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1.
Heliyon ; 9(1):e12704, 2023.
Article in English | ScienceDirect | ID: covidwho-2165332

ABSTRACT

Critically ill patients infected with SARS-CoV-2 display adaptive immunity, but it is unknown if they develop cross-reactivity to variants of concern (VOCs). We profiled cross-immunity against SARS-CoV-2 VOCs in naturally infected, non-vaccinated, critically ill COVID-19 patients. Wave-1 patients (wild-type infection) were similar in demographics to Wave-3 patients (wild-type/alpha infection), but Wave-3 patients had higher illness severity. Wave-1 patients developed increasing neutralizing antibodies to all variants, as did patients during Wave-3. Wave-3 patients, when compared to Wave-1, developed more robust antibody responses, particularly for wild-type, alpha, beta and delta variants. Within Wave-3, neutralizing antibodies were significantly less to beta and gamma VOCs, as compared to wild-type, alpha and delta. Patients previously diagnosed with cancer or chronic obstructive pulmonary disease had significantly fewer neutralizing antibodies. Naturally infected ICU patients developed adaptive responses to all VOCs, with greater responses in those patients more likely to be infected with the alpha variant, versus wild-type.

2.
Research and Practice in Thrombosis and Haemostasis ; : 100041, 2023.
Article in English | ScienceDirect | ID: covidwho-2165819

ABSTRACT

Background The significance of antiphospholipid antibodies (aPL) in COVID-19 remains uncertain. Objective We determined if aPL were associated with COVID-19, and/or thrombosis or adverse outcomes during COVID-19 hospitalization. Methods Symptomatic adults tested for SARS-CoV-2 for clinical reasons (March-July 2020) with either ≥1 PCR positive (COVID+) or all negative (non-COVID) were recruited to a biobank collecting plasma, clinical data, and outcomes. We tested baseline plasma (day 0-7) of all subjects (and day 30 samples in COVID+ subjects, where available) for aPL (anticardiolipin [aCL] IgM/IgG, anti-ß2-glycoprotein I IgM/IgG, anti-phosphatidylserine/prothrombin IgM/IgG, and lupus anticoagulant).We compared baseline aPL prevalence between COVID+ and non-COVID subjects. Among hospitalized COVID+ subjects, multivariable logistic regressions evaluated the association of aPL (and subtypes) with arterial or venous thromboembolic events, acute kidney injury (AKI), intensive care unit (ICU) admission, mechanical ventilation, and death, adjusting for potential confounders. Results At baseline, 123/289 (43%) COVID+ subjects had ≥1 +aPL versus 116/261 (32%) non-COVID comparators (difference 10%, 95% CI 3,18%). Among 89 COVID+ subjects with repeated samples, 15/34 (44%) with baseline +aPL persisted at day 30, and half of those without aPL at baseline developed new aPL. In hospitalized COVID+ subjects (n=241), baseline aPL was associated with AKI (OR 1.8;95% CI 1.1, 3.2) and mechanical ventilation (OR 3.2;95% CI 1.5, 6.8) but not death (OR 1.2;95% CI 0.6, 2.5). In secondary analyses, medium-high titer aCL IgG (>40) was associated with thromboembolic events (OR 7.3;95% CI 1.8, 30.1). Conclusion In COVID-19, aPL may identify increased risk for thrombosis and other adverse outcomes.

