th May 2020. Analysis of baseline characteristic, need of renal replacement therapy (RRT) and inflammatory parameters has been performed. Result(s): Of 71 patients (74,6% males;median age 71,9+/-11,15 years), 43 (60,6%) needed admission in the intensive care unit (ICU) for hemodynamic/respiratory support and 34 (47,9%) died during hospitalization. 13 (18,3%) needed RRT. 3 (23%) patients requiring RRT died during COVID-19 infection and 9 (69,2%) partially recovered renal function. Baseline serum creatinine of patients without RRT need during follow-up was 0,90+/-0,16 mg/dl with a peak serum creatinine 2,8+/-1,5 mg/dl. Patients that needed RRT support had a baseline serum creatinine 0,98+/-0,87 mg/dl and a peak serum creatinine of 4,34+/-3,35 mg/dl. Creatinine at discharge was of 1,5+/-0,59 mg/dl in the group of patients needing RRT and 1,2+/-0,52 mg/dl. At six months follow-up no significant differences were found in creatinine levels from discharge (p=0,65). Very poor correlation was observed between inflammatory parameters and serum creatinine peak levels (Dimer D levels and Serum creatinine peak R2=0,034;C reactive protein and creatinine peak levels R2=0,15 and Interleukin 6 and creatinine peak levels R2=0,042). Conclusion(s): COVID-19 infection is associated with AKI with and increased risk of chronic kidney disease after infection is resolved. No differences between renal function at discharge and at 6 months of follow-up was observed. No correlation between the studied inflammatory parameters and the worsening of renal function was observed.
ABSTRACT
BACKGROUND AND AIM: Following Covid-19 infection, children can develop an hyperinflammatory state termed Multisystem Inflammatory Syndrome in Children (MIS-C). Lung Ultrasound (LUS) features of COVID-19 in children have been described but data describing the LUS findings of MIS-C are limited. Aim of this retrospective observational study conducted between March, 1st, and December 31st, 2020, at a tertiary pediatric hospital in Milano, is to describe LUS patterns in patients with MIS-C and to verify correlation with illness severity. Secondary objective is to evaluate concordance of LUS with Chest X-Ray (CXR). METHOD(S): Clinical and laboratory data were collected for all patients (age 0-18 years) admitted with MIS-C, as well as LUS and CXR patterns at admission. PICU admission, need for respiratory support and inotrope administration, hospital and PICU length of stay were considered as outcomes and evaluated in the different LUS patterns. Agreement between LUS and CXR evaluation was assessed with Cohen' k. RESULT(S): 38 children were enrolled;24 had a LUS examination upon admission. LUS pattern of subpleural consolidations < or > 1 cm with or without pleural effusion were associated with worse Left Ventricular Ejection Fraction at admission and need for inotropes. Subpleural consolidations < 1 cm were also associated with PICU length of stay. Agreement of CXR with LUS for consolidations and effusion was slight. CONCLUSION(S): LUS pattern of subpleural consolidations and consolidations with or without pleural effusion are predictors of disease severity;under this aspect, LUS can be used at admission to stratify risk of severe disease.
ABSTRACT
BACKGROUND AND AIM: PIMS-TS is a multisystem inflammatory condition which has high morbidity requiring intensive care, most commonly due to the need for cardiovascular support. AIM: Review of patients managed on high dependency unit with PIMS-TS - who required inotropic support and their echocardiographic findings. METHOD(S): This is a retrospective analysis of the echocardiogram and inotropic support for all children admitted to HDU with a diagnosis of PIMS-TS, from October 2020-December 2021. RESULT(S): Thirty (10%) patients were admitted to HDU from the 300 patients diagnosed over the 15month period. Echocardiograms were performed on days 1, 3 and 7 to assess the coronaries and myocardial dysfunction. Echocardiogram was often performed when patients were already on inotropic support. Fifteen (50%) patients did not require any respiratory support. All patients required fluid resuscitation, between 20mls/kg to 70mls/kg. Ten (33%) out of thirty patients showed reduced fraction shortening on echocardiogram reflecting myocardial dysfunction. Patients with reduced myocardial function on echocardiogram required a median of 40mls/kg of resuscitation fluid, no difference when compared to other patients. Of those with myocardial dysfunction 50% patients required double inotropic agents rather than single agents. Two patients have coronary arteries ectasia - both patients only needed single agents. CONCLUSION(S): Patients with coronary ectasia or myocardial dysfunction did not require more support than patients with normal coronaries. Echocardiography findings provided reassurance when managing children requiring vasoactive therapy on HDU but ultimately clinician decision-making was a driver on management rather than echocardiographic findings.
