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3.
Respir Med ; 189: 106667, 2021.
Article in English | MEDLINE | ID: covidwho-1487955

ABSTRACT

PURPOSE: Deep sedation is sometimes needed in acute respiratory distress syndrome. Ketamine is a sedative that has been shown to have analgesic and sedating properties without having a detrimental impact on hemodynamics. This pharmacological profile makes ketamine an attractive sedative, potentially reducing the necessity for other sedatives and vasopressors, but there are no studies evaluating its effect on these medications in patients requiring deep sedation for acute respiratory distress syndrome. MATERIALS AND METHODS: This is a retrospective, observational study in a single center, quaternary care hospital in southeast Texas. We looked at adults with COVID-19 requiring mechanical ventilation from March 2020 to September 2020. RESULTS: We found that patients had less propofol requirements at 72 h after ketamine initiation when compared to 24 h (median 34.2 vs 54.7 mg/kg, p = 0.003). Norepinephrine equivalents were also significantly lower at 48 h than 24 h after ketamine initiation (median 38 vs 62.8 mcg/kg, p = 0.028). There was an increase in hydromorphone infusion rates at all three time points after ketamine was introduced. CONCLUSIONS: In this cohort of patients with COVID-19 ARDS who required mechanical ventilation receiving ketamine we found propofol sparing effects and vasopressor requirements were reduced, while opioid infusions were not.


Subject(s)
COVID-19/epidemiology , Deep Sedation , Hypnotics and Sedatives/administration & dosage , Ketamine/administration & dosage , Respiration, Artificial , Respiratory Distress Syndrome/epidemiology , Adult , Aged , Aged, 80 and over , Analgesics, Opioid/therapeutic use , COVID-19/therapy , Drug Utilization/statistics & numerical data , Female , Humans , Hydromorphone/therapeutic use , Male , Middle Aged , Norepinephrine/therapeutic use , Propofol/therapeutic use , Respiratory Distress Syndrome/therapy , Retrospective Studies , Texas/epidemiology
5.
Soins ; 66(855): 30-33, 2021 May.
Article in French | MEDLINE | ID: covidwho-1261962

ABSTRACT

The su rge of COVID-1 9 has been an unprecedented cataclysm requiring all health professionals to mobilise themselves in the face of a lethal risk threatening everyone. End-of-life issues have become relevant to all medical specialities, which have suddenly had to face up to a new, improvised clinical approach where deaths have become inevitable and frequent.


Subject(s)
COVID-19 , Deep Sedation , Terminal Care , Health Personnel , Humans , SARS-CoV-2
6.
Medicine (Baltimore) ; 100(22): e26240, 2021 Jun 04.
Article in English | MEDLINE | ID: covidwho-1258820

ABSTRACT

RATIONALE: There have been a few reports on the early rehabilitation of patients with coronavirus disease (COVID-19), and none on the effectiveness and adverse events of early mobilization for mechanical ventilation patients (other than COVID-19) during deep sedation. This report indicates that sitting without adverse events is possible in patients with severe COVID-19 pneumonia during deep sedation with muscle relaxation. PATIENT CONCERNS: A 65-year-old man with a history of diabetes mellitus, lacunar infarction, and Parkinson's disease was admitted to a local hospital for pneumonia due to COVID-19. After admission, the patient was managed on a ventilator under deep sedation with muscle relaxants and sedatives. Twelve days after admission, the patient was transferred to our hospital due to his worsening respiratory status. DIAGNOSIS: Pneumonia due to COVID-19 was diagnosed using a polymerase chain reaction-dependent method. INTERVENTIONS: The day following transfer, a physical therapist started passive range of motion training and sitting. OUTCOMES: The period spanning his initial rehabilitation to muscle relaxant medication interruption was 9 days, and he underwent 7 rehabilitation sessions. The patient was unable to sit during only one of the 7 sessions due to pre-rehabilitation hypoxemia. In 5 of the 6 sitting sessions, PaO2/FiO2 transiently decreased but recovered by the time of subsequent blood sampling. The patient's PaCO2 decreased during all sessions. His blood pressure did not drastically decrease in any sitting session, except the first. Sputum excretion via sputum suction increased during sitting, and peak inspiratory pressure did not change. LESSONS: The patient eventually died of pneumonia due to COVID-19. However, sitting during deep sedation with muscle relaxants did not cause any serious adverse events nor did it appear to cause obvious negative respiratory effects.


