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1.
Dtsch Arztebl Int ; 117(31-32): 528-533, 2020 08 03.
Article in English | MEDLINE | ID: covidwho-750754

ABSTRACT

BACKGROUND: The reported high mortality of COVID-19 patients in intensive care has given rise to a debate over whether patients with this disease are being intubated too soon and might instead benefit from more non-invasive ventilation. METHODS: This review is based on articles published up to 12 June 2020 that were retrieved by a selective literature search on the topic of invasive and non-invasive ventilation for respiratory failure in COVID-19. Guideline recommendations and study data on patients with respiratory failure in settings other than COVID-19 are also considered, as are the current figures of the intensive care registry of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin). RESULTS: The high mortality figures among patients receiving invasive ventilation that have been reported in studies from abroad cannot be uncritically applied to the current situation in Germany. Study data on ventilation specifically in COVID-19 patients would be needed to do justice to the special pathophysiology of this disease, but such data are lacking. Being intubated too early is evidently associated with risks for the patient, but being intubated too late is as well. A particularly im - portant consideration is the potential harm associated with prolonged spontaneous breathing, with or without non-invasive assistance, as any increase in respiratory work can seriously worsen respiratory failure. On the other hand, it is clearly unacceptable to intubate patients too early merely out of concern that the medical staff might become infected with COVID-19 if they were ventilated non-invasively. CONCLUSION: Nasal high flow, non-invasive ventilation, and invasive ventilation with intubation should be carried out in a stepwise treatment strategy, under appropriate intensive-care monitoring and with the observance of all relevant anti-infectious precautions. Germany is better prepared that other countries to provide COVID-19 patients with appropriate respiratory care, in view of the high per capita density of intensive-care beds and the availability of a nationwide, interdisciplinary intensive care registry for the guidance and coordination of intensive care in patients who need it.


Subject(s)
Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Coronavirus Infections/epidemiology , Germany/epidemiology , Humans , Noninvasive Ventilation , Pandemics , Pneumonia, Viral/epidemiology
3.
In Vivo ; 34(5): 3029-3032, 2020.
Article in English | MEDLINE | ID: covidwho-740633

ABSTRACT

BACKGROUND/AIM: Reports indicate that coronaviridae may inhibit insulin secretion. In this report we aimed to describe the course of glycemia in critically ill patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. PATIENTS AND METHODS: We studied 36 SARS-CoV-2 patients (with no history of diabetes) in one intensive care unit (ICU). All the patients were admitted for hypoxemic respiratory failure; all but four required mechanical ventilation. The mean (±SD) age of the patients was 64.7 (9.7) years; 27 were men; the mean (±SD) duration of ICU stay was 12.9 (8.3 days). RESULTS: Twenty of 36 patients presented with hyperglycemia; brief intravenous infusions of short-acting insulin were administered in six patients. As of May 29 2020, 11 patients had died (seven with hyperglycemia). In 17 patients the Hyperglycemia Index [HGI; defined as the area under the curve of (hyper)glycemia level*time (h) divided by the total time in the ICU] was <16.21 mg/dl (0.90 mmol/l), whereas in three patients the HGI was ≥16.21 mg/dl (0.90 mol/l) and <32.25 mg/dl (1.79 mmol/l). CONCLUSION: In our series of ICU patients with SARS-CoV-2 infection, and no history of diabetes, a substantial number of patients had hyperglycemia, to a higher degree than would be expected by the stress of critical illness, lending credence to reports that speculated a tentative association between SARS-CoV-2 and hyperglycemia. This finding is important, since hyperglycemia can lead to further infectious complications.


