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1.
Oncology (Williston Park) ; 34(8): 317-319, 2020 08 12.
Article in English | MEDLINE | ID: covidwho-713075

ABSTRACT

A 78-year-old man had a medical history of hypertension, atrial fibrillation, chronic kidney disease, and metastatic castration-resistant prostate cancer (CRPC). He had progressed to first-line therapy for CRPC with abiraterone plus androgen-deprivation therapy (ADT) and as second-line therapy he was being treated with docetaxel, with biochemical progression in his last prostate specific antigen measurement. He was admitted to the hospital on April 2020, in the middle of the coronavirus disease 2019 (COVID-19) pandemic, because of painful bone lesions and deterioration of renal function.


Subject(s)
Anticoagulants/therapeutic use , Bone Neoplasms/drug therapy , Coronavirus Infections/therapy , Palliative Care , Pneumonia, Viral/therapy , Prostatic Neoplasms, Castration-Resistant/drug therapy , Respiratory Insufficiency/therapy , Aged , Androgen Antagonists/therapeutic use , Androstenes/therapeutic use , Antineoplastic Agents/therapeutic use , Betacoronavirus , Bone Density Conservation Agents/therapeutic use , Bone Neoplasms/complications , Bone Neoplasms/secondary , Cancer Pain/complications , Cancer Pain/therapy , Coronavirus Infections/complications , Disease Progression , Docetaxel/therapeutic use , Drug Combinations , Eligibility Determination , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Intensive Care Units/supply & distribution , Lopinavir/therapeutic use , Male , Oxygen Inhalation Therapy , Pandemics , Pneumonia, Viral/complications , Prostatic Neoplasms, Castration-Resistant/complications , Prostatic Neoplasms, Castration-Resistant/pathology , Renal Insufficiency , Respiratory Insufficiency/etiology , Reverse Transcriptase Polymerase Chain Reaction , Ritonavir/therapeutic use , Severity of Illness Index , Zoledronic Acid/therapeutic use
2.
Tuberk Toraks ; 68(2): 168-174, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-705452

ABSTRACT

In recent years, high flow nasal cannula (HFNC) is a respiratory support system that has become prominent in the treatment of respiratory failure. HFNC provides higher concentration and flow of oxygen, resulting in decreasing anatomic dead space by preventing rebreathing and ensure positive end-expiratory. However, in COVID-19, the usage of HFNC is much controversial due to concerns about the benefits and risk of aerosol-dispersion. Considering the debates about the use of HFNC, we reviewed the literature related to the usage of HFNC in COVID-19. The available reports suggest that HFNC provides high concentrations of oxygen to the patients, who can not reach with conventional devices. HFNC can reduce the requiring of intubation in patients with COVID-19, and it can decrease the length of intensive care unit stay, and complications related to mechanical ventilation. Also HFNC can in achieving apneic oxygenation in patients during airway management. Besides that, the use of high-flow oxygen cannulas can produce aerosols. So, HFNC treatment should be carried out in a negative pressure room; when it is not possible, devices should be undertaken in a single room.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Oxygen Inhalation Therapy/methods , Oxygen/administration & dosage , Pneumonia, Viral/therapy , Respiratory Insufficiency/therapy , Cannula , Coronavirus Infections/complications , Humans , Intensive Care Units/organization & administration , Noninvasive Ventilation/methods , Pandemics , Pneumonia, Viral/complications , Respiration, Artificial , Respiratory Insufficiency/etiology
3.
Arch Bronconeumol ; 56 Suppl 2: 11-18, 2020 07.
Article in English, Spanish | MEDLINE | ID: covidwho-699748

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.


Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/complications , Noninvasive Ventilation/methods , Pneumonia, Viral/complications , Respiratory Distress Syndrome, Adult/therapy , Respiratory Insufficiency/therapy , Acute Disease , Adult , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Disease Transmission, Infectious/prevention & control , Health Personnel , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Noninvasive Ventilation/standards , Occupational Diseases/diagnosis , Occupational Diseases/prevention & control , Oxygen Inhalation Therapy/methods , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Respiratory Distress Syndrome, Adult/etiology , Respiratory Insufficiency/etiology , Societies, Medical , Spain
4.
Emerg Med J ; 37(9): 565-566, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-693760

ABSTRACT

We report the experience of prone ventilation in selected patients treated with helmet non-invasive ventilation (NIV) continuous positive airway pressure (CPAP) for acute respiratory failure in COVID-19 pneumonia. Preliminary results showed an improvement in the PaO2 value and PaO2/FiO2 ratio after 1 hour of prone ventilation. No variation of the lung ultrasound pattern before and after prone ventilation has been detected. At the time of writing, we attempted proning with helmet NIV CPAP in 10 patients. In 4 out of 10 patients, the attempt failed due to lack of compliance of the patient, scarce pain control even with ongoing treatment and refusal by the patient to prone positioning.


