Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 112
Filter
1.
Clin Lymphoma Myeloma Leuk ; 22 Suppl 2: S322, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2062037

ABSTRACT

CONTEXT: Hypereosinophilic syndrome (HES) is characterized by persistent blood eosinophilia, organ damage, and the absence of an underlying cause. Heterogeneous presentations, etiologies, and prognosis are recognized. The landscape of targeted therapies has emphasized the importance of its etiology and pathogenesis. We present a boy with extreme, refractory eosinophilia and end-organ complications. The persistence, severity, and outcome suggested an aggressive myeloid neoplasm. PRESENTATION: A 6-year-old boy presented with fever and respiratory symptoms. A blood count revealed hyperleukocytosis of 200×109/L with 90% eosinophils, normal platelets, and anemia with no hemolysis as well as increased cobalamin levels. Flow cytometry on the blood showed no evidence of hematolymphoid neoplasm. Fluorescent in-situ hybridization on the blood was negative for FIP1L1/PDGFRA, PDGFRB, FGFR1, and CBFB. Renal and liver functions were normal, and no evidence of tumor lysis was present. Parasitic and infectious etiologies were ruled out. Levels of immunoglobulin and complement as well as acute phase reactants were normal. CT scan showed no occult infection or lymphadenopathy. INTERVENTIONS: He was started on glucocorticoids and hydroxyurea as well as imatinib and a trial of antihelmintics. Signs of end-organ damage included 1) CNS hemiparesis, dysarthria, and MRI-documented small-vessel and white matter abnormalities; 2) myocarditis by cardiac ultrasound; and 3) respiratory distress with interstitial infiltrates. Covid PCR test was positive, so he was given Remdesivir, after which PCR became negative. Increased D-dimers led to enoxaparin, intravenous immunoglobulin, and support. Bone marrow evaluation ruled out an abnormal T-cell population and occult acute lymphoblastic leukemia by flow cytometry and immunohistochemistry. Marrow biopsy showed dysmorphic megakaryocytes, so a myeloid neoplasm could not be excluded. Cytogenetics on the marrow showed a normal karyotype, and myeloid-directed next generation sequencing on the blood was negative for mutations. A lung biopsy showed increased eosinophils within vessels and pleural fibrosis but no interstitial fibrosis or vasculitis. Subcutaneous interferon alfa was given 3 times weekly with no response. The 4 drugs were well tolerated. The boy was followed over 9 months, requiring antibiotics, anticoagulation, and oxygen support. Eosinophilia remained high at 40,000-150,000×109/L. The patient expired from respiratory failure. CONCLUSIONS: HES may be life-threatening in the pediatric population. Diagnosis and therapy can be challenging.


Subject(s)
COVID-19 , Hypereosinophilic Syndrome , Myeloproliferative Disorders , Acute-Phase Proteins/therapeutic use , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Child , Enoxaparin/therapeutic use , Fibrosis , Humans , Hydroxyurea/therapeutic use , Hypereosinophilic Syndrome/diagnosis , Hypereosinophilic Syndrome/drug therapy , Imatinib Mesylate/therapeutic use , Immunoglobulins, Intravenous/therapeutic use , Interferon-alpha/therapeutic use , Male , Myeloproliferative Disorders/diagnosis , Oxygen/therapeutic use , Receptor, Platelet-Derived Growth Factor beta/genetics , Receptor, Platelet-Derived Growth Factor beta/therapeutic use , Vitamin B 12
2.
S Afr Fam Pract (2004) ; 64(1): e1-e6, 2022 Sep 21.
Article in English | MEDLINE | ID: covidwho-2055672

ABSTRACT

BACKGROUND:  Medical grade oxygen is classified as a drug and needs to be prescribed by a qualified healthcare professional. Oxygen therapy is prescribed to people who cannot maintain normal blood oxygen saturation while breathing atmospheric air. The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of the rational use of this scarce commodity. This study investigated oxygen therapy practices in adult ward patients. METHODS:  A cross-sectional study design with an analytical component was used in the adults wards at a National District Hospital and the Pelonomi Academic Hospital in Bloemfontein. Data were collected from patient files, interviews and oxygen measurements of adult patients that received oxygen. RESULTS:  One hundred and fifteen patients were included in the study, of whom 47.0% received oxygen without an oxygen prescription. Around 62.3% of the patients with prescriptions did not receive oxygen as prescribed. The prescriptions and oxygen administration for COVID-19 patients were better than for non-COVID-19 patients. A quarter of the patients possibly received oxygen therapy unnecessarily. CONCLUSION:  Poor oxygen therapy practices were identified, including prescription errors, oxygen administration errors and oxygen wastage. A protocol should be developed and implemented for the prescription and administration of oxygen therapy. Training should occur to prevent oxygen wastage.Contribution: This study highlighted poor oxygen practices and prescriptions, as well as oxygen wastage in the absence of local oxygen therapy guidelines.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , COVID-19/therapy , Cross-Sectional Studies , Humans , Oxygen/therapeutic use , Pandemics , Pharmaceutical Preparations
3.
PLoS One ; 17(7): e0270594, 2022.
Article in English | MEDLINE | ID: covidwho-2039348

