Non-invasive mechanical ventilation in patients admitted to a provisional center for moderate COVID-19 patients

Introduction:Non-invasive mechanical ventilation is a ventilatory alternative for COVID-19 cases. Background:To describe the characteristics and evolution of non-invasive mechanical ventilation (NIMV) in patients discharged from Provisional Center for moderate COVID-19 patients in Figali, Panama. Methods:A descriptive, retrospective, longitudinal stu was carried out in all adult patients discharged from June to July 2021 and who received non-invasive mechanical ventilation. A questionnaire was used using the digital individual medical record as primary source. Descriptive statistics techniques were used. Results:35.9% of the patients (78/217) who were admitted required non-invasive mechanical ventilation on the ninth day of symptoms and the second day after admission. 62.8% (49/78) were obese and 29.5% (23/78) hypertensive. The respiratory rate 30 and the decrease in the PaO2/FiO2 ratio decided the begining of non-invasive mechanical ventilation in 56.4% (78/217) of those admitted. 62.8% (49/78) had moderate-severe acute respiratory distress syndrome, and the severity was related to ventilation failure out of the total number of ventilated patients. Ventilation was successful in 65.4% (51/78). PaO2/FiO2 <150 (62.9%), respiratory rate 30 (55.6%) and physical exhaustion (51.85%) decided ventilation failure. Conclusions:Non-invasive mechanical ventilation is an effective procedure in COVID-19 patients and moderate or severe respiratory distress;although its success is related to the less severe forms. Low PaO2/FiO2, together with symptoms, were key indicators to assess the begining, success or failure of NIMV;not so the values of PaO2, PaCO2 and SpO2.

The role of ROX index-based intubation in COVID-19 pneumonia: a cross-sectional comparison and retrospective survival analysis.

BACKGROUND: Coronavirus disease 2019 (COVID-19) patients with acute respiratory failure who experience delayed initiation of invasive mechanical ventilation have poor outcomes. The lack of objective measures to define the timing of intubation is an area of concern. We investigated the effect of timing of intubation based on respiratory rate-oxygenation (ROX) index on the outcomes of COVID-19 pneumonia. METHODS: This was a retrospective cross-sectional study performed in a tertiary care teaching hospital in Kerala, India. Patients with COVID-19 pneumonia who were intubated were grouped into early intubation (within 12 hours of ROX index <4.88) or delayed intubation (12 hours or more hours after ROX <4.88). RESULTS: A total of 58 patients was included in the study after exclusions. Among them, 20 patients were intubated early, and 38 patients were intubated 12 hours after ROX index <4.88. The mean age of the study population was 57±14 years, and 55.0% of the patients were male; diabetes mellitus (48.3%) and hypertension (50.0%) were the most common comorbidities. The early intubation group had 88.2% successful extubation, while only 11.8% of the delayed group had successful extubation (P<0.001). Survival was also significantly more frequent in the early intubation group. CONCLUSIONS: Early intubation within 12 hours of ROX index <4.88 was associated with improved extubation and survival in patients with COVID-19 pneumonia.

Non-invasive ventilation an alternative to invasive ventilation in COVID-19 patients

Objectives: To study the role of non-invasive ventilation (NIV) in the treatment of COVID-19 patients with mild to moderate acute respiratory distress syndrome (ARDS).

Clinical severity of patients with COVID-19 presenting to Nepal armed police force hospital: a descriptive cross-sectional study

