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2.
Am J Phys Med Rehabil ; 99(10): 873-875, 2020 10.
Article in English | MEDLINE | ID: covidwho-860315

ABSTRACT

A 65-yr-old man visited a primary care hospital with a continued fever of 38°C for 3 days. As his fever did not improve until 8 days after, he was admitted into another acute care hospital, where his respiratory condition rapidly worsened. Therefore, the patient was transferred to our hospital. On the day of transfer (day 1), he was started on mechanical ventilation. COVID-19 was diagnosed using a polymerase chain reaction assay 6 days after admission (day 6). The rehabilitation therapy was begun on day 6. The initial rehabilitation programs focused on positioning and postural drainage. The patient was extubated on day 19, and he began standing and stepping on the same day. Gait exercises began on day 22, and endurance training was initiated on day 28. The patient was discharged from our hospital on day 34 as he met the physical function milestones. One month after discharge, the Medical Research Council sum score and Barthel Index had each improved; therefore, muscle strength and daily activities had returned to normal. It was assumed that mobilization should be performed as soon as possible after the end of sedation during the acute phase of severe COVID-19 infection in patients receiving mechanical ventilation.


Subject(s)
Coronavirus Infections/rehabilitation , Drainage, Postural/methods , Exercise Therapy/methods , Pneumonia, Viral/rehabilitation , Respiratory Therapy/methods , Aged , Betacoronavirus , Coronavirus Infections/virology , Humans , Japan , Male , Pandemics , Pneumonia, Viral/virology , Respiration, Artificial , Treatment Outcome
3.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(5): 453-456, 2020 Oct 08.
Article in Chinese | MEDLINE | ID: covidwho-854259

ABSTRACT

OBJECTIVE: To explore the preventing infection measures of new coronavirus disease 2019(COVID-19) patients during mechanical ventilation, and to provide reference for the safe application of mechanical ventilation. METHODS: Retrieved from PubMed, Ovid and other databases, and combined with the application experience of mechanical ventilation were collected to explore the preventing infection measures of COVID-19 patients during mechanical ventilation. RESULTS: This paper put forward the preventing infection measures of external circuit, internal circuit, outer surface, filter and special parts in ventilator. The preventing infection measures of sputum suction and nebulization were summarized. CONCLUSIONS: The preventing infection measures of COVID-19 patients during mechanical ventilation are successfully completed, which can provide suggestions for the application and maintenance of mechanical ventilation.


Subject(s)
Coronavirus Infections/prevention & control , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Respiration, Artificial , Betacoronavirus , Coronavirus Infections/therapy , Humans , Pneumonia, Viral/therapy , Ventilators, Mechanical
4.
Am J Transplant ; 20(10): 2933-2937, 2020 10.
Article in English | MEDLINE | ID: covidwho-843550

ABSTRACT

Coronavirus disease 2019 (COVID-19) has been declared pandemic since March 2020. In Europe, Italy was the first nation affected by this infection. We report anamnestic data, clinical features, and therapeutic management of 2 lung transplant recipients with confirmed COVID-19 pneumonia. Both patients were in good clinical condition before the infection and were receiving immunosuppression with calcineurin inhibitors (CNI), mycophenolate mofetil, and corticosteroids. Whereas mycophenolate mofetil was withdrawn in both cases, CNI were suspended only in the second patient. The first patient always maintained excellent oxygen saturation throughout hospitalization with no need for additional oxygen therapy. He was discharged with a satisfactory pulmonary function and a complete resolution of radiological and clinical findings. However, at discharge SARS-CoV-2 RNA could still be detected in the nasopharyngeal swab and in the stools. The second patient required mechanical ventilation, had a progressive deterioration of his clinical conditions, and had a fatal outcome. Further insight into SARS-CoV-2 infection is eagerly awaited to improve the outcome of transplant recipients affected by COVID-19 pneumonia.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Lung Transplantation/methods , Pneumonia, Viral/diagnosis , Transplant Recipients , Aged , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Cystic Fibrosis/surgery , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Postoperative Period , Pulmonary Disease, Chronic Obstructive/surgery , Respiration, Artificial , Tomography, X-Ray Computed
5.
Respir Care ; 65(7): 920-931, 2020 07.
Article in English | MEDLINE | ID: covidwho-840991