ABSTRACT

BACKGROUND: Low dose radiation therapy (LDRT) has been used for non-malignant conditions since early 1900s based on the ability of single fractions between 50-150 cGy to inhibit cellular proliferation. Given scarcity of resources, poor access to vaccines and medical therapies within low and middle income countries, there is an urgent need to identify other cost-effective alternatives in management of COVID-19 pneumonia. We conducted a pilot phase Ib/II investigator-initiated clinical trial to assess the safety, feasibility, and toxicity of LDRT in patients with severe COVID-19 pneumonia at the Aga Khan University Hospital in Nairobi, Kenya. Additionally, we also assessed clinical benefit in terms of improvement in oxygenation at day 3 following LDRT and the ability to avoid mechanical ventilation at day 7 post LDRT. METHODS: Patients with both polymerase chain reaction (PCR) and high-resolution computer tomogram (HRCT) confirmed severe COVID-19 pneumonia, not improving on conventional therapy including Dexamethasone and with increasing oxygen requirement were enrolled in the study. Patients on mechanical ventilation were excluded. Eligible patients received a single 100cGy fraction to the whole lung. In the absence of any dose limiting toxicity the study proposed to treat a total of 10 patients. The primary endpoints were to assess the safety/feasibility, and toxicity within the first 24 hours post LDRT. The secondary endpoints were to assess efficacy of LDRT at Day 3, 7, 14 and 28 post LDRT. RESULTS: Ten patients were treated with LDRT. All (100%) of patients were able to complete LDRT without treatment related SAE within the first 24 hours post treatment. None of the patients treated with LDRT experienced any acute toxicity as defined by change in clinical and respiratory status at 24hr following LDRT. Majority (90%) of patients avoided mechanical ventilation within 7 days of LDRT. Four patients (40%) demonstrated at least 25% improvement in oxygen requirements within 3 days. Six patients (60%) were discharged and remained off oxygen, whereas four progressed and died (1 due to sepsis and 3 in cytokine storm). Median time to discharge (n = 6) was 16.5 days and median time to death (n = 4) was 11.0 days. Patients who ultimately died showed elevated inflammatory markers including Ferritin, CRP and D-dimers as compared to those who were discharged alive. CONCLUSION: LDRT was feasible, safe and shows promise in the management of severe COVID-19 pneumonia including in patients progressing on conventional systemic treatment. Additional phase II trials are warranted to identify patients most likely to benefit from LDRT.


Subject(s)
COVID-19 , Humans , Kenya , Lung/diagnostic imaging , Oxygen/therapeutic use , Thorax
4.
J Integr Med ; 20(6): 575-580, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2007877

ABSTRACT

This report presents the case of a 59-year-old man with severe COVID-19 that gradually progressed to cytokine release syndrome and then acute respiratory distress syndrome; he was successfully treated via integration of therapeutic plasma exchange and traditional Chinese medicine. The patient initially presented with a sore throat, severe muscle aches, productive cough and fever. On the worsening of symptoms, remdesivir was administered. However, as the symptoms continued to worsen and a cytokine release syndrome was suspected, oxygen was provided through a high-flow nasal cannula (50 L/min) and therapeutic plasma exchange was performed to prevent worsening of the acute respiratory distress syndrome. On the same day, a course of traditional Chinese medicine was introduced in consultation with the infectious house staff. The patient's symptoms gradually improved; the levels of C-reactive protein and D-dimers reduced, and the patient was weaned to a simple oxygen mask and eventually to room air. This is the first reported case of the integration of these treatments. Together, they prevented the patient from requiring intubation, played a role in cytokine management, and also improved the clinical symptoms, including productive purulent sputum, cough, frequent stool passage and intermittent fever, with no adverse effects. As a result, the patient was discharged within two weeks of the integration of these treatments. Therefore, the integration of therapeutic plasma exchange and traditional Chinese medicine is an effective therapy for patients with severe COVID-19.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Male , Humans , Middle Aged , COVID-19/therapy , Cytokine Release Syndrome , Plasma Exchange , Medicine, Chinese Traditional , Cough/drug therapy , Respiratory Distress Syndrome/therapy , Oxygen/therapeutic use
5.
Undersea Hyperb Med ; 49(3): 295-305, 2022.
Article in English | MEDLINE | ID: covidwho-1998882