Subject(s)
Continuous Positive Airway Pressure/methods , Coronavirus Infections , Noninvasive Ventilation/methods , Pandemics , Pneumonia, Viral , Prone Position , Respiratory Insufficiency , Aged , Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Italy/epidemiology , Male , Oxygen Consumption , Oxygen Inhalation Therapy/methods , Patient Positioning , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , Treatment Outcome
6.
Monaldi Arch Chest Dis ; 90(2)2020 Jun 23.
Article in English | MEDLINE | ID: covidwho-688266

ABSTRACT

There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 after discharge from acute care. To facilitate the knowledge of the evidence and its translation into practice, we developed suggestions based on experts' opinion. A steering committee identified areas and questions sent to experts. Other international experts participated to a RAND Delphi method in reaching consensus and proposing further suggestions. Strong agreement in suggestions was defined when the mean agreement was >7 (1 = no agreement and 9 = maximal agreement). Panelists response rate was >95%. Twenty-three questions from 4 areas: Personnel protection equipment, phenotypes, assessments, interventions, were identified and experts answered with 121 suggestions, 119 of which received high level of concordance. The evidence-based suggestions provide the clinicians with current evidence and clinical experts opinion. This framework can be used to facilitate clinical decision making within the context of the individual patient. Further studies will evaluate the clinical usefulness of these suggestions.


Subject(s)
Coronavirus Infections/rehabilitation , Physical Therapy Modalities , Pneumonia, Viral/rehabilitation , Respiratory Insufficiency/rehabilitation , Respiratory Therapy/methods , Ambulatory Care , Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Delphi Technique , Exercise Test , Humans , Intensive Care Units , Italy , Nutritional Status , Pandemics , Personal Protective Equipment , Pneumonia, Viral/complications , Pneumonia, Viral/physiopathology , Quality of Life , Respiratory Function Tests , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Stress Disorders, Post-Traumatic
8.
J Trauma Acute Care Surg ; 89(2): 265-271, 2020 08.
Article in English | MEDLINE | ID: covidwho-683261

ABSTRACT

BACKGROUND: The COVID-19 virus is highly contagious, and thus there is a potential of infecting operating staff when operating on these patients. This case series describes a method of performing open tracheostomy for COVID-19 patients while minimizing potential aerosolization of the virus using typically available equipment and supplies. METHODS: This is a case series of 18 patients who were COVID-19-positive and underwent open tracheostomy in the operating room under a negative pressure plastic hood created using readily available equipment and supplies. Patients had to be intubated for at least 14 days, be convalescing from their cytokine storm, and deemed to survive for at least 14 more days. Other indications for tracheostomy were altered mental status, severe deconditioning, respiratory failure and failed extubation attempts. RESULTS: There were 14 men and 4 women with severe SARS-CoV2 infection requiring long-term intubation since March 23 or later. The mean age was 61.7 years, body mass index was 32.6, and the pretracheostomy ventilator day was 20.4 days. The indications for tracheostomy were altered mental status, severe deconditioning and continued respiratory with hypoxia. Failed extubation attempt rate was 16.7% and hemodialysis rate was 38.9%. All patients were hemodynamically stable, without any evidence of accelerating cytokine storm. To date there was one minor bleeding due to postoperative therapeutic anticoagulation. CONCLUSION: This report describes a method of performing open tracheostomy with minimal aerosolization using readily available equipment and supplies in most hospitals. LEVEL OF EVIDENCE: Therapeutic/care management, Level V.


