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2.
Dtsch Med Wochenschr ; 146(13-14): 908-910, 2021 Jul.
Article in German | MEDLINE | ID: covidwho-1493269

ABSTRACT

COVID-19 continues to challenge health-care systems and ICUs around the globe more than one year into the pandemic and in spite of all advances in diagnosis and treatment of the disease caused by the novel SARS-CoV-2. Many open questions remain concerning optimal medical therapy, respiratory management and resource allocation, particuly in times of limited available health care personell. In the following short article, we summarized current knowlegde on management of COVID-19 in the ICU.


Subject(s)
COVID-19/therapy , Critical Care , Intensive Care Units , Humans , Intensive Care Units/standards , Intensive Care Units/trends
3.
Crit Care Med ; 49(11): 1974-1982, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1475880
7.
Am J Health Syst Pharm ; 77(18): 1510-1515, 2020 09 04.
Article in English | MEDLINE | ID: covidwho-1317902

ABSTRACT

PURPOSE: To describe our hospital pharmacy department's preparation for an influx of critically ill patients during the coronavirus disease 2019 (COVID-19) pandemic and offer guidance on clinical pharmacy services preparedness for similar crisis situations. SUMMARY: Personnel within the department of pharmacy at a medical center at the US epicenter of the COVID-19 pandemic proactively prepared a staffing and pharmacotherapeutic action plan in anticipation of an expected surge in admissions of critically ill patients with COVID-19 and expansion of acute care and intensive care unit (ICU) capacity. Guidance documents focusing on supportive care and pharmacotherapeutic treatment options were developed. Repurposing of non-ICU-trained clinical pharmacotherapy specialists to work collaboratively with clinician teams in ICUs was quickly implemented; staff were prepared for these duties through use of shared tools to facilitate education and practice standardization. CONCLUSION: As challenges were encountered at the initial peak of the pandemic, interdisciplinary collaboration and teamwork was crucial to ensure that all patients were proactively assessed and that their respective pharmacotherapeutic regimens were optimized.


Subject(s)
COVID-19/drug therapy , Medication Therapy Management/standards , Pharmacists/organization & administration , Pharmacy Service, Hospital/standards , COVID-19/epidemiology , Critical Care/organization & administration , Critical Care/standards , Critical Illness , Disaster Planning/organization & administration , Disaster Planning/standards , Emergencies , Humans , Intensive Care Units/organization & administration , Intensive Care Units/standards , Medication Therapy Management/organization & administration , Pandemics/prevention & control , Patient Care Team/organization & administration , Patient Care Team/standards , Pharmacy Service, Hospital/organization & administration , Practice Guidelines as Topic , Professional Role , Workforce/organization & administration , Workforce/standards
10.
Mycoses ; 64(9): 1028-1037, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1270864

ABSTRACT

Reports are increasing on the emergence of COVID-19-associated mucormycosis (CAM) globally, driven particularly by low- and middle-income countries. The recent unprecedented surge of CAM in India has drawn worldwide attention. More than 28,252 mucormycosis cases are counted and India is the first country where mucormycosis has been declared a notifiable disease. However, misconception of management, diagnosing and treating this infection continue to occur. Thus, European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology (ISHAM) felt the need to address clinical management of CAM in low- and middle-income countries. This article provides a comprehensive document to help clinicians in managing this infection. Uncontrolled diabetes mellitus and inappropriate (high dose or not indicated) corticosteroid use are the major predisposing factors for this surge. High counts of Mucorales spores in both the indoor and outdoor environments, and the immunosuppressive impact of COVID-19 patients as well as immunotherapy are possible additional factors. Furthermore, a hyperglycaemic state leads to an increased expression of glucose regulated protein (GRP- 78) in endothelial cells that may help the entry of Mucorales into tissues. Rhino-orbital mucormycosis is the most common presentation followed by pulmonary mucormycosis. Recommendations are focused on the early suspicion of the disease and confirmation of diagnosis. Regarding management, glycaemic control, elimination of corticosteroid therapy, extensive surgical debridement and antifungal therapy are the standards for proper care. Due to limited availability of amphotericin B formulations during the present epidemic, alternative antifungal therapies are also discussed.


