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1.
Nitric Oxide ; 2022.
Article in English | ScienceDirect | ID: covidwho-1821426

ABSTRACT

Inhaled nitric oxide (iNO) is a potent vasodilator approved for use in term and near-term neonates, but with broad off-label use in settings including acute respiratory distress syndrome (ARDS). As an inhaled therapy, iNO reaches well ventilated portions of the lung and selectively vasodilates the pulmonary vascular bed, with little systemic effect due to its rapid inactivation in the bloodstream. iNO is well documented to improve oxygenation in a variety of pathological conditions, but in ARDS, these transient improvements in oxygenation have not translated into meaningful clinical outcomes. In coronavirus disease 2019 (COVID-19) related ARDS, iNO has been proposed as a potential treatment due to a variety of mechanisms, including its vasodilatory effect, antiviral properties, as well as anti-thrombotic and anti-inflammatory actions. Presently however, no randomized controlled data are available evaluating iNO in COVID-19, and published data are largely derived from retrospective and cohort studies. It is therefore important to interpret these limited findings with caution, as many questions remain around factors such as patient selection, optimal dosing, timing of administration, duration of administration, and delivery method. Each of these factors may influence whether iNO is indeed an efficacious therapy - or not - in this context. As such, until randomized controlled trial data are available, use of iNO in the treatment of patients with COVID-19 related ARDS should be considered on an individual basis with sound clinical judgement from the attending physician.

2.
Annals of Internal Medicine ; 175(3):JC33, 2022.
Article in English | EMBASE | ID: covidwho-1818636
3.
Journal of Aerosol Medicine and Pulmonary Drug Delivery ; 35(2):A3, 2022.
Article in English | EMBASE | ID: covidwho-1815949

ABSTRACT

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the global pandemic of coronavirus disease 2019 (COVID-19), has afflicted more than 245 million people worldwide and caused more than 5 million deaths (1). COVID-19 primarily affects the respiratory tract and infected persons generate respiratory droplets and aerosols containing the virus that transmit the infection to susceptible hosts (2). Patients with COVID- 19 need inhaled therapies, either for pre-existing respiratory diseases or because of new onset respiratory distress and hypoxemia in patients with no previous pulmonary problems. Aerosolized therapies increase particle concentrations in the vicinity of patients receiving such treatments (3, 4). Inhalers (pMDIs, DPIs and SMIs) have a very low risk of contamination and the risk of spreading infection with those devices is largely due to ''bioaerosols'' generated by the patient during breathing, speaking, coughing or sneezing (2,5,6). In contrast, nebulizers, especially those that are operated continuously, release ''fugitive emissions'' that could remain in the indoor environment.

4.
Blood Purification ; 50(SUPPL 1):28, 2021.
Article in English | EMBASE | ID: covidwho-1816959

ABSTRACT

Background: SARS-CoV-2 is a highly pathogenic and transmissible coronavirus that primarily spreads through respiratory droplets and close contact. A cytokine storm is associated with COVID-19 severity and is also a crucial cause of death from COVID-19. This study aims to evaluate whether the early application of HA330 improves oxygenation, cytokine storm markers, and SOFA score in COVID-19 patients. Methods: Retrospective, interventional, open label study included a total of 52 patients, age > 18 yrs and < 75 yrs, with moderate and severe ARDS from covid-19 pneumonia requiring intubation or HFNC/NIV with high FiO2 requirements (>70%) and having cytokine storm. The patients divided into two groups, group A (HA330 group), n1 = 26 patients who received 3 sessions of HA330 hemoperfusion + regular standard of care, group B, n2 =26 patients who received regular standard of care. Results: The results showed a statistically significant difference (p <0.0001) between the groups, with progressively better oxygenation aiding in rapid decrease in fio2 requirement in the hemoperfusion group (group A). Comparison of mean of cytokine markers between the groups demonstrated significant decrease in the cytokine storm marked by a massive drop of pro-inflammatory markers in the HA330 group, with more significance from the second session of HA330 onwards. The results also showed significant difference in SOFA scores between the 2 groups, with high significance from day 3 onwards in the group A. However;secondary bacteremia, VAP, pulmonary embolism, pneumothorax, pneumomediastinum from the severe ARDS and stiff lung, caused delay in weaning from mechanical ventilator and thus did not decrease the lenth of ICU stay and all cause mortality. Conclusion: Early use of HA330 showed a significant difference from the regular standard of care to combat life threatening and refractory hypoxemia, profound cytokine storm, MODS and preventing from initiating costly and cumbersome therapies like ecmo and saving ICU costs significantly. It can be thus extrapolated to bacterial and viral ards and sepsis with proinflammatory surge and MODS to help protect from rapid clinical decline. .