Subject(s)
Betacoronavirus , Coronavirus Infections , Infection Control/methods , Pandemics , Pneumonia, Viral , Respiration, Artificial , Respiratory Insufficiency/therapy , Tracheostomy , Betacoronavirus/isolation & purification , Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Coronavirus Infections/therapy , Coronavirus Infections/virology , Cytokine Release Syndrome/etiology , Cytokine Release Syndrome/therapy , Equipment Design , Female , Humans , Male , Middle Aged , Occupational Exposure/prevention & control , Operating Rooms/methods , Operating Rooms/trends , Outcome and Process Assessment, Health Care , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Respiration, Artificial/adverse effects , Respiration, Artificial/instrumentation , Respiration, Artificial/methods , Respiratory Insufficiency/etiology , Tracheostomy/adverse effects , Tracheostomy/methods
9.
Pneumologie ; 74(7): 417-422, 2020 Jul.
Article in German | MEDLINE | ID: covidwho-680640

ABSTRACT

We present the case of a 48-year old man, a triathlet, with severe COVID-19 and extensive bilateral pneumonia. On day 7 since onset of symptoms, the patient had fever, cough, rheumatic pain, dyspnea as well as severe hypoxemic respiratory failure (PaO2 49,9 mmHg, PaCO2 35,7 mmHg, Horovitz-Index 130). CT of the lung showed extensive bilateral ground glass opacities.The patient was treated according to a predefined standard, including oxygen supplementation and, after intermittent worsening, with CPAP-ventilation. The patient improved and could be discharged with normal blood gases at ambient air after 12 days of hospitalization. Six weeks after discharge the patient was fully recovered and lung function as well as CT of the lungs were normal.Our case demonstrates that invasive ventilation can successfully be avoided in patients with severe hypoxemia caused by COVID-19 with bilateral pneumonia.


Subject(s)
Betacoronavirus , Continuous Positive Airway Pressure/methods , Coronavirus Infections , Oxygen/therapeutic use , Pandemics , Pneumonia, Viral/complications , Pneumonia/complications , Respiratory Insufficiency/therapy , Humans , Intubation, Intratracheal , Male , Masks , Middle Aged , Oxygen/blood , Respiratory Insufficiency/etiology , Treatment Outcome
10.
Clin Rheumatol ; 39(9): 2811-2815, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-679749

ABSTRACT

In the midst of the COVID-19 pandemic, further understanding of its complications points towards dysregulated immune response as a major component. Systemic lupus erythematosus (SLE) is also a disease of immune dysregulation leading to multisystem compromise. We present a case of new-onset SLE concomitantly with COVID-19 and development of antiphospholipid antibodies. An 18-year-old female that presented with hemodynamic collapse and respiratory failure, progressed to cardiac arrest, and had a pericardial tamponade drained. She then progressed to severe acute respiratory distress syndrome, severe ventricular dysfunction, and worsening renal function with proteinuria and hematuria. Further studies showed bilateral pleural effusions, positive antinuclear and antidouble-stranded DNA antibodies, lupus anticoagulant, and anticardiolipin B. C3 and C4 levels were low. SARS-Cov-2 PCR was positive after 2 negative tests. She also developed multiple deep venous thrombosis, in the setting of positive antiphospholipid antibodies and lupus anticoagulant. In terms of pathophysiology, COVID-19 is believed to cause a dysregulated cytokine response which could potentially be exacerbated by the shift in Th1 to Th2 response seen in SLE. Also, it is well documented that viral infections are an environmental factor that contributes to the development of autoimmunity; however, COVID-19 is a new entity, and it is not known if it could trigger autoimmune conditions. Additionally, it is possible that SARS-CoV-2, as it happens with other viruses, might lead to the formation of antiphospholipid antibodies, potentially contributing to the increased rates of thrombosis seen in COVID-19.


Subject(s)
Antiphospholipid Syndrome/immunology , Coronavirus Infections/immunology , Lupus Erythematosus, Systemic/immunology , Pneumonia, Viral/immunology , Adolescent , Anemia/etiology , Antibodies, Anticardiolipin/immunology , Antibodies, Antinuclear/immunology , Antibodies, Monoclonal, Humanized/therapeutic use , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/diagnosis , Antiphospholipid Syndrome/therapy , Anuria/etiology , Betacoronavirus , Cardiac Tamponade/diagnostic imaging , Cardiac Tamponade/etiology , Cardiac Tamponade/therapy , Complement C3/immunology , Complement C4/immunology , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , DNA/immunology , Echocardiography , Fatal Outcome , Female , Heart Arrest/etiology , Hematuria/etiology , Humans , Lupus Coagulation Inhibitor/immunology , Lupus Erythematosus, Systemic/blood , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Pandemics , Patient Positioning , Pericardiocentesis , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Prone Position , Proteinuria/etiology , Renal Dialysis , Renal Insufficiency/etiology , Renal Insufficiency/therapy , Respiration, Artificial , Respiratory Distress Syndrome, Adult/etiology , Respiratory Distress Syndrome, Adult/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Thrombocytopenia/etiology , Venous Thrombosis/etiology , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/etiology
11.
Proc Natl Acad Sci U S A ; 117(32): 18951-18953, 2020 08 11.
Article in English | MEDLINE | ID: covidwho-662427

