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1.
Trials ; 23(1): 218, 2022 Mar 18.
Article in English | MEDLINE | ID: covidwho-2098433

ABSTRACT

BACKGROUND: Non-invasive ventilation (NIV) is indicated to avoid orotracheal intubation (OTI) to reduce hospital stay and mortality. Patients infected by SARS-CoV2 can progress to respiratory failure (RF); however, in the initial phase, they can be submitted to oxygen therapy and NIV. Such resources can produce aerosol and can cause a high risk of contagion to health professionals. Safe NIV strategies are sought, and therefore, the authors adapted diving masks to be used as NIV masks (called an Owner mask). OBJECTIVE: To assess the Owner mask safety and effectiveness regarding conventional orofacial mask for patients in respiratory failure with and without confirmation or suspicion of COVID-19. METHODS: A Brazilian multicentric study to assess patients admitted to the intensive care unit regarding their clinical, sociodemographic and anthropometric data. The primary outcome will be the rate of tracheal intubation, and secondary outcomes will include in-hospital mortality, the difference in PaO2/FiO2 ratio and PaCO2 levels, time in the intensive care unit and hospitalization time, adverse effects, degree of comfort and level of satisfaction of the mask use, success rate of NIV (not progressing to OTI), and behavior of the ventilatory variables obtained in NIV with an Owner mask and with a conventional face mask. Patients with COVID-19 and clinical signs indicative of RF will be submitted to NIV with an Owner mask [NIV Owner COVID Group (n = 63)] or with a conventional orofacial mask [NIV orofacial COVID Group (n = 63)], and those patients in RF due to causes not related to COVID-19 will be allocated into the NIV Owner Non-COVID Group (n = 97) or to the NIV Orofacial Non-COVID Group (n = 97) in a randomized way, which will total 383 patients, admitting 20% for loss to follow-up. DISCUSSION: This is the first randomized and controlled trial during the COVID-19 pandemic about the safety and effectiveness of the Owner mask compared to the conventional orofacial mask. Experimental studies have shown that the Owner mask enables adequate sealing on the patient's face and the present study is relevant as it aims to minimize the aerosolization of the virus in the environment and improve the safety of health professionals. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC): RBR - 7xmbgsz . Registered on 15 April 2021.


Subject(s)
COVID-19 , Diving , Noninvasive Ventilation , Humans , Noninvasive Ventilation/adverse effects , Noninvasive Ventilation/methods , Pandemics/prevention & control , RNA, Viral , Randomized Controlled Trials as Topic , SARS-CoV-2
2.
Journal of Intensive Medicine ; JOUR
Article in English | ScienceDirect | ID: covidwho-2082984

ABSTRACT

Optimal initial non-invasive management of acute hypoxemic respiratory failure (AHRF), of both coronavirus disease 2019 (COVID-19) and non-COVID-19 etiologies, has been the subject of significant discussion. Avoidance of endotracheal intubation reduces related complications, but maintenance of spontaneous breathing with intense respiratory effort may increase risks of patients’ self-inflicted lung injury, leading to delayed intubation and worse clinical outcomes. High-flow nasal oxygen is currently recommended as the optimal strategy for AHRF management for its simplicity and beneficial physiological effects. Non-invasive ventilation (NIV), delivered as either pressure support or continuous positive airway pressure via interfaces like face masks and helmets, can improve oxygenation and may be associated with reduced endotracheal intubation rates. However, treatment failure is common and associated with poor outcomes. Expertise and knowledge of the specific features of each interface are necessary to fully exploit their potential benefits and minimize risks. Strict clinical and physiological monitoring is necessary during any treatment to avoid delays in endotracheal intubation and protective ventilation. In this narrative review, we analyze the physiological benefits and risks of spontaneous breathing in AHRF, and the characteristics of tools for delivering NIV. The goal herein is to provide a contemporary, evidence-based overview of this highly relevant topic.

3.
Cureus ; 14(9): e29543, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2072221

ABSTRACT

BACKGROUND: Studies exploring factors predicting postoperative ICU requirement in patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) were not found in the literature. The aim was to evaluate the demographic profile, comorbidities, pattern of steroid received, airway assessment, and intraoperative hemodynamic perturbations associated with ICU requirement amongst patients scheduled for sinonasal debridement. METHODS: This is a retrospective cohort study. All CAM patients of ≥18 years were included. The patients' characteristics, comorbidities, pattern of steroid received, airway assessment, intraoperative hemodynamic perturbations, and outcome data were retrieved. RESULTS: A total of 130 patients were included. Thirty got admitted to ICU, out of which 26 expired. Amongst the various comorbidities, diabetes was the most common (93.85%) and was associated with higher chances of ICU requirement. Of patients with a history of steroid intake, 71% had a significantly higher risk of ICU admission. Out of 30 patients admitted to ICU, 87% (n=26) received invasive ventilation, and the rest were admitted for observation only. CONCLUSION: Middle age, uncontrolled diabetes, history of steroid intake, increased levels of serum creatinine with low potassium, and increased total leucocyte count are the independent risk factors predicting postoperative ICU admission amongst patients with CAM scheduled for sinonasal debridement.

