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1.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-335564

ABSTRACT

Background: The antiviral efficacy of remdesivir is still controversial. We aimed at evaluating its clinical effectiveness in hospitalised patients with COVID-19, with indication of oxygen and/or ventilator support. Following prior publication of preliminary results, here we present the final results after completion of data monitoring. Methods: In this European multicentre, open-label, parallel-group, randomised, controlled trial (DisCoVeRy, NCT04315948;EudraCT2020-000936-23), participants were randomly allocated to receive usual standard of care (SoC) alone or in combination with remdesivir, lopinavir/ritonavir, lopinavir/ritonavir and IFN-β-1a, or hydroxychloroquine. Adult patients hospitalised with COVID-19 were eligible if they had clinical evidence of hypoxemic pneumonia, or required oxygen supplementation. Exclusion criteria included elevated liver enzyme, severe chronic kidney disease, any contra-indication to one of the studied treatments or their use in the 29 days before randomization, or use of ribavirin, as well as pregnancy or breast-feeding. Here, we report results for remdesivir + SoC versus SoC alone. Remdesivir was administered as 200 mg infusion on day 1, followed by once daily infusions of 100 mg up to 9 days, for a total duration of 10 days. It could be stopped after 5 days if the participant was discharged. Treatment assignation was performed via web-based block randomisation stratified on illness severity and administrative European region. The primary outcome was the clinical status at day 15 measured by the WHO 7-point ordinal scale, assessed in the intention-to-treat population. Findings: Between March 22nd, 2020 and January 21st, 2021, 857 participants were randomised to one of the two arms in 5 European countries and 843 participants were included for the evaluation of remdesivir (control, n=423;remdesivir, n=420). At day 15, the distribution of the WHO ordinal scale was as follow in the remdesivir and control groups, respectively: Not hospitalized, no limitations on activities: 62/420 (14.8%) and 72/423 (17.0%);Not hospitalized, limitation on activities: 126/420 (30%) and 135/423 (31.9%);Hospitalized, not requiring supplemental oxygen: 56/420 (13.3%) and 31/423 (7.3%);Hospitalized, requiring supplemental oxygen: 75/420 (17.9%) and 65/423 (15.4%);Hospitalized, on non-invasive ventilation or high flow oxygen devices: 16/420 (3.8%) and 16/423 (3.8%);Hospitalized, on invasive mechanical ventilation or ECMO: 64/420 (15.2%) and 80/423 (18.9%);Death: 21/420 (5%) and 24/423 (5.7%). The difference between treatment groups was not statistically significant (OR for remdesivir, 1.02, 95% CI, 0.62 to 1.70, P=0.93). There was no significant difference in the occurrence of Serious Adverse Events between treatment groups (remdesivir, n=147/410, 35.9%, versus control, n=138/423, 32.6%, p=0.29). Interpretation: Remdesivir use for the treatment of hospitalised patients with COVID-19 was not associated with clinical improvement at day 15.