ABSTRACT

Introduction: Few treatments have demonstrated mortality benefits among hospitalized hypoxic COVID-19 patients. We evaluated the use of hyperbaric oxygen (HBO2) therapy as a therapeutic intervention among hospitalized patients with a high oxygen requirement prior to vaccine approval. Methods: We extracted data on patients with COVID-19 hypoxia who required oxygen supplementation ranging from a 6L nasal cannula up to a high-flow nasal cannula at 100% FiO2 at 60L/minute with a 100% non-rebreather mask at 15 L/minute and were eligible for off-label HBO2 therapy from October 2020 to February 2021. We followed the Monitored Emergency use of Unregistered and Investigational Interventions or (MEURI) in conjunction with the consistent re-evaluation of the protocol using the Plan-Do-Study-Act (PDSA) tool [1]. We compared patient characteristics and used Fisher's exact test and a survival analysis to assess the primary endpoint of inpatient death. Results: HBO2 therapy was offered to 36 patients, of which 24 received treatment and 12 did not receive treatment. Patients who did not receive treatment were significantly older (p ≺ 0.01) and had worse baseline hypoxia (p = 0.06). Three of the 24 (13%) patients who received treatment died compared to six of 12 (50%) patients who did not receive treatment (RR ratio: 0.25, p = 0.04, 95% CI: 0.08 to 0.83). In the survival analysis, there was a statistically significant reduction in inpatient mortality in the treatment group (HR: 0.19, p = 0.02, 95% CI: 0.05-0.74). However, after adjusting for age and baseline hypoxia, there was no difference in inpatient mortality (hazard ratio: 0.48, p = 0.42, 95% CI: 0.08-2.86). Conclusion: The survival benefit of HBO2 therapy observed in our unadjusted analysis suggests that there may be therapeutic benefits of HBO2 in treating COVID-19 hypoxia as an adjunct to standard care.


Subject(s)
COVID-19 , Hyperbaric Oxygenation , Vaccines , COVID-19/therapy , Humans , Hyperbaric Oxygenation/methods , Hypoxia/etiology , Hypoxia/therapy , Oxygen/therapeutic use , Treatment Outcome
6.
J Korean Med Sci ; 37(29): e238, 2022 Jul 25.
Article in English | MEDLINE | ID: covidwho-1963382

ABSTRACT

Despite the low prevalence of secondary bacterial infection in coronavirus disease 2019 (COVID-19) patients, most of them were administered antibiotic therapy empirically. However, the prognostic impact of empirical antibiotic therapy has not been evaluated. We conducted retrospective propensity score-matched case-control study of 233 COVID-19 patients with moderate to severe illnesses who required oxygen therapy and evaluated whether empirical antibiotic therapy could improve clinical outcomes. Empirical antibiotic therapy did not improve clinical outcomes including length of stay, days with oxygen requirement, the proportion of patients with increased oxygen demand, the proportion of patients who required mechanical ventilation, and overall mortality. This finding implies that routine administration of antibiotics for the treatment of COVID-19 is not essential and should be restricted.


Subject(s)
COVID-19 , Anti-Bacterial Agents/therapeutic use , Case-Control Studies , Humans , Oxygen/therapeutic use , Retrospective Studies
7.
Niger J Clin Pract ; 25(7): 1088-1093, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1954420