4.
J Clin Med ; 11(20)2022 Oct 14.
Article in English | MEDLINE | ID: covidwho-2071543

ABSTRACT

The best timing for endotracheal intubation in patients with coronavirus disease 2019 (COVID-19) hypoxemic acute respiratory failure (hARF) remains debated. Aim of this study is to compare the outcomes of COVID-19 patients with hARF receiving either a trial of non-invasive ventilation (NIV) or intubated with no prior attempt of NIV ("straight intubation"). All consecutive patients admitted to the 25 participating ICUs were included and divided in two groups: the "straight intubation" group and the "NIV" group. A propensity score matching was performed to correct for biases associated with the choice of the respiratory support. Primary outcome was in-hospital mortality. Secondary outcomes were length of mechanical ventilation, hospital stay and reintubation rate. A total of 704 COVID-19 patients were admitted to ICUs during the study period. After matching, 141 patients were included in each group. No clinically relevant difference at ICU admission was found between groups. In-hospital mortality was significantly lower in the NIV group (22.0% vs. 36.2%), with no significant difference in secondary endpoints. There was no significant mortality difference between patients who received straight intubation and those intubated after NIV failure. In COVID-19 patients with hARF it is worth and safe attempting a trial of NIV prior to intubation.

5.
Colombian Journal of Anesthesiology ; 50(4) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2067057

ABSTRACT

Introduction: The ventilator-induced lung injury (VILI) depends on the amount of energy per minute transferred by the ventilator to the lung measured in Joules, which is called mechanical power. Mechanical power is a development variable probably associated with outcomes in ventilated patients. Objective(s): To describe the value of mechanical power in patients with SARS-CoV-2 infection and ventilated for other causes and its relationship between days of mechanical ventilation, length of stay in the intensive care unit (ICU), and mortality. Method(s): A multicenter, analytical, observational cohort study was conducted in patients with SARS-CoV-2 infection who required invasive mechanical ventilation and patients ventilated for other causes for more than 24 hours. Result(s): The cohort included 91 patients on mechanical ventilation in three tertiary care centers in the city of Pereira, Colombia. The average value of the mechanical power found was 22.7 +/- 1 Joules/min. In the subgroup of patients with SARS-CoV-2 infection, the value of mechanical power was higher 26.8 +/- 9 than in the subgroup of patients without a diagnosis of SARS-CoV-2 infection 18.2 +/- 1 (p <0.001). Conclusion(s): Mechanical power is an important variable to consider during the monitoring of mechanical ventilation. This study found an average value of mechanical power of 22.7 +/- 1 Joules/min, being higher in patients with SARS-CoV-2 infection related to longer days of mechanical ventilation and a longer stay in the ICU. Copyright © 2022 Lippincott Williams and Wilkins. All rights reserved.

6.
Indian Journal of Critical Care Medicine ; 26(10):1159-1160, 2022.
Article in English | EMBASE | ID: covidwho-2066997
7.
Sri Lankan Journal of Anaesthesiology ; 30(2):118-123, 2022.
Article in English | EMBASE | ID: covidwho-2066752

ABSTRACT

Background and aims:The ongoing Covid pandemic has burdened the medical system, more so due to the limited availability of ventilators. Our study aims at identifying the role of hematological markers in the risk stratification and the need for ventilator support among ICU admitted COVID-19 patients. Method(s): A single centre prospective study was conducted on 100 Covid positive patients admitted in the ICU to determine association between the haematological markers such as Hb, Platelet count, Total and Differential leukocyte count, CRP, AST, ALT, LDH, Ferritin and D-Dimer with the need for oxygen therapy with or without invasive ventilatory support. Comparative analysis was performed between the 2 groups. Result(s): Neutrophilia, a mean of 76.7% among those ventilated and 71.6% among those non ventilated (p value 0.002;highly significant) and Lymphocytopenia (p value 0.004) with a mean of 14% and 18.6% respectively was noted. Hemoglobin levels were lower in ventilated (mean 11.6g/dl) as against those non ventilated (mean 12.58%) p value 0.046 which was significant. D-dimer was increased in COVID-19 patients;mean 5380 ng/ml in ventilated patients and mean 949ng/ml in those non ventilated (P < 0.001 highly significant). Elevated D-dimer and presence of diabetes correlated with increased chances of mechanical ventilation, while higher hemoglobin levels and associated COPD have a negative association with the need of mechanical ventilation. Conclusion(s): Hypercoagulability along with neutrophilia and lymphocytopenia can be used as positive associations for the need for invasive mechanical ventilation. Copyright © 2022, College of Anaesthesiologists of Sri Lanka. All rights reserved.