Subject(s)
Coronavirus Infections/therapy , Diabetes Mellitus/therapy , Hyperglycemia/therapy , Insulin/metabolism , Pneumonia, Viral/therapy , Betacoronavirus/pathogenicity , Blood Glucose/metabolism , Coronavirus Infections/complications , Coronavirus Infections/virology , Diabetes Mellitus/genetics , Diabetes Mellitus/virology , Female , Hospitalization , Humans , Hyperglycemia/complications , Hyperglycemia/virology , Intensive Care Units , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/virology , Respiration, Artificial , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , Severe Acute Respiratory Syndrome/complications , Severe Acute Respiratory Syndrome/therapy , Severe Acute Respiratory Syndrome/virology
4.
BMJ Open Respir Res ; 7(1)2020 08.
Article in English | MEDLINE | ID: covidwho-733150

ABSTRACT

Invasive mechanical has been associated with high mortality in COVID-19. Alternative therapy of high flow nasal therapy (HFNT) has been greatly debated around the world for use in COVID-19 pandemic due to concern for increased healthcare worker transmission.This was a retrospective analysis of consecutive patients admitted to Temple University Hospital in Philadelphia, Pennsylvania, from 10 March 2020 to 24 April 2020 with moderate-to-severe respiratory failure treated with HFNT. Primary outcome was prevention of intubation. Of the 445 patients with COVID-19, 104 met our inclusion criteria. The average age was 60.66 (+13.50) years, 49 (47.12 %) were female, 53 (50.96%) were African-American, 23 (22.12%) Hispanic. Forty-three patients (43.43%) were smokers. Saturation to fraction ratio and chest X-ray scores had a statistically significant improvement from day 1 to day 7. 67 of 104 (64.42%) were able to avoid invasive mechanical ventilation in our cohort. Incidence of hospital-associated/ventilator-associated pneumonia was 2.9%. Overall, mortality was 14.44% (n=15) in our cohort with 13 (34.4%) in the progressed to intubation group and 2 (2.9%) in the non-intubation group. Mortality and incidence of pneumonia was statistically higher in the progressed to intubation group. CONCLUSION: HFNT use is associated with a reduction in the rate of invasive mechanical ventilation and overall mortality in patients with COVID-19 infection.


Subject(s)
Coronavirus Infections/therapy , Healthcare-Associated Pneumonia/epidemiology , Hypoxia/therapy , Intubation, Intratracheal/statistics & numerical data , Oxygen Inhalation Therapy/methods , Pneumonia, Viral/therapy , Respiratory Insufficiency/therapy , Adrenal Cortex Hormones/therapeutic use , African Americans , Aged , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Antirheumatic Agents/therapeutic use , Azithromycin/therapeutic use , Betacoronavirus , Cannula , Comorbidity , Coronavirus Infections/epidemiology , Diabetes Mellitus/epidemiology , European Continental Ancestry Group , Female , Heart Diseases/epidemiology , Hispanic Americans , Humans , Hydroxychloroquine/therapeutic use , Hypertension/epidemiology , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Lung Diseases/epidemiology , Male , Middle Aged , Pandemics , Philadelphia/epidemiology , Pneumonia, Ventilator-Associated/epidemiology , Pneumonia, Viral/epidemiology , Pulse Therapy, Drug , Renal Insufficiency, Chronic/epidemiology , Retrospective Studies , Severity of Illness Index , Smoking/epidemiology
5.
Crit Care Nurs Q ; 43(4): 369-380, 2020.
Article in English | MEDLINE | ID: covidwho-729217

ABSTRACT

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection can vary from asymptomatic to severe symptoms. It can lead to respiratory failure and acute respiratory distress syndrome requiring intubation and mechanical ventilation. Triaging patients is key to prevent spread, conserving medical resources, and providing appropriate care. The treatment of these patients remains supportive. Respiratory failure due to the virus should be managed by providing supplemental oxygen and early intubation. Some patients develop acute respiratory distress syndrome and refractory hypoxemia. In this article, we review the 2 phenotypes of respiratory failure, mechanical ventilation and the management of refractory hypoxemia.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Respiratory Insufficiency/therapy , Respiratory Insufficiency/virology , Coronavirus Infections/prevention & control , Humans , Intubation , Pandemics/prevention & control , Phenotype , Pneumonia, Viral/prevention & control , Randomized Controlled Trials as Topic , Respiration, Artificial , Triage
6.
Tidsskr Nor Laegeforen ; 140(11)2020 08 18.
Article in English, Norwegian | MEDLINE | ID: covidwho-724572