ABSTRACT

Background: The management of acute respiratory failure in COVID-19 patients and the role and limitations of high-flow nasal oxygen therapy (HFNOT) remain unclear. Aim: This study aimed to investigate the effect of HFNOT, identify the characteristics of patients who will benefit from therapy, and determine monitoring strategies to decide on endotracheal intubation for patients with COVID-19. Patients and Methods: We conducted a prospective observational study of COVID-19 patients who were admitted to the intensive care unit (ICU) and required HFNOT for at least 2 days between 20 March 2020 and 20 June 2020. The exclusion criteria were a severe respiratory failure, reduced levels of consciousness, combination with other noninvasive ventilation strategies, and exhaustion. The patients were followed up until ICU discharge. The primary outcome was the proportion of patients with COVID-19 who were successfully weaned from HFNOT, whereas failure comprised intubation or death on HFNOT. Results: Thirty-five subjects (24 males, mean-age: 61.62, standard deviation: 14.9 yr.) were included in the study. A total of 20/35 (57.1%) subjects survived to discharge. C-reactive-protein (CRP) and interleukin-6 (IL-6) levels were significantly increased in the treatment failure group (CRP; effect size (r):0.35, P: 0.037, IL-6; r: 0.37, P: 0.03). Although there was a difference between repeated measures of partial-pressure-of-oxygen/fraction-of-inspired-oxygen (PaO2/FiO2:P/F) rates (partial-eta-squared (ηp2):0.79, P < 0.001), no difference was found between carbon dioxide levels (ηp2:0.29, p: 0.44). There was also no difference between ROX (ratio-of-oxygen-saturation/FiO2 to respiratory-rate) rates (Kendall's W: 0.33 P = 0.310). Conclusion: In COVID-19 patients with mild-to-moderate dyspnea and hypoxemia who are nonresponsive to conventional-oxygen-therapies, the initial approach may involve the use of HFNOT. In this study, patient monitoring could be performed with ROX and P/F ratios, and the effectiveness of the treatment could be decided by looking at these rates in the second hour. Prolongation of the period and awake prone positioning did not improve the outcome.


Subject(s)
COVID-19 , COVID-19/therapy , Humans , Interleukin-6 , Intubation, Intratracheal , Male , Middle Aged , Oxygen/therapeutic use , Oxygen Inhalation Therapy
8.
Sci Rep ; 12(1): 9622, 2022 06 10.
Article in English | MEDLINE | ID: covidwho-1947488

ABSTRACT

This network meta-analysis (NMA) assessed the efficacy of remdesivir in hospitalized patients with COVID-19 requiring supplemental oxygen. Randomized controlled trials of hospitalized patients with COVID-19, where patients were receiving supplemental oxygen at baseline and at least one arm received treatment with remdesivir, were identified. Outcomes included mortality, recovery, and no longer requiring supplemental oxygen. NMAs were performed for low-flow oxygen (LFO2); high-flow oxygen (HFO2), including NIV (non-invasive ventilation); or oxygen at any flow (AnyO2) at early (day 14/15) and late (day 28/29) time points. Six studies were included (N = 5245 patients) in the NMA. Remdesivir lowered early and late mortality among AnyO2 patients (risk ratio (RR) 0.52, 95% credible interval (CrI) 0.34-0.79; RR 0.81, 95%CrI 0.69-0.95) and LFO2 patients (RR 0.21, 95%CrI 0.09-0.46; RR 0.24, 95%CrI 0.11-0.48); no improvement was observed among HFO2 patients. Improved early and late recovery was observed among LFO2 patients (RR 1.22, 95%CrI 1.09-1.38; RR 1.17, 95%CrI 1.09-1.28). Remdesivir also lowered the requirement for oxygen support among all patient subgroups. Among hospitalized patients with COVID-19 requiring supplemental oxygen at baseline, use of remdesivir compared to best supportive care is likely to improve the risk of mortality, recovery and need for oxygen support in AnyO2 and LFO2 patients.


Subject(s)
COVID-19 , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , COVID-19/drug therapy , Humans , Oxygen/therapeutic use , Randomized Controlled Trials as Topic , Treatment Outcome
10.
Crit Care Clin ; 38(4): 795-808, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1914202

ABSTRACT

Supplemental oxygen is an essential medication in critical care. The optimal oxygen dose delivery system remains unclear, however. The "dose" and "delivery" of oxygen carry significant importance for resource-limited settings, such as low- and middle-income countries (LMICs). Regrettably, LMICS often experience significant inequities in oxygen supply and demand, with major impacts on preventable mortality. These inequities have become particularly prominent during the global COVID-19 pandemic, highlighting the need for additional investment and research into the best methods to utilize supplemental oxygen and ensure stable access to medical oxygen.