ABSTRACT

Around the tenth day after diagnosis, ∼20% of patients with coronavirus disease 2019 (COVID-19)-associated pneumonia evolve toward severe oxygen dependence (stage 2b) and acute respiratory distress syndrome (stage 3) associated with systemic inflammation often termed a "cytokine storm." Because interleukin-1 (IL-1) blocks the production of IL-6 and other proinflammatory cytokines, we treated COVID-19 patients early in the disease with the IL-1 receptor antagonist, anakinra. We retrospectively compared 22 patients from three different centers in France with stages 2b and 3 COVID-19-associated pneumonia presenting with acute severe respiratory failure and systemic inflammation who received either standard-of-care treatment alone (10 patients) or combined with intravenous anakinra (12 patients). Treatment started at 300 mg⋅d-1 for 5 d, then tapered with lower dosing over 3 d. Both populations were comparable for age, comorbidities, clinical stage, and elevated biomarkers of systemic inflammation. All of the patients treated with anakinra improved clinically (P < 0.01), with no deaths, significant decreases in oxygen requirements (P < 0.05), and more days without invasive mechanical ventilation (P < 0.06), compared with the control group. The effect of anakinra was rapid, as judged by significant decrease of fever and C-reactive protein at day 3. A mean total dose of 1,950 mg was infused with no adverse side effects or bacterial infection. We conclude that early blockade of the IL-1 receptor is therapeutic in acute hyperinflammatory respiratory failure in COVID-19 patients.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , Coronavirus Infections/drug therapy , Immunologic Factors/therapeutic use , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Pneumonia, Viral/drug therapy , Respiratory Insufficiency/drug therapy , Aged , Anti-Inflammatory Agents/administration & dosage , Case-Control Studies , Coronavirus Infections/complications , Female , Humans , Immunologic Factors/administration & dosage , Injections, Intravenous , Interleukin 1 Receptor Antagonist Protein/administration & dosage , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/etiology , Respiratory Insufficiency/etiology
12.
Pneumologie ; 74(7): 417-422, 2020 Jul.
Article in German | MEDLINE | ID: covidwho-647910

ABSTRACT

We present the case of a 48-year old man, a triathlet, with severe COVID-19 and extensive bilateral pneumonia. On day 7 since onset of symptoms, the patient had fever, cough, rheumatic pain, dyspnea as well as severe hypoxemic respiratory failure (PaO2 49,9 mmHg, PaCO2 35,7 mmHg, Horovitz-Index 130). CT of the lung showed extensive bilateral ground glass opacities.The patient was treated according to a predefined standard, including oxygen supplementation and, after intermittent worsening, with CPAP-ventilation. The patient improved and could be discharged with normal blood gases at ambient air after 12 days of hospitalization. Six weeks after discharge the patient was fully recovered and lung function as well as CT of the lungs were normal.Our case demonstrates that invasive ventilation can successfully be avoided in patients with severe hypoxemia caused by COVID-19 with bilateral pneumonia.


Subject(s)
Betacoronavirus , Continuous Positive Airway Pressure/methods , Coronavirus Infections , Oxygen/therapeutic use , Pandemics , Pneumonia, Viral/complications , Pneumonia/complications , Respiratory Insufficiency/therapy , Humans , Intubation, Intratracheal , Male , Masks , Middle Aged , Oxygen/blood , Respiratory Insufficiency/etiology , Treatment Outcome
13.
Medicine (Baltimore) ; 99(28): e21046, 2020 Jul 10.
Article in English | MEDLINE | ID: covidwho-646088

