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1.
Research Journal of Pharmacy and Technology ; 15(11):4950-4954, 2022.
Article in English | EMBASE | ID: covidwho-2207040

ABSTRACT

Indian traditional system of medicine has a definite role in the treatment of Covid-19. This case report presents the outcome of Ayurvedic interventions along with modern medicines in a severe covid-19 infected patient with breathlessness. A patient with a history of cough, breathing difficulty and generalized weakness tested positive for the rapid antigen test and prescribed the standard treatment of care with 14 days of strict home quarantine. During follow-up, there was no clinical improvement and oxygen saturation was fluctuating and required oxygen support. Therefore, the patient sought ayurvedic intervention at the covid-19 healthcare center with supportive oxygen therapy. The patient was managed with ayurvedic intervention along with modern medicines. On the date of admission to the covid-19 care center, the patient's SpO2 72% on room air, HRCT 80-90%, and ESR, CRP, and LDH were 40(mm/hour), 11.47(mg/L), and 306(Units/L) respectively. By adhering to the integrated therapy patient's oxygen saturation and clinical profile were improved with time. On the 11th day of treatment patient, SpO2 was sustained at 95% and HRCT report was 70-80%, and clinical profile improved remarkably. The patient's HRCT after one month was50-60% compared to the previous report suggestive of remarkable improvement. The effect on inflammatory markers and oxygen saturation suggests that integration of modern medicines along with ayurvedic medicine in the patient was significant and deserves further studies. Integrating ayurvedic treatment along with modern medicine might be considered as an effective approach in the management of severe covid-19 patients. Copyright © RJPT All right reserved.

2.
Anesteziologie a Intenzivni Medicina ; 32(1):9-13, 2021.
Article in Czech | EMBASE | ID: covidwho-2206300

ABSTRACT

Acute hypoxemic respiratory failure (which occures also with severe course of COVID-19) requires oxygen therapy. The in vasiveness and intensity of chosen therapy corresponds with patient's condition and technical means available. If a large number of patients with hypoxic failure suddenly occur, the available equipment and/or human capacity to provide effective oxygen therapy may be greatly strained. The goal of our experiment was to test functionality of a simple device equipped with a Venturi nozzle Corovalve which we designed and printed on a 3D printer. We incorporated the nozzle into a system assembled from parts commonly available in the Czech Republic. We put this device through a static test and a dynamic test performed on ourselves and measured its basic parameters. In our experiment during spontaneous ventilation the device was able to generate positive mean airway pressure. At higher flow rates, the system was able to maintain a slightly positive pressure even during the inspiration, so we can talk about a system that allows, under certain circumstances, spontaneous ventilation at continuous positive airway pressure. The most effective from setting tested was oxygen input of 15 L/min combined with PEEP valve set to 10-15 cm H 2 O. Mean airway pressure ranged at 9-12 cm H 2 O and oxygen concentration in the inspiration mixture was 40-42%. We therefore conclude that our nozzle Corovalve printed on a 3D printer can be used in a simple device allowing positive pressure oxygen application during spontaneous ventilation EPAP/CPAP. It is economical and easy to provide method and therefore of a rather interesting potential. With a sufficient number of 3D printed nozzles it could be deployed quickly and on a mass scale. Copyright © 2021, Czech Medical Association J.E. Purkyne. All rights reserved.

3.
Respiratory Care ; 68(1):167-168, 2023.
Article in English | CINAHL | ID: covidwho-2202186

ABSTRACT

The article discusses the importance of optimizing respiratory care for COVID-19 patients while protecting clinicians from risks of aerosol transmission during high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), or noninvasive ventilation (NIV) procedures. A summary of studies on viral detection during NIV and HFNC in COVID-19 is provided. It suggests mitigation of bioaerosol generation and transportation, use of personal protection equipment and vaccination.