Subject(s)
COVID-19 , Pandemics , Critical Care , Developing Countries , Humans , Oxygen/therapeutic use
11.
Crit Care ; 26(1): 183, 2022 06 18.
Article in English | MEDLINE | ID: covidwho-1894497

ABSTRACT

BACKGROUND: Clarithromycin may act as immune-regulating treatment in sepsis and acute respiratory dysfunction syndrome. However, clinical evidence remains inconclusive. We aimed to evaluate whether clarithromycin improves 28-day mortality among patients with sepsis, respiratory and multiple organ dysfunction syndrome. METHODS: We conducted a multicenter, randomized, clinical trial in patients with sepsis. Participants with ratio of partial oxygen pressure to fraction of inspired oxygen less than 200 and more than 3 SOFA points from systems other than the respiratory function were enrolled between December 2017 and September 2019. Patients were randomized to receive 1 gr of clarithromycin or placebo intravenously once daily for 4 consecutive days. The primary endpoint was 28-day all-cause mortality. Secondary outcomes were 90-day mortality; sepsis response (defined as at least 25% decrease in SOFA score by day 7); sepsis recurrence; and differences in peripheral blood cell populations and leukocyte transcriptomics. RESULTS: Fifty-five patients were allocated to each arm. By day 28, 27 (49.1%) patients in the clarithromycin and 25 (45.5%) in the placebo group died (risk difference 3.6% [95% confidence interval (CI) - 15.7 to 22.7]; P = 0.703, adjusted OR 1.03 [95%CI 0.35-3.06]; P = 0.959). There were no statistical differences in 90-day mortality and sepsis response. Clarithromycin was associated with lower incidence of sepsis recurrence (OR 0.21 [95%CI 0.06-0.68]; P = 0.012); significant increase in monocyte HLA-DR expression; expansion of non-classical monocytes; and upregulation of genes involved in cholesterol homeostasis. Serious and non-serious adverse events were equally distributed. CONCLUSIONS: Clarithromycin did not reduce mortality among patients with sepsis with respiratory and multiple organ dysfunction. Clarithromycin was associated with lower sepsis recurrence, possibly through a mechanism of immune restoration. Clinical trial registration clinicaltrials.gov identifier NCT03345992 registered 17 November 2017; EudraCT 2017-001056-55.


Subject(s)
Clarithromycin , Sepsis , Administration, Intravenous , Clarithromycin/pharmacology , Clarithromycin/therapeutic use , Humans , Multiple Organ Failure/complications , Multiple Organ Failure/drug therapy , Oxygen/therapeutic use , Sepsis/complications
12.
PLoS One ; 17(6): e0270646, 2022.
Article in English | MEDLINE | ID: covidwho-1910691

ABSTRACT

OBJECTIVE: To compare the efficacy and outcomes with inhaled nitric oxide (iNO) and inhaled epoprostenol (iEPO) in patients with refractory hypoxemia due to COVID-19. DESIGN: Retrospective Cohort Study. SETTING: Single health system multicenter academic teaching hospitals. PATIENTS OR SUBJECTS: Age group of 18-80 years admitted to the medical ICU. INTERVENTIONS: Mechanically ventilated patients with COVID-19 infection, who received either iNO or iEPO between March 1st, 2020, and June 30th, 2020. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the change in the PaO2/FiO2 (P/F) ratio 1 hour after initiation of pulmonary vasodilator therapy. Secondary outcomes include P/F ratios on days 1-3 after initiation, positive response in P/F ratio (increase of at least 20% in PaO2), total days of treatment, rebound hypoxemia (if there was a drop in oxygen saturation after treatment was stopped), ventilator free days (if any patient was extubated), days in ICU, days to extubation, days to tracheostomy, mortality days after intubation, 30-day survival and mortality. 183 patients were excluded, as they received both iNO and iEPO. Of the remaining 103 patients, 62 received iEPO and 41 received iNO. The severity of ARDS was similar in both groups. Change in P/F ratio at one hour was 116 (70.3) with iNO and 107 (57.6) with iEPO (Mean/SD). Twenty-two (53.7%) patients in the iNO group and 25 (40.3%) in the iEPO group were responders to pulmonary vasodilators n(%)(p = 0.152) (more than 20% increase in partial pressure of oxygen, Pao2), and 18 (43.9%) and 31 (50%) patients in the iNO and iEPO group (p = 0.685), respectively, had rebound hypoxemia. Only 7 patients in the cohort achieved ventilator free days (3 in the iEPO group and 4 in iNO group). CONCLUSIONS: We found no significant difference between iNO and iEPO in terms of change in P/F ratio, duration of mechanical ventilation, ICU, in-hospital mortality in this cohort of mechanically ventilated patients with COVID-19. Larger, prospective studies are necessary to validate these results.


