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1.
Trends in Anaesthesia and Critical Care ; : 101208, 2022.
Article in English | ScienceDirect | ID: covidwho-2165884

ABSTRACT

Introduction COVID-19 can lead to acute respiratory failure (ARF) requiring admission to intensive care unit (ICU). This study analyzes COVID-19 patients admitted to the ICU, according to the initial respiratory support. Its main aim is to determine if the use of combination therapy: high-flow oxygen system with nasal cannula (HFNC) and non-invasive ventilation (NIV), is effective and safe in the treatment of these patients. Methods Retrospective observational study with a prospective database. All COVID-19 patients, admitted to the ICU, between March 11, 2020, and February 12, 2022, and who required HFNC, NIV, or endotracheal intubation with invasive mechanical ventilation (ETI-IMV) were analyzed. HFNC failure was defined as therapeutic escalation to NIV, and NIV failure as the need for ETI-IMV or death in the ICU. The management of patients with non-invasive respiratory support included the use of combined therapy with different devices. The study period included the first six waves of the pandemic in Spain. Results 424 patients were analyzed, of whom 12 (2.8%) received HFNC, 397 (93.7%) NIV and 15 (3.5%) ETI-IMV as first respiratory support. PaO2/FiO2 was 145 ± 30, 119 ± 26 and 117 ± 29 mmHg, respectively (p = 0.003). HFNC failed in 11 patients (91.7%), who then received NIV. Of the 408 patients treated with NIV, 353 (86.5%) received combination therapy with HFNC. In patients treated with NIV, there were 114 failures (27.9%). Only the value of SAPS II index (p = 0.001) and PaO2/FiO2 (p < 0.001) differed between the six analyzed waves, being the most altered values in the 3rd and 6th waves. Hospital mortality was 18.7%, not differing between the different waves (p = 0.713). Conclusions Severe COVID-19 ARF can be effectively and safely treated with NIV combined with HFNC. The clinical characteristics of the patients did not change between the different waves, only showing a slight increase in severity in the 3rd and 6th waves, with no difference in the outcome.

2.
Frontiers in Medicine ; 9, 2022.
Article in English | Web of Science | ID: covidwho-2163048

ABSTRACT

High-flow nasal oxygen (HFNO) is a type of non-invasive advanced respiratory support that allows the delivery of high-flow and humidified air through a nasal cannula. It can deliver a higher inspired oxygen fraction than conventional oxygen therapy (COT), improves secretion clearance, has a small positive end-expiratory pressure, and exhibits a washout effect on the upper air space that diminishes dead space ventilation. HFNO has been shown to reduce the work of breathing in acute hypoxemic respiratory failure (AHRF) and has become an interesting option for non-invasive respiratory support. Evidence published before the COVID-19 pandemic suggested a possible reduction of the need for invasive mechanical ventilation compared to COT. The COVID-19 pandemic has resulted in a substantial increase in AHRF worldwide, overwhelming both acute and intensive care unit capacity in most countries. This triggered new trials, adding to the body of evidence on HFNO in AHRF and its possible benefits compared to COT or non-invasive ventilation. We have summarized and discussed this recent evidence to inform the best supportive strategy in AHRF both related and unrelated to COVID-19.

3.
Journal of Pharmaceutical Negative Results ; 13(3):662-667, 2022.
Article in English | Web of Science | ID: covidwho-2156297

ABSTRACT

The COVID-19 respiratory disease pandemic caused by a type of Coronavirus, SARS-CoV 2, not previously known to infect humans, began in late 2019 and continues to this day. The clinical picture of the disease in adults is already well understood;risk factors for infection, disease severity, and mortality have been identified;diagnostic methods have been developed and successfully applied;virus spread control procedures are in place. However, despite such impressive advances, there is still no standard antiviral drug therapy nor recommendations for respiratory support for COVID-19 with proven effectiveness in pneumonia. There are currently several non-invasive respiratory support options for COVID-19 patients with mild to moderate respiratory disorders. These may significantly reduce the number of patients needing intubation and mechanical ventilation due to severe acute respiratory failure. That is why for patients with COVID-19 when choosing respiratory support, a balance must be struck between the clinical benefit of the intervention and the risk of intra-hospital spread of infection. It is important to note that during the treatment of COVID-19 patients with respiratory failure, the full range of invasive and non-invasive lung ventilation options should be considered.