Introduction: Coronavirus Disease 2019 (COVID-19), since its emergence, has spread rapidly as a pandemic causing massive loss of human life. This study aims to describe clinical severity of the disease in relation to age, mode of oxygen delivery and clinical outcome of patients admitted to a tertiary care center in Nepal. Methods: This was a descriptive cross-sectional study of data records of 130 COVID-19 patients 18 years and above admitted in Nepal Armed Police Force Hospital from April 2021 to June 2021 with Severe Acute Respiratory syndrome SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction positive status. Ethical approval was obtained from Nepal Health research Council. Data were collected using structured proforma and analyzed using SPSS version 23. Results: Patients with severe illness (52/130) constituted 40% of the bulk of COVID-19 patients, 48 of them requiring intensive care. Among them, 38.5% required non-invasive ventilation and 32.7% were intubated during treatment. Severity of illness was variable among different age groups but mortality was high among severely ill patients, 19/52 (36.5%) and with increasing age. The overall mortality was 19/130 (14%) over the study period, all of which were among severely ill patients. Conclusions: Most of the clinically severe cases required Intensive Care Unit admission, the majority receiving oxygen therapy via non-invasive or invasive mechanical ventilation, with a high mortality rate. The number of severely ill COVID-19 patients was variable in different age groups. Mortality, however, was observed in severely ill patients only and proportionately increased in COVID-19 patients with advancing age.

Role of initial and follow-up IL-6 (interleukin-6) titre in COVID-19 pneumonia: a single center experience

Background: Robust data of IL-6 is available in bacterial infection, and now it can be utilized in currently ongoing COVID-19 (corona virus disease-19) pneumonia pandemic to guide treatment strategy as marker of inflammation. Methods: Prospective, observational study included 1,000 COVID-19 cases confirmed with RT PCR (reverse transcription polymerase chain reaction). All cases were undergone categorized after clinical details, HRCT (high resolution computerized tomography) thorax, oxygen saturation, IL-6 (interleukin 6) at entry point and follow up. Age, gender, comorbidity and use BIPAP/NIV (bilevel positive airway pressure/non-invasive ventilation), and outcome as with or without lung fibrosis as per HRCT severity were key observations. Statistical analysis is done by using Chi-square test. Results: In study of 1,000 COVID-19 pneumonia cases, age (<50 and >50 years) and gender has significant association with IL-6. HRCT severity score at entry point has significant correlation with IL-6 level (p < 0.00001). IL-6 level has significant association with duration of illness (p < 0.00001). Comorbidities has significant association with IL-6 level (p < 0.00001). IL-6 level has significant association with oxygen saturation (p < 0.00001). BIPAP/NIV requirement has significant association with IL-6 level (p < 0.00001). Timing of BIPAP/NIV requirement during course of hospitalization has significant association with IL-6 level (p < 0.00001). Follow-up IL-6 titer during hospitalization as compared to entry point normal and abnormal IL-6 has significant association with post-COVID-19 lung fibrosis, respectively (p < 0.00001). Conclusion: IL-6 has very crucialrole in COVID-19 pneumonia in predicting severity of illness, progression of illness including 'cytokine storm' and assessing response to treatment during hospitalization and follow-up titers in analyzing post-COVID-19 lung fibrosis.

Incidence and predisposing factors for de novo post-COVID-19 irritable bowel syndrome

Objective: Postinfectious irritable bowel syndrome (IBS) is a known entity. We evaluated the incidence of post-COVID-19 IBS in patients discharged from the hospital and analyzed its correlation with the clinical and laboratory parameters, and treatment during the hospital stay. Methods: Three hundred three COVID-19 hospitalized patients without prior history of IBS were prospectively followed after their discharge and were evaluated as per Rome-IV criteria for IBS. Results: One hundred seventy-eight patients were males (58.7%). The age range was 17-95 years (mean +or- SD, 55.9 +or- 15.8). A total of 194 (64%) had mild COVID-19, 74 (24.4%) had moderate COVID-19, whereas 35 (11.6%) had severe COVID-19 infection. Sixteen (5.3%) patients had concomitant GI symptoms during COVID-19 infection. IBS symptoms were found to be present in 32 (10.6%) patients, out of which 17 (53.13%) had diarrhea-predominant, 10 (31.25%) had constipation-predominant, and five (15.62%) had mixed-type IBS. Post-COVID-19 IBS was more common in the female sex (P < 0.001), concomitant GI symptoms with COVID-19 (P < 0.001), oxygen requirement (P = 0.015), deranged liver function tests at the time of admission (P = 0.002), high procalcitonin (P = 0.013), high C-reactive protein levels (P = 0.035);whereas negative correlation was found with remdesivir treatment (P = 0.047). After performing regression analysis, female sex (P < 0.001), oxygen requirement during hospital stay (P = 0.016), GI symptoms during COVID-19 infection (P < 0.001), and high procalcitonin levels (P = 0.017) were independently associated with post-COVID-19 IBS. Conclusion: GI symptoms during active COVID-19 infection increase the chances of developing post-COVID-19 IBS. The risk of developing post-COVID-19 IBS increases in female patients, those requiring oxygen and having high procalcitonin levels during COVID-19 infection.