ABSTRACT

BACKGROUND: COVID-19 pneumonia can result in severe hypoxaemic respiratory failure that requires intensive medical care. We wished to describe COVID-19 intensive care patients who were treated with and without invasive ventilatory support. MATERIAL AND METHOD: The material was retrieved from the local quality register and comprises data on patients with COVID-19 admitted to the intensive care department at Oslo University Hospital Ullevål from 5 March-28 May 2020. The patients were categorised in three groups on the basis of the treatment they received for respiratory failure (oxygen alone, supplemental non-invasive ventilation (NIV), and intubation/ventilator) and described using descriptive statistics. RESULTS: Of 165 hospitalised COVID-19 patients, a total of 26 (16 %) were treated in our intensive care department. Four of them had do-not-resuscitate-orders and were excluded. The 22 patients included in this study had an average age of 56 years (range 25 to 78 years); 17 (77 %) were men. Eleven patients received ventilator treatment, seven oxygen by mask, and four supplemental NIV. In the ventilator group, as of 28 May 2020 two had died, and the remainder had been discharged alive from the intensive care department, with one remaining hospitalised on a ward. All patients treated with oxygen and NIV were alive and had been discharged from hospital. INTERPRETATION: For many patients with COVID-19 respiratory failure and need for intensive care, increased oxygen and NIV are sufficient, but the need for intubation must be continuously assessed. More than 90 % of actively treated intensive care patients survived.


Subject(s)
Coronavirus Infections/therapy , Noninvasive Ventilation , Pneumonia, Viral/therapy , Respiration, Artificial , Respiratory Insufficiency/therapy , Adult , Aged , Betacoronavirus , Critical Care , Female , Humans , Intensive Care Units , Male , Middle Aged , Norway , Oxygen/therapeutic use , Pandemics , Respiratory Insufficiency/virology
7.
Am J Case Rep ; 21: e925849, 2020 Aug 17.
Article in English | MEDLINE | ID: covidwho-721633

ABSTRACT

BACKGROUND Pneumonia caused by coronavirus originated in Wuhan, China in late 2019 and has spread around the world, becoming a pandemic. Many patients deteriorate rapidly and require intubation and mechanical ventilation, which is causing the collapse of healthcare systems in many countries. Coronavirus infection is associated with extensive lung inflammation and microvascular thrombosis, which can result in hypoxia. It can also cause severe and lasting harm in other organs, including the heart and kidneys. At present, there is no proven and efficacious treatment for this new disease. Consequently, there is a growing tendency to use novel methods. Ozone therapy consists of administration of a mixture of oxygen and ozone (a molecule consisting of 3 oxygen atoms). The potential benefits of this therapy include reduced tissue hypoxia, decreased hypercoagulability, renal and heart protection, modulated immune function, improved phagocytic function, and impaired viral replication. CASE REPORT We report rapidly improved hypoxia with associated decreases in inflammatory markers and D-dimer immediately after 1-4 sessions of oxygen-ozone (O2-O3) therapy in 3 patients with COVID-19 pneumonia who presented with respiratory failure. Invasive mechanical ventilation was not required in these 3 patients. All patients were discharged home on days 3-4 after O2-O3 therapy. CONCLUSIONS O2-O3 therapy appears to be an effective therapy for COVID-19 patients with severe respiratory failure. Large controlled clinical trials are required to study the efficacy and safety of using O2-O3 therapy compared with the standard supportive case in patients with COVID-19 in terms of the need for invasive ventilation and length of hospital and intensive care unit stays.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Oxygen/therapeutic use , Ozone/therapeutic use , Pneumonia, Viral/therapy , Blood Transfusion, Autologous , C-Reactive Protein/analysis , Coronavirus Infections/diagnosis , Female , Ferritins/blood , Fibrin Fibrinogen Degradation Products/analysis , Humans , Hypoxia/therapy , Hypoxia/virology , Infusions, Intravenous , L-Lactate Dehydrogenase/blood , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Radiography , Respiratory Insufficiency/therapy , Respiratory Insufficiency/virology
8.
Paediatr Respir Rev ; 35: 3-8, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-716917