2.
BMJ : British Medical Journal (Online) ; 368, 2020.
Article in English | ProQuest Central | ID: covidwho-1837197

ABSTRACT

ObjectiveTo delineate the clinical characteristics of patients with coronavirus disease 2019 (covid-19) who died.DesignRetrospective case series.SettingTongji Hospital in Wuhan, China.ParticipantsAmong a cohort of 799 patients, 113 who died and 161 who recovered with a diagnosis of covid-19 were analysed. Data were collected until 28 February 2020.Main outcome measuresClinical characteristics and laboratory findings were obtained from electronic medical records with data collection forms.ResultsThe median age of deceased patients (68 years) was significantly older than recovered patients (51 years). Male sex was more predominant in deceased patients (83;73%) than in recovered patients (88;55%). Chronic hypertension and other cardiovascular comorbidities were more frequent among deceased patients (54 (48%) and 16 (14%)) than recovered patients (39 (24%) and 7 (4%)). Dyspnoea, chest tightness, and disorder of consciousness were more common in deceased patients (70 (62%), 55 (49%), and 25 (22%)) than in recovered patients (50 (31%), 48 (30%), and 1 (1%)). The median time from disease onset to death in deceased patients was 16 (interquartile range 12.0-20.0) days. Leukocytosis was present in 56 (50%) patients who died and 6 (4%) who recovered, and lymphopenia was present in 103 (91%) and 76 (47%) respectively. Concentrations of alanine aminotransferase, aspartate aminotransferase, creatinine, creatine kinase, lactate dehydrogenase, cardiac troponin I, N-terminal pro-brain natriuretic peptide, and D-dimer were markedly higher in deceased patients than in recovered patients. Common complications observed more frequently in deceased patients included acute respiratory distress syndrome (113;100%), type I respiratory failure (18/35;51%), sepsis (113;100%), acute cardiac injury (72/94;77%), heart failure (41/83;49%), alkalosis (14/35;40%), hyperkalaemia (42;37%), acute kidney injury (28;25%), and hypoxic encephalopathy (23;20%). Patients with cardiovascular comorbidity were more likely to develop cardiac complications. Regardless of history of cardiovascular disease, acute cardiac injury and heart failure were more common in deceased patients.ConclusionSevere acute respiratory syndrome coronavirus 2 infection can cause both pulmonary and systemic inflammation, leading to multi-organ dysfunction in patients at high risk. Acute respiratory distress syndrome and respiratory failure, sepsis, acute cardiac injury, and heart failure were the most common critical complications during exacerbation of covid-19.

3.
Complexity ; 2022, 2022.
Article in English | ProQuest Central | ID: covidwho-1832701

ABSTRACT

In recent years, precise high flow oxygen therapy as a new type of oxygen therapy machine has gradually attracted people’s attention and has been widely used in hospital emergency and clinical treatment of respiratory diseases;especially in recent years, severe coronavirus disease (COVID-19) has played an important role in the treatment of patients. This paper presents a new type of precise high flow oxygen therapy machine with electromagnetic pneumatic flow valve as the core control element. A sliding mode control strategy based on the system is proposed to realize the accurate control of oxygen concentration and output flow of oxygen therapy mixture. The physical equipment of the precision high flow system is established, and its working performance is verified through the test platform. The optimization design goal of the precision high flow equipment is achieved.

4.
Crit Care ; 26(1): 89, 2022 04 02.
Article in English | MEDLINE | ID: covidwho-1833332

ABSTRACT

Description of all consecutive critically ill COVID 19 patients hospitalized in ICU in University Hospital of Guadeloupe and outcome according to delay between steroid therapy initiation and mechanical ventilation onset. Very late mechanical ventilation defined as intubation after day 7 of dexamethasone therapy was associated with grim prognosis and a high mortality rate of 87%.


Subject(s)
COVID-19 , Humans , Intensive Care Units , Intubation, Intratracheal , Prognosis , Time Factors
5.
Can J Anaesth ; 69(5): 582-590, 2022 05.
Article in English | MEDLINE | ID: covidwho-1827189

ABSTRACT

PURPOSE: The optimal noninvasive modality for oxygenation support in COVID-19-associated hypoxemic respiratory failure and its association with healthcare worker infection remain uncertain. We report here our experience using high-flow nasal oxygen (HFNO) as the primary support mode for patients with COVID-19 in our institution. METHODS: We conducted a single-centre historical cohort study of all COVID-19 patients treated with HFNO for at least two hours in our university-affiliated and intensivist-staffed intensive care unit (Jewish General Hospital, Montreal, QC, Canada) between 27 August 2020 and 30 April 2021. We report their clinical characteristics and outcomes. Healthcare workers in our unit cared for these patients in single negative pressure rooms wearing KN95 or fit-tested N95 masks; they underwent mandatory symptomatic screening for COVID-19 infection, as well as a period of asymptomatic screening. RESULTS: One hundred and forty-two patients were analysed, with a median [interquartile range (IQR)] age of 66 [59-73] yr; 71% were male. Patients had a median [IQR] Sequential Organ Failure Assessment Score of 3 [2-3], median [IQR] oxygen saturation by pulse oximetry/fraction of inspired oxygen ratio of 120 [94-164], and a median [IQR] 4C score (a COVID-19-specific mortality score) of 12 [10-14]. Endotracheal intubation occurred in 48/142 (34%) patients, and overall hospital mortality was 16%. Barotrauma occurred in 21/142 (15%) patients. Among 27 symptomatic and 139 asymptomatic screening tests, there were no cases of HFNO-related COVID-19 transmission to healthcare workers. CONCLUSION: Our experience indicates that HFNO is an effective first-line therapy for hypoxemic respiratory failure in COVID-19 patients, and can be safely used without significant discernable infection risk to healthcare workers.