5.
Lung India ; 39(3):247-253, 2022.
Article in English | ProQuest Central | ID: covidwho-1810866

ABSTRACT

Background: Hypoxia in patients with COVID-19 is one of the strongest predictors of mortality. Silent hypoxia is characterised by the presence of hypoxia without dyspnoea. Silent hypoxia has been shown to affect the outcome in previous studies. Methods: This was a retrospective study of a cohort of patients with SARS-CoV-2 infection who were hypoxic at presentation. Clinical, laboratory and treatment parameters in patients with silent hypoxia and dyspnoeic hypoxia were compared. Multivariate logistic regression models were fitted to identify the factors predicting mortality. Results: Among 2080 patients with COVID-19 admitted to our hospital, 811 patients were hypoxic with SpO2 <94% at the time of presentation. Among them, 174 (21.45%) did not have dyspnoea since the onset of COVID-19 symptoms. Further, 5.2% of patients were completely asymptomatic for COVID-19 and were found to be hypoxic only on pulse oximetry. The case fatality rate in patients with silent hypoxia was 45.4% as compared to 40.03% in dyspnoeic hypoxic patients (P = 0.202). The odds ratio of death was 1.1 (95% CI: 0.41–2.97) in the patients with silent hypoxia after adjusting for baseline characteristics, laboratory parameters, treatment and in-hospital complications, which did not reach statistical significance (P = 0.851). Conclusion: Silent hypoxia may be the only presenting feature of COVID-19. As the case fatality rate is comparable between silent and dyspnoeic hypoxia, it should be recognised early and treated as aggressively. Because home isolation is recommended in patients with COVID-19, it is essential to use pulse oximetry in the home setting to identify these patients.

6.
Current Treatment Options in Cardiovascular Medicine ; 2022.
Article in English | EMBASE | ID: covidwho-1800310

ABSTRACT

Purpose of Review: A significant proportion of patients infected by the severe acute respiratory syndrome-coronavirus (SARS-CoV2) (COVID-19) also have disorders affecting the cardiac rhythm. In this review, we provide an in-depth review of the pathophysiological mechanisms underlying the associated arrhythmic complications of COVID-19 infection and provide pragmatic, evidence-based recommendations for the clinical management of these conditions. Recent Findings: Arrhythmic manifestations of COVID-19 include atrial arrhythmias such as atrial fibrillation or atrial flutter, sinus node dysfunction, atrioventricular conduction abnormalities, ventricular tachyarrhythmias, sudden cardiac arrest, and cardiovascular dysautonomias including the so-called long COVID syndrome. Various pathophysiological mechanisms have been implicated, such as direct viral invasion, hypoxemia, local and systemic inflammation, changes in ion channel physiology, immune activation, and autonomic dysregulation. The development of atrial or ventricular arrhythmias in hospitalized COVID-19 patients has been shown to portend a higher risk of in-hospital death. Summary: Arrhythmic complications from acute COVID-19 infection are commonly encountered in clinical practice, and COVID-19 patients with cardiac complications tend to have worse clinical outcomes than those without. Management of these arrhythmias should be based on published evidence-based guidelines, with special consideration of the acuity of COVID-19 infection, concomitant use of antimicrobial and anti-inflammatory drugs, and the transient nature of some rhythm disorders. Some manifestations, such as the long COVID syndrome, may lead to residual symptoms several months after acute infection. As the pandemic evolves with the discovery of new SARS-CoV2 variants, development and use of newer anti-viral and immuno-modulator drugs, and the increasing adoption of vaccination, clinicians must remain vigilant for other arrhythmic manifestations that may occur in association with this novel but potentially deadly disease.