ABSTRACT

RATIONALE: Although there have been several studies describing clinical and radiographic features about the novel coronavirus (COVID-19) infection, there is a lack of pathologic data conducted on biopsies or autopsies. PATIENT CONCERNS: A 56-year-old and a 70-year-old men with fever, cough, and respiratory fatigue were admitted to the intensive care unit and intubated for respiratory distress. DIAGNOSIS: The nasopharyngeal swab was positive for COVID-19 and the chest Computed Tomography (CT) scan showed the presence of peripheral and bilateral ground-glass opacities. INTERVENTIONS: Both patients developed pneumothoraces after intubation and was managed with chest tube. Due to persistent air leak, thoracoscopies with blebs resection and pleurectomies were performed on 23rd and 16th days from symptoms onset. OUTCOMES: The procedures were successful with no evidence of postoperative air-leak, with respiratory improvement. Pathological specimens were analyzed with evidence of diffuse alveolar septum disruption, interstitium thickness, and infiltration of inflammatory cells with diffuse endothelial dysfunction and hemorrhagic thrombosis. LESSONS: Despite well-known pulmonary damages induced by the COVID-19, the late-phase histological changes include diffused peripheral vessels endothelial hyperplasia, in toto muscular wall thickening, and intravascular hemorrhagic thrombosis.


Subject(s)
Coronavirus Infections/pathology , Endothelium, Vascular/pathology , Lung , Pandemics , Pleura , Pneumonia, Viral/pathology , Thrombosis/pathology , Thrombosis/parasitology , Aged , Betacoronavirus/isolation & purification , Biopsy/methods , Chest Tubes/adverse effects , Clinical Laboratory Techniques/methods , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Humans , Lung/blood supply , Lung/diagnostic imaging , Lung/pathology , Lung/surgery , Male , Middle Aged , Pleura/pathology , Pleura/surgery , Pneumonia, Viral/complications , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Pneumothorax/etiology , Pneumothorax/therapy , Respiration, Artificial/methods , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Thoracoscopy/methods , Tomography, X-Ray Computed/methods , Treatment Outcome
16.
BMJ Open Respir Res ; 7(1)2020 07.
Article in English | MEDLINE | ID: covidwho-634563

ABSTRACT

The aim of this case series is to describe and evaluate our experience of continuous positive airway pressure (CPAP) to treat type 1 respiratory failure in patients with COVID-19. CPAP was delivered in negative pressure rooms in the newly repurposed infectious disease unit. We report a cohort of 24 patients with type 1 respiratory failure and COVID-19 admitted to the Royal Liverpool Hospital between 1 April and 30 April 2020. Overall, our results were positive; we were able to safely administer CPAP outside the walls of a critical care or high dependency unit environment and over half of patients (58%) avoided mechanical ventilation and a total of 19 out of 24 (79%) have survived and been discharged from our care.


Subject(s)
Continuous Positive Airway Pressure/methods , Coronavirus Infections , Pandemics , Pneumonia, Viral , Procedures and Techniques Utilization/statistics & numerical data , Respiratory Care Units , Respiratory Insufficiency , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Critical Pathways/trends , Female , Humans , Male , Medical Records/statistics & numerical data , Middle Aged , Outcome Assessment, Health Care , Oxygen Consumption , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Respiratory Care Units/methods , Respiratory Care Units/organization & administration , Respiratory Insufficiency/etiology , Respiratory Insufficiency/mortality , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , Survival Analysis , United Kingdom/epidemiology
17.
BMJ Open Respir Res ; 7(1)2020 07.
Article in English | MEDLINE | ID: covidwho-634533

ABSTRACT

Since the outbreak of COVID-19 in China in December 2019, a pandemic has rapidly developed on a scale that has overwhelmed health services in a number of countries. COVID-19 has the potential to lead to severe hypoxia; this is usually the cause of death if it occurs. In a substantial number of patients, adequate arterial oxygenation cannot be achieved with supplementary oxygen therapy alone. To date, there has been no clear guideline endorsement of ward-based non-invasive pressure support (NIPS) for severely hypoxic patients who are deemed unlikely to benefit from invasive ventilation. We established a ward-based NIPS service for COVID-19 PCR-positive patients, with severe hypoxia, and in whom escalation to critical care for invasive ventilation was not deemed appropriate. A retrospective analysis of survival in these patients was undertaken. Twenty-eight patients were included. Ward-based NIPS for severe hypoxia was associated with a 50% survival in this cohort. This compares favourably with Intensive Care National Audit and Research Centre survival data following invasive ventilation in a less frail, less comorbid and younger population. These results suggest that ward-based NIPS should be considered as a treatment option in an integrated escalation strategy in all units managing respiratory failure secondary to COVID-19.