8.
Clinical and Experimental Rheumatology ; 40(10):83-84, 2022.
Article in English | EMBASE | ID: covidwho-2067774

ABSTRACT

Objectives. To determine characteristics associated with a more severe COVID-19 outcome in people with Sjogren's disease (SJD). Methods. People with SJD and COVID-19 reported to two international registries (Sjogren Big Data Consortium and COVID-19 Global Rheumatology Alliance) from March 2020 to October 2021 were included. An ordinal COVID-19 severity scale was defined: (1) not hospitalized, (2) hospitalized with no ventilation, (3) hospitalized requiring non-invasive ventilation, (4) hospitalized requiring invasive ventilation, and (5) death. Odds ratios (OR) were estimated using a multivariable ordinal logistic regression model adjusted for age, sex, comorbidities and anti-rheumatic medications included as covariates. Results. A total of 898 people with SJD were included (825 (91.8%) women, mean age SARS-CoV-2 infection diagnosis: 55.5 years), including 652 patients with primary SJD and 246 with other associated systemic rheumatic diseases. 33.9% were hospitalized, 14.5% required ventilation, and 4.3% died. In the multivariable model, older age (OR 1.03, 95% CI 1.02 to 1.05), male sex (OR 1.81, 95% CI 1.10 to 2.92), two or more comorbidities (OR 2.99, 95% CI 1.92 to 4.67;vs none), baseline therapy with corticosteroids (OR 2.04, 95% CI 1.20 to 3.46), immunosuppressive agents (OR 2.09, 95% CI 1.30 to 3.38) and B-cell depleting agents (OR 5.38, 95% CI 2.77 to 10.47) were associated with worse outcomes (reference for all medications: hydroxychloroquine only). Conclusions. More severe COVID-19 outcomes in individuals with Sjogren's are largely driven by demographic factors and baseline comorbidities. Patients using immunosuppressants, especially rituximab, also experienced more severe outcomes.

9.
Journal of Clinical Outcomes Management ; 29(5):58-64, 2022.
Article in English | EMBASE | ID: covidwho-2067256

ABSTRACT

Objective: To compare the utilization of oxygen therapies and clinical outcomes of patients admitted for COVID-19 during the second surge of the pandemic to that of patients admitted during the first surge. Design(s): Observational study using a registry database. Setting(s): Three hospitals (791 inpatient beds and 76 intensive care unit [ICU] beds) within the Beth Israel Lahey Health system in Massachusetts. Participant(s): We included 3183 patients with COVID-19 admitted to hospitals. Measurements: Baseline data included demographics and comorbidities. Treatments included low-flow supplemental oxygen (2-6 L/min), high-flow oxygen via nasal cannula, and invasive mechanical ventilation. Outcomes included ICU admission, length of stay, ventilator days, and mortality. Result(s): A total of 3183 patients were included: 1586 during the first surge and 1597 during the second surge. Compared to the first surge, patients admitted during the second surge had a similar rate of receiving low-flow supplemental oxygen (65.8% vs 64.1%, P= .3), a higher rate of receiving high-flow nasal cannula (15.4% vs 10.8%, P= .0001), and a lower ventilation rate (5.6% vs 9.7%, P< .0001). The outcomes during the second surge were better than those during the first surge: lower ICU admission rate (8.1% vs 12.7%, P< .0001), shorter length of hospital stay (5 vs 6 days, P< .0001), fewer ventilator days (10 vs 16, P= .01), and lower mortality (8.3% vs 19.2%, P< .0001). Among ventilated patients, those who received high-flow nasal cannula had lower mortality. Conclusion(s): Compared to the first surge of the COVID-19 pandemic, patients admitted during the second surge had similar likelihood of receiving low-flow supplemental oxygen, were more likely to receive high-flow nasal cannula, were less likely to be ventilated, and had better outcomes. Copyright © 2022 Turner White Communications Inc.. All rights reserved.

10.
Journal of Clinical and Diagnostic Research ; 16(9):OC05-OC09, 2022.
Article in English | EMBASE | ID: covidwho-2067202