7.
Crit Care Explor ; 2(5): e0127, 2020 May.
Article in English | MEDLINE | ID: covidwho-1795103

ABSTRACT

SETTING: The coronavirus disease 2019 pandemic has raised fear throughout the nation. Current news and social media predictions of ventilator, medication, and personnel shortages are rampant. PATIENTS: Patients with coronavirus disease 2019 are presenting with early respiratory distress and hypoxemia, but not hypercapnia. INTERVENTIONS: Patients who maintain adequate alveolar ventilation, normocapnia, and adequate oxygenation may avoid the need for tracheal intubation. Facemask continuous positive airway pressure has been used to treat patients with respiratory distress for decades, including those with severe acute respiratory syndrome. Of importance, protocols were successful in protecting caregivers from contracting the virus, obviating the need for tracheal intubation just to limit the spread of potentially infectious particles. CONCLUSIONS: During a pandemic, with limited resources, we should provide the safest and most effective care, while protecting caregivers. Continuous positive airway pressure titrated to an effective level and applied early with a facemask may spare ventilator usage. Allowing spontaneous ventilation will decrease the need for sedative and paralytic drugs and may decrease the need for highly skilled nurses and respiratory therapists. These goals can be accomplished with devices that are readily available and easier to obtain than mechanical ventilators, which then can be reserved for the sickest patients.

8.
J Investig Med High Impact Case Rep ; 10: 23247096221090843, 2022.
Article in English | MEDLINE | ID: covidwho-1794049

ABSTRACT

Covid 19 positive patients requiring oxygen therapy to maintain saturations above 90% were given a trial of oral prednisolone between 15 and 30 mg until they were weaned to room air maintaining saturations >95%. This treatment resulted in the rapid resolution of worsening respiratory function of 4 Covid 19 positive patients within the High Dependency unit in a tertiary medical center. The cases are from the "first wave" in Trinidad, March 2020. The signs and symptoms of respiratory failure resolved after 72 hours of prednisolone treatment and none of these patients were escalated to non-invasive or invasive respiratory support. The patients were kept for a further 48 hours after the steroids were discontinued to monitor for relapse of symptoms, all patients were discharged home after quarantine. The initiation of a prednisolone steroid trial must be considered in Covid 19 positive patients needing supplementary oxygen therapy or developing worsening shortness of breath. Early Covid respiratory failure responds to a low dose for a short duration and prevents escalation to non-invasive/invasive respiratory support.

9.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793904

ABSTRACT

Introduction: Invasive ventilation initiation after a prolonged period of non-invasive ventilation (NIV) trial can be associated with poor outcome in coronavirus disease 2019 (COVID-19) ARDS patients. This study aimed to document our center's experience with COVID-19 ARDS patients treated with veno-venous ECMO (VVECMO) after a prolonged NIV trial period to avoid intubation. We speculated that VV-ECMO support is not associated with a worse outcome than invasive ventilation in these patients. Methods: We retrospectively reviewed 6 patients with COVID-19 ARDS who presented severe hypoxemia and pneumomediastinum after NIV (ECMO group). Twenty patients with COVID - 19 and age less than 70 years old were treated in the first wave of the national outbreak and underwent NIV trials for more than 24 h before intubation (Control group). The primary outcome was intensive care unit (ICU) survival and secondary ECMO or mechanical ventilation weaning at 28 days. Results: The age of the patients in the ECMO group was 59 years (IQR: 46 - 65) and SAPS II score 47 (IQR: 46 - 52), compared to 60 years (IQR: 51 - 66) (p = 0.71) and 48 (IQR: 45 - 54) (p = 0.63) in the control group. NIV duration before ECMO or invasive ventilation initiation was 5 days (IQR: 2 - 8) and 3 days (IQR: 1 - 5), respectively (p = 0.13). Drainage multistage femoral cannula 25 F and internal jugular infusion cannula 21 F were placed percutaneously. After cannulation, the patients received light sedation that permitted communication, active physiotherapy and oral feeding. None of the patients in the ECMO group died within 28 days after ECMO initiation (Fig. 1, Panel A) or received invasive ventilation. VV-ECMO was not associated with longer mechanical support than invasive ventilation (HR: 1.26 95%CI: 0.24 - 6.55, p = 0.77) (Fig. 1, Panel B). Conclusions: VV-ECMO can be a not inferior strategy to invasive ventilation for treating patients with COVID-19 ARDS and severe hypoxemia not responding to long trials of NIV. (Table Presented).