Subject(s)
Antifungal Agents/standards , Antifungal Agents/therapeutic use , COVID-19/complications , Intensive Care Units/standards , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/physiopathology , Adult , Aged , Aged, 80 and over , COVID-19/microbiology , Female , Humans , Male , Middle Aged , Practice Guidelines as Topic , SARS-CoV-2
13.
Mycoses ; 64(9): 1002-1014, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1148083

ABSTRACT

Invasive aspergillosis (IA) is an increasingly recognised phenomenon in critically ill patients in the intensive care unit, including in patients with severe influenza and severe coronavirus disease 2019 (COVID-19) infection. To date, there are no consensus criteria on how to define IA in the ICU population, although several criteria are used, including the AspICU criteria and new consensus criteria to categorise COVID-19-associated pulmonary aspergillosis (CAPA). In this review, we describe the epidemiology of IA in critically ill patients, most common definitions used to define IA in this population, and most common clinical specimens obtained for establishing a mycological diagnosis of IA in the critically ill. We also review the most common diagnostic tests used to diagnose IA in this population, and lastly discuss the most common clinical presentation and imaging findings of IA in the critically ill and discuss areas of further needed investigation.


Subject(s)
Aspergillus/genetics , COVID-19/complications , Diagnostic Techniques and Procedures/standards , Intensive Care Units/standards , Invasive Pulmonary Aspergillosis/classification , Invasive Pulmonary Aspergillosis/diagnosis , Practice Guidelines as Topic , Adult , Aged , Aged, 80 and over , Aspergillus/isolation & purification , COVID-19/microbiology , Critical Illness/classification , Female , Humans , Invasive Pulmonary Aspergillosis/physiopathology , Male , Mannans/blood , Middle Aged , Polymerase Chain Reaction , SARS-CoV-2
14.
Intensive Crit Care Nurs ; 65: 103034, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1141880

ABSTRACT

OBJECTIVES: To determine the impact of the first COVID-19 surge (March through June 2020) on mental well-being and associated risk factors among intensive care unit nurses. RESEARCH METHODOLOGY: In September 2020, a nationwide cross-sectional survey study among Dutch intensive care nurses was carried out to measure prevalence rates of symptoms of anxiety, depression, posttraumatic stress disorder, and need for recovery (NFR), objectified by the HADS-A, HADS-D, IES-6 and NFR questionnaires, respectively. Associated risk factors were determined using multivariate logistic regression analyses. RESULTS: Symptoms of anxiety, depression, and post traumatic stress disorder were reported by 27.0%, 18.6% and 22.2% of the 726 respondents, respectively. The NFR was positive, meaning not being recovered from work, in 41.7%. Working in an academic hospital, being afraid of infecting relatives and experiencing insufficient numbers of colleagues were associated with more mental symptoms, while having been on holiday was associated with reduced depression symptoms and need for recovery. CONCLUSION: The first COVID-19 surge had a high impact on the mental well-being of intensive care nurses, increasing the risk for drop out and jeopardising the continuity of care. Effort should be made to optimize working conditions and decrease workload to guarantee care in the next months of the COVID-19 pandemic.


Subject(s)
COVID-19/psychology , Critical Care Nursing/trends , Nurses/psychology , Occupational Stress/complications , Adult , Anxiety/etiology , Anxiety/physiopathology , Burnout, Professional/etiology , Burnout, Professional/physiopathology , Burnout, Professional/psychology , COVID-19/prevention & control , COVID-19/transmission , Critical Care Nursing/methods , Cross-Sectional Studies , Depression/etiology , Depression/psychology , Female , Humans , Intensive Care Units/organization & administration , Intensive Care Units/standards , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Nurses/statistics & numerical data , Occupational Stress/psychology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/physiopathology , Surveys and Questionnaires
16.
Best Pract Res Clin Anaesthesiol ; 35(3): 351-368, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1049749