3.
Reddy, Dereddi Raja, Cuenca, John A.; Botdorf, Joshua, Muthu, Mayoora, Hanmandlu, Ankit, Wegner, Robert, Crommett, John, Gutierrez, Cristina, Rathi, Nisha, Sajith, Bilja, Knafl, Mark, Abbas, Hussein A.; Woodman, Scott E.; Nates, Joseph L.; Aaroe, Ashley, Aloia, Thomas A.; Andrews, Lee, Badami, Kiran K.; Baganz, Janna A.; Bajwa, Pratibha, Baker, Lori R.; Barbosa, Gregory R.; Beird, Hannah C.; Bourgeois, Matt, Brock, Kristy, Burton, Elizabeth M.; Cata, Juan, Chung, Caroline, Cutherell, Michael, Cuenca, John A.; Cyr, Pierre B.; Dabaja, Bouthaina, Dagher, Hiba, Daniels, Kevin M.; Domask, Mary, Draetta, Giulio, Fisher, Sarah, French, Katy Elizabeth, Futreal, Andrew, Gaeta, Maria, Gibbons, Christopher, Godoy, Myrna, Goldstein, Drew, Gunther, Jillian, Hernandez, Cristhiam, Hutcheson, Kate, Jaffray, David, Jin, Jeff, John, Teny Matthew, Kell, Trey, Knafl, Mark, Kothari, Anai, Kwan, Rayson C.; Lee, J. Jack, Liao, Yue, Litton, Jennifer, Liu, Alex, McEnery, Kevin W.; McGuire, Mary, Musunuru, Tego, Muthu, Mayoora, Nates, Joseph L.; Owen, Craig S.; Padmakumar, Priyadharshini, Page, Melody, Palaskas, Nicholas, Patel, Jay J.; Bajwa, Pratibha, Ravi, Vinod, Russell, Ludivine, Sajith, Bilja, Scheet, Paul A.; Schmidt, Stephanie, Shaw, Kenna R.; Shete, Sanjay, Shoenthal, Daniel P.; Stoltenberg, Lessley J.; Subbiah, Ishwaria, Suitor, Chuck, Tawbi, Hussein, Thompson, Phillip, Turin, Anastasia, Unni, Samir, Vicknamparampil, Benju, Weber, Max C.; Weinstein, John, Williams, Zoe, Woodman, Scott E.; Wozny, Mark C.; Wu, Carol, Wu, Jia, Yao, James C.; Young, Chingyi, Yu, Emily, Zatorski, Steven.
Mayo Clinic Proceedings ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165689

ABSTRACT

There is scant information on the clinical progression, end-of-life decisions, and cause of death of cancer patients diagnosed with COVID-19. Therefore, we conducted a case series of patients admitted to a comprehensive cancer center who did not survive their hospitalization. To determine the cause of death of death three board-certified intensivists reviewed the electronic medical records. Concordance regarding cause of death was calculated. Discrepancies were resolved through a joint case-by-case review and discussion between the three reviewers. During the study period, 551 patients with cancer and COVID-19 were admitted to a dedicated specialty unit;among them, 61 (11.6%) were non-survivors. Among non-survivors, thirty-one (51%) patients had hematological, and 29 (48%) had undergone cancer-directed chemotherapy within 3 months before admission. The median time to death was 15 days (95% CI, 11.8-18.2). There were no differences in time to death by cancer category or cancer treatment intent. The majority of decedents (84%) had full code status at admission;however, 53 (87%) had a Do-Not-Resuscitate order at the time of death. Most deaths were deemed to be COVID-19-related (88.5%). The concordance between the reviewers for the cause of death was 78.7%. In contrast to the belief that COVID-19 decedents perish due to their comorbidities, in our study only one of every ten patients died of cancer–related causes. Full-scale interventions were offered to all patients irrespective of oncologic treatment intent. However, most decedents in this population preferred care with non-resuscitative measures rather than full support at the end of life.

