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1.
Pakistan Armed Forces Medical Journal ; 72(2):560-563, 2022.
Article in English | Scopus | ID: covidwho-1863759

ABSTRACT

Objective: To determine the relation between days on ventilatory support and overall mortality to total days of pre-ventilator illness in COVID-19 patients. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi Pakistan, from Mar to Aug 2020. Methodology: A total of 140 admitted patients within the prescribed time frame were observed in the established COVID-Intensive Care Units of Pak Emirates Military Hospital, Rawalpindi. The criteria for inclusion in the study were patients of any age and gender on ventilatory support with a confirmatory diagnosis of SARS-CoV-2 both by RT-PCR, and radiological evidence on HRCT Chest. Results: The mean age of patients was 59.39 ± 13.517 years. Patients who presented with a confirmed diagnosis of COVID-19 and more than ten days of illness with respiratory compromise had a higher occurrence to be placed on mechanical ventilation. There was a strong linear and positive correlation between the total days of illness on presentation and the total days on ventilatory support (p-value <0.01). This linear relationship consequently translated into overall mortality of 78.6% with a 21.4% survival rate. Conclusion: To conclude, the total days of illness in critical COVID-19 patients had a linear relationship to days on ventilatory support and overall mortality. © 2022, Army Medical College. All rights reserved.

2.
2022 Global Medical Engineering Physics Exchanges/ Pan American Health Care Exchanges, GMEPE/PAHCE 2022 ; 2020-March, 2022.
Article in English | Scopus | ID: covidwho-1840238

ABSTRACT

The expanded use of the Masi ventilators to more regions of Peru is important, particularly for regions located at high altitudes, due to the ventilatory support latent need, which also represents a challenge in the calibration and the adjustment of metrological parameters to ensure its correct performance. In a previous study, in Puno city at 3800 m.a.s.l., it was found an error above 15.0% (minimum tolerance) in the tidal volume, for which a negative correction of 25.0% was applied. In the present study, a Masi ventilator was transported to Chachapoyas city, at an altitude of 2400 m.a.s.l. to continue evaluating the effect of altitude on the parameters of the device. Once there, ventilators were acclimated and calibrated. Tidal volume, inspiration-expiration ratio (I:E), positive end-expiratory pressure (PEEP), peak inspiratory flow (PIF) and peak inspiratory pressure (PIP) were tested, and the maximum percentages errors presented were 13.5% and 13.9% in the tidal volume and the PIF, respectively. For that reason, although errors were under 15.0%, an update of the software of Masi was needed, applying a negative correction of 14.0%. Then, the parameters were tested again obtaining results with errors below 6.0% and 8.0% in volume controlled an pressure controlled ventilation modes, respectively. These results allowed the use of the Masi ventilator at ICU area. Finally, a software update for the Masi ventilator is performed by applying a linear equation that relates altitudes and percentage errors tested. © 2022 IEEE.

3.
Lijecnicki Vjesnik ; 144(1-2):59-65, 2022.
Article in Bosnian | Scopus | ID: covidwho-1727301

ABSTRACT

Majority of mechanically ventilated patients in intensive care units (ICU) suffer from diaphragm dysfunction. It occurs in approximately 60 to 80 % of such patients. Early after the initiation of mechanical ventilation pathophysiological processes leading to diaphragm dysfunction are triggered. Inadequate diaphragm function significantly contributes to difficult weaning, prolonged mechanical ventilation as well as increased morbidity and mortality. Etiology of ventilation induced diaphragm dysfunction (VIDD) is complex and multifactorial. Metabolic and inflammatory changes in muscular tissue are one of the hallmarks of critical illness and together with patient-ventilator asynchrony and prolonged vasopressor support play a key role in VIDD pathophysiology. Treatment of primary cause of respiratory insufficiency is of utmost importance, but besides this, adequate titration of sedatives and muscle relaxants, monitoring of respiratory mechanics and deployment of proportional modes of ventilation are of great significance in prevention and treatment of VIDD. Proportional modes offer support to spontaneous breathing. However, unlike the conventional modes, this support is not constant, it changes with every breath, offering assistance that is proportional to activity of respiratory muscles. The aim of this article was to offer an insight into latest data from scientific literature to healthcare providers. The electronic search of Pubmed, Medline and Google Scholar was conducted by using MeSH (Medical Subject Headings) terms. Our search was limited to randomized controlled trials and review articles written in English, which were published from 2016 to 2021 and conducted on adult patients. Conclusion: During the pandemic of SARS-CoV-2, the importance of mechanical ventilation with all its aspects came into the focus of medical community. Mechanical ventilation is considered as a life saving method of treatment, but serious adverse effects such as dysfunction of diaphragm can be encountered. There are ongoing developments of new strategies and modes of mechanical ventilation aiming at protection of lungs and diaphragm. Diaphragm protective mechanical ventilation reduces the duration of mechanical ventilator support, decreases the incidence of severe complications such as multiple organ failure and consequntely mortality. © 2022 Hrvatski Lijecnicki Zbor. All rights reserved.