10.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793899

ABSTRACT

Introduction: Emergency intubation of COVID-19 patients is a highrisk procedure and a challenge to intensivists [1,2]. The aim was to determine major adverse events related to tracheal intubation in COVID-19 patients: severe hypoxemia, hemodynamic instability and cardiac arrest. Methods: This is a prospective, observational, dual-center study of COVID-19 patients undergoing advanced airway management for respiratory failure and admitted in ICU from November 2020 to May 2021. We reported data about demographics, comorbidities and parameters related to the intubation and expertise. Within 30 min from the intubation, we recorded the occurrence of severe hypoxia, cardiac arrest, hemodynamic instability. We collected data about difficult airways, the need of front of neck airways position, death within 30 min from the intubation, arrhythmia, esophageal intubation, pneumomediastinum and pneumothorax recognized within 6 h from the intubation. Results: Within 142 patients considered for our analysis, 73.94% experienced at least 1 major adverse peri-intubation event. The predominant event was cardiovascular instability in 65.49% of patients, followed by severe hypoxemia (43.54%) and cardiac arrest (2.82%). First-pass success was achieved for 90.84% of patients. The rate of major adverse events was significantly lower with first-pass intubation success than for 2 attempts. No difference was found in ICU LOS between patients with a major adverse periintubation event and patients without events. Conclusions: In this observational study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were observed frequently.

11.
Cureus J Med Sci ; 14(3):10, 2022.
Article in English | Web of Science | ID: covidwho-1791865

ABSTRACT

Background Point-of-care ultrasound (POCUS) is an indispensable tool in emergency medicine. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a need for improved diagnostic capabilities and prognostic indicators for patients who are symptomatic for COVID-19 has become apparent. POCUS has been demonstrated to be a useful diagnostic and prognostic tool in the emergency department (EI)) in assessing other lung complications. Still, limited data regarding its utility in assessing COVID-19 are available. This study sought to evaluate whether POCUS findings in the ED were correlated with vital signs or laboratory abnormalities typically seen among patients with COVID-19. Methods A retrospective study was conducted that included 39 patients who presented with COVID-19 and systemic inflammatory response syndrome (SIRS) to a large, urban tertiary care ED. The study population was limited to adults aged 18 and above who came to the ED with the primary complaint of respiratory symptoms, met SIRS criteria on admission, and had images of at least one anterior and one posterior intercostal space per lung and a minimum of four intercostal spaces. POCUS images were obtained by trained operators in the ED using portable ultrasound machines, recorded in an image database, and reviewed by ultrasound fellowship-trained emergency physicians. Clinical data (e.g., acute phase reactants and vital signs) were obtained through a chart review of patients' electronic medical records. Results Both the percentage of intercostal spaces with B-lines and the percentage of merging B-lines were correlated with decreased oxygen saturation on presentation. No other statistically significant correlations were observed between these sonographic findings and other vital signs or acute phase reactants, nor between these clinical data and the percentage of intercostal spaces that were positive for the shred sign. Conclusions With the emergence of the COVID-19 pandemic, emergency medicine physicians are on the frontline of identifying and caring for patients affected by the virus. This study found that sonographic findings associated with interstitial pneumonitis, notably merging B-lines, and the overall percentage of intercostal spaces with B-lines, were clearly associated with worsening oxygen saturation, now thought to be one of the driving causes of morbidity and mortality in COVID-19. As ultrasound has become a ubiquitous and indispensable tool in the ED, this study demonstrated its utility in assessing and managing patients with COVID-19. Bedside ultrasound is a cheap, fast, and non-invasive tool that healthcare providers can use as an essential adjunct in addition to laboratory markers and other imaging modalities for the diagnosis and prognosis of COVID-19.

12.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793884

ABSTRACT

Introduction: Airway management and intubation are challenging in the ICU especially for COVID-19 patients with severe hypoxemia. Although recommended for COVID-19 patients, because of their capacity to reduce transmission to healthcare providers, there is no evidence that video laryngoscopes improve airway management and reduce time for intubation. The purpose of this study was to compare the McGRATH video laryngoscope and the Direct Laryngoscope (DL) in COVID-19 ICU patients with acute respiratory failure. Methods: Forty patients meeting tracheal intubation criteria for respiratory failure were enrolled and equally randomized into 2 groups according to the used device: McGRATH Group and DL group. All patients had pre oxygenation with noninvasive ventilation withFiO2 = 1, Pep and pressure support levels were set to achieve a tidal volume of 6 ml/kg of ideal body weight. Demographic data, difficult intubation criteria were recorded. Our primary outcome was time to intubation defined as the time from the introduction of the blade in patient's mouth until the first efficient breath delivered. Secondary outcomes were the lowest SpO2 recorded during the procedure, the drop in SpO2, the number of attempts, the use of alternative methods for intubation and the experience of the operators. Results: The 2 groups were comparable concerning demographic data, BMI and difficult intubation criteria (p = 0.091). Time to intubation was shorter in the McGRATH group with no significant difference (p = 0.597). The Delta SpO2 and the lowest SpO2 were similar (p = 0.546 and 0.458 respectively). No difference was noticed concerning the number of attempts (p = 0.378), the use of alternative methods (p = 0.276) and the operator's skills (p = 0.076). Conclusions: These results show that the DL is as effective as the recommended McGRATH video laryngoscope for intubation in COVID patients with severe hypoxemia.