Subject(s)
COVID-19/rehabilitation , Deep Sedation/methods , Early Ambulation/methods , Sitting Position , Aged , Humans , Hypnotics and Sedatives/administration & dosage , Hypnotics and Sedatives/adverse effects , Male , Neuromuscular Agents/administration & dosage , Neuromuscular Agents/adverse effects , Range of Motion, Articular , Respiration, Artificial , SARS-CoV-2
8.
Pan Afr Med J ; 38: 373, 2021.
Article in English | MEDLINE | ID: covidwho-1236952

ABSTRACT

Although the severity of coronavirus disease 2019 (COVID-19) being more frequently related to acute respiratory distress syndrome and acute cardiac and renal injuries, thromboembolic events have been increasingly reported. Acute respiratory distress syndrome due to SARS-CoV-2 (Severe Acute Respiratory Syndrome - Corona Virus 2) often requires intensive care follow-up. As well as respiratory failure, the SARS-CoV-2 may cause central nervous system (CNS) involvement. The pandemic has raised many challenges in managing critically ill older adults, a population preferentially killed by COVID-19. The mortality and morbidity rates are extremely high in critically ill patients with COVID-19. Recent studies have reported the potential development of a hypercoagulable state in COVID-19. Viral infections and hypoxia may cause these state. It is increasingly reported that thromboembolic events are associated with a poor prognosis. Due to these thromboembolic complications, COVID-19 patients often have neurological symptoms. These symptoms may not be observed in intensive care patients who are sedated. We report one case who was sedated COVID-19 pneumonia and who was later diagnosed with cerebral venous thrombosis with cranial imaging when he could not awaken even though sedation was discontinued. Since COVID-19 causes intense thrombotic susceptibility due to cytokine storm, cerebrovascular thromboembolic complications associated with COVID-19 infection should be considered first and foremost for unconsciousness ventilated patients. Severe and potentially cerebral thrombosis may prolong the patient´s stay in intensive care.


Subject(s)
COVID-19/complications , Intracranial Thrombosis/etiology , COVID-19/therapy , Critical Care , Deep Sedation , Humans , Male , Middle Aged
10.
J Clin Neurosci ; 86: 180-183, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1032688

ABSTRACT

Cerebrovascular complications among critically ill patients with COVID-19 have yet to be fully characterized. In this retrospective case series from a single academic tertiary care referral center in New York City, we present 12 patients with ischemic or hemorrhagic strokes that were found on imaging after a period of prolonged sedation in the setting of COVID-19 pneumonia. This series demonstrates a pattern of cerebrovascular events clinically masked by deep sedation required for management of COVID-19 related acute respiratory distress syndrome (ARDS). Of the 12 patients included, 10 had ischemic stroke, 4 of which had hemorrhagic conversion, and 2 had primary intracerebral hemorrhage. Ten patients were on therapeutic anticoagulation prior to discovery of their stroke, and the remainder received intermediate dose anticoagulation (in a range between prophylactic and therapeutic levels). Additional studies are needed to further characterize the counterbalancing risks of ischemic and hemorrhagic stroke, as well as the optimal management of this patient population.


Subject(s)
COVID-19/complications , Deep Sedation/adverse effects , Stroke/diagnosis , Stroke/virology , Aged , Anticoagulants/adverse effects , Critical Illness , Female , Humans , Male , Middle Aged , Respiration, Artificial/methods , Retrospective Studies , SARS-CoV-2
13.
Br J Community Nurs ; 25(11): 526-530, 2020 Nov 02.
Article in English | MEDLINE | ID: covidwho-916555

ABSTRACT

The pandemic caused by Covid-19 has long term ramifications for many, especially those patients who have experienced an intensive care unit (ICU) admission including ventilation and sedation. This paper will explore aspects of care delivery in the ICU regarding the current pandemic and the impact of such on the mental health of some of these patients. Post discharge, patients will be returning to a very different community incorporating social distancing, and in some cases, social isolation and/or shielding. Many may experience a multitude of physical and mental health complications which can ultimately impact upon each other, therefore a bio-psycho-pharmaco-social approach to discharge, case management, risk assessment and positive behavioural support planning is recommended.


Subject(s)
Aftercare/psychology , Coronavirus Infections/nursing , Coronavirus Infections/psychology , Critical Care/psychology , Deep Sedation/psychology , Mental Health/statistics & numerical data , Pneumonia, Viral/nursing , Pneumonia, Viral/psychology , Respiration, Artificial/psychology , Social Isolation/psychology , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Female , Humans , Male , Middle Aged , Pandemics , Patient Admission/statistics & numerical data , SARS-CoV-2
14.
Obstet Gynecol ; 136(5): 962-964, 2020 11.
Article in English | MEDLINE | ID: covidwho-616704