4.
Indian J Crit Care Med ; 25(12): 1343-1348, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1559072

ABSTRACT

BACKGROUND: India, along with the rest of the world, faced the challenging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The second wave in India lagged behind that in the Western world, due to different timing of seasons. There is scarce data about the differences between the two waves, for intensive care unit (ICU) patients. We present the data of 3,498 patients from 9 ICUs of western Maharashtra. MATERIALS AND METHODS: We collected prospective data of hospitalized, RT-PCR confirmed, coronavirus-2019 (COVID-19) patients, from nine tertiary centers, after institutional ethics committee (IEC) approval. Then, we segregated and analyzed the data of patients admitted to the ICU, for comorbidities, high-resolution computed tomography (HRCT) score, ventilatory support, etc. The primary outcomes were ICU and hospital mortality. We also performed multivariable analysis for predictors of ICU mortality. RESULTS: Overall, there were 3,498 ICU patients. In the first wave, 1,921 patients needed ICU admission, while in the second wave, 1,577 patients. Patients in the second wave had significantly higher ICU (26.1 vs 13.4%, p <0.001) and hospital mortality (29.9 vs 18.2%, p <0.001) and need for ventilatory support of any type. More patients received steroids during the second wave. On multivariable regression, male gender, ICU admission during the second wave, increasing HRCT score, and need for intubation and mechanical ventilation were significant predictors of ICU mortality. CONCLUSION: ICU patients admitted during the two waves were of the similar age, but there were more females, and more patients had comorbidities during the second wave. The ICU and hospital mortality were significantly higher during the second wave. HOW TO CITE THIS ARTICLE: Zirpe KG, Dixit S, Kulkarni AP, Pandit RA, Ranganathan P, Prasad S, et al. The Second- vs First-wave COVID-19: More of the Same or a Lot Worse? A Comparison of Mortality between the Two Waves in Patients Admitted to Intensive Care Units in Nine Hospitals in Western Maharashtra. Indian J Crit Care Med 2021; 25(12):1343-1348.

5.
Anaesth Crit Care Pain Med ; 40(6): 100976, 2021 12.
Article in English | MEDLINE | ID: covidwho-1499575

ABSTRACT

BACKGROUND: We aimed to evaluate the ability of diaphragmatic excursion at hospital admission to predict outcomes in patients with coronavirus disease-2019 (COVID-19). METHODS: In this prospective observational study, we included adult patients with severe COVID-19 admitted to a tertiary hospital. Ultrasound examination of the diaphragm was performed within 12 h of admission. Other collected data included peripheral oxygen saturation (SpO2), respiratory rate, and computed tomography (CT) score. The outcomes included the ability of diaphragmatic excursion, respiratory rate, SpO2, and CT score at admission to predict the need for ventilatory support (need for non-invasive or invasive ventilation) and patient mortality using the area under the receiver operating characteristic curve (AUC) analysis. Univariate and multivariable analyses about the need for ventilatory support and mortality were performed. RESULTS: Diaphragmatic excursion showed an excellent ability to predict the need for ventilatory support, which was the highest among respiratory rate, SpO2, and CT score; the AUCs (95% confidence interval [CI]) was 0.96 (0.85-1.00) for the right diaphragmatic excursion and 0.94 (0.82-0.99) for the left diaphragmatic excursion. The right diaphragmatic excursion also had the highest AUC for predicting mortality in relation to respiratory rate, SpO2, and CT score. Multivariable analysis revealed that low diaphragmatic excursion was an independent predictor of mortality with an odds ratio (95% CI) of 0.55 (0.31-0.98). CONCLUSION: Diaphragmatic excursion on hospital admission can accurately predict the need for ventilatory support and mortality in patients with severe COVID-19. Low diaphragmatic excursion was an independent risk factor for in-hospital mortality.