RéSUMé: OBJECTIF: La modalité non invasive optimale pour le soutien en oxygène lors d'insuffisance respiratoire hypoxémique liée à la COVID-19 et son association avec l'infection des travailleurs de la santé restent incertaines. Nous rapportons ici notre expérience avec l'utilisation de canules nasales à haut débit (CNHD) comme principale modalité de soutien pour les patients atteints de COVID-19 dans notre établissement. MéTHODE: Nous avons mené une étude de cohorte historique monocentrique de tous les patients atteints de COVID-19 traités par CNHD pendant au moins deux heures dans notre unité de soins intensifs affiliée à l'université et dotée d'intensivistes (Hôpital général juif, Montréal, QC, Canada) entre le 27 août 2020 et le 30 avril 2021. Nous rapportons leurs caractéristiques cliniques et leurs résultats. Les travailleurs de la santé de notre unité ont soigné ces patients dans des chambres individuelles à pression négative en portant des masques KN95 ou N95 ajustés; ils ont subi un dépistage symptomatique obligatoire de l'infection à la COVID-19, ainsi qu'un dépistage en période asymptomatique. RéSULTATS: Cent quarante-deux patients ont été analysés, avec un âge médian [écart interquartile (ÉIQ)] de 66 [59-73] ans; 71 % étaient des hommes. Les patients avaient un score SOFA (Sequential Organ Failure Assessment) médian [ÉIQ] de 3 [2, 3], un ratio médian [ÉIQ] de saturation en oxygène par oxymétrie de pouls/fraction d'oxygène inspiré de 120 [94-164], et un score 4C (un score de mortalité spécifique à la COVID-19) médian [ÉIQ] de 12 [10­14]. Dans l'ensemble, 48/142 patients (34 %) ont reçu une intubation endotrachéale, et la mortalité hospitalière globale était de 16 %. Un barotraumatisme est survenu chez 21/142 (15 %) patients. Parmi les 27 tests de dépistage symptomatiques et 139 tests asymptomatiques, aucun cas de transmission de COVID-19 liée aux CNHD aux travailleurs de la santé n'a été observé. CONCLUSION: Notre expérience indique que les CNHD constituent un traitement de première intention efficace pour l'insuffisance respiratoire hypoxémique chez les patients atteints de COVID-19 qui peut être utilisé en toute sécurité, sans risque d'infection significatif discernable pour les travailleurs de la santé.


Subject(s)
COVID-19 , Noninvasive Ventilation , Respiratory Insufficiency , COVID-19/complications , COVID-19/therapy , Cohort Studies , Female , Humans , Male , Oxygen , Oxygen Inhalation Therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy
6.
Ann Med Surg (Lond) ; 77: 103709, 2022 May.
Article in English | MEDLINE | ID: covidwho-1821117

ABSTRACT

The impact on mortality associated with covid-19 today exceeds five million deaths worldwide, and the number of deaths continues to rise. The complications of the survivors, socio-economic implications at a global level, economic limitations in the health systems, and physical and emotional exhaustion of health personnel are detrimental. Therapeutic strategies are required to limit the evolution of the disease, improve the prognosis of critically ill patients, and, in countries with low purchasing power, create affordable alternatives that can help contain the evolution towards the severity of infected people with mild to moderate symptoms. The misinformation and myths that today are more frequent on social networks and the implementation of practices without scientific support is a problem that aggravates the general panorama. This review aims to concentrate on the best evidence for treating SARS-CoV-2 infection in a simple and summarized manner, addressing therapies from their bases to the most innovative alternatives available today.