4.
European Journal of Molecular and Clinical Medicine ; 9(7):3220-3226, 2022.
Article in English | EMBASE | ID: covidwho-2147076

ABSTRACT

Background & Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19 is a novel betacoronavirus that first appeared in Wuhan, Hubei Province, China in late December 2019. Real-time reverse-transcription polymerase chain reaction (RT-PCR) test has been routinely used as the diagnostic test to detect SARS-CoV-2 nucleic acids in respiratory specimen swabs from throat, nasopharynx, and nose of individuals suspected of COVID-19 during the acute phase of infection. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cycle threshold (Ct) has been suggested as an approximate measure of initial viral burden. So this study was undertaken retrospectively to evaluate association of CT values of patients tested positive for SARS CoV 2 by RT-PCR with clinical features and the outcomes of patients. Material(s) and Method(s): A retrospective study was performed among patients tested positive for SARS CoV 2 by RT-PCR & admitted in at Dr.Chandramma Dayananda Sagar institute of Medical education and research, Harohalli, Ramanagara. during the period of 08 months from January 2021 to August 2021. The details of the patients on duration of hospital stay, age, presence of comorbidities, intubation, mortality were recorded. The obtained CT values were classified into 3 Groups: Group 1 > 30.0, Group 2-25.0-29.9, Group 3 < 25. The data was analysed using descriptive statistics. Result(s): The study comprised of 668 (men 451,women 217) patients tested positive for SARS CoV 2 by RT-PCR. The mean age in men was 51 years and women was 38 years. 209 patients of Group 3, (31.2%) patients were significantly higher age, co-morbidities like Hypertension, Diabetes mellitus and obstructive lung disease, more than 418 patients of Group 2 (62.5%) and 41 patients of Group 1 (6.13%) patients. Duration of hospital stay was 14 days in Group 3 compared to Group 2 and Group 1 patients. Noninvasive ventilation (12.8%), Invasive ventilation (11.4%) and mortality (11.6%) is more in Group 3 compared to Group 2 and Group 1 patients. Conclusion(s): This study provide evidence that Low CT values suggestive of greater SARS CoV 2 viral load are associated with the severity of illness and duration of hospitalization. CT values may allow for early risk stratification in patients with SARS CoV 2. Copyright © 2022 Ubiquity Press. All rights reserved.

5.
Prescrire International ; 31(242):262-263, 2022.
Article in English | Scopus | ID: covidwho-2124425
6.
Journal of Sleep Research Conference: 26th Conference of the European Sleep Research Society Athens Greece ; 31(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2137093

ABSTRACT

Introduction: There is a physiological plausibility for obstructive sleep apnoea (OSA) being a factor to long COVID-19 symptoms: OSA activates the renin-angiotensin-aldosterone system and angiotensinconverting enzyme 2, which is the entry receptor SARS-CoV-2 in the cells. The aim of this study is to identify the incidence of obstructive sleep apnea in long COVID-19 patients. Method(s): Observational cohort, cross-sectional study of post- COVID-19 symptomatic patients, admitted in the out patient post COVID-19 clinic in Portimao Hospital (Portugal), from july 2021 to december 2021. Inclusion criteria: >=18 years;previous COVID-19 at least six months before the initial study protocol evaluation, confirmed by a positive real-time reverse-transcription polymerase chain reaction on a nasopharyngeal swab.;persistent symptoms after cure criteria defined by WHO. Exclusion criteria: Patients who had a concomitant neurological disorder;patients who were on invasive mechanical ventilation and patients with persistent fatigue symptoms in the 6 months before SARS-CoV 2 infection. The OSA diagnosis was assessed using portable monitoring device type III (in-home polygraphy), between the 6-7th months after the diagnosis of COVID-19. The OSA severity was performed using the American Academy of Sleep Medicine scoring criteria. Result(s): A total of 88 patients attended the post-COVID-19 consultation, 24 patients meet the exclusion criteria and 64 patients were enrolled: 28,1% (18) had mild COVID-19, 17,2% (11) moderate and 54,7% (35) severe acute disease. The average age was 56 years, the BMI was 29 Kg/m2 and 56% were men. We found a OSA incidence of 75% (48). The distribution of OSA severity was: 50% (24) mild, 29% (14) moderate and 21% (10) severe. In this group of post COVID-19 patients with OSA, the median age and BMI was the same of the total enrolled patients, and 58% were men. Conclusion(s): There is a high incidence of OSA, in long COVID-19 patients. The knowledge of this risk is essential to establish the follow up and investigation protocol for postcovid-19 patients.