13.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793881

ABSTRACT

Introduction: Critically ill patients with coronavirus disease 2019 (COVID-19) may present severe tissue perfusion abnormalities. The mixed venous-to-arterial carbon dioxide tension difference ( PvaCO2) is an easily derived parameter identifying insufficient tissue perfusion. The purpose of this study was to evaluate the clinical relevance of high values of PvaCO2 in COVID - 19 patients early after their admission to intensive care unit (ICU). We speculated that high PvaCO2 values might be associated with poor outcome in critically ill COVID-19 patients. Methods: This was a retrospective study conducted in two independent centers of Belgium. We included patients treated in the first wave of the national outbreak with available PvaCO2 within 3 days of admission and without severe hypercapnia ( PCO2 > 75 mmHg). The highest value was registered. Normal values were considered ≤ 6 mmHg, moderate elevations 7 - 9 mmHg, and high elevations > 9 mmHg. The primary outcome was ICU discharge alive and secondary outcome mortality at 28 days. Results: Seventy-three patients were included with median age of 60 years (IQR: 52 to 68), and simplified acute physiology score II (SAPS II) 26.1 (IQR: 19.8 to 29.5). Fifty-three (76%) patients needed invasive ventilation within 24 h after ICU admission (12 h (IQR: 12 to 24). The worst ratio of partial pressure arterial oxygen to the fraction of inspired oxygen ( PaO2/FiO2) within 3 days after admission was 151 (IQR: 86 to 243) and PvaCO2 6 mmHg (IQR: 5 to 9). PvaCO2 > 9 mmHg was associated with longer ICU stay (ICU free days: 0 days (0 - 0) vs 1 day (0 - 18), p = 0.02), independently of PaO2/FiO2 and SAPS II score (HR: 0.21, 95% - CI: 0.05 - 0.92, p = 0.04) (Fig. 1, Panel A), but not to 28 days mortality (HR:1.71, 95% - CI: 0.48 - 5.91, p = 0.41) (Fig. 1, Panel B). Conclusions: In COVID-19 patients, high PvaCO2 values early after ICU admission are associated with prolonged ICU stay independently of hypoxemia and disease severity. (Figure Presented).

14.
Journal of Cardiovascular Disease Research ; 13(1):236-241, 2022.
Article in English | EMBASE | ID: covidwho-1791337

ABSTRACT

After the COVID 19 pandemic, wide varieties of clinical manifestations were identified globally. In addition to major pulmonary manifestations SARS-COV2 virus also causes neurological symptoms particularly anosmia and dysgeusia. In this review article we describe an unusual manifestation of COVID-19 in the form of erectile dysfunction. Apparently healthy young man with COVID 19 presented with erectile dysfunction and asymptomatic hypoxemia. Early diagnosis and treatment of happy hypoxemia and erectile dysfunction in COVID19 patients is deemed necessary for better management and outcome.

15.
American Journal of Obstetrics and Gynecology ; 226(1):S36-S37, 2022.
Article in English | EMBASE | ID: covidwho-1757065