ABSTRACT
BACKGROUND AND AIM: Since the outbreak of Covid-19 in december 2019, studies have been multiplied in all the health care sectors particularly neonatal and pediatric sphere. The purpose was to identify the clinical characteristics and outcome of pregnancies complicated by severe Covid-19 infection, as well as clinical features and short-term outcome of newborns. METHOD(S): This was a retrospective study of 10 10 newborns form mothers with a severe Covid-19 infection requiring hospitalization in intensive care during 2020 and 2021. RESULT(S): The middle age of these mothers was 31.2 years old. All women were not vaccinated against covid-19 and 10% were obese. ventilatory support is indicated (10cases) for an average period of 7.6 days with 60% recourse to mechanical ventilation. Circulatory failure was noted in 30% and cardiac failure in 20%. the death occurred in 5mothers. Premature delivery was indicated for a maternel rescue in 50% of cases. The adaptation to extrauterine life was bad in 10%. Neonatal resuscitation was necessary for 30% of newborns. All newborns were eutrophic. They presented a neonatal respiratory syndrom in 60% of cases. A covid 19 PCR testing was performed in the age of 5days and then 7days for 20 % of these newborns returning negative. The evolution of infants was favorable. CONCLUSION(S): The covid 19 infection has a significant impact on the progressive profile of mothers with severe forms, but there is no particular neonatal involvement outside of the induced prematurities.
ABSTRACT
BACKGROUND AND AIM: Evidence for therapies for pediatric COVID-19 is limited. Primary aim was to study the effect of steroid administration within 2 days of admission for pediatric non-MIS-C-COVID-19 on hospital and ICU length of stay (LOS). The secondary aim was to study its effect on inflammation and fever defervescence. METHOD(S): A retrospective study of 1163 children hospitalized with non-MISC-COVID-19, from 03/20 to 09/21, from 58 hospitals (7 countries, 92% US), in the Viral Infection and Respiratory Illness Universal Study (VIRUS) registry. Effect of steroid administration <= 2 days of admission on hospital and ICU LOS was studied using intention to treat analysis, adjusted for confounders by multivariable mixed linear regression. RESULT(S): Median age was 7(IQR 0.9,14.3) years. 184(15.8%) children who received steroids within <= 2 days were compared to 979 (84.1%) children who did not. 56.5% (n=658) required respiratory support. Patients in the steroid group were older, with higher severity of illness. A greater proportion required respiratory and vasoactive support. On multivariable linear regression with random intercept for site (Table), there was no significant difference in hospital LOS (exponentiated [exp] co-efficient 0.92, 95%CI = 0.77, 1.10, p=0.374) or ICU LOS (exp co-efficient 1.02, 95%CI = 0.78, 1.34, p=0.864) between the groups. There was no significant difference in time to fever defervescence and normalization of inflammatory mediators by Day 3. CONCLUSION(S): In pediatric non-MIS-C COVID-19, steroid treatment <= 2 days of hospital admission did not show a statistically significant effect on hospital or ICU LOS. (Table Presented).