7.
J Nephrol ; 2022.
Article in English | PubMed | ID: covidwho-2129570

ABSTRACT

BACKGROUND: This study presents our data on mortality in end stage renal disease (ESRD) patients on peritoneal dialysis (PD) who developed COVID-19. MATERIALS AND METHODS: Sri Padmavathi Medical College Hospital, Sri Venkateswara Institute of Medical Sciences University, was designated the State COVID Hospital in March 2020. In a retrospective observational study, we collected the data of ESRD patients on PD and identified the risk factors for mortality. RESULTS: Prior to the pandemic, 136 patients with ESRD were on peritoneal dialysis at our Institute. Among them, 27 (19.8%) eventually developed COVID-19, and 14 of them (51.8%) died. Serum albumin levels were lower and D-dimer levels were significantly higher in deceased patients than in survivors. DISCUSSION: The mortality rate in ESRD patients on PD with COVID-19 at our institution was higher than in other published studies.

8.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128116

ABSTRACT

Background: Endothelial injury and coagulation activation are prominent axis in coronavirus disease 19 (COVID-19) pathogenesis. However, only few studies have compared profiles of biomarkers of coagulopathy and endotheliopathy with regard to the initial severity of COVID-19 and the time course of the disease. Aim(s): The main objective of our study is to point profiles of biomarkers of coagulopathy and endotheliopathy associated with initial severity of COVID-19 and the time course of the disease. Method(s): In a prospective longitudinal study, we explored coagulation and endothelial function biomarkers at admission, at day 3 and at day 7 in two cohorts of severe and moderate COVID-19 patients and according to outcome. Result(s): We found that D-dimers, free tissue factor pathway inhibition (TFPI) and extracellular vesicles -tissue factor (EV-TF) at admission were associated with disease severity. Concerning outcome, TFPI, EV-TF and von Willebrand factor antigen (VWF)/ADAMTS13 ratio at admission, at day 3 and at day 7 were associated with not favorable outcome defined as the onset of death or need of invasive mechanical ventilation. TFPI with a cut-off value of 37.5 ng/ml had 87% sensitivity and 94% and specificity and EV-TF with a cut-off value of 13 fM had 87% sensitivity and 83% specificity. ROC curves analysis for severe outcome was significant with AUC = 0.90 for TFPI and AUC = 0.88 for EV-TF (p < 0.001 for both). Conclusion(s): We found a specific profile of specialized biomarkers of coagulopathy and endotheliopathy associated with severe form of COVID-19 and not favorable outcome. We identified free TFPI and EV-TF of potential interest to stratify patient's risk or to design specific treatment targeting coagulation pathways. Additional studies are warranted to confirm our results and study the interaction between these biomarkers' values and anticoagulation treatment. (Table Presented).

9.
Journal of the American Society of Nephrology ; 33:330, 2022.
Article in English | EMBASE | ID: covidwho-2126099

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) is a newly emerging disease caused by the SARS-CoV-2 virus resulting in a global crisis. Activation of the cytokine cascades plays a crucial role in the pathophysiology of severe pneumonia caused by COVID-19. Several treatments targeting pro-inflammatory cytokines have been introduced, however, their efficacy remains controversial. We aimed to demonstrate the comparative efficacy between hemoperfusion and tocilizumab in the reduction of mortality from severe COVID-19 pneumonia. Method(s): A multicentered, ambispective study was conducted on adult patients who were diagnosed with COVID-19 pneumonia between January 1st, 2020, and December 31th, 2021. Clinical parameters including the specific therapy with hemoperfusion (Hemoadsorption cartridge, HA330 JACFRON) or tocilizumab were collected for analysis. Univariable and multivariable regression analyses were performed to determine the association between the specific therapy and the 28-day mortality. Result(s): A total of 92 patients with COVID-19 pneumonia were eligible for analyses (25 patients received hemoperfusion and 67 patients received tocilizumab). The 28-day mortality in the hemoperfusion and tocilizumab groups were 64.0% and 25.4% respectively (p=0.001). However, receiving Tocilizumab was not associated with mortality rate, compared to hemoperfusion in the multivariable analysis [OR 0.56 (95%CI 0.13 -2.39);p=0.428]. Receiving invasive mechanical ventilator (%), duration of hospitalization, and successful withdrawal of invasive mechanical ventilation was not different between the two groups. Inflammatory marker (CRP) was significantly reduced with hemoperfusion and tocilizumab -46.2 (-88.37, -24.9) (p=0.013) and -45.1 (-54.6, -26.15) (p=<0.001). Conclusion(s): The 28-day mortality of COVID-19 pneumonia patients receiving hemoperfusion and tocilizumab were comparable.

10.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 2022 Nov 14.
Article in Chinese | MEDLINE | ID: covidwho-2118006

ABSTRACT

The coronavirus disease 2019(COVID-19) pandemic poses a severe threat to global health.As an emerging infectious disease mainly attacking the respiratory tract,it has severely challenged the management of chronic non-infectious respiratory diseases including obstructive sleep apnea(OSA) and asthma.This article reviews the impact of OSA on the incidence of COVID-19 and the underlying pathophysiological mechanism,as well as the effects of OSA on the hospitalization risk and the prognosis and outcome of COVID-19 patients,which will provide novel ideas for the management of OSA during the COVID-19 pandemic.