4.
Indian Journal of Respiratory Care ; 11(3):246-252, 2022.
Article in English | Web of Science | ID: covidwho-2201833

ABSTRACT

Introduction: This retrospective study attempted to assess the recruitability of the lungs that were affected by acute respiratory distress syndrome (ARDS) due to COVID-19. This was done with the combined use of transpulmonary pressure monitoring (to limit the stress), measurement of end-expiratory lung volume (EELV) (to measure the actual volume gain and be within limits of strain), electrical impedance tomography (EIT), and compliance (to diagnose overdistension). Recruitment was judged clinically by an increase in the SpO2 values. Methods: Retrospective data from the charts and progress sheets were collected from 27 patients admitted to the intensive care unit (between February 2021 and June 2021) with a ratio of arterial Partial pressure of oxygen (PaO2 in mmHg) to fractional inspired oxygen (FiO2) < 150 (i.e., PaO2/FiO2 < 150) with a diagnosis of ARDS. The esophageal pressure was monitored using the polyfunctional nasogastric tube (Nutrivent (TM)). The end-expiratory volume was measured using the Carescape R860 (GE Healthcare) by the nitrogen multiple breath wash-out/wash-in (EELV) at a positive end-expiratory pressure of 5. EIT measurements were performed using the Pulmo Vista 500. We performed a recruitment maneuver using the "staircase maneuver. " Results: As per the results of our study, we found that almost 2/3rd (66.7%) of the patients affected with COVID lungs affected with ARDS were recruitable. Conclusion: The results of our study again make us believe that majority of COVID-19 lungs affected with ARDS may be recruitable in the earlier stage of the illness (within the 1st week of ARDS). Thus, in such patients, safe, monitored lung recruitment should be attempted to improve oxygenation rather than directly proning the patient, which is fraught with its own set of complications.

5.
Open Forum Infectious Diseases ; 9(Supplement 2):S595-S596, 2022.
Article in English | EMBASE | ID: covidwho-2189845

ABSTRACT

Background. Necrotizing soft tissue infections (NSTI) are characterized by fulminant tissue destruction and high mortality rates. Primary treatment is surgical debridement and antibiotics;hyperbaric oxygen therapy (HBOT) may be considered as adjuvant therapy. HBOT for NSTI remains controversial given the lack of quality evidence. HBOT is frequently used for NSTI at our institution;however, the early COVID-19 pandemic forced a significant decrease in its utilization. This practice change created an unusually high proportion of NSTI patients who did not receive HBOT at our institution and thus provided an opportunity to compare outcomes amongst NSTI patients who received HBOT against those who did not. Methods. We performed a retrospective cohort study of patients aged 18 years and older admitted with the diagnosis of NSTI between January 2018 and December 2020, a period that included the first 6 months of the pandemic (Figure 1). We collected data on patient demographics, comorbidities, infection location, pathogen, severity of illness (APACHE II score), whether HBOT was provided and number of dives. Outcomes included 90-day mortality, amputations, inpatient antibiotic days, ventilator days, and hospital length of stay. (Table Presented) Results. 253 patients were included of whom 143 (56%) received HBOT and 110 (43.3%) did not. Baseline characteristics were similar between the groups except for Wound Surface Area (WSA) and APACHE II score (Table 1). Length of stay was significantly longer in HBOT patients (15.3 days vs 11.7 days p=0.005, Table 2). Fewer HBOT patients had amputations (7.5% vs 21% p=0.007) and fewer died within 90 days of admission (6.3% vs 14.5% p=0.029). When stratifying patients by APACHE II score, HBOT patients with APACHE II scores > 18 had significantly lower mortality than non-HBOT patients (9.7% vs 32.4% p=0.035). Conclusion. In this population of NSTI patients who underwent surgical debridement, HBOT was associated with lower incidence of amputation, and lower mortality. Patients with APACHE II scores >18 who received HBOT had lower mortality than those who did not. A prospective study should further evaluate the impact of HBOT on mortality and amputations.