ABSTRACT

BACKGROUND: The overwhelming demand for mechanical ventilators due to COVID-19 has stimulated interest in using one ventilator for multiple patients (ie, multiplex ventilation). Despite a plethora of information on the internet, there is little supporting evidence and no human studies. The risk of multiplex ventilation is that ventilation and PEEP effects are largely uncontrollable and depend on the difference between patients' resistance and compliance. It is not clear whether volume control ventilation or pressure control ventilation is safer or more effective. We designed a simulation-based study to allow complete control over the relevant variables to determine the effects of various degrees of resistance-compliance imbalance on tidal volume (VT), end-expiratory lung volume (EELV), and imputed pH. METHODS: Two separate breathing simulators were ventilated with a ventilator using pressure control and volume control ventilation modes. Evidence-based lung models simulated a range of differences in resistance and compliance (6 pairs of simulated patients). Differences in VT, EELV, and imputed pH were recorded. RESULTS: Depending on differences in resistance and compliance, differences in VT ranged from 1% (with equal resistance and compliance) to 79%. Differences in EELV ranged from 2% to 109%, whereas differences in pH ranged from 0% to 5%. Failure due to excessive VT (ie, > 8 mL/kg) did not occur, but failure due to excessive EELV difference (ie, > 10%) was evident in 50% of patient pairs. There was no difference in failure rate between volume control and pressure control ventilation modes. CONCLUSIONS: These experiments confirmed the potential for markedly different ventilation and oxygenation for patients with uneven respiratory system impedances during multiplex ventilation. Three critical problems must be solved to minimize risk: (1) partitioning of inspiratory flow from the ventilator individually between the 2 patients, (2) measurement of VT delivered to each patient, and (3) provision for individual PEEP. We provide suggestions for solving these problems.


Subject(s)
Airway Resistance/physiology , Coronavirus Infections , Lung Compliance/physiology , Materials Testing/methods , Pandemics , Pneumonia, Viral , Respiration, Artificial , Betacoronavirus , Computer Simulation , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Critical Care/methods , Equipment Design , Humans , Models, Biological , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Respiration, Artificial/instrumentation , Respiration, Artificial/methods , Ventilators, Mechanical/standards , Ventilators, Mechanical/supply & distribution
7.
Rev. enferm. UERJ ; 28: e50721, jan.-dez. 2020.
Article in English, Portuguese | LILACS (Americas) | ID: covidwho-828134

ABSTRACT

Objetivo: apresentar atualizações para a ressuscitação cardiopulmonar em pacientes suspeitos e confirmados com COVID-19. Método: revisão compreensiva da literatura, com síntese narrativa das evidências de diretrizes e recomendações da Organização Mundial de Saúde, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma e National Association of Emergency Medical Technicians. Resultados: as principais atualizações trazem informações sobre especificidades das manobras de ressuscitação cardiopulmonar; preparação do ambiente, recursos humanos e materiais, reconhecimento da parada cardiorrespiratória e ações iniciais; estratégias de ventilação e acesso invasivo da via aérea; ajustes do ventilador mecânico e manobras de ressuscitação cardiopulmonar em pacientes pronados. Considerações finais: profissionais de saúde envolvidos no atendimento à parada cardiorrespiratória de pacientes suspeitos e/ou confirmados com COVID-19 podem encontrar inúmeros desafios, portanto devem seguir com rigor o protocolo estabelecido para maximizar a efetividade das manobras de ressuscitação e minimizar o risco de contágio pelo vírus e sua disseminação.


Objective: to present updates for cardiopulmonary resuscitation in suspected and confirmed patients with COVID-19. Method: comprehensive literature review with narrative synthesis of the evidence of guidelines and recommendations from World Health Organization, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Results: the main updates bring information about the specifics of cardiopulmonary resuscitation maneuvers; preparation of the environment and human and material resources, recognition of cardiorespiratory arrest and initial actions; ventilation and invasive airway access strategies; mechanical ventilator adjustments and cardiopulmonary resuscitation maneuvers in patients in the prone position. Final considerations: health professionals involved in the care of cardiorespiratory arrest of suspected and/or confirmed patients with COVID-19 can face numerous challenges, so they must strictly follow the protocol established to maximize the effectiveness of resuscitation maneuvers and minimize the risk of contagion by the virus and its spread.


