Predictive factors of mechanical ventilation among critically ill adults with COVID-19

Introduction: Acute respiratory failure is the main indication for ICU admission in COVID-19 patients. Most of these patients will require invasive mechanical ventilation (IMV). Aim(s): Identify predictive factors for IMV in Tunisian patients with COVID19 hospitalized in intensive care unit (ICU). Method(s): Cross sectional comparative study conducted in Rabta hospital in Tunis, Tunisia from January 2021 and December 2021. Patients with laboratory confirmed COVID-19 admitted in ICU department were enrolled. Clinical, biological and radiological features of all patients were assessed. Patients requiring MV (G1) and those no (G2) were compared. Result(s): A total of 95 patients were included (61 in G1;34 in G2). There was no significant difference between the 2 groups regarding to age or gender. However, comorbidities such as dyslipidemia, stroke and hypertension were more frequent in G1. Among symptoms, anosmia and confusion were predictive for IMV. Patients with anosmia and confusion had respectively 45% and 25% higher risk for IMV. C-reactive protein (CRP) level (95% in G1 VS 89% in G2;p=0.003), D-dimer rate (86.5% in G1 VS 60% in G2;p=0.008) and severe radiological extension (>50%) (64% in G1 VS 35% in G2;p=0.08) were significantly higher in G1. Conclusion(s): Among ICU admitted patients, comorbidities, neurological symptoms, elevated rate of D-dimer and CRP and important radiological damage are the main risk factors for requiring IMV.

Covid-19 circuit management: La rabta experience

Covid-19 pandemic was associated to fear among patients, doctors and nurses, it was responsible of a work impairment in health structures organisation. All patients were at home, only Covid patients were at hospital. Our country has a quick reaction, we declared the pandemic as a social disease with free management. All hospital had the order to create their own Covid-19 circuit. We report the experience of our hospital in the crisis management with the creation of the circuit, its organisation, the management of the different financial, technical, human, sanitary, psychological and logistical aspects. The great point of this crisis was the fear, stress of caregivers for themselves and their families. The other point for members of Covid Cell was the race against time, the learning of a new job: a manager or a polyvalent chief. The presence of a Covid-19 circuit is necessary for each hospital at the epidemic time but it must be managed by infectious diseases doctors, lung specialists, intensive care givers and emergency room caregivers in collaboration. An enhancement of the structures is necessary at the level of medical wards and beds of intensive care. © 2020, Maison du Medicine. All rights reserved.