7.
J Med Virol ; 2022 May 04.
Article in English | MEDLINE | ID: covidwho-1819370

ABSTRACT

Hospital readmissions due to COVID-19 are one of the main concerns for the health system due to risks to the patient's life and increased use of health resources. Studies focusing on this issue are important to understand the risk factors and create strategies to avoid readmissions. We evaluated the readmission of patients with confirmed COVID-19 in a private hospital in southern Brazil, between March 2020 and 2021. Also, the characteristics and clinical outcomes of patients admitted to the intensive care unit (ICU) and nonadmitted were compared. Poisson regression models with prevalence ratio (PR) with 95% confidence intervals (95% CIs) were applied to confirm the association between variables and ICU admission. Of the 2084 hospitalized patients with COVID-19, 1806 were discharged alive. Among them, 106 were readmitted for unplanned reasons during one year. Early hospital readmission (≤30 days) occurred in 52.8% of the cases. The main reasons were respiratory, gastroenterological, kidney, and cardiac disease. The median age was 73.0 years old and women correspond to 52.8%. The presence of at least one comorbidity was detected in 87.7% of patients. Hypertension, diabetes, cardiac, and lung disease were more frequent. The ICU admitted patients (n = 43; 40.5%) mostly had 4-5 comorbidities, pulmonary involvement ≥50%, length of stay (LOS), and days between discharge and first readmission. Longer LOS (PR: 3.46; 95% CI: 1.24-5.67), days between discharge/first readmission (PR: 2.21; 95% CI: 1.15-5.88), and pulmonary involvement (≥50%; PR: 1.59; 95% CI: 1.11-3.54) were independently associated with ICU admission. Longer LOS, longer days between discharge/first readmission, and pulmonary involvement (≥50%) were associated with ICU admission in readmitted patients. Readmissions evaluation is pivotal and may help in ensuring safe care transition and postdischarge follow-up.

8.
Asian Journal of Pharmaceutical and Clinical Research ; 15(4):118-121, 2022.
Article in English | EMBASE | ID: covidwho-1818973

ABSTRACT

Objective: The studies describing the clinicoepidemiological features of coronavirus disease-2019 (COVID-19) patients of first wave are available but about second wave, very few studies have documented. This study was aimed to describe the clinicoepidemiological features and the causes of mortality of COVID-19 patients of second wave admitted in our center. Methods: This retrospective, observational, and cross-sectional study was carried out among 200 randomly selected and confirmed COVID-19 indoor patients admitted between April 7, 2021 and July 3, 2021 in Dr. N. D. Desai Hospital, Nadiad. The demographic profile, clinical features, comorbidities, inflammatory markers, and causes of mortality in these patients were analyzed. Results: A total 200 patients of COVID-19 of second wave were analyzed. Majority of them were males (64.5%) and the patients between 18 and 60 years of age constituted 60%. Hypertension (70.93%) and diabetes mellitus (46.51%) were common comorbidities followed by ischemic heart diseases and chronic kidney disease. The most common presenting features were fever (75.7%), cough (68.8%), and shortness of breath (60%). The median duration of hospital stay was 7 days [interquartile range, 4-12]. The patients needed any kind of mode of oxygen therapy were 82.5%. The most common cause of death was cardiac arrest (70.58%) followed by severe acute respiratory distress syndrome (ARDS) (35.29%). Conclusions: In this retrospective study, most patients were young males with the age <60 years. The patients had one or more comorbidities, hypertension being the most common. Inflammatory markers were significantly higher in patients who died in our hospital.