6.
Respiratory Physiology & Neurobiology ; : 104015, 2023.
Article in English | ScienceDirect | ID: covidwho-2182741

ABSTRACT

Introduction Severe acute respiratory distress syndrome coronavirus disease-2 (SARS-CoV-2) can lead to acute hypoxemic respiratory failure (AHRF) with possible multisystemic involvement. Ventilation/perfusion mismatch and shunt increase are critical determinants of hypoxemia. Understanding hypoxemia and the mechanisms involved in its genesis is essential to determine the optimal therapeutic strategy. High flow nasal oxygen (HFNO) and awake prone positioning (APP) in patients with COVID-19 AHRF showed promising benefits. The aim of this systematic review was to depict current situation around the combined use of HFNO and APP in patients with COVID-19 AHRF. Particularly, to investigate and report the pathophysiological rationale for adopting this strategy and to evaluate the (1) criteria for initiation, (2) timing, monitoring and discontinuation, and to assess the (3) impact of HFNO/ APP on outcome. Methods We performed a systematic search collecting the articles present in PubMed, Scopus, EMBASE, and Cochrane databases with the following keywords: COVID-19 pneumonia, high flow nasal oxygen, awake prone position ventilation. Results Thirteen studies displayed inclusion criteria and were included, accounting for 1242 patients who received HFNO/ APP. The combination of HFNO/ APP has an encouraging pathophysiological rationale for implementing this technique. The recognition of patients who can benefit from HFNO/ APP is difficult and there are no validated protocols to start, monitoring, and discontinue HFNO/ APP therapy. The most used method to monitor the efficacy and failure of this combined technique are oxygenation indexes, but discontinuation techniques are inconsistently and poorly described limiting possible generatability. Finally, this technique provided no clear benefits on outcome. Conclusions Our systematic search provided positive feedbacks for improving the utilization of this combination technique, although we still need further investigation about methods to guide timing, management, and discontinuation, and to assess the intervention effect on outcome.

7.
Health Science Reports ; 6(1), 2023.
Article in English | Web of Science | ID: covidwho-2172951

ABSTRACT

Background and AimsProviding respiratory support (RS) to patients may improve their oxygenation and ventilation, reducing the work of breathing. Emergency department (ED) patients often need RS;COVID-19 has heightened this need. Patients receiving RS may need escalation of their treatment;hence, studies considering the prevalence of escalation are warranted. MethodThis is a protocol for a prospective, observational, multicenter point prevalence study (PPS). Researchers will collect data over 2 days. All participants are adult ED patients needing RS. The setting is four EDs in New Zealand. The primary research question asks, "Which patients receiving RS require escalation of therapy in the ED?" For example, transitioning from conventional oxygen therapy (COT) to intubation is deemed an escalation of therapy. A sample size of 80 participants is required to resolve the primary research question. Secondary research questions: (1) Which patients receive nasal high flow (NHF) in the ED? (2) How is NHF therapy delivered in the ED? (3) What are the effects of NHF therapy on physiological and patient-centered outcomes? Research Electronic Data Capture (REDCap) will be used for data organization. Data will be imported for analysis from REDCap to IBM SPSS software (Statistics for Windows, Version 27.0). Data reporting on the primary outcome shall be considered by analysis of variance, regression modeling, and determination of two treatment effects: Odds Ratio and Number Needed to Treat. Statistical significance for inferential statistics shall use a two-sided alpha with p-values fixed at <= 0.05 level of significance and 95% confidence intervals. This protocol has ethical approval from Massey University, New Zealand. ConclusionThis novel PPS may reduce the evidence and clinical practice gap on RS delivery and ED patient outcomes, as evidenced by the emergence of COVID-19.

8.
BMC Pulm Med ; 22(1): 227, 2022 Jun 13.
Article in English | MEDLINE | ID: covidwho-1885300

ABSTRACT

BACKGROUND: This study was designed to explore the early predictive value of the respiratory rate oxygenation (ROX) index modified by PaO2 (mROX) in high-flow nasal cannula (HFNC) therapy in patients with acute hypoxemia respiratory failure (AHRF). METHOD: Seventy-five patients with AHRF treated with HFNC were retrospectively reviewed. Respiratory parameters at baseline and 2 h after HFNC initiation were analyzed. The predictive value of the ROX (ratio of pulse oximetry/FIO2 to respiratory rate) and mROX (ratio of arterial oxygen /FIO2 to respiratory rate) indices with two variations by adding heart rate to each index (ROX-HR and mROX-HR) was evaluated. RESULTS: HFNC therapy failed in 24 patients, who had significantly higher intensive care unit (ICU) mortality and longer ICU stay. Both the ROX and mROX indices at 2 h after HFNC initiation can predict the risk of intubation after HFNC. Two hours after HFNC initiation, the mROX index had a higher area under the receiver operating characteristic curve (AUROC) for predicting HFNC success than the ROX index. Besides, baseline mROX index of greater than 7.1 showed a specificity of 100% for HFNC success. CONCLUSION: The mROX index may be a suitable predictor of HFNC therapy outcomes at the early phase in patients with AHRF.