Objetivo: apresentar actualizaciones para la reanimación cardiopulmonar en pacientes sospechos os y confirmados con COVID-19. Método: revisión exhaustiva de la literatura con síntesis narrativa de la evidencia de guías y recomendaciones de la Organización Mundial de la Salud, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Resultados: las principales actualizaciones aportan información sobre los detalles de las maniobras de reanimación cardiopulmonar; preparación del medio ambiente y recursos humanos y materiales, reconocimiento de paro cardiorrespiratorio y acciones iniciales; estrategias de ventilación y acceso invasivo a las vías aéreas; ajustes del ventilador mecánico y maniobras de reanimación cardiopulmonar en pacientes en decúbito prono. Consideraciones finales: los profesionales de la salud involucrados en la atención del paro cardiorrespiratorio de pacientes sospechosos y/o confirmados con COVID-19 pueden enfrentar numerosos desafíos, por lo que deben seguir estrictamente el protocolo establecido para maximizar la efectividad de las maniobras de reanimación y minimizar el riesgo de contagio por el virus y supropagación.


Subject(s)
Humans , Male , Female , Cardiopulmonary Resuscitation/standards , Coronavirus Infections/complications , Betacoronavirus , Heart Arrest/etiology , Respiration, Artificial/methods , Clinical Protocols/standards , Cardiopulmonary Resuscitation/methods , Containment of Biohazards/standards , Heart Arrest/rehabilitation , Heart Massage/methods , Nursing, Team/standards
8.
Acta Med Indones ; 52(3): 274-282, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-833780

ABSTRACT

The most severe clinical feature of COVID-19 is Acute Respiratory Distress Syndrome (ARDS) which requires intubation and mechanical ventilation and it occurs in approximately 2.3% of cases. About 94% of of these cases end in death. This case series report two confirmed COVID-19 patients who had met criteria of intubation and mechanical ventilation, but not performed to them. Both patients experienced clinical improvement and recovery. Probably this is due to differences of COVID-19 ARDS (CARDS) with typical or classic ARDS.  CARDS is divided into two phenotypes of type L (Low Elastance) and type H (High Elastance). These different phenotypic also distinguish subsequent pathophysiology and clinical management. These phenotype can be differentiate by chest CT scan. This case series emphasizes the importance of understanding this phenotype so that clinicians can provide more appropriate treatment management and also availability of CT scans in health facilities that manage COVID -19.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Coronavirus Infections/epidemiology , Humans , Intubation, Intratracheal , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Prognosis , Respiration, Artificial , Tomography, X-Ray Computed
9.
BMJ Case Rep ; 13(6)2020 Jun 14.
Article in English | MEDLINE | ID: covidwho-832843

ABSTRACT

A 57-year-old man presented with a progressive flaccid symmetrical motor and sensory neuropathy following a 1-week history of cough and malaise. He was diagnosed with Guillain-Barré syndrome secondary to COVID-19 and started on intravenous immunoglobulin. He proceeded to have worsening respiratory function and needed intubation and mechanical ventilation. This is the first reported case of this rare neurological complication of COVID-19 in the UK, but it adds to a small but growing body of international evidence to suggest a significant association between these two conditions. Increasing appreciation of this by clinicians will ensure earlier diagnosis, monitoring and treatment of patients presenting with this.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Guillain-Barre Syndrome , Immunoglobulins, Intravenous/administration & dosage , Pandemics , Pneumonia, Viral , Respiration, Artificial/methods , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Early Diagnosis , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/physiopathology , Guillain-Barre Syndrome/therapy , Humans , Immunologic Factors/administration & dosage , Lung/diagnostic imaging , Male , Middle Aged , Neurologic Examination/methods , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Tomography, X-Ray Computed/methods , Treatment Outcome
10.
Lancet ; 395(10231): 1225-1228, 2020 04 11.
Article in English | MEDLINE | ID: covidwho-830460

ABSTRACT

The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already taken on pandemic proportions, affecting over 100 countries in a matter of weeks. A global response to prepare health systems worldwide is imperative. Although containment measures in China have reduced new cases by more than 90%, this reduction is not the case elsewhere, and Italy has been particularly affected. There is now grave concern regarding the Italian national health system's capacity to effectively respond to the needs of patients who are infected and require intensive care for SARS-CoV-2 pneumonia. The percentage of patients in intensive care reported daily in Italy between March 1 and March 11, 2020, has consistently been between 9% and 11% of patients who are actively infected. The number of patients infected since Feb 21 in Italy closely follows an exponential trend. If this trend continues for 1 more week, there will be 30 000 infected patients. Intensive care units will then be at maximum capacity; up to 4000 hospital beds will be needed by mid-April, 2020. Our analysis might help political leaders and health authorities to allocate enough resources, including personnel, beds, and intensive care facilities, to manage the situation in the next few days and weeks. If the Italian outbreak follows a similar trend as in Hubei province, China, the number of newly infected patients could start to decrease within 3-4 days, departing from the exponential trend. However, this cannot currently be predicted because of differences between social distancing measures and the capacity to quickly build dedicated facilities in China.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adult , Aged , Aged, 80 and over , Coronavirus Infections/therapy , Female , Global Health , Health Policy/trends , Hospital Bed Capacity/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Intensive Care Units/supply & distribution , Italy/epidemiology , Male , Middle Aged , Models, Biological , Pandemics , Pneumonia, Viral/therapy , Respiration, Artificial/statistics & numerical data
11.
Rev Med Suisse ; 16(N° 691-2): 863-868, 2020 Apr 29.
Article in French | MEDLINE | ID: covidwho-827285