4.
Journal of Infection and Chemotherapy ; 2023.
Article in English | ScienceDirect | ID: covidwho-2165564

ABSTRACT

Introduction Quantitative thorax Computed Tomography (CT) is used to determine the severity of COVID-19 pneumonia. With a new approach, quantitative thoracic CT is to contribute to the triage of patients with severe COVID-19 pneumonia in the ICU and to evaluate its relation with mortality by taking into account the vaccination status. Methods Fifty-six patients who had a diagnosis of COVID-19 pneumonia confirmed in the adult ICU were evaluated retrospectively. To evaluate the degree of parenchymal involvement, the quantitative CT "craniocaudal diameter of the thorax/craniocaudal largest lesion diameter (CCDT/CCDL)” ratio and semi-quantitative total CT severity scores (TCTSS) (0:0%;1:1–25%;2:26–50%;3:51–75% and 4:76–100%) were calculated. Both methods were analyzed with comparative ROC curves for predicting mortality. The effects of vaccines on thorax CT findings and laboratory parameters were also investigated. Results The sensitivities and specificities were found to be 72.5%, 75.61%, and 80%, 73.33% when CCDT/CCDL and TCTSS cutoff value was taken <1.4, and >9, respectively, to predict mortality in COVID-19 pneumonia (Area Under the Curve = AUC = 0.797 and 0.752). Both methods predicted mortality well and no statistical differences were detected between them (p = 0.3618). In vaccinated patients, CRP was higher (p = 0.045), and LDH and ferritin were lower (p = 0.049, p = 0.004). The number of lobes involved was lower in the vaccinated group (p = 0.001). Conclusions The quantitative CT score (CCDT/CCDL) may play as important a role as TCTSS in diagnosing COVID-19 pneumonia, determining the severity of the disease, and predicting the related mortality. COVID-19 vaccines may affect laboratory parameters and cause less pneumonia on thoracic CT than in unvaccinated individuals.

5.
Clin Simul Nurs ; 2022 Mar 14.
Article in English | MEDLINE | ID: covidwho-2158750

ABSTRACT

Coronavirus disease (COVID-19) required innovative training strategies for emergent aerosol generating procedures (AGPs) in intensive care units (ICUs). This manuscript summarizes institutional operationalization of COVID-specific training, standardized across four ICUs. An interdisciplinary team collaborated with the Simulator Program and OpenPediatrics refining logistics using process maps, walkthroughs and simulation. A multimodal approach to information dissemination, high-volume team training in modified resuscitation practices and technical skill acquisition included instructional videos, training superusers, small-group simulation using a flipped classroom approach with rapid cycle deliberate practice, interactive webinars, and cognitive aids. Institutional data on application of this model are presented. Success was founded in interdisciplinary collaboration, resource availability and institutional buy in.

6.
Laboratory Diagnostics Eastern Europe ; 11(4):404-419, 2022.
Article in Russian | Scopus | ID: covidwho-2164704

ABSTRACT

Introduction. The COVID-19 infection caused by SARS-CoV-2 is often severe and can lead to fatal outcomes. It is known that the main route of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is airborne. Studies revealed that up to 25% of subjects from at-risk groups who have been affected by severe viral respiratory infections acquired secondary bacterial infections. These individuals have been reported to have superinfections and co-infections with SARS-CoV-2. Numerous opportunistic infections have been identified in patients with COVID-19, including the major bacterial pathogens responsible for healthcare-associated infections. The prevalence, frequency, and characteristics of bacterial agents isolated in patients during the COVID-19 pandemic are poorly understood and are considered to be a significant gap in knowledge. Therefore, it seemed appropriate to perform a comparative analysis of changes in the structure of bacterial etiological agents in patients hospitalized in intensive care units before and during the COVID-19 pandemic. Purpose. To review research and to study the structure of opportunistic bacterial agents isolated in hospitalized patients and to evaluate the impact of the COVID-19 pandemic impact on changes in incidence and characteristics of the main opportunistic infectious agents compared to the same period before the pandemic. Materials and methods. Bacteria were isolated and identified by conventional bacteriological methods using a variety of biochemical series, test systems for identification, as well as with the use of an automatic hemocultivator, a microbiological analyzer, and a mass spectrometer. The analysis includes data from the WHONET database of the centralized microbiological laboratory of the city of Minsk regarding the test results of blood and respiratory samples from adult patients hospitalized in intensive care units. A comparative analysis of the structure of etiological agents was carried out quarterly for two equal time periods. It's important to note that any bacteria detected from sources other than the respiratory tract or bloodstream was excluded from this data. In addition, all the data received from the intensive care units (ICUs) were analyzed apart from data obtained in other units. Results. The results of respiratory and blood samples of 52,530 patients have been analyzed. A comparative analysis of the structure of microorganisms isolated from 33,539 samples (63.8%, CI95% 63.6–64.0) was performed. In addition, isolates classified as of opportunistic bacterial pathogens were identified in samples of 20,053 patients (59.8%, CI95% 59.5–61.1). It was found that during the COVID-19 pandemic there was a 2.6–fold increase in the number of patients with blood samples tested and a 1.8–fold increase in the number of patients with respiratory specimens tested. The most frequent isolate from both blood samples (pre-pandemic 20.2% (CI95% 19.0–21.4) and 19.9% (CI95% 19.3–20.5) during the pandemic) and respiratory specimens (pre-pandemic 39.0% (CI95% 38.0–40.0) and 40.6% (CI95% 39.9–41.3) during the pandemic) was K. pneumoniae. At the same time, the structure of bacterial agents was modified due to increasing prevalence of non-fermenting gram-negative bacteria. Thus, the frequency of A. baumannii isolated from blood samples increased by 1.8 times, and those isolated from respiratory specimens by 1.3 times. For K. pneumoniae an increase in resistance frequency against penicillins, 3rd-and 4th-generation cephalosporins, carbapenems, fluoroquinolones, colistin, tetracycline, and tigecycline was established;for A. baumannii isolated from blood samples an increase in resistance frequency against gentamicin, tobramycin, and colistin was revealed, and for those from respiratory specimens an increase in resistance frequency against imipenem, meropenem, and tetracycline was revealed during the pandemic. Conclusion. An increase in frequency of isolation of gram-negative pathogens was established. It was indirectly confirmed that co-infection a d or superinfection with K. pneumoniae and A. baumannii and other opportunistic bacteria characterized by multiple resistance to antibacterial drugs, could increase the risks of severe course of underlying disease and lead to lethal outcomes. Prevention of secondary bacterial infections in ICU patients, including those diagnosed with COVID-19, requires an improvement in prevention programs, infection control practices and antibiotic therapy management systems. © 2022, Professionalnye Izdaniya. All rights reserved.