9.
Indian Journal of Critical Care Medicine ; 26(4):528-530, 2022.
Article in English | Web of Science | ID: covidwho-1818519
12.
Geriatric Orthopaedic Surgery and Rehabilitation ; 12:22, 2021.
Article in English | EMBASE | ID: covidwho-1817114

ABSTRACT

Introduction: hip fractures in elderly patients have been associated with high morbidity and mortality rate and are dependent on the presence of associated comorbidities. SARS-CoV-2 disease (Covid-19) is nowadays considered to be an independent risk factor increasing mortality rates. The aim of our report was to analyse the management of a vaccinated versus a non-vaccinated elderly patient that were both diagnosed positive to SARS-CoV-2 after having sustained an intracapsular neck of femur fracture. Methods: Two patients (Patient A 91 and Patient B 88 years old, both female) were referred to our hospital after sustaining an intracapsular neck of femur hip fracture as a result of low energy trauma. Both patients tested positive for Covid-19 during their preoperative screening tests. Patient A had not been vaccinated against Covid-19 in contrast to patient B who had completed the 2 dose regimen of the Pfizer-BioNTech COVID-19 vaccine. Patient A presented on arrival Leukopenia (WBC: 1.2 μc/l, Neutrophils 0.4 mcL) and Thrombocytopenia (PLT 70.000). The Procalcitonin, C-Reactive Protein and Ferritin levels long as Arterial blood Gases were measured in both patients on arrival. Patient A required administration of Granulocyte colony stimulating factor and platelet transfusion prior to surgery. Results: Both patients underwent uncemented hip hemiarthroplasty. Patient A was operated 5 days after hospital admission as optimization of the patient's Covid-19 related Leukopenia and Thrombocytopenia was required and Patient B was operated within 24 hours after hospital admission. Patient A required transfusion of 4 blood Units (bleeding related to Thrombocytopenia) compared to 2 blood units that were administered in Patient B. Patient A developed Covid 19 related Pneumonia and Lung disease on the 6th post-operative day (PO2 SO2) and required high flow nasal cannula therapy for 7 days followed by oxygen therapy for 8 days delaying her mobilization and hospital discharge. Patient A was discharged on the 29th post-operative day and Patient B was discharged on the 6th post-operative day. Conclusion: Covid 19 related complications in elderly hip fracture patients are challenging and require multidisciplinary approach and hospital resources. However, Vaccination against covid-19 seems to prevent Covid related complications and can improve the outcome. Large series studies and further research is required to support our thesis.

13.
Pakistan Armed Forces Medical Journal ; 72(1):338, 2022.
Article in English | ProQuest Central | ID: covidwho-1813019
14.
Biochemical and Cellular Archives ; 21(2):1-2, 2021.
Article in English | EMBASE | ID: covidwho-1812557
15.
Beni Suef Univ J Basic Appl Sci ; 11(1): 57, 2022.
Article in English | MEDLINE | ID: covidwho-1791007

ABSTRACT

Background: Continuous Positive Airway Pressure (CPAP), BiPhasic Positive Airway Pressure (BiPAP), and high flow nasal cannula (HFNC) show some evidence to have efficacy in COVID-19 patients. Delivery during noninvasive mechanical ventilation (NIV) or HFNC gives faster and more enhanced clinical effects than when aerosols are given without assisted breath. The present work aimed to compare the effect of BiPhasic Positive Airway Pressure (BiPAP) mode at two different pressures; low BiPAP (Inspiratory Positive Airway Pressure (IPAP)/Expiratory Positive Airway Pressure (EPAP) of 10/5 cm water) and high BiPAP (IPAP/EPAP of 20/5 cm water), with HFNC system on pulmonary and systemic drug delivery of salbutamol. On the first day of the experiment, all patients received 2500 µg salbutamol using Aerogen Solo vibrating mesh nebulizer. Urine samples 30 min post-dose and cumulative urinary salbutamol during the next 24 h were collected on the next day. On the third day, the ex-vivo filter was inserted before the patient to collect the delivered dose to the patient of the 2500 µg salbutamol. Salbutamol was quantified using high-performance liquid chromatography (HPLC). Results: Low-pressure BiPAP showed the highest amount delivered to the lung after 30 min followed by HFNC then high-pressure BiPAP. But the significant difference was only observed between low and high-pressure BiPAP modes (p = 0.012). Low-pressure BiPAP showed the highest delivered systemic delivery amount followed by HFNC then high-pressure BiPAP. Low-pressure BiPAP was significantly higher than HFNC (p = 0.017) and high-pressure BiPAP (p = 0.008). No significant difference was reported between HFNC and high-pressure BiPAP. The ex-vivo filter was the greatest in the case of low-pressure BiPAP followed by HFNC then high-pressure BiPAP. Low-pressure BiPAP was significantly higher than HFNC (p = 0.033) and high-pressure BiPAP (p = 0.008). Also, no significant difference was found between HFNC and high-pressure BiPAP. Conclusions: Our results of pulmonary, systemic, and ex-vivo drug delivery were found to be consistent. The low BiPAP delivered the highest amount followed by the HFNC then the high BiPAP with the least amount. However, no significant difference was found between HFNC and high BiPAP.