Subject(s)
Noninvasive Ventilation , Respiratory Insufficiency , Blood Gas Analysis , Cannula , Humans , Oxygen Inhalation Therapy , Respiratory Insufficiency/therapy , Respiratory Rate , Retrospective Studies
9.
J Clin Med ; 11(23), 2022.
Article in English | PubMed | ID: covidwho-2163465

ABSTRACT

BACKGROUND: Since data on the safety and effectiveness of home telemonitoring and oxygen therapy started directly after Emergency Department (ED) assessment in COVID-19 patients are sparse but could have many advantages, we evaluated these parameters in this study. METHODS: All COVID-19 patients ≥18 years eligible for receiving home telemonitoring (November 2020-February 2022, Albert Schweitzer hospital, the Netherlands) were included: patients started directly after ED assessment (ED group) or after hospital admission (admission group). Safety (number of ED reassessments and hospital readmissions) and effectiveness (number of phone calls, duration of oxygen usage and home telemonitoring) were described in both groups. RESULTS: 278 patients were included (n = 65 ED group, n = 213 admission group). ED group: 23.8% (n = 15) was reassessed, 15.9% (n = 10) was admitted and 7.7% (n = 5) ICU admitted. Admission group: 15.8% (n = 37) was reassessed, 6.5% (n = 14) was readmitted and 2.4% (n = 5) ICU (re)admitted. Ten patients died, of whom 7 due to COVID-19 (1 in ED group;6 in the admission group). ED group: median duration of oxygen therapy was 9 (IQR 7-13) days;the total duration of home telemonitoring was 14 (IQR 9-18) days. Admission group: duration of oxygen therapy was 10 (IQR 6-16) days;total duration of home telemonitoring was 14 (IQR 10-20) days. CONCLUSION: it appears to be safe to start home telemonitoring and oxygen therapy directly after ED assessment.

10.
Tijdschrift voor Geneeskunde en Gezondheidszorg ; 78(11), 2022.
Article in Dutch | EMBASE | ID: covidwho-2156291

ABSTRACT

This retrospective cohort study analyses the impact of the COVID-19 pandemic on the prehospital pathology in 1 emergency response unit of Brussels. Three months of prehospital data with in total 1,030 interventions were analysed: 1 month in the first and second COVID-19 outbreak (April and November 2020 respectively) and 1 in the intermediate period (June 2020). The subtracted data contained altered respiratory signs as primary outcome parameter. Secondary outcome parameters were mean age, time from call to arrival of the intervention team, oxygen administration, medication administration, artificial ventilation and prehospital death. Statistical analyses are performed using SPSS, the cross table, the Chi-squared test and the Kruskal-Wallis test. Altered respiratory signs appeared in 31.9, 24.6 and 32.9% of the cases in April, June and November respectively (p-value: 0.039). Mean age was 59, 57 and 60 years (null hypothesis retained). Time from call to arrival of the intervention team was 11 minutes in all 3 periods (null hypothesis retained). Oxygen was administrated in 31.4, 27.4 and 32.6% of the cases (p-value: 0.315). Medication was given in 41.1, 39.7 and 41.2% (p-value: 0.908). Artificial ventilation was necessary in 2.8, 5.5 and 5.8% of the interventions (p-value: 0.115). Prehospital death was declared in 6.1, 4.9 and 6.9% of the cases. The COVID-19 pandemic had a significant impact on the prevalence of prehospital altered respiratory signs. Furthermore, no significant difference has been observed in the secondary outcome parameters. Copyright © 2022 The authors.