7.
COVID-19 Hastalarında Gelişen Pnömotoraks Mortalite Belirteci Olabilir mi? ; 28(4):357-361, 2022.
Article in English | Academic Search Complete | ID: covidwho-2164315

ABSTRACT

Objectives: The purpose of this study is to investigate the effects of pneumothorax (PX), a rare complication of COVID-19, on mortality. Methods: All patients admitted to our hospital with the diagnosis of COVID-19 were screened, and patients who developed PX were included in the study. Patient demographics data, number of days of hospitalization for comorbidities, day and duration of thorax tube insertion, and laboratory findings during hospitalization were recorded by scanning the hospital automation system and patient records. Results: For our study, 7485 patients hospitalized with the diagnosis of COVID-19 were screened in intensive care unit. PX was detected in 32 (0.296%) of the patients. About 59.4% of these patients included in the study were male. DM was the most common comorbid condition at 56.3%. In these patients, the mortality rate was found to be 90.6%. Conclusion: The data obtained indicate that PX, a COVID-19 complication, leads to a serious increase in mortality. We believe that using protective ventilation methods to avoid the development of pneumotarax will help to reduce mortality. Keywords: COVID-19, mortality, pneumothorax (English) [ FROM AUTHOR]

8.
Haseki Tip Bulteni ; 60(5):447-452, 2022.
Article in English | EMBASE | ID: covidwho-2163948

ABSTRACT

Aim: The recommendation to avoid general anesthesia in pregnant women with coronavirus disease-2019 (COVID-19) and to use neuraxial blockade techniques, if possible, has not changed over time. On the other hand, general anesthesia also has to be applied to some patients in clinical practice. In this study, we evaluated anesthesia management, maternal outcomes, and clinical course in pregnant women with COVID-19 who delivered by cesarean section. Method(s): One hundred and seven pregnant women with COVID-19 who underwent cesarean sections between October 2020 and April 2021 were included in the study. Anesthesia methods, presenting symptoms, comorbidities, laboratory test results, and radiological data at admission, length of hospital stay, intensive care unit admissions, and mortality rates were retrospectively analyzed. Result(s): Out of 107 pregnant women, 85 underwent cesarean surgery under spinal anesthesia and 22 under general anesthesia. Forty patients (37%) had at least one symptom, whereas sixty-seven (63%) had no symptoms at all. Fifty percent of symptomatic and only 6% of asymptomatic pregnant women were admitted to the intensive care unit, and there was a significant difference between them. Mortality was 30% in symptomatic patients and only 1% in asymptomatic patients, and the difference in mortality was significant (p<0.05). Conclusion(s): Since the risk of intensive care and mortality is higher, particularly in symptomatic pregnant women with COVID-19, these patients should be evaluated, operated and followed up by experienced teams. Copyright © 2022 by The Medical Bulletin of Istanbul Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayinevi.