Subject(s)
COVID-19 , Epoprostenol , Administration, Inhalation , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/drug therapy , Epoprostenol/therapeutic use , Humans , Hypoxia/drug therapy , Middle Aged , Nitric Oxide/therapeutic use , Oxygen/therapeutic use , Prospective Studies , Retrospective Studies , Vasodilator Agents/therapeutic use , Young Adult
13.
BMJ Open ; 12(5): e058901, 2022 05 02.
Article in English | MEDLINE | ID: covidwho-1891834

ABSTRACT

INTRODUCTION: The aim of this evaluation is to understand whether introducing stabilisation rooms equipped with pulse oximetry and oxygen systems to frontline health facilities in Ikorodu, Lagos State, alongside healthcare worker (HCW) training improves the quality of care for children with pneumonia aged 0-59 months. We will explore to what extent, how, for whom and in what contexts the intervention works. METHODS AND ANALYSIS: Quasi-experimental time-series impact evaluation with embedded mixed-methods process and economic evaluation. SETTING: seven government primary care facilities, seven private health facilities, two government secondary care facilities. TARGET POPULATION: children aged 0-59 months with clinically diagnosed pneumonia and/or suspected or confirmed COVID-19. INTERVENTION: 'stabilisation rooms' within participating primary care facilities in Ikorodu local government area, designed to allow for short-term oxygen delivery for children with hypoxaemia prior to transfer to hospital, alongside HCW training on integrated management of childhood illness, pulse oximetry and oxygen therapy, immunisation and nutrition. Secondary facilities will also receive training and equipment for oxygen and pulse oximetry to ensure minimum standard of care is available for referred children. PRIMARY OUTCOME: correct management of hypoxaemic pneumonia including administration of oxygen therapy, referral and presentation to hospital. SECONDARY OUTCOME: 14-day pneumonia case fatality rate. Evaluation period: August 2020 to September 2022. ETHICS AND DISSEMINATION: Ethical approval from University of Ibadan, Lagos State and University College London. Ongoing engagement with government and other key stakeholders during the project. Local dissemination events will be held with the State Ministry of Health at the end of the project (December 2022). We will publish the main impact results, process evaluation and economic evaluation results as open-access academic publications in international journals. TRIAL REGISTRATION NUMBER: ACTRN12621001071819; Registered on the Australian and New Zealand Clinical Trials Registry.


Subject(s)
COVID-19 , Pneumonia , Australia , Child, Preschool , Hospitals , Humans , Hypoxia/complications , Infant , Infant, Newborn , Nigeria , Oximetry , Oxygen/therapeutic use , Pneumonia/complications
14.
Clin Med (Lond) ; 22(3): 197-202, 2022 05.
Article in English | MEDLINE | ID: covidwho-1856277

ABSTRACT

BACKGROUND: There is a lack of data on the safety of providing oxygen at home to stable patients recovering from COVID-19. METHODS: A retrospective analysis of patients discharged to a COVID-19 virtual ward (CVW) between January 2021 and March 2021 at a UK district general hospital was performed. Patients with improving clinical trajectories and oxygen requirements up to 4 L/minute were eligible. Outcomes measured were 30-day mortality and readmission rate. RESULTS: From 02 January 2021 to 16 March 2021 (74 days), 147 patients discharged to the CVW were included: 71 received continuous or ambulatory oxygen, and 76 received pulse oximetry monitoring only. Five patients were readmitted within 30 days and two patients died. There were no significant differences between readmission and mortality rates between those discharged with or without oxygen. CONCLUSION: Provision of oxygen at home for selected patients recovering from COVID-19 is safe with low risk of readmission and death.