ABSTRACT

Introduction: Coronavirus Disease-2019 (COVID-19) had devastating effects on the healthcare and economic sector worldwide. India stands second in the list of most number of COVID-19 cases. Most of the deaths due to COVID-19 were seen in patients with associated co-morbidities like hypertension, diabetes, chronic kidney disease and obesity. This study would like to examine specific co-morbidities in relation to the COVID-19 disease progression and outcomes. Aim(s): To compare the clinicoradiological profile and outcome of COVID-19 in patients with and without co-morbidities (diabetes and hypertension). Material(s) and Method(s): The present observational, cross-sectional study was conducted at Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh between June 2020 to September 2020, after obtaining Institutional Ethics Committee (IEC) approval. A total of 148 patients with COVID-19 were included in the study. The COVID-19 patients admitted in the hospital were divided into four groups as those having only diabetes, only hypertension, both diabetes and hypertension, and those without any co-morbidities. Those with any other co-morbidity were excluded from the study. The general clinical characteristics, laboratory parameters, disease severity, morbidity and mortality were compared among various groups and the data was analysed. Categorical data were analysed using the Chi-square test. Result(s): A total of 148 patients with COVID-19 were included in the study, of which 26 patients were diabetic, 36 were hypertensive, 24 were both hypertensive and diabetic and 62 patients didn't had any significant co-morbidity. Severe COVID-19 disease was most commonly observed in those with diabetes (n=14) (53.8%). The highest proportion of patients requiring oxygen (84.6%) and Non Invasive Ventilator (NIV) support (46.1%) was also seen among diabetics. The presence of diabetes, severe disease and leukocytosis at presentation increased the risk of mortality. The association of hypertension with COVID-19 does not seem to affect the in-hospital mortality. Conclusion(s): COVID-19 in diabetics is associated with both increased risk of severe disease and increased odds of death. In diabetics, those with uncontrolled diabetes were more prone to severe disease and death than those with good glycaemic control. Hypertension, on the other hand, showed no association. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.

11.
Journal of Interdisciplinary Medicine ; 7(2):25-30, 2022.
Article in English | EMBASE | ID: covidwho-2065358

ABSTRACT

Mucormycosis is a potentially fatal disease caused by a fungus of the order Mucorales, most commonly involving the nasal sinuses, orbits, brain, lungs, and skin. The disease affects mostly immunosuppressed individuals and patients with chronic diseases such as diabetes. The prevalence of mucormycosis is 80 times higher (0.14 per 1000) in India compared to developed countries. Since the outbreak of the COVID-19 pandemic, there has been a sudden surge in the number of mucormycosis cases, especially on the Indian subcontinent. This can be attributed to what we consider to be the perfect iatrogenic recipe: a combination between the immunosuppression caused by COVID-19, the large prevalence of uncontrolled diabetes and the simultaneous use of corticosteroids. Other factors include the excessive use of antibiotics, antifungal drugs and zinc supplements, invasive ventilation, poor hygiene and sanitization as well as the use of industrial oxygen in hospitals. As a result, an overwhelmingly large number of COVID-19 patients have developed mucormycosis during the pandemic. A review of the literature suggests that all efforts should be made to keep tight control of glycemia in COVID-19 patients along with judicious use of corticosteroids. The treatment of mucormycosis involves a combination of medical and surgical therapy, with the early initiation of antifungal drugs and aggressive surgical debridement of the affected tissues. Copyright © 2022 Mandip Singh Bhatia et al., published by Sciendo.

12.
Pharmaceutical Journal ; 306(7947), 2022.
Article in English | EMBASE | ID: covidwho-2064936
13.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P74-P75, 2022.
Article in English | EMBASE | ID: covidwho-2064505

ABSTRACT

Introduction: The purpose of this study is to evaluate longterm laryngotracheal outcomes in patients who required 10 or more days of invasive mechanical ventilation (IMV) for COVID-19. Method(s): This is a prospective cohort study of patients previously hospitalized for active COVID-19 infection between January 2020 and March 2021 who required intubation for 10+ days. Subjects who met criteria were enrolled at an outpatient laryngology clinic, where they underwent a clinical evaluation with head and neck exam, nasolaryngoscopy, and patient-reported outcome measures (Voice Handicap Index, EAT-10). Medical history was collected through electronic medical record review. Result(s): In total, 166 patients met criteria based on chart review. Of these patients, 31 (18.6%) were deceased since discharge. Enrolled subjects included 16 patients, 2 women and 14 men, with mean (SD) age of 57.4 (14.12) years. The mean duration (SD) of IMV was 36.8 (21.8) days. Fourteen of 16 patients underwent tracheostomy for prolonged endotracheal intubation. The mean time (SD) from hospital admission to intubation was 2.7 (3.2) days, intubation to tracheostomy or extubation was 13.9 (5.3) days, and tracheostomy to decannulation was 38.1 (22.6) days. Conclusion(s): Patients who required prolonged mechanical ventilation to treat COVID acute respiratory distress syndrome demonstrated significant laryngeal or tracheal pathology during laryngoscopy at 1-year follow-up, though subjectively, their self-reported voice and swallowing deficits were mild.