16.
Journal of Clinical and Diagnostic Research ; 16(4):OC01-OC04, 2022.
Article in English | EMBASE | ID: covidwho-1798691

ABSTRACT

Introduction: Patients with history of past or active malignancy are at increased risk of contracting the virus and developing Coronavirus Disease 2019 (COVID-19) related complications. With the global prevalence of cancer and the high transmissibility of Severe Acute Respiratory Syndrome Corona Virus 2 (SARSCoV-2), an understanding of the disease course of COVID-19 and factors influencing clinical outcomes in patients with cancer is necessary and is largely unknown. Aim: To study the laboratory characteristics of patients with malignancy and COVID-19 infection and to evaluate the outcomes in terms of clinical features, severity of infection and mortality of patients with malignancy and COVID-19 infection. Materials and Methods: The present study was a cross-sectional study conducted at Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India after obtaining Institutional Ethical Committee (IEC) clearance, involving 72 subjects with COVID-19 infection. The duration of the study was from April-November 2020. Demographic details and data were collected in patients with active or previous malignancy and COVID-19 illness based on Indian Council of Medical Research (ICMR) criteria. Clinical outcome of the patients was measured based on need for Intensive Care Unit (ICU) admission, oxygen therapy and mortality. Descriptive statistics of the explanatory and outcome variables were calculated by mean, Standard Deviation (SD), median and Interquartile Range (IQR) for quantitative variables, frequency and proportions for qualitative variables. Inferential statistics like Chi-square test was applied for qualitative variables. Results: The mean age of the subjects was 52.10±14.512 years with 29 males, 43 females. Among 72 patients with malignancy, patients were classified as mild (23), moderate (22) and severe (27) according to ICMR case type respectively. Among the total patients, 21 (29.2%) were asymptomatic and 51 (70.8%) were symptomatic with 26 (36.1%) symptomatic patients having severe disease. Also, 30 (41.7%) had requirement of O2 and 28 (38.9%) were admitted to ICU. Most common was solid organ (66) lung carcinoma (13), breast (10), compared to haematological malignancies (6). A total of 22 (30.6%) patients had mortality with most common complication being Acute Respiratory Distress Syndrome (ARDS) (20.8%) followed by sepsis (4.2%). Conclusion: The results of present study revealed higher mortality and increased inflammatory markers in patients with severe COVID-19 infection and malignancy.