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces coronavirus-19 disease (COVID-19) and is a major health concern. Following two SARS-CoV-2 pandemic "waves," intensive care unit (ICU) specialists are treating a large number of COVID19-associated acute respiratory distress syndrome (ARDS) patients. From a pathophysiological perspective, prominent mechanisms of COVID19-associated ARDS (CARDS) include severe pulmonary infiltration/edema and inflammation leading to impaired alveolar homeostasis, alteration of pulmonary physiology resulting in pulmonary fibrosis, endothelial inflammation (endotheliitis), vascular thrombosis, and immune cell activation. Although the syndrome ARDS serves as an umbrella term, distinct, i.e., CARDS-specific pathomechanisms and comorbidities can be noted (e.g., virus-induced endotheliitis associated with thromboembolism) and some aspects of CARDS can be considered ARDS "atypical." Importantly, specific evidence-based medical interventions for CARDS (with the potential exception of corticosteroid use) are currently unavailable, limiting treatment efforts to mostly supportive ICU care. In this article, we will discuss the underlying pulmonary pathophysiology and the clinical management of CARDS. In addition, we will outline current and potential future treatment approaches.


Subject(s)
COVID-19/therapy , Critical Care/standards , Health Knowledge, Attitudes, Practice , Intensive Care Units/standards , Respiratory Distress Syndrome/therapy , Adrenal Cortex Hormones/administration & dosage , Anticoagulants/administration & dosage , COVID-19/diagnosis , COVID-19/physiopathology , Critical Care/trends , Humans , Immunologic Factors/administration & dosage , Intensive Care Units/trends , Respiration, Artificial/standards , Respiration, Artificial/trends , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/physiopathology
17.
J Healthc Qual ; 43(1): 3-12, 2021.
Article in English | MEDLINE | ID: covidwho-1039763

ABSTRACT

INTRODUCTION: As the COVID-19 pandemic spread, patient care guidelines were published and elective surgeries postponed. However, trauma admissions are not scheduled and cannot be postponed. There is a paucity of information available on continuing trauma care during the pandemic. The study purpose was to describe multicenter trauma care process changes made during the COVID-19 pandemic. METHODS: This descriptive survey summarized the response to the COVID-19 pandemic at six Level I trauma centers. The survey was completed in 05/2020. Questions were asked about personal protective equipment, ventilators, intensive care unit (ICU) beds, and negative pressure rooms. Data were summarized as proportions. RESULTS: The survey took an average of 5 days. Sixty-seven percent reused N-95 respirators; 50% sanitized them with 25% using ultraviolet light. One hospital (17%) had regional resources impacted. Thirty-three percent created ventilator allocation protocols. Most hospitals (83%) designated more beds to the ICU; 50% of hospitals designated an ICU for COVID-19 patients. COVID-19 patients were isolated in negative pressure rooms at all hospitals. CONCLUSIONS: In response to the COVID-19 pandemic, Level I trauma centers created processes to provide optimal trauma patient care and still protect providers. Other centers can use the processes described to continue care of trauma patients during the COVID-19 pandemic.


Subject(s)
COVID-19/therapy , Critical Care/statistics & numerical data , Critical Care/standards , Intensive Care Units/statistics & numerical data , Intensive Care Units/standards , Trauma Centers/statistics & numerical data , Trauma Centers/standards , Humans , Pandemics , Practice Guidelines as Topic , SARS-CoV-2 , United States
19.
J Surg Res ; 260: 38-45, 2021 04.
Article in English | MEDLINE | ID: covidwho-974321