14.
Archives of Disease in Childhood ; 107(Supplement 2):A363, 2022.
Article in English | EMBASE | ID: covidwho-2064046

ABSTRACT

Aims Background Alder Hey is a tertiary children's hospital in North-West England with co-located Intensive Care and High Dependency units, covering North West England, North Wales and Isle of Man. PIMS-TS is a new multisystem inflammatory condition which has led to an increased demand on critical care beds. Some children presenting with PIMS-TS need haemodynamic support in the form of inotropes, which would traditionally need an PICU bed. Aim Review of all patients managed on Critical Care with PIMS-TS. Methods All patients in the region were discussed in a PIMSTS multidisciplinary meeting attended by Paediatrics, Infectious Diseases, Rheumatology, Cardiology and Critical Care daily. Patients across the region needing haemodynamic support or cardiology evaluation were highlighted as, in need of either HDU or PICU bed and transferred by the North West & Wales Paediatric Transport Service (NWTS). This is a retrospective analysis of all children admitted to HDU or PICU with a diagnosis of PIMS-TS, from October 2020-December 2021. Results Thirty (10%) patients were admitted to HDU from the 300 patients discussed over the 15month period. 16 (53%) of patients were female. Mean age was 10 years (range 3-17). Median length of stay (LOS) on HDU was 2 days (range 1-8) with a median hospital LOS of 6 days (range 2- 10). All patients admitted were monitored appropriately and had full echocardiography assessment. Twenty nine (97%) patients admitted to HDU required inotropic support, twelve (40%) patients required a single agent and seventeen (57%) required double agents with a combination of adrenaline, noradrenaline and milrinone. Median fluid resuscitation was 40mls/kg (range 20-70mls/ kg). Eight patients (27%) were escalated to PICU for either invasive ventilation (4) or higher inotropic requirements of 0.2micrograms/kg/minute. There were no adverse events. Conclusion Most children with PIMS-TS have low to moderate haemodynamic instability that can be safely managed on HDU with appropriate monitoring and agreed limits to vasopressor therapy. Our experience in managing with these patients successfully and safely in a high dependency setting has helped in the use of a critical care bed efficiently, thus reducing dependency on the availability of a PICU bed.

15.
Chest ; 162(4):A2637, 2022.
Article in English | EMBASE | ID: covidwho-2060976

ABSTRACT

SESSION TITLE: Late Breaking Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: (1) Assess the characteristics of COVID-19 patients who developed pulmonary cysts, bullae, blebs, and pneumatoceles. (2) Investigate outcomes of patients who developed cystic lung disease from COVID-19. METHODS: A literature search using Pubmed, Cochrane, and Embase was performed for case reports from 2020 to 2022 describing COVID-19 patients who developed lung cysts, bullae, blebs and pneumatoceles. The following data were extracted: patient demographics, presence of underlying lung disease, history of smoking, maximum oxygen requirements during acute illness, imaging findings, complications, and patient mortality. RESULTS: 65 publications (11 case series and 54 case reports) with a total sample size of 76 patients were analyzed. The mean age of patients was 52.2 ± 15.8 years. A majority of the cases were males (n=67, 88.2%). Twelve (15.8%) cases had an underlying lung disease, such as COPD or asthma, and 16 (21.1%) cases had a history of smoking tobacco. We categorized severity of illness based on the levels of oxygen requirement defined as: (1) mild - 0 to 2 liters of oxygen, (2) moderate - greater than 2 liters of oxygen to face mask/venturi mask and (3) severe - high flow nasal cannula, non-invasive ventilation, or mechanical ventilation. The majority of patients (n=40, 52.6%) had severe illness while 7 (9.2%) and 17 (22.4%) presented with mild and moderate disease, respectively. Of the 25 (32.9%) patients who required invasive mechanical ventilation, duration of ventilator days was provided for 14 patients, with a median of 40 days (interquartile range=54). Twenty-one (27.6%) patients were found to have cysts on imaging, 26 (34.2%) were found to have bullae, 3 (3.9%) were found to have blebs, 15 (19.7%) were found to have pneumatoceles, and 11 (14.5%) were found to have more than one of the aforementioned findings. A total of 53 (69.7%) patients developed pneumothorax and 12 (15.8%) developed pneumomediastinum. Seventeen (22.4%) patients were on the mechanical ventilator while pulmonary complications occurred. Additionally, 41 (53.9%) required chest tube placement, 16 (21.1%) required surgical intervention including open thoracotomy or video assisted thoracoscopy. A total of 47 (61.8%) cases reported either resolution of symptoms and complications, or improved imaging findings following interventions. The rate of inpatient mortality was 11.8%. CONCLUSIONS: Patients with severe COVID-19 may have a higher risk for developing cystic lung disease, hence, increasing the risk for complications such as pneumothorax and pneumomediastinum. CLINICAL IMPLICATIONS: Patients who had severe COVID-19 may benefit from closer follow up and serial imaging for early detection of cystic lung disease. DISCLOSURES: No relevant relationships by Kavita Batra No relevant relationships by Rajany Dy No relevant relationships by Christina Fanous No relevant relationships by Wilbur Ji No relevant relationships by Max Nguyen No relevant relationships by Omar Sanyurah