11.
Respir Res ; 23(1):329, 2022.
Article in English | PubMed | ID: covidwho-2153588

ABSTRACT

BACKGROUND: High-flow nasal oxygen therapy (HFNC) may be an attractive first-line ventilatory support in COVID-19 patients. However, HNFC use for the management of COVID-19 patients and risk factors for HFNC failure remain to be determined. METHODS: In this retrospective study, we included all consecutive COVID-19 patients admitted to our intensive care unit (ICU) in the first (Mars-May 2020) and second (August 2020- February 202) French pandemic waves. Patients with limitations for intubation were excluded. HFNC failure was defined as the need for intubation after ICU admission. The impact of HFNC use was analyzed in the whole cohort and after constructing a propensity score. Risk factors for HNFC failure were identified through a landmark time-dependent cause-specific Cox model. The ability of the 6-h ROX index to detect HFNC failure was assessed by generating receiver operating characteristic (ROC) curve. RESULTS: 200 patients were included: HFNC was used in 114(57%) patients, non-invasive ventilation in 25(12%) patients and 145(72%) patients were intubated with a median delay of 0 (0-2) days after ICU admission. Overall, 78(68%) patients had HFNC failure. Patients with HFNC failure had a higher ICU mortality rate (34 vs. 11%, p = 0.02) than those without. At landmark time of 48 and 72 h, SAPS-2 score, extent of CT-Scan abnormalities > 75% and HFNC duration (cause specific hazard ratio (CSH) = 0.11, 95% CI (0.04-0.28), per + 1 day, p < 0.001 at 48 h and CSH = 0.06, 95% CI (0.02-0.23), per + 1 day, p < 0.001 at 72 h) were associated with HFNC failure. The 6-h ROX index was lower in patients with HFNC failure but could not reliably predicted HFNC failure with an area under ROC curve of 0.65 (95% CI(0.52-0.78), p = 0.02). In the matched cohort, HFNC use was associated with a lower risk of intubation (CSH = 0.32, 95% CI (0.19-0.57), p < 0.001). CONCLUSIONS: In critically-ill COVID-19 patients, while HFNC use as first-line ventilatory support was associated with a lower risk of intubation, more than half of patients had HFNC failure. Risk factors for HFNC failure were SAPS-2 score and extent of CT-Scan abnormalities > 75%. The risk of HFNC failure could not be predicted by the 6-h ROX index but decreased after a 48-h HFNC duration.

12.
Clin Case Rep ; 10(11): e6524, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2127620

ABSTRACT

Kienböck disease, also known as lunatomalacia, is a rare condition which can lead to progressive wrist pain and abnormal carpal motion. We present the case of a 30-year-old patient with Down syndrome who came to our observation for treatment of stage III C Kienböck disease. In September 2019, the patient reported wrist pain with limitation in movements and initially underwent conservative treatment without benefit. In October 2020, pain symptoms and difficult movements with reduced strength worsened and surgical treatment was proposed, but the patient and his family declined. Thereby the patient underwent conservative treatment with hyperbaric oxygen therapy (HBOT) 60 sessions, 100% oxygen at 2.5 absolute atmospheres (ATA), oxygen total time 60 min, once daily, five times per week. After 6 months, a positive clinical and radiological evolution were observed, with an improvement in the patterns of pain, motion, and strength and an almost complete involution of the process of aseptic necrosis of the semilunar. To the best of our knowledge, this is the first report of stage III C Kienböck's disease in Down's syndrome patient treated with HBOT.

13.
European Journal of Mechanics B: Fluids ; 97:93-110, 2023.
Article in English | Academic Search Complete | ID: covidwho-2130821

ABSTRACT

The Covid-19 global pandemic has reshaped the requirements of healthcare sectors worldwide. Following the exposure risks associated with Covid-19, this paper aims to design, optimise, and validate a wearable medical device that reduces the risk of transmission of contagious droplets from infected patients in a hospital setting. This study specifically focuses on those receiving high-flow nasal oxygen therapy. The design process consisted of optimising the geometry of the visor to ensure that the maximum possible percentage of harmful droplets exhaled by the patient can be successfully captured by a vacuum tube attached to the visor. This has been completed by deriving a number of concept designs and assessing their effectiveness, based on numerical analysis, computational fluid dynamics (CFD) simulations and experimental testing. The CFD results are validated using various experimental methods such as Schlieren imaging, particle measurement testing and laser sheet visualisation. Droplet capturing efficiency of the visor was measured through CFD and validated through experimental particle measurement testing. The results presented a 5% deviation between CFD and experimental results. Also, the modifications based on the validated CFD results improved the visor effectiveness by 47% and 38% for breathing and coughing events, respectively [ FROM AUTHOR]