ABSTRACT

The SARS-coronavirus 2 disease initially reported in December 2019 in China (COVID-19) represents a major challenge for intensive care medicine, due to the high number of ICU admission and the prolonged stay for many patients. Up to 5 % of COVID-19 infected patients develop severe acute hypoxemic respiratory failure requiring invasive mechanical ventilation as supportive treatment. Apart from early antiviral and anti-inflammatory treatment, the management of COVID-19 patients is mainly applying protective mechanical ventilation, to support the injured lungs. However recently acquired data and clinical experience suggest that COVID-19-related ARDS presents some specificities that will be summarized in the present article.


Subject(s)
Betacoronavirus , Coronavirus Infections , Critical Care , Pandemics , Pneumonia, Viral , China , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Humans , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Respiration, Artificial
12.
J Med Case Rep ; 14(1): 186, 2020 Oct 06.
Article in English | MEDLINE | ID: covidwho-818136

ABSTRACT

INTRODUCTION: A novel coronavirus named severe acute respiratory syndrome coronavirus 2, was first reported in Wuhan, China, in December 2019. The virus, known as COVID-19, is recognized as a potentially life-threatening disease by causing severe respiratory disease. Since this virus has not previously been detected in humans, there is a paucity of information regarding its effects on humans. In addition, only limited or no information exists about its impact during pregnancy. CASE PRESENTATION: In the present case study, we report the death of a neonate born to a 32-year-old mother with coronavirus disease 2019 in Ilam, Iran, with Kurdish ethnicity. We report the infection and death of a neonate in Iran with a chest X-ray (CXR) marked abnormality 2 hours after birth demonstrating coronavirus disease 2019 disease. The neonate was born by elective cesarean section, the fetal health was assessed using fetal heart rate and a non-stress test before the birth, and there was no evidence of fetal distress. All the above-mentioned facts and radiographic abnormalities suggested that coronavirus disease 2019 is involved. CONCLUSIONS: In this case study, we report the death of a neonate born to a mother with coronavirus disease 2019, 11 hours after birth. There is a paucity of data on the vertical transmission and the adverse maternal-fetal consequences of this disease, so vertical transmission from mother to child remains to be confirmed.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Critical Care/methods , Infant, Newborn, Diseases , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Adult , Cesarean Section/methods , Clinical Deterioration , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Fatal Outcome , Female , Humans , Infant, Newborn , Infant, Newborn, Diseases/diagnosis , Infant, Newborn, Diseases/physiopathology , Infant, Newborn, Diseases/therapy , Infectious Disease Transmission, Vertical , Iran , Neonatal Screening/methods , Perinatal Death , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/therapy , Respiration, Artificial/methods
15.
BMJ Open ; 10(9): e040175, 2020 09 29.
Article in English | MEDLINE | ID: covidwho-809016