9.
Facets ; 7(1):1411-1472, 2022.
Article in English | Scopus | ID: covidwho-2161981

ABSTRACT

The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity. The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces. Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions. This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided. © 2022 Gibney et al.

10.
10th International Workshop on Innovative Simulation for Health Care, IWISH 2021 ; : 76-83, 2021.
Article in English | Scopus | ID: covidwho-2156274

ABSTRACT

The COVID-19 pandemic has underscored the importance of awareness and preparedness on the part of medical personnel. Virtual reality (VR) may be viewed as a useful tool in enabling knowledge and ability of medical practitioners in protecting themselves during the pandemic. This research describes the details of a VR application developed to train healthcare personnel in an intensive care unit (ICU) environment on some of the critical procedures related to COVID-19 patients. We discuss design considerations of VR for healthcare training as well as a process of selecting, based on expert opinion, key ICU training modules. The process of creating a 3D model of the ICU is outlined, and the major components and the use of the VR application are discussed. We find that a practical VR training program should apply a suitable VR platform and simulation techniques, while placing emphasis on addressing emerging problems and needs of healthcare personnel during the pandemic. © 2021 The Authors.

11.
45th Mexican Conference on Biomedical Engineering, CNIB 2022 ; 86:836-842, 2023.
Article in English | Scopus | ID: covidwho-2148592

ABSTRACT

This research summarizes the strategies employed in reconfiguring healthcare facilities in OECD member countries to care for patients with COVID-19. The findings were organized by highlighting each country’s hospital reconfiguration strategies, strategies targeting medical devices for treating COVID-19 patients, and medical devices classified by patient severity. Specific hospitals or new units were designated to treat patients in 79% of member countries, 47% reported having reoriented hospital areas for patient care, and 57% reported having increased capacity to treat patients in intensive care units. Telematic consultations (57%) and postponement of non-urgent interventions (76%) were reported strategies for reducing contagion. The 38 countries reported increased personal protective equipment, hospital beds, ventilators, and oxygenation supplies. Significantly few countries reported an increase in ECMO machines, negative pressure systems and rooms, and the availability of imaging equipment. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

12.
Anaesthesia and Intensive Care Medicine ; 23(10):589-593, 2022.
Article in English | Web of Science | ID: covidwho-2147230

ABSTRACT

Airway management practices in the intensive care unit (ICU) are still evolving, evidenced by an increasing proliferation of guidelines and al-gorithms in recent years. Specific considerations relate to the out-of-theatre environment and the physiological state in this patient popula-tion. Airway management in ICU is ultimately a multifaceted process spanning team training, simulation, preassessment, preparation, posi-tioning of the patient, equipment decisions, guidelines/algorithm adherence and most recently the consideration of the coronavirus dis-ease (COVID-19) pandemic. The use of video laryngoscopy has increased, as have the practices of apnoeic oxygenation and the use of checklists. Emergency front-of-neck access (FONA) should be taught to all staff and standardized equipment made available. This article highlights the factors a multidisciplinary team must navi-gate when approaching airway management in the ICU.