16.
Chest ; 162(4):A2628, 2022.
Article in English | EMBASE | ID: covidwho-2060975

ABSTRACT

SESSION TITLE: Late Breaking Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: To identify the association between SII, NLR and PLR and the prognosis in SARS-CoV-2 pneumonia. METHODS: A cross-sectional study that took place in Tacuba General Hospital, Mexico City. Adults hospitalized with SARS-CoV-2 infection were included. Descriptive statistic was made using Mann-Whitney's U test. Spearman’s Rank correlation coefficient was calculated. The risk of invasive mechanical ventilation (IMV) and mortality was calculated for each index with logistic regression. The analysis was made using the STATA 14.0 program. RESULTS: The current analysis included 295 subjects, 64% men. There was difference in SII and NLR levels between subjects who died and those who did not. Females with acute respiratory distress syndrome had a positive correlation for each index and length of stay: for SII rs=0.739;for NLR rs=0.689;for PLR rs=0.649. Males had weak correlations. The risk of IMV with SII exceeding its cutoff value had an odds ratio of 2.50 (95% CI 1.38-4.51);a higher risk for IMV with NLR above its reference was detected (OR 2.34, 95% CI 1.36-4.05). Also, the elevated SII and NLR levels had an increased risk of mortality;for SII an OR 2.54 (95% CI 1.55-4.15);for NLR an OR 2.16 (95% CI 1.35-3.46). Statistical significance was considered with p=<0.05. CONCLUSIONS: These indexes are an accessible and low-cost tool that can help assess the prognosis of patients hospitalized for SARS-CoV-2 pneumonia. CLINICAL IMPLICATIONS: The SII, NLR and PLR could be useful in identifying patients at risk of death or severe illness who require invasive mechanical ventilation in the earlier phase of SARS-CoV-2 pneumonia. As these indexes are easily quantified from blood sample data, they can reflect the body’s immune status and help assess the prognosis of SARS-CoV-2 pneumonia. DISCLOSURES: No relevant relationships by Amaury Bravo Rodríguez No relevant relationships by JAVIER FIESCO PIÑA No relevant relationships by José Antonio García Cuéllar No relevant relationships by Ruben Antonio Gomez Mendoza No relevant relationships by Damayanty Gomez villanueva No relevant relationships by Karen Hopf Estandía No relevant relationships by Eduardo León Guadarrama No relevant relationships by Alma Daniela Martinez Carrillo No relevant relationships by José Peña Ramírez No relevant relationships by José Pérez Nieto No relevant relationships by Mariela Rosas García No relevant relationships by Fernando Sánchez Mata No relevant relationships by Damayanty Solis Contreras

17.
Chest ; 162(4):A2600, 2022.
Article in English | EMBASE | ID: covidwho-2060972

ABSTRACT

SESSION TITLE: Late Breaking Posters in Critical Care SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Multiple mechanisms may cause acute kidney injury (AKI) after mechanical ventilation. Cross-talk between the lung and kidney precipitates other complications such as fluid overload, electrolyte derangements and pro-inflammatory cytokine production. In this study, we compared hospital mortality rates in unvaccinated COVID-19 patients with respiratory failure (requiring mechanical ventilation) who developed oliguric AKI. METHODS: Using an observational database, we analyzed 3183 unvaccinated hospitalized COVID-19 PCR-positive patients at Methodist Health System (Dallas, TX) from March 2020 to December 2020. The primary endpoint was all-cause in-hospital mortality in patients with respiratory failure requiring mechanical ventilation who developed AKI (as defined by the kidney disease improving global outcomes (KDIGO) guidelines). We also counted the rate of kidney replacement therapy and degree of kidney recovery among the survivors who developed AKI. Chi-square (X2), Fischer’s exact test, and odds ratio tests were used to analyze observed variables. RESULTS: Of the 3183 COVID-19 patients, 351 (11%) developed respiratory failure requiring invasive mechanical ventilation. Of those, 313 (89%) had previously normal kidney function (no documented CKD). Of the 313 intubated patients, 186 (59.4%) developed AKI and 127 (40.5%) patients did not. Thirty-five (18.9%) of the patients who developed AKI survived hospital admission, while 54 (42.5%) patients without AKI survived (OR = 3.306, 95% CI = 1.98-5.51, P<0.001). Ischemic acute tubular necrosis from septic shock was the most common cause of AKI. Hyperkalemia and metabolic acidosis were the most common indication for kidney replacement therapy, and continuous kidney replacement therapy was the most common modality used. The mean age for the AKI vs no AKI groups were 63.5 (SD 14.5) vs 62 (SD 14.49) years old. Mean BMI was comparable between both groups 32 (SD 9.7) vs 32 (SD 9.64), while the BUN level 26 (SD 26.75) vs 19 (SD 9.9) mg/dl and Cr 1.15 (SD 1.59) vs 0.08 (SD 0.27) mg/dl were higher in the AKI group. In the AKI group, kidney replacement therapy was prescribed in 73(39.2%) patients, of which only 33 (17.7%) recovered meaningful kidney function. CONCLUSIONS: As the world emerged from the COVID-19 pandemic, there are innumerable lessons still to be learned. In our study, we demonstrated that AKI in COVID-19 patients with respiratory failure is associated with a higher incidence of mortality compared to patients without AKI. CLINICAL IMPLICATIONS: The risk of new SARS-CoV-2 variants and the possibility of future pandemics makes the recognition of high-risk medical complications of COVID-19 crucial to improve outcomes in acutely ill patients. A true multi-disciplinary team and an incredible amount of resources is required to identify and treat such patients. This study reminds us that kidney replacement therapy is only a means of supportive treatment rather than a cure to COVID-19-related kidney pathology. DISCLOSURES: No relevant relationships by Victor Canela No relevant relationships by Manavjot Sidhu No relevant relationships by Lucas Wang