14.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128190

ABSTRACT

Background: Lupus anticoagulants (LA) that appear in antiphospholipid syndrome, known as causes of thrombophilia, are commonly detected during various viral infection. As previously reported, LA is frequently detected in COVID-19 patients who often exhibited thrombosis. However, clinical significance of LA remains unclear, and there are no accurate reports of LA detection patterns. Aim(s): In this study, we performed to analyze clinical significance and detection pattern of LA in COVID-19 patients. Method(s): We performed retrospective chart analysis of COVID-19 patients who underwent LA test at Asan Medical Center from March 2020 to November 2021. We compared laboratory data and disease severity parameters, such as oxygen treatment, between LA-negative and LA-positive groups who detected LA at least once after infection. For LA-positive patients who underwent multiple LA tests, subgroup analysis was performed to determine detection pattern of LA. Result(s): A total of 219 COVID-19 patients were enrolled, 148(67.6%) were LA-positive. LA-positive group more received high flow nasal cannula (p = 0.024). The LA-positive group showed prolonged aPTT, high levels of fibrinogen and CRP (all p's < 0.05). In a subgroup analysis, 127(86.5%) detected LA within 10days of infection and 87(58.8%) were detected LA within 5 days of infection. Among LA-positive patients, 100 were confirmed negative by follow-up test. All 87 patients showed LA-negative conversion within 12 weeks, with exception of 13 patients who underwent follow-up after 12 weeks. The median time to negative conversion was 10 days. Conclusion(s): LA was found in high proportion of COVID-19 patients. LA-positive patients showed higher oxygen demand and higher level of inflammatory parameters. LA is expected to be a predictive indicator of disease severity in COVID-19 patients. LA appears in early stages of infection and disappears rapidly within 10 days in half of cases. Therefore, it is recommended to perform LA test when confirmed COVID-19 infection to predict the course of the disease. (Table Presented).

15.
Prescrire International ; 31(242):268, 2022.
Article in English | Scopus | ID: covidwho-2124426
16.
Open Medicine ; - (1):1833-1839, 2022.
Article in English | ProQuest Central | ID: covidwho-2140826

ABSTRACT

Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19). We conducted a retrospective study of COVID-19 inpatients in Wuhan Pulmonary Hospital (Wuhan, China) from January 1 to February 29, 2020. The subjects were divided into four groups due to different treatment regimes. We used the Kaplan–Meier method to determine the cumulative rates of in-hospital death and the Cox proportional hazard model to calculate the risk factors and corresponding hazard ratios. A total of 185 patients were included in this study. The median age of the patients was 62 years, including 94 men and 91 women. Kaplan–Meier analysis demonstrated that mortality was higher in older patients, higher in men, and lower in the low-flow oxygen therapy group. Body mass index (BMI) had no influence on mortality, as well as high flow oxygen therapy, Lopinavir–ritonavir (LPV/r) therapy, and the interferon-alpha add LPV/r therapy. Cox proportional hazard regression confirmed that the low flow oxygen therapy was independent protective factor for in-hospital death after adjusting for age, gender, and BMI. In conclusion, the mortality was higher in older patients, higher in men, and lower in the low-flow oxygen therapy group. BMI had no influence on mortality, as well as high flow oxygen therapy, LPV/r therapy, and interferon-alpha add LPV/r therapy.

17.
Int J Environ Res Public Health ; 19(22)2022 Nov 18.
Article in English | MEDLINE | ID: covidwho-2116158

ABSTRACT

The coronavirus disease (COVID-19) epidemic is a public health emergency of international concern. It was believed that SARS-CoV-2 virus was much less likely affect children. Statistics show that children account for 2-13% of all COVID-19 patients in individual countries. In the youngest population, acute respiratory failure is not as serious a problem as complications after COVID-19, mainly pediatric inflammatory multisystem syndrome (PIMS, MIS-C). This study used a bibliography review. The Medline database (using the PubMed platform) and the Cochrane Clinical Trials database were searched using the following keywords: hyperbaric oxygen therapy for children, treatment of children with COVID-19, and use of HBOT in the treatment of children following COVID-19. Thirteen publications that quantitatively and qualitatively described the efficacy of HBOT application in the treatment of pediatric diseases were eligible among the studies; those relating to the use of HBOT in the treatment of children with COVID-19 and its complications were not found. The bibliographic review showed that hyperbaric oxygen therapy can be used in the treatment of children after carbon monoxide poisoning, with soft tissue necrosis, bone necrosis, after burns, or after skin transplant. No evidence supported by research has been found in scientific journals on the effectiveness of the use of hyperbaric oxygen therapy in children with a history of COVID-19 infection. Research data are needed to develop evidence-driven strategies with regard to the use of HBOT therapy in the treatment of children and to reduce the number of pediatric patients suffering because of complications after COVID-19.


Subject(s)
COVID-19 , Carbon Monoxide Poisoning , Hyperbaric Oxygenation , Humans , Child , COVID-19/therapy , SARS-CoV-2
18.
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.