13.
Acta Anaesthesiologica Belgica ; 72:275-280, 2021.
Article in English | Scopus | ID: covidwho-2124817

ABSTRACT

Objective: During the first wave of the COVID-19 epidemic in Belgium, major concern existed regarding bed and nurse capacity to care for all ICU eligible patients. Since age is linked with increased comorbidity and potentially decreased quality of life, physicians may be reluctant to allocate scarce ICU beds to the elderly patients. However, we believe elderly patients with good premorbid quality of life can have sufficient quality of life after COVID-19 associated critical illness. Methods: We retrospectively analyzed all 97 patients who were admitted to the ICU for severe COVID-19 induced respiratory failure from March 13th until June 20th 2020. Electronic patient files were queried for baseline characteristics and ventilation strategy. Data on outcome were collected in collaboration with our post-intensive care clinic. In this clinic, patients were contacted 8 to 12 weeks after discharge to screen for symptoms of the postintensive care syndrome. Results: Despite increased comorbidities in elderly patients, admission frailty scores were similar amongst all age groups. Mortality was higher in the elderly patient groups. Patients experienced a drop in selfreported quality of life after ICU admission. However, after dichotomization based on the age of 70 years old, the change in self-reported quality of life in the elderly does not appear to be significantly bigger than in younger patients. Conclusion: Despite higher mortality rates in the elderly patient admitted to the ICU due to COVID-19 induced respiratory failure, the drop in self-reported quality of life is not affected by age. As such, ICU clinicians should look beyond crude ICU mortality and consider utilizing premorbid self-reported quality of life and frailty scores to estimate whether ICU admission adds value to the individual patients life. © Acta Anæsthesiologica Belgica, 2021.

14.
Jundishapur Journal of Microbiology ; 15(1):552-565, 2022.
Article in English | GIM | ID: covidwho-2124674

ABSTRACT

BACKGROUND: Coronavirus Disease 19 (COVID-19) damages the lungs and may potentially culminate in acute respiratory distress syndrome (ARDS). Several therapy strategies, including corticosteroids, have been attempted across the world with favorable results. However, the most suitable corticosteroid type and dose for COVID-19 treatment remain undefined. Therefore, we performed a study to retrospectively compare the efficacy of two popular corticosteroid therapies: dexamethasone and methylprednisolone, in treating severe COVID-19 pneumonia. METHODS: This observational retrospective cohort analysis comprised 1001 patients diagnosed with an established diagnosis of severe COVID-19 pneumonia who were hospitalized to a tertiary care hospital, Dr. Ziauddin Hospital North Nazimabad, Karachi, Pakistan, from April 2020 through February 2021. RESULTS: Between the two study groups, no significant difference was reported in patient mortality. A significantly higher percentage of MTP patients required admission to the ICU (194 (33.0%) vs. 89 (21.5%);P- < 0.001). Patients in the DXM group had significantly lower chances of being admitted to the ICU (OR: 0.419, 95% CI: 0.273-0.642;P- < 0.001), supported by a significantly lower risk of the need of ICU admission (HR 0.538, 95% CI: 0.383-0.755;P- < 0.001). Additionally, on Kaplan-Meier analysis, the DXM group patients received discharge from the hospital significantly earlier (6.83 vs. 8.20 days;Log Rank P-0.003) and required ICU admission much later (5.01 vs. 2.40 days;Log Rank P- < 0.001). CONCLUSION: Dexamethasone was found to have a significant reduction in the need for intensive care unit admission as well as early hospital discharge.

15.
Int J Risk Saf Med ; 2022 Nov 15.
Article in English | MEDLINE | ID: covidwho-2141613

ABSTRACT

BACKGROUND: The COVID-19 pandemic highlighted the need for a new dynamic in the organization and practices of health services, as it required rapid restructuring to promote safe and harm-free assistance. OBJECTIVE: To assess the dimensions of the patient safety culture (PSC) from the perspective of the health team professionals in clinical-surgical ICU (G1) compared to a COVID-19 ICU (G2). METHODS: Cross-sectional, analytical, descriptive and inferential study, using the "Hospital Survey on Patient Safety Culture" questionnaire. RESULTS: The domain "Supervisor/Manager Expectations and Actions Promoting Patient Safety (PS)" was a potential weakness for G1 (p = 0.003). G2 was most positive on improving PS, being informed about errors, considering PS as a top priority to management, and that the units work together to provide the best care (p > 0.05). G1 was most negative about the work culture with staff from other units, exchange of information across units, and shift changes (p > 0.05). The highest PS grade was related to greater communication, and a smaller frequency of events was reported only for G2 (p > 0.05). CONCLUSION: There must be a balance in terms of attention focused on PS between different ICUs in times of crisis, especially regarding the supervisors/managers actions.