Subject(s)
Continuous Positive Airway Pressure/methods , Coronavirus Infections , Frailty , Geriatric Assessment/methods , Pandemics , Pneumonia, Viral , Respiratory Care Units , Respiratory Insufficiency , Aged, 80 and over , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Female , Frailty/diagnosis , Frailty/physiopathology , Frailty/therapy , Humans , Lung/diagnostic imaging , Male , Outcome and Process Assessment, Health Care , Oximetry/methods , Oximetry/statistics & numerical data , Oxygen Consumption , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Respiratory Care Units/methods , Respiratory Care Units/organization & administration , Respiratory Insufficiency/etiology , Respiratory Insufficiency/mortality , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , Survival Analysis , Tomography, X-Ray Computed/methods , United Kingdom/epidemiology
18.
J Intensive Care Med ; 35(8): 818-824, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-634271

ABSTRACT

It has been well known for decades that prone positioning (PP) improves oxygenation. However, it has gained widespread acceptance only in the last few years since studies have shown significant survival benefit. Many centers have established prone ventilation in their treatment algorithm for mechanically ventilated patients with severe acute respiratory distress syndrome (ARDS). Physiologically, PP should also benefit awake, non-intubated patients with acute hypoxemic respiratory failure. However, proning in non-intubated (PINI) patients did not gain any momentum until a few months ago when the Coronavirus disease 2019 (COVID-19) pandemic surged. A large number of sick patients overwhelmed the health care system, and many centers faced a dearth of ventilators. In addition, outcomes of patients placed on mechanical ventilation because of COVID-19 infection have been highly variable and often dismal. Hence, increased focus has shifted to using various strategies to prevent intubation, such as PINI. There is accumulating evidence that PINI is a low-risk intervention that can be performed even outside intensive care unit with minimal assistance and may prevent intubation in certain patients with ARDS. It can also be performed safely at smaller centers and, therefore, may reduce the patient transfer to larger institutions that are overwhelmed in the current crisis. We present a case series of 2 patients with acute hypoxemic respiratory failure who experienced significant improvements in oxygenation with PP. In addition, the physiology of PP is described, and concerns such as proning in obese and patient's anxiety are addressed; an educational pamphlet that may be useful for both patients and health care providers is provided.


Subject(s)
Anxiety , Coronavirus Infections , Obesity , Pandemics , Patient Positioning/methods , Pneumonia, Viral , Prone Position/physiology , Respiratory Insufficiency , Adult , Anxiety/physiopathology , Anxiety/prevention & control , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/metabolism , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Humans , Hypoxia/etiology , Hypoxia/therapy , Male , Obesity/epidemiology , Obesity/physiopathology , Oxygen Consumption , Oxygen Inhalation Therapy/methods , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/epidemiology , Pneumonia, Viral/etiology , Pneumonia, Viral/metabolism , Pneumonia, Viral/physiopathology , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , Respiration, Artificial/methods , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/psychology , Respiratory Insufficiency/therapy , Treatment Outcome
19.
J Clin Apher ; 35(4): 378-381, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-633842

ABSTRACT

As the COVID-19 pandemic continues to claim lives across the globe, insufficient data exists regarding the optimal treatment. It is well known that patients 55 years of age or older and patients with certain chronic diseases are at higher risk of severe illness, including acute respiratory distress syndrome and death. A potentially fatal pulmonary complication of sickle cell disease, acute chest syndrome, can be precipitated by acute infections, including respiratory viruses. We report the case of a patient with sickle cell disease (HbSC) who developed COVID-19 pneumonia and acute chest syndrome who was treated with emergent red blood cell exchange in order to avoid endotracheal intubation.


Subject(s)
Anemia, Sickle Cell/complications , Betacoronavirus , Coronavirus Infections/complications , Erythrocyte Transfusion/methods , Intubation, Intratracheal , Pandemics , Pneumonia, Viral/complications , Respiratory Insufficiency/therapy , Acute Chest Syndrome/etiology , Acute Chest Syndrome/therapy , Adult , Analgesics/therapeutic use , Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , Combined Modality Therapy , Contraindications, Procedure , Coronavirus Infections/drug therapy , Humans , Hydroxychloroquine/therapeutic use , Male , Methylprednisolone/therapeutic use , Oxygen Inhalation Therapy , Pneumonia, Viral/drug therapy , Respiration, Artificial , Respiratory Insufficiency/etiology
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