ABSTRACT

INTRODUCTION: The course of the disease in SARS-CoV-2 infection in mechanically ventilated patients is unknown. To unravel the clinical heterogeneity of the SARS-CoV-2 infection in these patients, we designed the prospective observational Maastricht Intensive Care COVID cohort (MaastrICCht). We incorporated serial measurements that harbour aetiological, diagnostic and predictive information. The study aims to investigate the heterogeneity of the natural course of critically ill patients with a SARS-CoV-2 infection. METHODS AND ANALYSIS: Mechanically ventilated patients admitted to the intensive care with a SARS-CoV-2 infection will be included. We will collect clinical variables, vital parameters, laboratory variables, mechanical ventilator settings, chest electrical impedance tomography, ECGs, echocardiography as well as other imaging modalities to assess heterogeneity of the course of a SARS-CoV-2 infection in critically ill patients. The MaastrICCht is also designed to foster various other studies and registries and intends to create an open-source database for investigators. Therefore, a major part of the data collection is aligned with an existing national intensive care data registry and two international COVID-19 data collection initiatives. Additionally, we create a flexible design, so that additional measures can be added during the ongoing study based on new knowledge obtained from the rapidly growing body of evidence. The spread of the COVID-19 pandemic requires the swift implementation of observational research to unravel heterogeneity of the natural course of the disease of SARS-CoV-2 infection in mechanically ventilated patients. Our study design is expected to enhance aetiological, diagnostic and prognostic understanding of the disease. This paper describes the design of the MaastrICCht. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the medical ethics committee (Medisch Ethische Toetsingscommissie 2020-1565/3 00 523) of the Maastricht University Medical Centre+ (Maastricht UMC+), which will be performed based on the Declaration of Helsinki. During the pandemic, the board of directors of Maastricht UMC+ adopted a policy to inform patients and ask their consent to use the collected data and to store serum samples for COVID-19 research purposes. All study documentation will be stored securely for fifteen years after recruitment of the last patient. The results will be published in peer-reviewed academic journals, with a preference for open access journals, while particularly considering deposition of the manuscripts on a preprint server early. TRIAL REGISTRATION NUMBER: The Netherlands Trial Register (NL8613).


Subject(s)
Coronavirus Infections , Critical Care/methods , Critical Illness , Multimodal Imaging/methods , Pandemics , Pneumonia, Viral , Respiration, Artificial , Betacoronavirus/isolation & purification , Cohort Studies , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Critical Illness/epidemiology , Critical Illness/therapy , Female , Humans , Male , Middle Aged , Netherlands/epidemiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Prognosis , Registries/statistics & numerical data , Respiration, Artificial/methods , Respiration, Artificial/statistics & numerical data , Severity of Illness Index
16.
PLoS One ; 15(9): e0240014, 2020.
Article in English | MEDLINE | ID: covidwho-808956

ABSTRACT

Data regarding safety of bedside surgical tracheostomy in novel coronavirus 2019 (COVID-19) mechanically ventilated patients admitted to the intensive care unit (ICU) are lacking. We performed this study to assess the safety of bedside surgical tracheostomy in COVID-19 patients admitted to ICU. This retrospective, single-center, cohort observational study (conducted between February, 23 and April, 30, 2020) was performed in our 45-bed dedicated COVID-19 ICU. Inclusion criteria were: a) age over 18 years; b) confirmed diagnosis of COVID-19 infection (with nasopharyngeal/oropharyngeal swab); c) invasive mechanical ventilation and d) clinical indication for tracheostomy. The objectives of this study were to describe: 1) perioperative complications, 2) perioperative alterations in respiratory gas exchange and 3) occurrence of COVID-19 infection among health-care providers involved into the procedure. A total of 125 COVID-19 patients were admitted to the ICU during the study period. Of those, 66 (53%) underwent tracheostomy. Tracheostomy was performed after a mean of 6.1 (± 2.1) days since ICU admission. Most of tracheostomies (47/66, 71%) were performed by intensivists and the mean time of the procedure was 22 (± 4.4) minutes. No intraprocedural complications was reported. Stoma infection and bleeding were reported in 2 patients and 7 patients, respectively, in the post-procedure period, without significant clinical consequences. The mean PaO2 / FiO2 was significantly lower at the end of tracheostomy (117.6 ± 35.4) then at the beginning (133.4 ± 39.2) or 24 hours before (135.8 ± 51.3) the procedure. However, PaO2/FiO2 progressively increased at 24 hours after tracheostomy (142 ± 50.7). None of the members involved in the tracheotomy procedures developed COVID-19 infection. Bedside surgical tracheostomy appears to be feasible and safe, both for patients and for health care workers, during COVID-19 pandemic in an experienced center.


Subject(s)
Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Safety , Tracheostomy , Aged , Betacoronavirus , Coronavirus Infections/transmission , Female , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intensive Care Units , Male , Middle Aged , Pneumonia, Viral/transmission , Respiration, Artificial , Retrospective Studies
18.
Am J Case Rep ; 21: e926101, 2020 Sep 28.
Article in English | MEDLINE | ID: covidwho-802888