ABSTRACT

Objective: The impact of maternal COVID-19 infection on fetal health remains to be determined. Using targeted metabolomic analysis of newborn umbilical cord blood, we aimed to evaluate the biological consequences of maternal infection on the fetus and develop metabolite biomarkers for the identification of newborn intrauterine exposure. Study Design: Cord blood serum samples from 23 COVID-19 cases (mother infected/ newborn negative) and 23 gestational age-matched controls were analyzed using nuclear magnetic spectroscopy and direct injection liquid chromatography mass spectrometry-mass spectrometry. Logistic regression models were developed using metabolites to predict intrauterine exposure with Area under the Receiver Operating Characteristics curve [AUC (95% CI)], sensitivity, and specificity. Metabolite set enrichment analysis was used to evaluate altered biochemical pathways to highlight biological mechanisms of COVID-19 intrauterine exposure. Results: There were no significant differences in gestational age at delivery between groups (p >0.05). All neonates tested negative for COVID-19 infection. Significant concentration differences (p-value < 0.05 or -log10=1.301) were observed in 19 metabolites between groups. The top metabolite model [cortisol and Ceramide (d18:1/20:0)] achieved an AUC (95% CI) = 0.839 (0.722 - 0.956) with a sensitivity of 91% and specificity of 69% (Table 1). Enrichment analysis revealed significantly (p< 0.05) altered metabolic pathway of steroidogenesis and gluconeogenesis (Figure 1). Cortisol is the stress hormone that increases glucose production through gluconeogenesis resulting in higher oxidative metabolism and energy generation. Ceramides are known to have anti-inflammatory properties. Elevated hypoxanthine has also been correlated with tissue hypoxia and inflammation. Conclusion: We found evidence of intrauterine stress, altered energy metabolism and inflammation in fetal life in cases of maternal COVID-19 infection but ultimately negative newborn culture. Elucidation of long-term consequences is imperative considering the large number of exposures in the population. [Formula presented] [Formula presented]

16.
J Appl Physiol (1985) ; 132(4): 1104-1113, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1759485

ABSTRACT

The common pulmonary consequence of SARS-CoV-2 infection is pneumonia, but vascular clot may also contribute to COVID pathogenesis. Imaging and hemodynamic approaches to identifying diffuse pulmonary vascular obstruction (PVO) in COVID (or acute lung injury generally) are problematic particularly when pneumonia is widespread throughout the lung and hemodynamic consequences are buffered by pulmonary vascular recruitment and distention. Although stimulated by COVID-19, we propose a generally applicable bedside gas exchange approach to identifying PVO occurring alone or in combination with pneumonia, addressing both its theoretical and practical aspects. It is based on knowing that poorly (or non) ventilated regions, as occur in pneumonia, affect O2 more than CO2, whereas poorly (or non) perfused regions, as seen in PVO, affect CO2 more than O2. Exhaled O2 and CO2 concentrations at the mouth are measured over several ambient-air breaths, to determine mean alveolar Po2 and Pco2. A single arterial blood sample is taken over several of these breaths for arterial Po2 and Pco2. The resulting alveolar-arterial Po2 and Pco2 differences (AaPo2, aAPco2) are converted to corresponding physiological shunt and deadspace values using the Riley and Cournand 3-compartment model. For example, a 30% shunt (from pneumonia) with no alveolar deadspace produces an AaPO2 of almost 50 torr, but an aAPco2 of only 3 torr. In contrast, a 30% alveolar deadspace (from PVO) without shunt leads to an AaPO2 of only 12 torr, but an aAPco2 of 9 torr. This approach can identify and quantify physiological shunt and deadspace when present singly or in combination.NEW & NOTEWORTHY Identifying pulmonary vascular obstruction in the presence of pneumonia (e.g., in COVID-19) is difficult. We present here conversion of bedside measurements of arterial and alveolar Po2 and Pco2 into values for shunt and deadspace-when both coexist-using Riley and Cournand's 3-compartment gas exchange model. Deadspace values higher than expected from shunt alone indicate high ventilation/perfusion ratio areas likely reflecting (micro)vascular obstruction.