Clinical and epidemiological profile of SARS-CoV-2 in patients with severe acute respiratory illness (SARI) at a tertiary care hospital of north India

Background: Severe acute respiratory illness due to SARS-CoV-2 represents great global public health concern. The spectrum of disease ranges from mild to life-threatening. Surveillance of hospitalized patients with severe acute respiratory infections (SARI) is an important public health tool used to identify etiologies to understand the disease, track changes in circulating viruses and as an alert mechanism for potential pandemic viruses. We aim to find out the rate of SARS-CoV-2 positivity in SARI cases and further study the epidemiological and clinical characteristics of patients. Material & Methods: A Prospective study was conducted on 200 Severe Acute Respiratory Illness patients admitted at tertiary care hospital. The clinical, demographic, epidemiological, risk factors / co-morbidities of all the patients were recorded. Oropharyngeal and nasopharyngeal samples were collected and tested for SARS-CoV-2 by real time reverse transcriptase (RT-PCR) test. Results: Out of 200 SARI patients, 51 (25.5%) were tested positive for SARS-CoV-2. Maximum cases (54.90%) were in the age group of 41-60 years;males were infected predominantly (52.94%). The most common symptoms of presentation were fever (100%), cough (86.27%), dyspnoea (82.35%) and sore throat (56.86%). Comorbidities associated with COVID-19 were Hypertension (56.86%), Diabetes Mellitus (33.33%), Chronic Obstructive Pulmonary Disease (13.72%) and Coronary Artery disease (9.8%). More than 30% of the patients were admitted in ICU and 9.80% received mechanical ventilation. Conclusions: Evaluation of clinical and epidemiological profiles of SARI patients can help in understanding and managing the outbreak more efficiently. Close monitoring and quarantine will be required to prevent extensive transmission within the community.

Clinical epidemiology of hospitalized patients with tuberculosis and COVID 19 co-infection in Qaemshahr Razi Teaching Hospital, 2020-2022

Background and purpose: There are limited studies on co-infection of COVID-19 and tuberculosis (TB). This study aimed to describe the clinical, radiological, laboratory characteristics, treatment and outcome of patients admitted with tuberculosis and COVID 19 co-infection. Materials and methods: In this retrospective study, we investigated all patients with either active TB or old TB and COVID-19 admitted to Qaemshahr Razi Teaching Hospital between 2020 and 2022. Results: A total of 9251 patients with COVID-19 were admitted to our hospital between February 2020 and May 2022. There were eight patients with pulmonary tuberculosis and COVID-19 co-infection, including five (62.5%) male patients. The mean age of these patients was 61.13..22.63 years old. The mean time of symptom onset to hospital admission was 15.13..30.56 days and 50% were diagnosed with active TB and other half had old TB. Four patients were admitted to the ICU, three of whom required ventilation. Finally, four (50%) patients deceased. In this study, among factors that influence patients' outcomes, only underlying diseases were significantly associated with death. Conclusion: Tuberculosis is assumed to cause a higher mortality risk in COVID-19 patients, especially in those with chronic underlying diseases.