ABSTRACT

BACKGROUND The novel coronavirus disease (COVID-19) has been declared a pandemic. With the ever-increasing number of COVID-19 patients, it is imperative to explore the factors related to the disease to aid patient management until a definitive vaccine is ready, as the disease is not limited to the respiratory system alone. COVID-19 has been associated with various cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. The infection is severe in patients with pre-existing cardiovascular disease, and a systemic inflammatory response due to a cytokine storm in severe COVID-19 cases can lead to acute myocardial infarction. CASE REPORT We present the case of a 56-year-old man with cardiovascular risk factors including coronary artery disease, hypertension, ischemic cardiomyopathy, and hyperlipidemia, who had COVID-19-induced pneumonia complicated with acute respiratory distress syndrome. He subsequently developed myocardial infarction during his hospitalization at our facility. He had a significant contact history for COVID-19. He was managed with emergent cardiac revascularization after COVID-19 was confirmed by real-time reverse transcription-polymerase chain reaction testing from a nasopharyngeal swab as per hospital policy for admitted patients. Apart from dual antiplatelet therapy, tocilizumab therapy was initiated due to the high interleukin-6 levels. His hospitalization was complicated by hemodialysis and failed extubation and intubation, resulting in a tracheostomy. Upon improvement, he was discharged to a long-term facility with a plan for outpatient follow-up. CONCLUSIONS In high-risk patients with COVID-19-induced pneumonia and cardiovascular risk factors, a severe systemic inflammatory response can lead to atherosclerotic plaque rupture, which can manifest as acute coronary syndrome.


Subject(s)
Coronavirus Infections/complications , Inferior Wall Myocardial Infarction/complications , Inferior Wall Myocardial Infarction/therapy , Percutaneous Coronary Intervention/methods , Pneumonia, Viral/complications , Severe Acute Respiratory Syndrome/complications , Clinical Laboratory Techniques/methods , Coronary Angiography/methods , Coronavirus Infections/diagnosis , Critical Illness , Follow-Up Studies , Humans , Inferior Wall Myocardial Infarction/diagnostic imaging , Long-Term Care/methods , Male , Middle Aged , Multimorbidity , Pandemics , Pneumonia, Viral/diagnosis , Respiration, Artificial/methods , Risk Assessment , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/therapy , Time Factors , Tracheostomy/methods , Treatment Outcome
19.
Med Sci Monit ; 26: e926974, 2020 Sep 26.
Article in English | MEDLINE | ID: covidwho-801911

ABSTRACT

BACKGROUND Data on the outcomes of patients with coronavirus disease 2019 (COVID-19) requiring Intensive Care Unit (ICU) care in Poland are limited. There are no data on critically ill patients with COVID-19 who did not meet criteria for ICU admission. MATERIAL AND METHODS We analyzed patients admitted to the ICU and those ineligible for ICU admission in a large COVID-19-dedicated hospital, during the first 3 months of the pandemic in Poland. Data from 67 patients considered for ICU admissions due to COVID-19 infection, treated between 10 March and 10 June 2020, were reviewed. Following exclusions, data on 32 patients admitted to the ICU and 21 patients ineligible for ICU admission were analyzed. RESULTS In 38% of analyzed patients, symptoms of COVID-19 infection occurred during a hospital stay for an unrelated medical issue. The mean age of ICU patients was 62.4 (10.4) years, and the majority of patients were male (69%), with at least one comorbidity (88%). The mean admission APACHE II and SAPS II scores were 20.1 (8.1) points and 51.2 (15.3) points, respectively. The Charlson Comorbidity Index and Clinical Frailty Scale were lower in ICU patients compared with those disqualified: 5.9 (4.3) vs. 9.1 (3.5) points, P=0.01, and 4.7 (1.7) vs. 6.9 (1.2) points, P<0.01, respectively. All ICU patients required intubation and mechanical ventilation. ICU mortality was 67%. Hospital mortality among patients admitted to the ICU and those who were disqualified was 70% and 79%, respectively. CONCLUSIONS Patients with COVID-19 requiring ICU admission in our studied population were frail and had significant comorbidities. The outcomes in this group were poor and did not seem to be influenced by ICU admission.


Subject(s)
Coronavirus Infections/epidemiology , Intensive Care Units/statistics & numerical data , Pandemics , Patient Admission/statistics & numerical data , Pneumonia, Viral/epidemiology , Aged , Betacoronavirus , Comorbidity , Coronavirus Infections/therapy , Cross-Sectional Studies , Female , Health Status Indicators , Hospital Mortality , Hospitals, State/statistics & numerical data , Humans , Intubation, Intratracheal , Male , Middle Aged , Pneumonia, Viral/therapy , Poland/epidemiology , Respiration, Artificial , Retrospective Studies , Survivors , Treatment Outcome
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