ABSTRACT

COVID-19 is a coronavirus responsible for a global pandemic that started in China in December 2019 and has quickly spread to almost all countries. Approximately 2% of cases are diagnosed in children. There is increasing evidence for transmission by asymptomatic or presymptomatic adults and children. The clinical features do not differ from those of other respiratory viral infections, although rare cases manifest an unusual rash involving the digits. Disease is generally mild in children but deaths have been reported. Risk groups for severe disease in children are yet to be delineated. All treatments remain experimental.


Subject(s)
Coronavirus Infections/physiopathology , Cytokine Release Syndrome/physiopathology , Pneumonia, Viral/physiopathology , Respiratory Insufficiency/physiopathology , Antiviral Agents/therapeutic use , Betacoronavirus , Child , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Cytokine Release Syndrome/therapy , Extracorporeal Membrane Oxygenation , Humans , Lung/diagnostic imaging , Lung/physiopathology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Respiration, Artificial , Respiratory Insufficiency/therapy , Severity of Illness Index
9.
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
10.
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
11.
Front Immunol ; 11: 1841, 2020.
Article in English | MEDLINE | ID: covidwho-704519

ABSTRACT

Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is a betacoronavirus, and is associated with cytokine storm inflammation and lung injury, leading to respiratory distress. The transmission of the virus is mediated by human contact. To control and prevent the spread of this virus, the majority of people worldwide are facing quarantine; patients are being subjected to non-specific treatments under isolation. To prevent and stop the COVID-19 pandemic, several clinical trials are in the pipeline. The current clinical trials either target the intracellular replication and spread of the virus or the cytokine storm inflammation seen in COVID-19 cases during the later stages of the disease. Since both targeting strategies are different, the window drug administration plays a crucial role in the efficacy of the treatment. Here, we review the mechanism underlying SARS-CoV-2 cell infection and potential future therapeutic approaches.


Subject(s)
Coronavirus Infections/drug therapy , Coronavirus Infections/prevention & control , Cytokine Release Syndrome/drug therapy , Pandemics/prevention & control , Pneumonia, Viral/drug therapy , Pneumonia, Viral/prevention & control , Respiratory Insufficiency/therapy , Anti-Inflammatory Agents/therapeutic use , Antibodies, Viral/therapeutic use , Anticoagulants/therapeutic use , Antiviral Agents/therapeutic use , Betacoronavirus/drug effects , Betacoronavirus/immunology , Coronavirus Infections/transmission , Humans , Pneumonia, Viral/transmission , Quarantine/methods
12.
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
13.
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
14.
J Coll Physicians Surg Pak ; 30(6): 46-47, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-691103

ABSTRACT

Hypoxemia is the most common cause for hospitalization in COVID-19 patients. Acute hypoxemic respiratory failure or acute respiratory distress syndrome (ARDS) is the most common complication in COVID-19 patients. Close monitoring of respiratory decompensation is essential. Supplemental oxygen, high flow nasal canula, non-invasive ventilation and endotracheal intubation are the most commonly suggested methods to improve oxygenation. Early intubation with pre-oxygenation, modified rapid sequence intubation and intubation using a video laryngoscope has been advised as a strategy including lung protective ventilation, prone position ventilation, adequate sedation and extracorporeal membrane oxygenation. Strict personal precautions and challenges related to airway management has been currently studied. The authors summarize here the issues of mechanical ventilation and some strategies to resolve them. Key Words: Mechanical ventilation, COVID-19, Hypoxemia.