ABSTRACT
BACKGROUND AND AIM: Multisystem inflammatory syndrome in children (MIS-C) has been associated with SARS-CoV-2 infection in pediatric population treated at Pediatric Intensive Care Unit (PICU). To compare patients with pediatric acute respiratory distress syndrome (PARDS) with those who also presented a diagnosis of MIS-C. METHOD(S): Retrospective cohort study with 167 patients admitted to the PICU Covid-19 at Baca Ortiz Pediatric Hospital (BOPH) located in Quito, Ecuador from June 2020 - June 2021, who developed PARDS with or without MIS-C. We performed a logistic regression analysis to calculated Odds Ratios (OR) with 95% CI. RESULT(S): Of the 167 patients, PCR test was positive in 20.1%. 58.7% of the study population developed MIS-C. This was associated with respiratory bacterial coinfection (OR: 3.63 [95% CI: 1.81-7.29]), circulatory support (OR: 38.8 [11.2-134.6]), acute renal failure (OR: 6.09 [2.4-15.5]), septic shock (OR: 89.9 [28.5-283.9]), coronary dilatation (OR: 3.79 [1.45-9.8]);multi-organ failure (OR: 44.9 [5.99- 337.3]), death (OR: 14.5 [4.27-49.5]). Further, a severe inflammatory state and high risk of sepsis were present as shown by an elevated D-dimer (OR: 6.53 [2.06-20.7]);total CPK (6.96 [3.5-13.9]);and procalcitonin (OR: 10.5 [5.06- 21.8]). Treatment in the MIS-C group included antibiotics (100%), corticoids (79.5%), immunoglobulin (IV) (86.4%), and ventilatory support (11.5 +/- 12.6 days). CONCLUSION(S): The MIS-C associated with Covid-19 produced a more severe condition, as a result of a dysregulated inflammatory state;which resulted in failure of various organ systems and high mortality in the PICU. This was evidenced by the clinical and analytical profile and the treatments used.
ABSTRACT
BACKGROUND AND AIM: Bronchiolitis is the most common lower respiratory illness in young children, mostly caused by Respiratory Syncitial Virus (RSV);PICU admission for respiratory support is required in some cases. The recent Covid-19 pandemic has altered dynamics of viral transmission in the community. We aim to describe if there has been a modification in the number and characteristics of patients admitted to Italian PICUs between the pre-pandemic and post-pandemic period. METHOD(S): Multicenter retrospective observational study based on the national electronic web-based national registry of the Italian Network of PICU Study Group (TIPNet). PICU admissions due to bronchiolitis were compared from 2017 to 2022, considering the seasonal peak periods (October, 1st to April, 30th). RESULT(S): 918 patients have been admitted due to bronchiolitis to Italian PICUs in the above mentioned years. Cumulative yearly admissions are reported in Figure 1. The winter season of 2020-2021 reported a significantly lower number of admissions. RSV was consistently the reported cause in most cases throughout the years except in season 2020-2021, when it was never reported. In the 2020-2021 season, enterovirus was reported in 23% of cases. Covid-19 as cause of bronchiolitis was reported in one case in 2020- 21 and 2 cases in 2021-22. CONCLUSION(S): Covid-19 pandemic, due to possibly multiple factors, has changed the panorama of PICU admissions due to bronchiolitis in Italy. Although research is still ongoing, it seems that Covid itself is not a cause of severe bronchiolitis requiring respiratory support. (Figure Presented).
ABSTRACT
BACKGROUND AND AIM: Alder Hey is a tertiary children's hospital in North-West England. Patients who require respiratory support in the form of non-invasive ventilation (NIV) are managed in the High Dependency Unit (HDU) jointly by the lead subspecialist teams and critical care service. Escalation and weaning strategies varied significantly between consultants. To provide consistent practice, a protocol was implemented with agreement from all the stakeholders and used from March 2020. AIMS: To evaluate the impact of using an agreed protocol on (1) ventilation days and (2) length of stay (LOS) in HDU. METHOD(S): A year's baseline data (March 2019-February 2020) was compared with the implementation year (March 2020-February 2021). Patients who deteriorated requiring invasive ventilation and those who progressed to long term ventilation were excluded. RESULT(S): In the pre-intervention year, 115 patients received 963 ventilation days over 1203 HDU days, with a mean of 8.4 ventilation days [IQR 5-9] and LOS of 10.5 days per patient. In the post-intervention year, 63 patients received 261 ventilation days over 667 HDU days, with a mean of 4.1 ventilation days [IQR 3-6] and LOS of 10.6 days per patient. CONCLUSION(S): COVID-19 lockdown restrictions almost halved the number of patients requiring NIV (63 vs 115), with reduced admissions across all specialties. Despite this, we demonstrated that unifying the management of NIV halved the ventilation days (4.1 vs 8.4) however, this reduction was not translated to a reduced length of stay on HDU.