ABSTRACT

BACKGROUND: Urgent guidance is needed on the safety for providers of percutaneous tracheostomy in patients diagnosed with COVID-19. The objective of the study was to demonstrate that percutaneous dilational tracheostomy (PDT) with a period of apnea in patients requiring prolonged mechanical ventilation due to COVID-19 is safe and can be performed for the usual indications in the intensive care unit. METHODS: This study involves an observational case series at a single-center medical intensive care unit at a level-1 trauma center in patients diagnosed with COVID-19 who were assessed for tracheostomy. Success of a modified technique included direct visualization of tracheal access by bronchoscopy and a blind dilation and tracheostomy insertion during a period of patient apnea to reduce aerosolization. Secondary outcomes include transmission rate of COVID-19 to providers and patient complications. RESULTS: From April 6th, 2020 to July 21st, 2020, 2030 patients were admitted to the hospital with COVID-19, 615 required intensive care unit care (30.3%), and 254 patients required mechanical ventilation (12.5%). The mortality rate for patients requiring mechanical ventilation was 29%. Eighteen patients were assessed for PDT, and 11 (61%) underwent the procedure. The majority had failed extubation at least once (72.7%), and the median duration of intubation before tracheostomy was 15 d (interquartile range 13-24). The median positive end-expiratory pressure at time of tracheostomy was 10.8. The median partial pressure of oxygen (PaO2)/FiO2 ratio on the day of tracheostomy was 142.8 (interquartile range 104.5-224.4). Two patients had bleeding complications. At 1-week follow-up, eight patients still required ventilator support (73%). At the most recent follow-up, eight patients (73%) have been liberated from the ventilator, one patient (9%) died as a result of respiratory/multiorgan failure, and two were discharged on the ventilator (18%). Average follow-up was 20 d. None of the surgeons performing PDT have symptoms of or have tested positive for COVID-19. CONCLUSIONS: and relevance: PDT for patients with COVID-19 is safe for health care workers and patients despite higher positive end-expiratory pressure requirements and should be performed for the same indications as other causes of respiratory failure.


Subject(s)
Bronchoscopy/adverse effects , COVID-19/therapy , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Postoperative Complications/epidemiology , Respiration, Artificial/adverse effects , Tracheostomy/adverse effects , Adult , Aged , Airway Extubation/statistics & numerical data , Bronchoscopy/instrumentation , Bronchoscopy/methods , Bronchoscopy/standards , COVID-19/diagnosis , COVID-19/mortality , COVID-19/transmission , COVID-19 Nucleic Acid Testing/statistics & numerical data , Female , Follow-Up Studies , Hospital Mortality , Humans , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Intensive Care Units/standards , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Postoperative Complications/etiology , Respiration, Artificial/instrumentation , Respiration, Artificial/methods , Respiration, Artificial/statistics & numerical data , Retrospective Studies , SARS-CoV-2/isolation & purification , Severity of Illness Index , Time Factors , Tracheostomy/instrumentation , Tracheostomy/methods , Tracheostomy/standards , Treatment Outcome
20.
Rev Mal Respir ; 37(10): 811-822, 2020 Dec.
Article in French | MEDLINE | ID: covidwho-971294

ABSTRACT

INTRODUCTION: The new coronavirus disease 2019 (COVID-19) is responsible for a global pandemic and many deaths. This context requires an adaptation of health systems as well as the role of each healthcare professional, including physiotherapists. STATE OF THE ART: In order to optimize the management of people with COVID-19, many savant societies published guidelines about physiotherapy interventions within the crisis but none offered a global overview from the intensive care unit to home care. Therefore, the aim of this review is to offer an overview of recommended physiotherapy interventions in order to facilitate the management of these patients, whatever the stage of the disease. PERSPECTIVES: Owing to the emergent character of the COVID-19, actual guidelines will have to be adjusted according to the evolution of the pandemic and the resources of the hospital and liberal sectors, in particular for the long-term follow-up of these patients. Current and future research will aim to assess the effectiveness of physiotherapy interventions for people with COVID-19. CONCLUSION: The emergence of COVID-19 required a very rapid adaptation of the health system. The role of physiotherapists is justified at every stage of patients care in order to limit the functional consequences of the disease.


Subject(s)
COVID-19/therapy , Home Care Services/standards , Intensive Care Units/standards , Physical Therapy Modalities/standards , Practice Guidelines as Topic , COVID-19/epidemiology , Critical Pathways/organization & administration , Critical Pathways/standards , Humans , Internationality , Pandemics , Physical Therapy Modalities/statistics & numerical data , Physical Therapy Modalities/trends , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/statistics & numerical data , Practice Patterns, Physicians'/trends , SARS-CoV-2/physiology
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