17.
European Heart Journal Cardiovascular Imaging ; 23(SUPPL 1):i606, 2022.
Article in English | EMBASE | ID: covidwho-1795302

ABSTRACT

Myocardial dysfunction is common and associated with worse outcomes in patients with ARDS, pulmonary embolism or severe sepsis due to pulmonary hypoxic vasoconstriction. Thrombotic events, myocarditis and endothelial dysfunction may contribute to these effects in COVID- 19 infection. The evaluation of myocardial function can provide prognostic information regarding the severity of a current COVID-19 infection, but scarce data available on the role of Deformation Indices obtained by Speckle Tracking Analysis to describe unique features of myocardial dysfunction in COVID-19 pneumonitis. AIMS: to evaluate the value of ventricular and atrial Deformation Imaging in patients with COVID- 19 infection and hypoxia who had preserved systolic function in comparison with age-, gender-, BSA, hypoxia-matched control subjects with respiratory disease on oxygen therapy, thus excluding the effects of pulmonary vasoconstriction. We also assessed the impact of biochemical and inflammatory markers on the Echo-Indices. METHODS: 21 patients with PCR-confirmed COVID-pneumonitis (15 males, age:60.1 ± 16.1yrs, range:43-89) and 31 control, PCR-negative subjects (age:62.8 ± 15.5yrs, range:22-92) on oxygen with matched biometric data were compared. 2 examiners, blinded to the clinical data performed off-line standard Echocardiographic assessment and Deformation Imaging by 2D-Speckle Tracking Analysis with the TomTec Arena software package (Unterschleissheim, Germany) in both ventricles and atria. Plasma chemistry data were compared between the groups. RESULTS: No differences found in the biometric data and the cardiac chamber sizes between the groups. The global systolic strain indices were reduced in the COVID-group in the LV, but not the EF (LV-GLS -13.6 ± 2.9 vs -16 ± 1.1%, LV-GCS -24.8 ± 2.4 vs -28.9 ± 2.8%, p = 0.001, LVEF 61 ± 3.7 vs 60.7 ± 4.9%, p = NS), and these were reduced in the RV and RA, but not the TAPSE and TDI-S' when compared to the controls (RV-FWS -12.3 ± 2.9 vs -16.2 ± 1.5%, RV-GLS -14.6 ± 3.4 vs -17.1 ± 1.7%, RASr 18.5 ± 6 vs 22.3 ± 4.8% p = 0.005. Interestingly, the dispersion of contraction was increased in the COVID-patients in both the LV (LV-SD 416.2 ± 81.8 vs 309.8 ± 69.8ms, p < 0.001) and the RV and the RA (RV-SD 414.9 ± 117 vs 303.8 ± 61ms, RA-SD 33.5 ± 6.7 vs 26.1 ± 4.7ms, p < 0.001). The right heart indices correlated well with the biochemical data (RV-FWS and RV-SD with Ferritin r = 0.54 and -0.46, p = 0.003, RASr with GLS r = 0.64, p = 0.002, RA-SD with Troponin, p = 0.01 and with the RV-coupling Index r = 0.72, p = 0.02). CONCLUSIONS: Myocardial dysfunction is common among severely ill and hypoxic COVID-19 patients. The conventional Echo-parameters of systolic function or pulmonary pressures do not appear being specific but the Deformation Indices can provide tools to detect unique changes of the myocardial function and dys-synchrony imposed by the COVID-19 infection, independently from the impact of hypoxia or raised pulmonary pressures, hence they can predict outcome more accurately.