17.
Pakistan Journal of Medical Sciences ; 38(4):816-821, 2022.
Article in English | Scopus | ID: covidwho-1753962

ABSTRACT

Objective: To determine the frequency of Acute Kidney Injury (AKI) and its underlying risk factors in patients with Coronavirus Disease (COVID-19). Methods: This retrospective study was conducted by reviewing the medical records of patients admitted in Covid-19 Intensive Care Unit (ICU) of Farooq Hospital, West Wood Branch, Lahore during the period from 1st April, 2020 to 30th June, 2020. COVID-19 was diagnosed on basis of Real Time Polymerase Chain Reaction (RT-PCR) through nasal swab. Demographic, clinical and laboratory data were collected at the time of admission in the hospital. AKI was diagnosed on basis of ≥ 0.3 mg/dl increase in serum Creatinine (sCr) from baseline during the hospital stay. The outcome of study was AKI. Results: One hundred and seventy-six patients who fulfilled the inclusion criteria were recruited of which most were males (78.4%). The mean age was 51.26 ± 15.20 years and the frequency of AKI was 51.1%. The risk factors for AKI were increasing age (OR=2.10, p=0.017);presence of COVID-19 symptoms (OR=6.62, p=0.004);prolonged hospital stay (OR=2.26, p=0.011);Diabetes Mellitus (OR=1.81, p=0.057);hypoxemia (OR=5.98, p=0.000);leukocytosis (OR=2.91, p=0.002);lymphopenia (OR=5.77, p=0.000);hypoalbuminemia (OR=4.94, p=0.000);elevated C-reactive protein (CRP) (OR=6.20, p=0.000) and raised D-diamers (OR=3.16, p=0.000). Conclusions: AKI was present in half of the COVID-19 patients. The most significant risk factors for AKI were increasing age, prolonged hospital stay, hypoxemia, hypoalbuminemia, DM and raised inflammatory markers. © 2022, Professional Medical Publications. All rights reserved.

18.
Open Forum Infectious Diseases ; 8(SUPPL 1):S350-S351, 2021.
Article in English | EMBASE | ID: covidwho-1746499

ABSTRACT

Background. Patients affected by COVID-19 pneumonia who present severe symptoms with manifest hypoxemia and cytokine storm have a high mortality rate, which is why therapies focused on reducing inflammation and improving lung function have been used, one of them being jakinibs through of the blocking of the JAK tracks. Methods. Patients who presented data of severe pneumonia due to COVID-19 with data of severe hypoxemia and cytokine storm were selected, from June to August 2020, to whom the SaO2/FiO2 ratio is measured at the beginning, intermediate and end of treatment, as well as D dimer and serum ferritin. Comorbidity and drugs taken previously are analyzed. The patients being cared for at home. Results. We included data from 30 patients, 8 (27%) women and 22 (73%) men, with a median age of 58.5 (46.5 - 68.0) years. 23 patients (77%) had comorbidities, the most frequent being arterial hypertension (43%), followed by obesity (30%), type 2 diabetes mellitus (27%), among others. In the laboratory, the medians of D-Dimer 982 ng/ mL, Ferritin 1,375 ng/mL and C-Reactive Protein 10.0 mg/dL. Regarding the use of previous medications, we found that 29 (97%) patients had treatment with some medication, the most frequent: azithromycin (77%), ivermectin (53%) and dexamethasone (47%). The median number of medications received was 3. The initial pulse oximetry (SaO2) measurement with room air had a median of 80.5% and the median SaO2/FiO2 (SAFI) was 134;Regarding the type of SIRA, 90% had moderate SIRA and 10% had severe SIRA. The median day of evolution on which baricitinib was started was 10 days, all received 4 mg/day, and the median days of treatment with baricitinib was 14.0 days. At follow-up, SaO2 at 7 days had a median of 93.0% and the median SAFI at 7 days was 310.0;the median SaO2 at 14 days was 95.0% and the median SAFI at 14 days was 452.0. In comparative analysis, baseline SaO2/SAFI was significantly lower compared to 7 and 14 days (p = 0.001 for both comparisons). The outcomes, 27 (90%) patients improved and there were 3 (10%) who died. Conclusion. Baricitinib therapy in these patients with severe COVID-19 pneumonia who present with severe hypoxemia and cytokine storm presented good results by improving clinical status and pulmonary failure, with patients being cared for at home and avoiding mechanical ventilation.

19.
Annals of Clinical Cardiology ; 3(2):85-88, 2021.
Article in English | EMBASE | ID: covidwho-1744818

ABSTRACT

Platypnea-Orthodeoxia syndrome (POS) is a rare condition in which dyspnoea and arterial oxygen desaturation are present in the upright position, while in the supine position, they are alleviated. It is observed in the presence of an anatomical (intra-or extracardiac) communication between the right and left heart causing a right-to-left shunt. POS is most frequently caused by a patent foramen ovale (PFO) and usually, the clinical assessment and a transthoracic echocardiograms with bubble study are enough to reach the diagnosis. The only possible treatment of POS is the percutaneous closure of the defect. We describe two cases of POS due to a PFO which manifested itself years after an episode of acute pulmonary embolism (PE), a finding never reported to date in the literature. Few cases describe the relationship between PE and POS, but these conditions may be more closely related than we currently think.

20.
Respiratory Care ; 67(1):i, 2022.
Article in English | EMBASE | ID: covidwho-1743993
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