18.
Chest ; 162(4):A2036, 2022.
Article in English | EMBASE | ID: covidwho-2060889

ABSTRACT

SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Inhaled nitric oxide (iNO) is a potent vasodilator of pulmonary vasculature improving perfusion to ventilated alveoli in ARDS and other lung pathologies. During the pandemic, intensivists turned to iNO as “salvage” therapy in COVID-19 patients. Rationale was driven by vasodilatory effect and antiviral properties despite lack of evidence of clear benefit even in patients without COVID. We hypothesized that iNO would provide reduced increases in pulmonary perfusion and subsequent gas exchange improvement in COVID-19 patients due to extensive endothelial damage and coagulopathy throughout the pulmonary vasculature. METHODS: Our IRB exempt analysis examined patients hospitalized with and without COVID-19 from January 2020 to September 2021 who received at least 24h of invasive mechanical ventilation with iNO (15-20ppm). Effectiveness outcomes were PaO2/FIO2 ratio(PFR), PEEP/CPAP level, and PaCO2 serially measured and observed up to 24 hours prior to initiation of iNO and for up to 120h post iNO administration. Data were statistically controlled for age, sex, race, time to initiation of therapy and COVID-19 directed treatment. RESULTS: From January 2020 and September 2021, 42 patients were admitted to the ICU and received invasive mechanical ventilation and iNO. Results are sequenced as ARDS COVID-negative, ARDS COVID-positive, viral pneumonia COVID-negative, viral-pneumonia COVID-positive. Patient n = 8/14/6/14. Median age was 56/55/63/62 years. Demographics split 64-62% male vs 36-38% female in ARDS without/with COVID, 50%/83% male vs 50%/17% female in viral pneumonia without/with COVID. Racial distribution resulted 75%/93%/86%/83% White vs 25%/0%/17%/14% Black. Other races constituted less than 7% of patient total in any category. PFR delta from -24h to +120h post-iNO = +35/+35/+41/+22. PEEP/CPAP delta from -24h to +120h = -4/-1/-3/-2. PaCO2 delta mmHg from -24h to +120h = -21/-23/-9/-13. Median Hospital LOS = 26/26.5/17/19 days. Median ICU LOS = 15.8/19.0/13.8/17.6 days. Hospital mortality = 100% across all 4 subgroups. CONCLUSIONS: ARDS patients with or without COVID showed similar rates of PFR response to iNO, however viral pneumonia patients with COVID exhibited a blunted PFR response vs those without COVID. No statistically significant difference was observed with respect to PEEP/CPAP levels, PaCO2 mmHg, hospital or ICU LOS, or mortality. CLINICAL IMPLICATIONS: Our findings suggest that the presence of COVID-19 did not significantly inhibit response to iNO in ARDS or other viral pneumonia patients. Further evaluation of other indirect markers of gas exchange could provide further evidence of responsiveness. DISCLOSURES: No relevant relationships by Katherine Burns No relevant relationships by Karen Hamad No relevant relationships by Bobby Malik No relevant relationships by Richard Walo Jr No relevant relationships by Wilhelmine Wiese-Rometsch No relevant relationships by Stephanie Williams