Subject(s)
Coronavirus Infections/complications , Extracorporeal Membrane Oxygenation/methods , Hypoxia/therapy , Oxygen Inhalation Therapy/methods , Pneumonia, Viral/complications , Respiration, Artificial/adverse effects , Respiration, Artificial/statistics & numerical data , Respiratory Distress Syndrome, Adult/complications , Respiratory Distress Syndrome, Adult/therapy , Respiratory Insufficiency/therapy , Betacoronavirus , Humans , Hypoxia/complications , Pandemics , Respiratory Distress Syndrome, Adult/etiology , Respiratory Insufficiency/complications , Ventilator-Induced Lung Injury/prevention & control
15.
Am J Case Rep ; 21: e925776, 2020 Jul 30.
Article in English | MEDLINE | ID: covidwho-690469

ABSTRACT

BACKGROUND As the severe acute respiratory syndrome coronavirus 2 (SARS CoV2) spreads around the world infecting people of all ages, clinicians and researchers are working to gather data on the presentation of coronavirus disease (COVID-19). Further study is necessary to better diagnose and treat COVID-19 patients. CASE REPORT We describe the case of an 8-year-old boy admitted with status epilepticus, who also tested positive for COVID-19, while afebrile, with no initial respiratory symptoms. Benzodiazepines were given per treatment guidelines, abating the seizure activity. He subsequently developed respiratory distress and desaturation requiring temporary emergent intubation. All clinical symptoms resolved within a few hours. Results of a computed tomography (CT) scan of the brain were within normal limits. Results of a 24-h electroencephalogram (EEG) were abnormal, indicative of diffuse cerebral dysfunction. As a result of intubation and findings of bilateral infiltrates on chest x-ray, a COVID-19 test was administered and the result was positive. CONCLUSIONS For proper diagnosis and treatment, patients and clinicians should be aware that COVID-19 may not present in the typical fashion of respiratory distress and fever. The present case suggests a rare neurological presentation of COVID-19.


Subject(s)
Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Status Epilepticus/virology , Betacoronavirus , Child , Humans , Intubation, Intratracheal , Lung/diagnostic imaging , Male , Pandemics , Radiography , Respiratory Insufficiency/therapy , Respiratory Insufficiency/virology
17.
Trials ; 21(1): 687, 2020 Jul 29.
Article in English | MEDLINE | ID: covidwho-684574