ABSTRACT

BACKGROUND: In the global coronavirus disease 2019 (COVID-19) pandemic, to date, delivery of critically ill pregnant patients has predominantly been by cesarean. CASE: A 27-year-old pregnant woman was admitted to a 166-bed community hospital at 33 weeks of gestation with acute hypoxemic respiratory failure secondary to COVID-19. She underwent mechanical ventilation for 9 days. While ventilated, she underwent induction of labor, resulting in a successful forceps assisted-vaginal birth. She was extubated on postpartum day 5 and discharged on postpartum day 10. The neonate was intubated for 24 hours but was otherwise healthy and discharged home at 36 2/7 weeks postmenstrual age. CONCLUSION: Critically ill patients requiring mechanical ventilation, in this case due to COVID-19, may undergo induction of labor and vaginal delivery when carefully selected.


Subject(s)
Coronavirus Infections , Labor, Induced/methods , Labor, Obstetric , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Respiration, Artificial/methods , Adult , Betacoronavirus , COVID-19 , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Critical Illness/therapy , Deep Sedation/methods , Female , Fetal Monitoring/methods , Gestational Age , Humans , Infant, Newborn , Neonatal Screening/methods , Patient Selection , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Pregnancy , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/virology , Pregnancy Outcome , SARS-CoV-2 , Treatment Outcome
15.
Neurophysiol Clin ; 50(3): 155-165, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-613786

ABSTRACT

OBJECTIVES: Although rare, neurological manifestations in SARS-CoV-2 infection are increasingly being reported. We conducted a retrospective systematic study to describe the electroencephalography (EEG) characteristics in this disease, looking for specific patterns. METHODS: EEGs performed in patients with positive PCR for SARS-CoV-2 between 25/03/2020 and 06/05/2020 in the University Hospital of Bicêtre were independently reviewed by two experienced neurologists. We used the American Clinical Neurophysiology Society's terminology for the description of abnormal patterns. EEGs were classified into five categories, from normal to critically altered. Interobserver reliability was calculated using Cohen's kappa coefficient. Medical records were reviewed to extract demographics, clinical, imaging and biological data. RESULTS: Forty EEGs were reviewed in 36 COVID-19 patients, 18 in intensive care units (ICU) and 22 in medicine units. The main indications were confusion or fluctuating alertness for 23 (57.5%) and delayed awakening after stopping sedation in ICU in six (15%). EEGs were normal to mildly altered in 23 (57.5%) contrary to the 42.5% where EEG alterations were moderate in four (10%), severe in eight (20%) and critical in five (12.5%). Generalized periodic discharges (GPDs), multifocal periodic discharges (MPDs) or rhythmic delta activity (RDA) were found in 13 recordings (32.5%). EEG alterations were not stereotyped or specific. They could be related to an underlying morbid status, except for three ICU patients with unexplained encephalopathic features. CONCLUSION: In this first systematic analysis of COVID-19 patients who underwent EEG, over half of them presented a normal recording pattern. EEG alterations were not different from those encountered in other pathological conditions.


Subject(s)
Betacoronavirus , Confusion/etiology , Coronavirus Infections/complications , Delayed Emergence from Anesthesia/etiology , Electroencephalography , Pneumonia, Viral/complications , Adult , Aged , Aged, 80 and over , Arousal/physiology , Betacoronavirus/isolation & purification , Brain Waves/physiology , COVID-19 , Cardiovascular Diseases/complications , Cardiovascular Diseases/physiopathology , Comorbidity , Confusion/physiopathology , Coronavirus Infections/physiopathology , Coronavirus Infections/psychology , Deep Sedation , Delayed Emergence from Anesthesia/physiopathology , Dementia/complications , Dementia/physiopathology , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/physiopathology , Pneumonia, Viral/psychology , Polymerase Chain Reaction , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/physiopathology , Retrospective Studies , SARS-CoV-2
16.
Contraception ; 102(2): 137-138, 2020 08.
Article in English | MEDLINE | ID: covidwho-271243

ABSTRACT

In this case report we discuss changes in hospital-based abortion care due to the COVID-19 pandemic. We highlight our experience with exposure to an asymptomatic COVID-19 positive patient. We hope early lessons from the United States epicenter will guide clinicians providing abortion care during this and future pandemics.


Subject(s)
Abortion, Induced , Anemia, Sickle Cell/therapy , Asymptomatic Infections , Coronavirus Infections/transmission , Pneumonia, Viral/transmission , Pregnancy Complications, Hematologic/therapy , Pregnancy Complications, Infectious , Adult , Anemia, Sickle Cell/complications , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Deep Sedation , Disease Progression , Female , Hospitalization , Humans , Length of Stay , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pregnancy , SARS-CoV-2 , Time-to-Treatment
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