Subject(s)
COVID-19 , Adult , Hospitalization , Hospitals , Humans , SARS-CoV-2
6.
Am J Emerg Med ; 50: 106-110, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1474264

ABSTRACT

BACKGROUND: This study aimed to evaluate the accuracy of pulse oximetry-derived oxygen saturation (SpO2) on room air, determined at hospital admission, as a predictor for the need for mechanical ventilatory support in patients with Coronavirus Disease-2019 (COVID-19). METHODS: In this retrospective observational study, demographic and clinical details of the patients were obtained during ICU admission. SpO2 and respiratory rate (RR) on room air were determined within the first 6 h of hospital admission. As all measurements were obtained on room air, we calculated the simplified respiratory rate­oxygenation (ROX) index by dividing the SpO2 by the RR. Based on the use of any assistance of mechanical ventilator (invasive or noninvasive), patients were divided into mechanical ventilation (MV) group and oxygen therapy group. The accuracy of the SpO2, CT score, and ROX index to predict the need to MV were determined using the Area under receiver operating curve (AUC). RESULTS: We included 72 critically ill patients who tested COVID-19-positive. SpO2 on the room air could predict any MV requirement (AUC [95% confidence interval]: 0.9 [0.8-0.96], sensitivity: 70%, specificity 100%, cut-off value ≤78%, P < 0.001). Within the MV group, the use of noninvasive ventilation (NIV) was successful in 37 (74%) patients, whereas 13 patients (26%) required endotracheal intubation. The cut-off ROX value for predicting early NIV failure was ≤1.4, with a sensitivity of 85%, a specificity of 86%, and an AUC of 0.86 (95% confidence interval of 0.73-0.94, P < 0.0001). CONCLUSIONS: A baseline SpO2 ≤78% is an excellent predictor of MV requirement with a positive predictive value of 100%. Moreover, the ROX index measured within the first 6 h of hospital admission is a good indicator of early NIV failure.


Subject(s)
COVID-19/metabolism , COVID-19/therapy , Critical Care , Respiration, Artificial , Respiratory Rate , Adult , Aged , Blood Gas Analysis , COVID-19/physiopathology , Diagnostic Tests, Routine , Female , Hospitalization , Humans , Male , Middle Aged , Oxygen Inhalation Therapy , Predictive Value of Tests , Retrospective Studies , Treatment Outcome
7.
Ann Transl Med ; 9(9): 813, 2021 May.
Article in English | MEDLINE | ID: covidwho-1257379

ABSTRACT

BACKGROUND: Patients with coronavirus disease 2019 (COVID-19) may need hospitalization for supplemental oxygen, and some need intensive care unit (ICU) admission for escalation of care. Practice of adjunctive and supportive treatments remain uncertain and may vary widely between countries, within countries between hospitals, and possibly even within ICUs. We aim to investigate practice of adjunctive and supportive treatments, and their associations with outcome, in critically ill COVID-19 patients. METHODS: The 'PRactice of Adjunctive Treatments in Intensive Care Unit Patients with Coronavirus Disease 2019' (PRoAcT-COVID) study is a national, observational study to be undertaken in a large set of ICUs in The Netherlands. The PRoAcT-COVID includes consecutive ICU patients, admitted because of COVID-19 to one of the participating ICUs during a 3-month period. Daily follow-up lasts 28 days. The primary endpoint is a combination of adjunctive treatments, including types of oxygen support, ventilation, rescue therapies for hypoxemia refractory to supplementary oxygen or during invasive ventilation, other adjunctive and supportive treatments, and experimental therapies. We will also collect tracheostomy rate, duration of invasive ventilation and ventilator-free days and alive at day 28 (VFD-28), ICU and hospital length of stay, and the mortality rates in the ICU, hospital and at day 90. DISCUSSION: The PRoAcT-COVID study is an observational study combining high density treatment data with relevant clinical outcomes. Information on treatment practices, and their associations with outcomes in COVID-19 patients in highly and urgently needed. The results of the PRoAcT-COVID study will be rapidly available, and circulated through online presentations, such as webinars and electronic conferences, and publications in peer-reviewed journals-findings will also be presented at a dedicated website. At request, and after agreement of the PRoAcT-COVID steering committee, source data will be made available through local, regional and national anonymized datasets. TRIAL REGISTRATION: The PRoAcT-COVID study is registered at clinicaltrials.gov (study identifier NCT04719182).