ABSTRACT

OBJECTIVE: The trial objective is to determine if Continuous Positive Airway Pressure (CPAP) or High-Flow Nasal Oxygen (HFNO) is clinically effective compared to standard oxygen therapy in patients with confirmed or suspected COVID-19. TRIAL DESIGN: Adaptive (group-sequential), parallel group, pragmatic, superiority randomised controlled, open-label, multi-centre, effectiveness trial. PARTICIPANTS: The trial is being conducted across approximately 60 hospitals across England, Wales, Scotland, and Northern Ireland. Inpatients at participating hospitals are eligible to participate if they have respiratory failure with suspected or proven COVID-19, and meet all of the inclusion criteria and none of the exclusion criteria. INCLUSION CRITERIA: 1) Adults ≥ 18 years; 2) Admitted to hospital with suspected or proven COVID-19; 3) Receiving oxygen with fraction of inspired oxygen (FiO2) ≥0.4 and peripheral oxygen saturation (SpO2) ≤94%; and 4) Plan for escalation to tracheal intubation if needed. EXCLUSION CRITERIA: 1) Planned tracheal intubation and mechanical ventilation imminent within 1 hour; 2) Known or clinically apparent pregnancy; 3) Any absolute contraindication to CPAP or HFNO; 4) Decision not to intubate due to ceiling of treatment or withdrawal of treatment anticipated; and 5) Equipment for both CPAP and HFNO not available. INTERVENTION AND COMPARATOR: Intervention one: Continuous positive airway pressure delivered by any device. Set-up and therapy titration is not protocolised and is delivered in accordance with clinical discretion. Intervention two: High-flow nasal oxygen delivered by any device. Set-up and therapy titration is not protocolised and is delivered in accordance with clinical discretion. Comparator group: Standard care- oxygen delivered by face mask or nasal cannula (excluding the use of continuous positive airway pressure or high-flow nasal oxygen). Set-up and therapy titration is not protocolised and is delivered in accordance with clinical discretion. Intervention delivery continues up to the point of death, tracheal intubation, or clinical determination that there is no ongoing need (palliation or improvement). MAIN OUTCOMES: The primary outcome is a composite outcome comprising tracheal intubation or mortality within 30 days following randomisation. Secondary outcomes include tracheal intubation rate, time to tracheal intubation, duration of invasive ventilation, mortality rate, time to mortality, length of hospital stay, and length of critical care stay. RANDOMISATION: Participants are randomised in a 1:1:1 ratio to receive either continuous positive airway pressure, high-flow nasal oxygen or standard care. Due to the challenging environment of study delivery, a specific intervention may not always be available at the hospital site. The study uses two integrated randomisation systems to allow, where required, the site to randomise between all three interventions, between CPAP and standard care, and between HFNO and standard care. System integration ensures maintenance of balance between interventions. Randomisation is performed using a telephone-based interactive voice response system to maintain allocation concealment. The randomisation sequence was computer-generated using the minimisation method. Participant randomisation is stratified by site, gender (M/F), and age (<50, >=50 years). BLINDING (MASKING): The nature of the trial interventions precludes blinding of the researcher, patient and clinical team. Primary and secondary outcomes are all objective outcomes, thereby minimising the risk of detection bias. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 4002 participants (1334 to be randomized to each of the three study arms) TRIAL STATUS: Current protocol: Version 4.0, 29th May 2020. Recruitment began on April 6, 2020 and is anticipated to be complete by April 5, 2021. The trial has been awarded Urgent Public Health status by the National Institute of Health Research on 13th April 2020. TRIAL REGISTRATION: ISRCTN, ISRCTN16912075. Registered 6th April 2020, http://www.isrctn.com/ISRCTN16912075 FULL PROTOCOL: The full protocol (version 4.0, 29th May 2020) is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Subject(s)
Betacoronavirus , Continuous Positive Airway Pressure/methods , Coronavirus Infections/complications , Oxygen/therapeutic use , Pneumonia, Viral/complications , Randomized Controlled Trials as Topic , Respiratory Insufficiency/therapy , Humans , Pandemics
18.
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
19.
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
20.
Pneumologie ; 74(7): 423-428, 2020 Jul.
Article in German | MEDLINE | ID: covidwho-680639

ABSTRACT

We report the case of a 60-year old female patient with advanced severe lung injury as a consequence of COVID-19-pneumonia. The patient was initially treated with highflow oxygen via nasal cannula (HFNC) and CPAP for two days but had to be intubated and mechanically ventilated. After failure of mechanical ventilation because of persistant severe hypoxemia treatment was switched to ECMO which was applicated for 24 days. Prognostic parameters indicated a favourable trend after day 14. After discontinuation of ECMO and 11 days of intermittent assisted ventilation via tracheostoma and low dose oxygen (1 l/min), the patient could be transferred to rehabilitation. The last chest radiograph prior to transferral revealed a nearly complete resolution of bilateral pulmonary infiltrates. Our case demonstrates that severe COVID-19-associated lung injury can be reversible even after prolonged ECMO.


Subject(s)
Coronavirus Infections/complications , Coronavirus , Extracorporeal Membrane Oxygenation/methods , Pneumonia, Viral/complications , Respiratory Distress Syndrome, Adult/therapy , Respiratory Insufficiency/therapy , Betacoronavirus , Coronavirus Infections/virology , Female , Humans , Lung/physiopathology , Middle Aged , Pandemics , Pneumonia, Viral/virology , Respiratory Distress Syndrome, Adult/etiology , Treatment Outcome
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