18.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793894

ABSTRACT

Introduction: Even if life-saving in most cases, excess O2 may have adverse effects. We described the prevalence of hyperoxemia and excess O2 administration in patients with severe acute respiratory syndrome due to novel coronavirus (SARS-CoV-2) and explored the association with mortality in the intensive care unit (ICU) or ventilatorassociated pneumonia (VAP). Methods: Retrospective single-centre study on 134 patients with SARS-CoV-2 requiring mechanical ventilation for ≥ 48 h. We calculated the excess O2 administered based on an ideal arterial O2 tension ( PaO2) target of 55-80 mmHg. We defined hyperoxemia as PaO2 > 100 mmHg and hyperoxia + hyperoxemia as an inspired O2 fraction (FiO2) > 60% + PaO2 > 100 mmHg. Risk factors for ICU-mortality and VAP were assessed with multivariate analyses. Results: Each patient received an excess O2 of 1121 [829-1449] l per day of mechanical ventilation. Hyperoxemia was found in 38 [27-55] % of arterial blood gases, hyperoxia + hyperoxemia in 11 [5-18] %. The FiO2 was not reduced in 69 [62-76] % of cases of hyperoxemia. Adjustments were more frequent with higher PaO2 or initial FiO2 levels. ICU-mortality was 32%. VAP was diagnosed in 48.5% of patients. Hyperoxemia (odds ratio [OR] 1.300 95% confidence interval [1.097- 1.542]) and hyperoxia + hyperoxemia (OR 1.144 [1.008-1.298]) were associated with higher risk for ICU-mortality, independently of age, Sequential Organ failure Assessment score at ICU-admission and mean PaO2/FiO2. Hyperoxemia (OR 1.033 [1.006-1.061]), hyperoxia + hyperoxemia (OR 1.038 [1.003-1.075]) and daily excess O2 (OR 1.001 [1.000- 1.001]) were identified as risk factors for VAP, independently of body mass index, blood transfusions, days of neuromuscular blocking agents before VAP, prolonged prone positioning and mean PaO2/FiO2 before VAP. Conclusions: Excess O2 administration and hyperoxemia were common in mechanically ventilated patients with SARS-CoV-2 and may be associated with ICU-mortality and greater risk for VAP.

19.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793853

ABSTRACT

Introduction: The COVID-19 epidemic has been developing in Tunisia officially since March 2, 2020. Since the spread of the epidemic, the governorate of Mahdia has experienced 23,271 cases of contamination including 673 deaths and 20,739 cases of recovery. The aim of this study is to describe the epidemiological and clinical characteristics of patients with COVID-19 who have been hospitalized in the emergency department of Mahdia. Methods: This is a retrospective study, carried out in the Emergency Department of Mahdia over a period of 12 months extending from September 2020 until August 2021. We included patients over 18 years-old hospitalized with COVID-19 lung disease confirmed either by RT-PCR or rapid antigen testing. For all patients included, demographic, clinical, biological and therapeutic data were collected as well as the patient's outcome. Results: A total of 976 patients were included, the mean age was 67. Patients over 70 years of age accounted for 40%. The sex ratio 1.06. 74.2% of patients had at least one comorbidity, including hypertension (52%) and diabetes (46%). The most frequent clinical sign was dyspnea (77%). Initial management included low flow oxygen therapy in 319 patients (33%), high flow oxygen therapy in 426 patients (44%). And 102 patients (10%) received non-invasive ventilation and 13 (1%) received invasive ventilation. Severe forms are frequent (43% of cases). Patients admitted to the emergency department only (360 or 37%), compared to those transferred to intensive care (209, 21%) and to the COVID department (373, 38%), were older [age average respectively: 73 years (SD ± 13);66 (SD ± 13);61 (SD ± 13);p = 0.001] and likely to have at least one comorbidity (79%, 76%, 73% respectively). The case fatality rate was 31.5% in all patients. Conclusions: In this study, our patients were mainly elderly, male, having at least one comorbidity with a high mortality rate, hence the need for a prospective study specifying the predictive factors of mortality.

20.
Pak. Heart J. ; 55(1):4-9, 2022.
Article in English | Web of Science | ID: covidwho-1791250

ABSTRACT

Acute heart failure (AHF) is a life-threatening condition. The majority of patients come to the emergency room (ER) with pulmonary congestion and respiratory failure. Therefore, oxygen therapy is an essential modality in AHF apart from diuretics and improving hemodynamic Non-invasive ventilation (NIV) is often required to reduce hypercapnia, acidosis, and respiratory rate in AHF. However, it is more invasive than conventional oxygen therapy. NIV is also less comfortable for patients and has limited use in the ER. The high-flow nasal oxygen (HFNO) is increasing in popularity during the COVID-19 pandemic. HFNO can deliver high flow oxygen with a constant fraction in patients with respiratory failure. Studies have reported the benefits of HFNO in acute heart failure. Therefore, HFNO may benefit and may be used as an alternative to acute heart failure patients who cannot tolerate NIV.

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