11.
Cureus ; 14(9): e29721, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2110928

ABSTRACT

BACKGROUND: Non-invasive oxygen therapy (NIT) consists of high-flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP). NIT is routinely being used for the management of acute respiratory failure secondary to coronavirus disease-2019 (COVID-19) with variable outcomes. However, previously published studies show that NIT failure might delay endotracheal intubation and invasive mechanical ventilation and results in worse outcomes in patients with hypoxemic respiratory failure. Early prediction of failure of NIT, will help in early decision-making in initiating invasive mechanical ventilation. We retrospectively studied the predictors for NIT failure in patients with moderate to severe COVID-19. METHODS: Adult patients (>18 years) admitted to the intensive care unit (ICU) with moderate to severe COVID-19 ARDS and received NIT [HFNO and CPAP non-invasive ventilation (NIV)] were included in this study. Baseline clinical and laboratory data were collected retrospectively from the electronic hospital information system. NIT failure was defined as the need for invasive mechanical ventilation after the initiation of NIT in the ICU. Univariate and multivariate logistic regression analyses were used to find out the possible predictors of NIT failure. RESULTS: Out of 254 patients admitted to ICU, 127 patients were initiated NIT at admission to ICU. During the course of the ICU stay, 33 (26%) patients subsequently required invasive mechanical ventilation (NIT failure). Respiratory rate-oxygenation index (ROX index) of <2.97 at two hours and <3.63 at six hours of ICU admission predicted NIT failure in our cohort of patients with a high positive predictive value. CONCLUSION: Patient selection is crucial for successful NIT in COVID-19. Application of ROX index measured in the first six hours of ICU admission helps in the identification of patients at risk of NIT failure with moderate to severe COVID-19 ARDS.

12.
Healthcare (Basel) ; 10(11)2022 Nov 07.
Article in English | MEDLINE | ID: covidwho-2110003

ABSTRACT

BACKGROUND: During the COVID-19 breakout, a global call for low-cost portable ventilators was made following the strong demand for ventilatory support techniques. Among a few development projects, COVIDair non-invasive ventilator was developed and produced in a record time during the critical period of spring 2020. OBJECTIVES: To evaluate COVIDair performance (i.e., inspiratory trigger delay time, TDT, pressurization time and inspiratory to expiratory time ratio, I:E) on a test bench simulating physiological characteristics of breathing. METHOD: Performance tests were conducted on a breathing simulator (ASL 5000, IngMar Medical™) in two different lung mechanics (i.e., normal and severe restrictive). RESULTS: Under normal pulmonary mechanics, the inspiratory TDT is on average between 89.0 (±2.1) and 135.0 (±9.7) ms. In a situation of severe restrictive pulmonary mechanics, the inspiratory TDT is on average between 80 (±3.1) and 99.2 (±5.5) ms. Pressurization time to pre-set inspiratory pressure was on average from 234.6 (±5.5) to 318.6 (±1.9) ms. The absolute difference between the actual I:E cycling measure and the pre-set I:E cycling value ranged from 0.1 to 10.7% on average. CONCLUSION: In normal and severe restrictive pulmonary mechanics scenarios, the performance of COVIDair meets the expected standards for non-invasive ventilators.

13.
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
14.
Acta Colombiana de Cuidado Intensivo ; 22:S117-S122, 2022.
Article in English, Spanish | Scopus | ID: covidwho-2094955

ABSTRACT

Obesity-hypoventilation syndrome associated with COVID-19 rapidly leads to severe acute respiratory failure with the need for invasive mechanical ventilation, becoming a therapeutic challenge for intensive care personnel due to the absence of ventilatory strategies. The following is the case of a 51-year-old male patient with a history of Pickwickian syndrome who presented with severe SARS-CoV-2 pneumonia, which progressed early to severe acute respiratory distress syndrome requiring invasive mechanical ventilatory support with positive pressure, and the need for vasoactive support, also presenting with a malignant phenotype obesity-hypoventilation syndrome. Based on the above, we make a clinical management proposal based on the current scientific literature on obesity-hypoventilation syndrome and severe pneumonia secondary to SARS-CoV-2. Despite the high mortality related to COVID-19 and the difficulty presented during invasive mechanical ventilation, the patient's outcome was favourable. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

15.
Journal of Intensive Medicine ; 2022.
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.

16.
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.

17.
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.

18.
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.

19.
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.

20.
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.

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