16.
J Investig Med High Impact Case Rep ; 10: 23247096221140250, 2022.
Article in English | MEDLINE | ID: covidwho-2139082

ABSTRACT

Unvaccinated patients with comorbidities that impair the immune function, such as type 2 diabetes mellitus, are more likely to develop severe COVID-19. The COVID-19-associated acute respiratory distress syndrome has raised new concerns in intensive care units globally owing to the presence of secondary fungal infections. We report the case of a 71-year-old man from Ecuador with a history of type 2 diabetes mellitus, severe COVID-19 pneumonia, and lung cavitation associated with triple infections with Trichosporon asahii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The patient with a history of high blood pressure and type 2 diabetes was admitted to our hospital from a private care center with a diagnosis of COVID-19-associated acute respiratory distress syndrome. On arrival, the patient presented with signs of hypoxemic respiratory failure. During his stay at another hospital, he had received tocilizumab and corticosteroid therapy. Therefore, intubation was performed and mechanical ventilation was initiated. The patient developed a septic shock and renal failure with a glomerular filtration rate of 27.5 mL/min/1.73 m2; therefore, two hemodiafiltration sessions were started. The bronchoalveolar lavage revealed erythematous lesions in the bronchial tree and abundant purulent secretions and erosions in the bronchial mucosa, with a cavitary lesion in the right bronchial tree. The bronchoalveolar lavage samples were used to isolate Trichosporon asahii, Klebsiella pneumoniae, and Pseudomonas aeruginosa carbapenemase class A. Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) Biotyper mass spectrometry and polymerase chain reaction (PCR) molecular identification were performed. This case report suggested that patients with severe COVID-19 pneumonia, with or without comorbidities, are more susceptible to opportunistic infections.


Subject(s)
COVID-19 , Coinfection , Diabetes Mellitus, Type 2 , Respiratory Distress Syndrome , Male , Humans , Aged , Klebsiella pneumoniae , Pseudomonas aeruginosa , COVID-19/complications , Diabetes Mellitus, Type 2/complications , Ecuador , Lung
17.
J Laryngol Otol ; 136(7): 649-653, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-2133060

ABSTRACT

OBJECTIVE: The main objective was to assess the prevalence of dysphagia in the intensive care unit in patients with coronavirus disease 2019.Methods. A cohort, observational, retrospective study was conducted of patients admitted to the intensive care unit for severe acute respiratory syndrome coronavirus 2 pneumonia at the University Hospital of Rouen in France. RESULTS: Over 4 months, 58 patients were intubated and ventilated, 43 of whom were evaluated. Screening revealed post-extubation dysphagia in 62.7 per cent of patients. In univariate analysis, a significant association was found between the presence of dysphagia and: the severity of the initial pathology, the duration of intubation, the duration of curare use, the degree of muscle weakness and the severity indicated on the initial scan. At the end of intensive care unit treatment, 22 per cent of the dysphagic patients had a normal diet, 56 per cent had an adapted diet and 22 per cent still received exclusive tube feeding. CONCLUSION: Post-extubation dysphagia is frequent and needs to be investigated.


Subject(s)
COVID-19 , Deglutition Disorders , COVID-19/complications , COVID-19/epidemiology , Cohort Studies , Deglutition Disorders/complications , Deglutition Disorders/etiology , Humans , Intensive Care Units , Prevalence , Retrospective Studies
18.
Rev Panam Salud Publica ; 46: e203, 2022.
Article in English | MEDLINE | ID: covidwho-2146252