ABSTRACT
INTRODUCTION: Awake prone positioning has been broadly utilised for non-intubated patients with COVID-19- related acute hypoxemic respiratory failure but the results from randomised controlled trials (RCTs) are inconsistent. Hence, we aimed to perform an updated meta-analysis to assess the efficacy and safety of awake prone positioning and identify the subpopulations which are likely to benefit the most. METHOD(S): We followed the PRISMA guidelines and an a priori protocol (PROSPERO CRD42022342426) to conduct our study. An electronic search was carried out on several databases including PubMed, Embase and ClinicalTrials.gov from inception to June 2022. We included only RCTs comparing awake prone position (intervention) with the supine positioning or standard of care with no prone positioning (control). Our primary outcomes were risk of intubation and all-cause mortality. Secondary outcomes included the need for escalating respiratory support, length of ICU and hospital stay, ventilation-free days and adverse events. RevMan 5.4 was used to conduct meta-analyses using a random-effects model. Risk ratios (RRs) and mean differences (MDs) were used as effect measures. RESULT(S): Eleven RCTs were included in our study with a cumulative sample size of 2385 patients. Our meta-analysis showed that awake prone positioning reduced the risk of intubation in the overall population (RR 0.84, 95% CI: 0.74- 0.95). In subgroup analyses, a greater benefit was observed among patients who received advanced respiratory support (i.e., high-flow nasal cannula or nasal intermittent positive pressure ventilation at enrolment) compared with patients receiving conventional oxygen therapy and in intensive care unit (ICU) settings compared with non-ICU settings. Awake prone positioning did not decrease the risk of mortality (RR 0.94, 95% CI: 0.78-1.12) and had no effect on any of the secondary outcomes. CONCLUSION(S): This meta-analysis demonstrated that in patients with COVID-19-related acute hypoxemic respiratory failure, awake prone positioning reduced the risk of intubation, particularly in those patients requiring advanced respiratory support and in those enrolled in the ICU setting but did not decrease the risk of death.
ABSTRACT
INTRODUCTION: High dose corticosteroids decrease ventilator free days in mechanically ventilated COVID-19 patients, however there is limited data on the benefit of higher doses in patients receiving non-invasive positive pressure ventilation. The purpose of this study was to compare high versus low dose corticosteroids' impact on ventilator free days for COVID-19 patients who received continuous noninvasive positive pressure respiratory support. METHOD(S): This retrospective study included COVID-19 positive patients diagnosed within 14 days of hospital admission, aged 18 years or older, and those who received at least 48 hours of corticosteroids while on continuous noninvasive positive pressure ventilation. Patients were excluded if they were pregnant, had active malignancy, transferred from an on outside facility, used oral corticosteroids within 10 days of hospitalization, and those who died or had comfort care orders placed within 24 hours of admission. The primary objective of this study compared ventilator free days between high dose (dexamethasone 20 mg or methylprednisolone >= 120 mg per day) and low dose (dexamethasone 6 mg per day) corticosteroids for patients who received continuous noninvasive positive pressure ventilation. Secondary objectives compared mortality, intensive care unit (ICU) length of stay, and hyperglycemia rates between groups. RESULT(S): A total of 72 patients were included in this study with 36 patients in each group. There was a statistically significant difference of 3 ventilator free days between the high and low dose corticosteroid groups (median [IQR], 12 days [8-16] vs 9 days [7-12], p=0.047). No difference was found between groups for ICU length of stay or inpatient mortality. There was an increased incidence of hyperglycemia in the high dose group compared to the low dose group (n [%], 32 patients [89] vs 24 patients [67], p=0.023). CONCLUSION(S): Initiating high dose corticosteroids for COVID-19 patients on non-invasive positive pressure ventilation is associated with an increase in ventilator-free days. The use of high dose corticosteroids in this patient population could help to delay or prevent intubation and the complications associated with mechanical ventilation. Future studies should evaluate duration of therapy and additional therapies for COVID-19 patients.