Subject(s)
COVID-19 , Hospitals, General , Humans , Oxygen/therapeutic use , Patient Discharge , Patient Readmission , Retrospective Studies
15.
Crit Care ; 25(1): 431, 2021 12 16.
Article in English | MEDLINE | ID: covidwho-1854857

ABSTRACT

BACKGROUND: We hypothesized that as CARDS may present different pathophysiological features than classic ARDS, the application of high levels of end-expiratory pressure is questionable. Our first aim was to investigate the effects of 5-15 cmH2O of PEEP on partitioned respiratory mechanics, gas exchange and dead space; secondly, we investigated whether respiratory system compliance and severity of hypoxemia could affect the response to PEEP on partitioned respiratory mechanics, gas exchange and dead space, dividing the population according to the median value of respiratory system compliance and oxygenation. Thirdly, we explored the effects of an additional PEEP selected according to the Empirical PEEP-FiO2 table of the EPVent-2 study on partitioned respiratory mechanics and gas exchange in a subgroup of patients. METHODS: Sixty-one paralyzed mechanically ventilated patients with a confirmed diagnosis of SARS-CoV-2 were enrolled (age 60 [54-67] years, PaO2/FiO2 113 [79-158] mmHg and PEEP 10 [10-10] cmH2O). Keeping constant tidal volume, respiratory rate and oxygen fraction, two PEEP levels (5 and 15 cmH2O) were selected. In a subgroup of patients an additional PEEP level was applied according to an Empirical PEEP-FiO2 table (empirical PEEP). At each PEEP level gas exchange, partitioned lung mechanics and hemodynamic were collected. RESULTS: At 15 cmH2O of PEEP the lung elastance, lung stress and mechanical power were higher compared to 5 cmH2O. The PaO2/FiO2, arterial carbon dioxide and ventilatory ratio increased at 15 cmH2O of PEEP. The arterial-venous oxygen difference and central venous saturation were higher at 15 cmH2O of PEEP. Both the mechanics and gas exchange variables significantly increased although with high heterogeneity. By increasing the PEEP from 5 to 15 cmH2O, the changes in partitioned respiratory mechanics and mechanical power were not related to hypoxemia or respiratory compliance. The empirical PEEP was 18 ± 1 cmH2O. The empirical PEEP significantly increased the PaO2/FiO2 but also driving pressure, lung elastance, lung stress and mechanical power compared to 15 cmH2O of PEEP. CONCLUSIONS: In COVID-19 ARDS during the early phase the effects of raising PEEP are highly variable and cannot easily be predicted by respiratory system characteristics, because of the heterogeneity of the disease.


Subject(s)
COVID-19/therapy , Positive-Pressure Respiration , Respiratory Distress Syndrome/therapy , Ventilator-Induced Lung Injury , COVID-19/diagnosis , Critical Care , Humans , Hypoxia , Middle Aged , Oxygen/therapeutic use , SARS-CoV-2 , Ventilator-Induced Lung Injury/diagnostic imaging
16.
Crit Care Clin ; 38(3): 601-621, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1850766

ABSTRACT

High-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) via facemask or helmet have been increasingly used in managing acute hypoxemic respiratory failure (AHRF) owing to COVID-19 with the premise of reducing the need for invasive mechanical ventilation and possibly mortality. Their use carries the risk of delaying intubation and nosocomial infection transmission. To date, most studies on the effectiveness of these modalities are observational and suggest that HFNO and NIV have a role in the management of AHRF owing to COVID-19. Trials are ongoing and are evaluating different aspects of noninvasive respiratory support in patients with AHRF owing to COVID-19.


Subject(s)
COVID-19 , Noninvasive Ventilation , Respiratory Insufficiency , COVID-19/therapy , Humans , Oxygen/therapeutic use , Oxygen Inhalation Therapy , Respiration, Artificial , Respiratory Insufficiency/therapy
17.
Rev Esp Quimioter ; 35 Suppl 1: 54-58, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1836619

ABSTRACT

Critically ill patients with COVID-19 face a higher risk of disease progression and complications. The current standard of care includes supportive care measures and fluid management. The Recovery trial observed a reduction in all-cause, 28-day mortality (p<0.001) when patients with COVID-19 requiring oxygen therapy received 6 mg of dexamethasone per day for 10 days. In contrast, in patients not requiring oxygen, no benefit was observed: 28-day mortality rates for the dexamethasone and routine care groups were 17.8% and 14%, respectively. To corroborate these results, the World Health Organization (WHO) performed a meta-analysis. The study showed that the use of systemic corticosteroids compared with routine care placebo was associated with a decrease in all-cause, 28-day mortality. With respect to the effectiveness of remdesivir, the ACTT-1 trial found that the drug conferred a benefit on time to clinical improvement. The subgroup analysis in the clinical trial also showed a benefit per mortality in patients requiring supplemental oxygen, albeit not those in need of mechanical ventilation.