8.
3D Print Med ; 7(1): 7, 2021 Mar 08.
Article in English | MEDLINE | ID: covidwho-1120068

ABSTRACT

BACKGROUND: 3D printing and distributed manufacturing represent a paradigm shift in the health system that is becoming critical during the COVID-19 pandemic. University hospitals are also taking on the role of manufacturers of custom-made solutions thanks to 3D printing technology. CASE PRESENTATION: We present a monocentric observational case study regarding the distributed manufacturing of three groups of products during the period of the COVID-19 pandemic from 14 March to 10 May 2020: personal protective equipment, ventilatory support, and diagnostic and consumable products. Networking during this period has enabled the delivery of a total of 17,276 units of products manufactured using 3D printing technology. The most manufactured product was the face shields and ear savers, while the one that achieved the greatest clinical impact was the mechanical ventilation adapters and swabs. The products were manufactured by individuals in 57.3% of the cases, and our hospital acted as the main delivery node in a hub with 10 other hospitals. The main advantage of this production model is the fast response to stock needs, being able to adapt almost in real time. CONCLUSIONS: The role of 3D printing in the hospital environment allows the reconciliation of in-house and distributed manufacturing with traditional production, providing custom-made adaptation of the specifications, as well as maximum efficiency in the working and availability of resources, which is of special importance at critical times for health systems such as the current COVID-19 pandemic.

9.
Ann Am Thorac Soc ; 18(6): 1020-1026, 2021 06.
Article in English | MEDLINE | ID: covidwho-1006326

ABSTRACT

Rationale: Treatment with noninvasive ventilation (NIV) in coronavirus disease (COVID-19) is frequent. Shortage of intensive care unit (ICU) beds led clinicians to deliver NIV also outside ICUs. Data about the use of NIV in COVID-19 is limited.Objectives: To describe the prevalence and clinical characteristics of patients with COVID-19 treated with NIV outside the ICUs. To investigate the factors associated with NIV failure (need for intubation or death).Methods: In this prospective, single-day observational study, we enrolled adult patients with COVID-19 who were treated with NIV outside the ICU from 31 hospitals in Lombardy, Italy.Results: We collected data on demographic and clinical characteristics, ventilatory management, and patient outcomes. Of 8,753 patients with COVID-19 present in the hospitals on the study day, 909 (10%) were receiving NIV outside the ICU. A majority of patients (778/909; 85%) patients were treated with continuous positive airway pressure (CPAP), which was delivered by helmet in 617 (68%) patients. NIV failed in 300 patients (37.6%), whereas 498 (62.4%) patients were discharged alive without intubation. Overall mortality was 25%. NIV failure occurred in 152/284 (53%) patients with an arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2) ratio <150 mm Hg. Higher C-reactive protein and lower PaO2/FiO2 and platelet counts were independently associated with increased risk of NIV failure.Conclusions: The use of NIV outside the ICUs was common in COVID-19, with a predominant use of helmet CPAP, with a rate of success >60% and close to 75% in full-treatment patients. C-reactive protein, PaO2/FiO2, and platelet counts were independently associated with increased risk of NIV failure.Clinical trial registered with ClinicalTrials.gov (NCT04382235).


Subject(s)
COVID-19/therapy , Continuous Positive Airway Pressure/methods , Hospital Mortality , Hypoxia/therapy , Intubation, Intratracheal/statistics & numerical data , Noninvasive Ventilation/methods , Patients' Rooms , Respiratory Insufficiency/therapy , Aged , Cannula , Female , Humans , Intensive Care Units , Italy , Male , Middle Aged , Oxygen Inhalation Therapy , Prospective Studies , SARS-CoV-2 , Treatment Failure
10.
J Neurol ; 268(5): 1580-1591, 2021 May.
Article in English | MEDLINE | ID: covidwho-716292

ABSTRACT

The novel Coronavirus disease-19 (COVID-19) pandemic has posed several challenges for neuromuscular disorder (NMD) patients. The risk of a severe course of SARS-CoV-2 infection is increased in all but the mildest forms of NMDs. High-risk conditions include reduced airway clearance due to oropharyngeal weakness and risk of worsening with fever, fasting or infection Isolation requirements may have an impact on treatment regimens administered in hospital settings, such as nusinersen, glucosidase alfa, intravenous immunoglobulin, and rituximab infusions. In addition, specific drugs for SARS-CoV2 infection under investigation impair neuromuscular function significantly; chloroquine and azithromycin are not recommended in myasthenia gravis without available ventilatory support and prolonged prone positioning may influence options for treatment. Other therapeutics may affect specific NMDs (metabolic, mitochondrial, myotonic diseases) and experimental approaches for Coronavirus disease 2019 may be offered "compassionately" only after consulting the patient's NMD specialist. In parallel, the reorganization of hospital and outpatient services may change the management of non-infected NMD patients and their caregivers, favouring at-distance approaches. However, the literature on the validation of telehealth in this subgroup of patients is scant. Thus, as the first wave of the pandemic is progressing, clinicians and researchers should address these crucial open issues to ensure adequate caring for NMD patients. This manuscript summarizes available evidence so far and provides guidance for both general neurologists and NMD specialists dealing with NMD patients in the time of COVID-19.