19.
Chest ; 162(4):A1821, 2022.
Article in English | EMBASE | ID: covidwho-2060870

ABSTRACT

SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Coronavirus disease 2019 (COVID-19) and influenza infections are associated with systemic inflammatory reactions that predispose to Takotsubo cardiomyopathy (TTS). Studies have investigated the epidemiology and clinical features of TTS in COVID-19 and influenza infection, however, there are limited data comparing TTS between patients with COVID-19 and influenza. METHODS: We searched PubMed/Medline, Web of Science, SCOPUS, EMBASE, and Google Scholar until November 1st, 2021, for case reports, case series, and observational cohort studies using these keywords: takotsubo syndrome/takotsubo cardiomyopathy, stress-induced cardiomyopathy, and broken heart syndrome combined with the terms COVID-19 and/or SARS-CoV-2, flu and/or influenza. All the published case reports included in the final analysis were in English and were categorized into patients with ‘COVID-19 + TTS’ and ‘Flu + TTS’. RESULTS: We identified 37 studies describing 64 patients with COVID-19+TTS and 10 case reports describing 10 patients with Flu + TTS. The mean age of patients in the COVID-19 + TTS was similar to the influenza group (69 years). Although women were more disproportionately affected by TTS in both groups, COVID-19 + TTS patients had a higher proportion of men than the Flu + TTS group (44% vs 30%) and previously reported incidence of TTS in men in the general population. Compared to patients with Flu + TTS, COVID-19 + TTS had a longer mean time from testing positive to developing TTS (7.3 days vs. 3.1 days), higher incidence rates of acute respiratory distress syndrome (77% vs. 40%), hypoxemic respiratory failure (86% vs. 60%), more likely to require invasive mechanical ventilation (63% vs. 40%) and higher in-hospital mortality rates (36%, n=23 vs 10%, n=1) CONCLUSIONS: Our systematic review highlights some important differences in the presentation and outcomes of TTS in patients with COVID-19 compared to seasonal influenza. Patients with COVID-19 + TTS had higher rates of respiratory complications and excess all-cause mortality compared to Flu + TTS. In contrast to the general population and patients infected with influenza, TTS tends to affect more men with COVID-19 infection. CLINICAL IMPLICATIONS: Hospitalized patients with COVID-19 who develop TTS appear to have a more severe disease course and poorer outcome compared to hospitalized patients with Flu+TTS. The study findings provide additional knowledge comparing complications between COVID-19 and influenza infections and may contribute to the continued efforts to manage the COVID-19 pandemic. DISCLOSURES: no disclosure on file for Temidayo Abe;No relevant relationships by Thomas Allingham No relevant relationships by Omovefe Edika No relevant relationships by Hammad Khalid No relevant relationships by Ifeoma Ogbuka No relevant relationships by Titilope Olanipekun No relevant relationships by Richard Snyder No relevant relationships by Abhinav Vedire No relevant relationships by Nicholas Wilson

20.
Chest ; 162(4):A1814, 2022.
Article in English | EMBASE | ID: covidwho-2060869

ABSTRACT

SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema are reported as rare complications of COVID-19 pneumonia in various observational studies. The purpose of this study is to investigate the incidence of these complications and their outcome in hospitalized patients with COVID-19 pneumonia, at our inner-city hospital system in Central Pennsylvania. METHODS: We performed a retrospective chart review of the patients admitted with COVID-19 pneumonia from March 2020 to March 2021 in 3 different hospitals located in central Pennsylvania. Data on their demographics, pre-existing comorbidities, inpatient location, radiologic findings, timeline of events, mode of oxygenation and ventilation, hematology, chemistry profile and inflammatory markers were obtained. Patients with known inciting events for barotrauma, other than COVID-19 pneumonia were excluded from our analysis. RESULTS: The mean age of patient cohort was 66 years (SD 14.07). Almost fifty two percent were obese with BMI more than 30 kg/m2 and 69.5% were male. Only 11.4% of the study population had history of COPD and majority (63.6%) did not have history of smoking. Out of 31,260 inpatients, only 44 (0.0014 %) patients spontaneously developed thoracic free air. Among them, 33 (75%) had pneumothorax, and 22 (50%) needed chest tube for the management. 18 (40.9%) had pneumomediastinum, and 20 (45.5%) had subcutaneous emphysema. These are not exclusive findings and some patients had free air in more than one location. Thirty (68.2%) patients were admitted to ICU (Intensive Care Unit), 20 (45.5%) patients needed invasive ventilation and 26 (61.4%) had in-hospital mortality. Mortality in ICU was significantly high (86.67%) compared to non-ICU patients (7.14%). The average duration of hospitalization was 28.18 days (SD 25.46). CONCLUSIONS: Incidence of spontaneous thoracic free air complication in COVID –19 pneumonia is a rare phenomenon. In our patient cohort, occurrence of these events was seen irrespective of type of oxygen delivery and ventilation. However, patients having these complications had a high rate of ICU admission. Mortality is significantly high especially in patients admitted to ICU. CLINICAL IMPLICATIONS: Spontaneous thoracic free air complication in COVID-19 pneumonia is rare but can be a marker of poor prognosis. Vaccination status of study population was unknown, therefore the role of vaccination to prevent these complications and their outcome needs to be explored. DISCLOSURES: No relevant relationships by Yi-Ju Chen No relevant relationships by Anatoliy Korzhuk No relevant relationships by Rajan Pathak No relevant relationships by Navitha Ramesh No relevant relationships by Michaela Sangillo

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