Subject(s)
COVID-19 , Pneumonia , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Dexamethasone/therapeutic use , Humans , Oxygen/therapeutic use , Pneumonia/drug therapy , SARS-CoV-2 , Steroids/therapeutic use
19.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1801631

ABSTRACT

Mucormycosis (Zygomycosis) is a rare and lethal invasive fungal infection, often acute and extremely severe caused by opportunist and ubiquitous fungi belonging to the class Phygomycetes, subclass Zygomycetes, order Mucorales, family Mucoraceae. India has reported surge in cases of post COVID 19 Mucormycosis over the past few months due to the increasing frequency of risk factors like corticosteroid therapy, uncontrolled diabetes, DKA, neutropenia and iron overload. Patients with a history of COVID-19 infection are at increased risk of developing fungal infections like Mucormycosis. The emergence of COVID-19 associated mucormycosis (CAM) across several nations, particularly India, warrants a detailed study to identify potential contributing factors. MATERIAL: This cross sectional study conducted at Bowring and Lady Curzon Hospital, Bangalore, involving 75 subjects diagnosed with CAM either clinically, radiological or microbiologically. The objective was to study the clinical profile of patients with COVID associated Mucormycosis and to correlate the levels of Serum ferritin and iron profile with severity and extent of disease in COVID associated Mucormycosis patients Data was collected on demographic details, co morbidities, vaccination status, history of treatment with remedesvir, oxygen therapy or steroid use, complications of past COVID 19 infection and stage of current Mucormycosis infection. Clinical outcome of the patients measured based on Iron profile, length of hospital stay, need for ICU admission, presence of diabetic ketoacidosis and mortality. The blood investigations which included were CBC with differential leukocyte count, qCRP, FBS, PPBS, HbA1c serum iron studies and serum ferritin. OBSERVATION: The mean age of the subjects was 48.19 with 52 males, 23 females. Among 75 patients with CAM, 90.7% were unvaccinated against COVID-19, 62.7% had oxygen usage and steroid therapy, 44% had use of remedesvir. Most common co morbidity was diabetes mellitus 60% with 20% of patients having DKA. Rhino orbital-cerebral mucormycosis(Stage 4- 44.6%) was the most common clinical presentation. The mean serum iron (50.37) and TIBC (255.37) were significantly higher in Stage 4 CAM cases compared with less invasive stage 2 CAM cases. Patients with Stage 4 CAM had elevated levels of inflammatory markers LDH (292) DDimer (457) CRP(74.64). Case fatality rates of CAM was 12%. CONCLUSION: The results of this study revealed significant correlation between the clinical severity of CAM and higher mortality, increased serum iron levels and inflammatory markers in this population of patients. Therefore, patients with elevated levels of available serum iron are uniquely susceptible to mucormycosis infection, suggesting dysregulated iron metabolism in its pathogenesis.


Subject(s)
COVID-19 , Diabetic Ketoacidosis , Mucormycosis , Cross-Sectional Studies , Diabetic Ketoacidosis/complications , Female , Ferritins , Humans , India/epidemiology , Iron , Male , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Oxygen/therapeutic use , Steroids/therapeutic use
20.
Med Klin Intensivmed Notfmed ; 117(5): 333-341, 2022 Jun.
Article in German | MEDLINE | ID: covidwho-1797664

ABSTRACT

Oxygen is essential for energy production and thus for the survival of human cells. If oxygen delivery is disrupted due to illness, injury or changes in environmental factors, the human body is to a certain extent able to activate compensatory mechanisms to ensure adequate delivery of oxygen for the function and integrity of the cells and organ systems. If these compensatory mechanisms are exhausted or overloaded, there is a risk of functional failure of cells and organ systems. In clinical practice, it is often difficult to decide whether the body's own compensation mechanisms are still sufficient or whether more invasive therapy options and their side effects should be used to prevent organ damage. The aim of this review is to reiterate the basic physiological mechanisms of oxygen delivery to cells, to show how insufficient oxygen can be detected, and to highlight the current state of studies and guidelines on target oxygen levels. Although the coronavirus disease 2019 (COVID-19) pandemic has brought recent attention to the pathophysiology and therapeutic strategies of oxygenation disorders, little new knowledge regarding oxygen targets has emerged from this pandemic. Thus, the previously recommended oxygen target values remain unchanged.


Subject(s)
COVID-19 , Humans , Hypoxia/therapy , Oxygen/therapeutic use , Oxygen Inhalation Therapy/adverse effects , Pandemics
SELECTION OF CITATIONS
SEARCH DETAIL