Subject(s)
COVID-19/epidemiology , Neuromuscular Diseases/therapy , Pandemics , Telemedicine , COVID-19/drug therapy , Humans , Neuromuscular Diseases/epidemiology , SARS-CoV-2/drug effects
11.
Adv Respir Med ; 88(3): 245-266, 2020.
Article in English | MEDLINE | ID: covidwho-676031

ABSTRACT

In 2019, a pandemic began due to infection with a novel coronavirus, SARS-CoV-2. In many cases, this coronavirus leads to the development of the COVID-19 disease. Lung damage in the course of this disease often leads to acute hypoxic respiratory failure and may eventually lead to acute respiratory distress syndrome (ARDS). Respiratory failure as a result of COVID-19 can develop very quickly and a small percent of those infected will die because of it. There is currently no treatment for COVID-19, therefore the key therapeutic intervention centers around the symptomatic treatment of respiratory failure. The main therapeutic goal is to main-tain gas exchange, mainly oxygenation, at an appropriate level and prevent the intensification of changes in the lung parenchyma. Depending on the severity of hypoxemia different techniques can be used to improve oxygenation. Medical staff dealing with COVID-19 patients should be familiar with both, methods used to treat respiratory failure and the epidemiological risks arising from their use. In some patients, conventional (passive) oxygen therapy alone is sufficient. In patients with worsening respiratory failure high flow nasal oxygen therapy (HFNOT) may be effective. The continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) methods can be used to a limited extent. With further disease progression, invasive ventilation must be used and in special situations, extracorporeal membrane oxygenation (ECMO) can also be administered. The authors of this article set themselves the goal of presenting the most current knowledge about the epidemiology and patho-physiology of respiratory failure in COVID-19, as well as the methods of its treatment. Given the dynamics of the developing pandemic, this is not an easy task as new scientific data is presented almost every day. However, we believe the knowledge contained in this study will help doctors care for patients with COVID-19. The main target audience of this study is not so much pneumonologists or intensivists who have extensive experience in the application of the techniques discussed here, but rather doctors of other specializations who must master new skills in order to help patients during the time of a pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/rehabilitation , Pneumonia, Viral/rehabilitation , Practice Guidelines as Topic , Respiratory Distress Syndrome/rehabilitation , COVID-19 , Coronavirus Infections/epidemiology , Critical Care/organization & administration , Humans , Pandemics , Pneumonia, Viral/epidemiology , Poland , Respiratory Distress Syndrome/epidemiology , SARS-CoV-2 , Societies, Medical
12.
Asian Bioeth Rev ; 12(2): 205-211, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-457335

ABSTRACT

Facing the possibility of a surge of COVID-19-infected patients requiring ventilatory support in Intensive Care Units (ICU), the Singapore Hospice Council and the Chapter of Palliative Medicine Physicians forward its position on the guiding principles that ought to drive the allocation of ICU beds and its role in care of these patients and their families.

13.
Clinics ; 75: e1894, 2020. graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-114337

ABSTRACT

This review aims to verify the main epidemiologic, clinical, laboratory-related, and therapeutic aspects of coronavirus disease 2019 (COVID-19) in critically ill pediatric patients. An extensive review of the medical literature on COVID-19 was performed, mainly focusing on the critical care of pediatric patients, considering expert opinions and recent reports related to this new disease. Experts from a large Brazilian public university analyzed all recently published material to produce a report aiming to standardize the care of critically ill children and adolescents. The report emphasizes on the clinical presentations of the disease and ventilatory support in pediatric patients with COVID-19. It establishes a flowchart to guide health practitioners on triaging critical cases. COVID-19 is essentially an unknown clinical condition for the majority of pediatric intensive care professionals. Guidelines developed by experts can help all practitioners standardize their attitudes and improve the treatment of COVID-19.


Subject(s)
Humans , Male , Female , Child , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Betacoronavirus , Time Factors , Severity of Illness Index , Positive-Pressure Respiration/methods , Critical Illness , Coronavirus Infections/metabolism , Clinical Laboratory Techniques , Reverse Transcriptase Polymerase Chain Reaction , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/therapy , Diagnosis, Differential , Pandemics , COVID-19 Testing , SARS-CoV-2 , COVID-19
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