ABSTRACT
ABSTRACT: Mortality of critically ill patients with coronavirus disease 2019 (COVID-19) was high. Aims to examine whether time from symptoms onset to intensive care unit (ICU) admission affects incidence of extra-pulmonary complications and prognosis in order to provide a new insight for reducing the mortality. A single-centered, retrospective, observational study investigated 45 critically ill patients with COVID-19 hospitalized in ICU of The Third People's Hospital of Yichang from January 17 to March 29, 2020. Patients were divided into 2 groups according to time from symptoms onset to ICU admission (>7 and ≤7âdays) and into 2 groups according to prognosis (survivors and non-survivors). Epidemiological, clinical, laboratory, radiological characteristics and treatment data were studied. Compared with patients who admitted to the ICU since symptoms onset ≤7âdays (55.6%), patients who admitted to the ICU since symptoms onset >7âdays (44.4%) were more likely to have extra-pulmonary complications (19 [95.0%] vs 16 [64.0%], Pâ=â.034), including acute kidney injury, cardiac injury, acute heart failure, liver dysfunction, gastrointestinal hemorrhage, hyperamylasemia, and hypernatremia. The incidence rates of acute respiratory distress syndrome, pneumothorax, and hospital-acquired pneumonia had no difference between the 2 groups. Except activated partial thromboplastin and Na+ concentration, the laboratory findings were worse in group of time from symptoms onset to ICU admission >7âdays. There was no difference in mortality between the 2 groups. Of the 45 cases in the ICU, 19 (42.2%) were non-survivors, and 16 (35.6%) were with hospital-acquired pneumonia. Among these non-survivors, hospital-acquired pneumonia was up to 12 (63.2%) besides higher incidence of extra-pulmonary complications. However, hospital-acquired pneumonia occurred in only 4 (15.4%) survivors. Critically ill patients with COVID-19 who admitted to ICU at once might get benefit from intensive care via lower rate of extra-pulmonary complications.
Subject(s)
COVID-19 , Critical Care , Critical Illness , Symptom Assessment , Time-to-Treatment/statistics & numerical data , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , COVID-19/complications , COVID-19/diagnosis , COVID-19/mortality , COVID-19/physiopathology , China/epidemiology , Critical Care/methods , Critical Care/statistics & numerical data , Critical Illness/mortality , Critical Illness/therapy , Digestive System Diseases/diagnosis , Digestive System Diseases/etiology , Female , Healthcare-Associated Pneumonia/diagnosis , Healthcare-Associated Pneumonia/mortality , Heart Diseases/diagnosis , Humans , Hyperamylasemia/diagnosis , Hyperamylasemia/etiology , Hypernatremia/diagnosis , Hypernatremia/etiology , Male , Middle Aged , Outcome and Process Assessment, Health Care , Prognosis , SARS-CoV-2/isolation & purification , Survival Analysis , Symptom Assessment/methods , Symptom Assessment/statistics & numerical dataABSTRACT
Hospital-acquired severe acute respiratory virus coronavirus 2 (SARS-CoV-2) infection is a healthcare challenge. We hypothesized that polymerase chain reaction testing of symptomatic triaged outpatients and all inpatients before hospitalization in Shinjuku, a coronavirus disease 2019 (COVID-19) epicenter in Tokyo, using the Tokyo Women's Medical University (TMWU) model would be feasible and efficient at preventing COVID-19. This retrospective study enrolled 2981 patients from March to May 2020. The prevalence of SARS-CoV-2 infection was 1.81% (95% credible interval [CI]: 0.95-3.47%) in triaged symptomatic outpatients, 0.04% (95% CI: 0.0002-0.2%) in scheduled asymptomatic inpatients, 3.78% (95% CI: 1.82-7.26%) in emergency inpatients, and 2.4% (95% CI: 1.49-3.82%) in symptomatic patients. There were no cases of hospital-acquired SARS-CoV-2 infection. This shows that the TWMU model could prevent hospital-acquired SARS-CoV-2 infection and is feasible and effective in reducing the impact of SARS-CoV-2 infection in the hospitals.
Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , COVID-19/prevention & control , Cross Infection/diagnosis , Cross Infection/prevention & control , Healthcare-Associated Pneumonia/diagnosis , Healthcare-Associated Pneumonia/prevention & control , Polymerase Chain Reaction/methods , Acute Disease , COVID-19/virology , Female , Healthcare-Associated Pneumonia/virology , Hospitals, University , Humans , Male , Middle Aged , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Schools, Medical , Severity of Illness Index , TokyoABSTRACT
The COVID-19 pandemic has placed significant strain on the oxygen delivery infrastructure of health facilities in resource-constrained health systems. In this case report, we describe a patient with severe COVID-19 pneumonia who was managed with high-flow nasal oxygen for 40 days, with an eventual successful outcome. We discuss the oxygen delivery infrastructure needed to offer this intervention, as well as the psychosocial impact on those undergoing treatment.
Subject(s)
Anticoagulants/therapeutic use , COVID-19/therapy , Glucocorticoids/therapeutic use , Hypoxia/therapy , Oxygen Inhalation Therapy/methods , Oxygen/supply & distribution , Patient Positioning/methods , Psychosocial Support Systems , Anti-Bacterial Agents/therapeutic use , Anxiety/psychology , Anxiety/therapy , Blood Gas Analysis , COVID-19/blood , COVID-19/physiopathology , COVID-19/psychology , Cannula , Citalopram/therapeutic use , Counseling , Dexamethasone/therapeutic use , Disease Progression , Enoxaparin/therapeutic use , Factor Xa Inhibitors/blood , Female , Healthcare-Associated Pneumonia/complications , Healthcare-Associated Pneumonia/diagnosis , Healthcare-Associated Pneumonia/drug therapy , Hematoma/chemically induced , Humans , Hypoxia/blood , Hypoxia/physiopathology , Middle Aged , Oxygen Inhalation Therapy/psychology , Patient Care Team , Patient Positioning/psychology , Piperacillin, Tazobactam Drug Combination/therapeutic use , Prone Position , Psychiatry , Resilience, Psychological , SARS-CoV-2 , Selective Serotonin Reuptake Inhibitors/therapeutic use , Severity of Illness Index , Social Work Department, Hospital , Thigh , Treatment OutcomeABSTRACT
We report the case of a 38 year-old man living with well-controlled HIV on antiretroviral therapy who developed cerebellar symptoms and was admitted to hospital for management of an intraventricular cryptococcoma. During his hospital stay he contracted SARS CoV-2 infection within the hospital setting with a fatal outcome.