ABSTRACT

Objectives: To assess factors associated with admission to an intensive care unit (ICU) and death from coronavirus disease 2019 (COVID-19) in fully vaccinated patients with severe COVID-19 in Brazil and the association between ICU admission and death from COVID-19. Methods: This was retrospective study of patients hospitalized for COVID-19 from February 12, 2021 to January 10, 2022 across Brazil who were fully vaccinated against COVID-19 before hospitalization. Outcomes were admission in an ICU for COVID-19 and death from COVID-19. Variables evaluated were: sex; age; self-reported skin color; macroregion; comorbidities; time between full vaccination and onset of symptoms; and time between onset of symptoms and hospitalization. A Poisson regression model was used to estimate crude and adjusted risk ratios. Results: Of 74 991 patients hospitalized for severe COVID-19, 67.28% were ≥ 70 years and 68.32% had at least one comorbidity. Men, patients aged 60-69 years, and patients aged 18-39 years with obesity had the greatest risk of ICU admission. Patients aged 18-39 years with obesity, diabetes, or renal diseases had the highest risk of death from COVID-19. When age and time between onset of symptoms and hospitalization were considered effect modifiers, patients admitted to an ICU 9-13 days after symptom onset in each age category had the greatest risk of death from COVID-19. Conclusion: Although older patients were at greatest risk of ICU admission and death from COVID-19, the difference in the risk of dying from COVID-19 between patients admitted to an ICU and those not admitted was greatest for young adults.

19.
Science & Healthcare ; 24(4):27-32, 2022.
Article in Russian | GIM | ID: covidwho-2146480

ABSTRACT

Since the beginning of the new coronavirus infection pandemic over 102.5 million people have been infected and over 2.2 million have died. The world statistics on COVID-19 rates Kazakhstan as 59 with revealed cases of COVID-19 and 68 with deaths cases. In 80% of patients with COVID-19, COVID-19 have mild or moderate disease, about 15% have severe disease requires oxygen support, and 5% have a critical illness requires stay in intensive care units. The average duration of ICU stay is 10.8 days. In 22.7% of patients, ICU length of stay is over 30 days. The mortality rate of patients in intensive care units was 40-61% during the first wave, but in most affected regions it was as high as 90%. In order to improve the results of intensive care, a team-based way introduced in many hospitals. These teams do most labor-consuming and potentially dangerous manipulations. This approach requires a sufficient number of engaged and well-trained staff. In in an acute shortage of ICU staff, some actions assumed to train medical personnel of other specialties to become doctors and nurses in intensive care units. Short and superficial courses, designed to prepare the maximum number of intensive care specialists in the shortest time, as a rule, leads to a deterioration in the quality of the provided intensive care and does not improve results and mortality.

20.
الاحتراق بين العاملين الصحيين خلال جائحة فيروس كورونا المستجد 19 ; 33(2):129-137, 2022.
Article in English | Academic Search Complete | ID: covidwho-2145314

ABSTRACT

Background: Burnout in healthcare providers (HCPs) can also impact their families, patients, and the healthcare system as a whole. The Coronavirus Disease (COVID-19) pandemic has had an extraordinary impact on the health care system and on HCPs. The current study examined its association with potential burnout. Methods: An internet survey was mailed to HCPs in the United States (US) and Turkey who agreed to participate. Participants completed demographic and work- related information and the shortened version of the Pines’ Burnout Scale. Chi-Square was utilized for most analyses. Results: Rates of burnout were related to age, with the youngest workers (<35 years) having the highest rate (67.2%) and the older workers (>55 years) having the lowest rate (41.2%;χ2 =15.3, P< 0.001). Women reported higher rates of burnout (67.6%) than men (51.6%, OR=1.96, 95% CI 1.47-2.62, p< 0.001). Frontline workers (in emergency rooms or intensive care units) (70.4% vs. 58.7%, χ2: 5.6, p=0.017) and those involved in COVID-19 care (66.7% vs. 55.5%;OR: 1.6, %95 CI 1.1 to 2.1, p=0.002) reported significantly higher burnout rates than others. Burnout rates were significantly lower when workers believed their employer was taking proper precautions to protect employees from COVID-19 (48.0% vs. 74.5%, OR: 3.1, %95 CI 2.3 to 4.2, p< 0.001). HCPs in Turkey were twice as likely to experience burnout than HCPs from the US (OR=1.95, 95% CI 1.29-2.95). [ FROM AUTHOR]

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