19.
Thorax ; 77(Suppl 1):A146, 2022.
Article in English | ProQuest Central | ID: covidwho-2118720

ABSTRACT

IntroductionA blinded ambulatory oxygen assessment protocol on a treadmill was established in 2005. Patients perform 2 walking tests, up to fifteen minutes each, on a treadmill at a set speed with a 30 minute rest between tests. The patient wears nasal cannulae on both tests, through which they receive 2L/min of air or Oxygen. Patients rate their breathlessness on a BORG scale every minute and this is recorded with Oxygen saturation via ear probe and heart rate. An increase in distance (10%) or decrease in BORG scores (1 point/10%) would indicate a need for ambulatory Oxygen prescription. The British Thoracic Society (BTS) 2015 ambulatory Oxygen therapy assessment protocol also states that an increase in SpO2 to ≥90% throughout the test would show a benefit to the patient1.AimHow many patients referred for assessment would benefit from prescription of ambulatory Oxygen based on the current BTS protocol?MethodsTest results, demographic and clinical data were collated for all patients referred for ambulatory Oxygen assessment over 1 year.Results88 patients were referred for assessment with 18 excluded (n=70). 11 patients only carried out the baseline test on air without progressing to the second test on oxygen as there was no significant desaturation during exercise. Of the 59 remaining patients 34 would be recommended ambulatory oxygen therapy, 19 would not and the remaining 6 may require higher flow rates than the 4L/min O2 that is the highest rate within the protocol. Only 18 patients (18/59=31%) had a decrease in BORG (felt better) by 10% or 1 point whilst on supplemental O2. 10 patients (10/59=17%) reported higher BORG scores on Oxygen (?fatigue, ? walked further).ConclusionOf the 70 patients included in the audit 34 (48.57%) would be recommended ambulatory oxygen therapy, 30 (42.86%) would not and the remaining 6 (8.57%) may require higher flow rates than the 4L/min that is the highest rate within the protocol. This protocol has been particularly useful during the COVID pandemic and the SOP has been shared with other departments.ReferencesHardinge M, Annandale J, Bourne S, et al. British Thoracic Society guidelines for home oxygen use in adults: accredited by NICE. Thorax 2015;70:i1-i43.

20.
Am J Emerg Med ; 63: 86-93, 2022 Oct 19.
Article in English | MEDLINE | ID: covidwho-2094988

ABSTRACT

BACKGROUND: To assess the effectiveness of non-rebreather mask combined with low-flow nasal cannula (NRB + NC) compared to high-flow nasal cannula (HFNC) in improving oxygenation in patients with COVID-19-related hypoxemic respiratory failure (HRF). METHODS: This retrospective study was conducted in emergency departments of two tertiary hospitals from June 1 to August 31, 2021. Consecutive patients aged >18 years admitted for COVID-19-related HRF (World Health Organization criteria: confirmed COVID-19 pneumonia with respiratory rate > 30 breaths/min, severe respiratory distress, or peripheral oxygen saturation < 90% on room air) requiring NRB + NC or HFNC were screened for enrollment. Primary outcome was improvement of partial pressure arterial oxygen (PaO2) at two hours. Secondary outcomes were intubation rate, ventilator-free days, hospital length of stay, and 28-day mortality. Data were analyzed using linear regression with inverse probability of treatment weighting (IPTW) based on propensity score. RESULTS: Among the 110 patients recruited, 52 (47.3%) were treated with NRB + NC, and 58 (52.7%) with HFNC. There were significant improvements in patients' PaO2, PaO2/FIO2 ratio, and respiratory rate two hours after the initiation of NRB + NC and HFNC. Comparing the two groups, after IPTW adjustment, there were no statistically significant differences in PaO2 improvement (adjusted mean ratio [MR] 2.81; 95% CI -5.82 to 11.43; p = .524), intubation rate (adjusted OR 1.76; 95% CI 0.44 to 6.92; p = .423), ventilator-free days (adjusted MR 0.00; 95% CI -8.84 to 8.85; p = .999), hospital length of stay (adjusted MR 3.04; 95% CI -2.62 to 8.69; p = .293), and 28-day mortality (adjusted OR 0.68; 95% CI 0.15 to 2.98; p = .608). CONCLUSION: HFNC may be beneficial in COVID-19 HRF. NRB + NC is a viable alternative, especially in resource-limited settings, given similar improvement in oxygenation at two hours, and no significant differences in long-term outcomes. The effectiveness of NRB + NC needs to be investigated by a powered randomized controlled trial.

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