A current and common cause of secondary spontaneous pneumothorax: COVID- 19 pneumonia

This study evaluated cases of spontaneous pneumothorax developing secondary to SARS-CoV-2 pneumonia. Sixteen cases presenting to our hospital due to spontaneous pneumothorax developing secondary to SARS-CoV-2 pneumonia between March 2020 and February 2020 were evaluated retrospectively. Ten patients (62.5%) were men, and six (37.5%) were women, with a mean age of 68 .. 20.3 years (range 18 - 90 years). Pneumothorax was in the right hemithorax in 11 cases (68.75%), in the left hemithorax in two (12.5%), and bilateral in three (17.75%). Pneumothorax developed during active SARS-CoV-2 pneumonia in all 16 cases (100%). No pneumothorax was detected following the healing of SARS-CoV-2 infection. Pneumothorax was observed while patients were not intubated in 15 cases (93.75%), but pneumothorax developed during mechanical ventilation in one case (6.25%). Tube thoracostomy was performed on all patients in treatment. Air leakage from the tube was observed in 14 cases (87.5%). The mean duration of tube thoracostomy was 18.3 .. 20.1 days (range 1 - 81 days). Pneumothorax resolved after treatment in seven cases (43.75%), while mortality occurred in nine (56.25%). Pneumothorax recurred after treatment in one case (6.25%). Pneumothorax is widely seen in the active period or after healing in cases infected with COVID-19. Aggressive treatment is generally required for this clinical manifestation with high mortality.

Predictors of mortality in COVID-19 disease

Background: COVID-19, an acute viral respiratory illness, was first noted in 2019, soon turned into pandemic with considerable mortality. With the objective of studying effect of comorbidities on COVID-19 disease severity and to identify laboratory markers associated with severe COVID-19 disease, we did a retrospective observational study in a tertiary care centre. Aims and Objectives: The objectives of this study were as follows: 1. To study effect of comorbidity on COVID-19 disease severity and 2. to identify laboratory markers associated with severe COVID-19 infection and mortality. Materials and Methods: This is an retrospective observational study conducted at SDMCMS&H, Dharwad from July 2020 to September 2020. A total of 402 cases who fall in the age group of 18 years and above were collected from medical record department. Statistical analysis used: The data were recorded in the Microsoft Excel sheet and analysis is done using Chi-square analysis and Cox linear regression method. Results: There were 402 patients whose data were collected. Out of 402 patients, 64 patients (15.92%) were in the age group of 18-39 years, 183 patients (45.52%) seen were in the age group of 40-60 years, 155 patients (38.56%) above 60 years, and consisting 291 male patients (72.39%) and 111 female patients (27.9%). Most common comorbidities seen were diabetes mellitus in 194 patients (48.26%) and hypertension in 182 patients (45.27%), followed by chronic kidney disease in 32 patients (7.96%) and ischemic heart disease in 24 patients (5.97%). Out 402 patients, 141 patients (35.07%) were on supplemental oxygen, which included 68 patients (48.23%) on low flow oxygen by face mask, seven patients (4.96%) were on non-rebreathing mask, 3 (2.13%) patients required NIV, and 63 patients (44.68%) required intubation and mechanical ventilation. It was found that uncontrolled diabetes rather than just presence of diabetes had significant impact on mortality with P=-0.0001 (95% CI OR 1.5-4.38). Patients with increased laboratory markers of inflammation such as Ferritin (95% CI OR 1.84-6.81) and LDH (95% CI OR 1.86-31.26) had strong association with mortality. The presence of thrombocytopenia showed significant association with mortality (95% CI OR 1.03-3.63). Conclusion: The presence of preceding uncontrolled hyperglycemia has significant effect on mortality. A state of hyperinflammation is directly associated with poor outcome.

Impact of acute kidney injury in COVID 19 infected patients

Background: Corona virus disease 2019 (covid-19) is a novel disease caused by a newly identified virus, severe acute respiratory syndrome corona virus 2 (sars-cov-2). The novel disease which begun in Wuhan, China in Dec 2019 was declared pandemic by world health organization on 11 march 2020. The most common reported reasons for intensive care unit admission for patients with severe corona virus disease 2019 (covid-19) are either hypoxemic respiratory failure leading to mechanical ventilation or hypotension requiring vasopressor support. Data on AKI are either lacking in this perspective, we emphasize that AKI can be a severe complication of covid-19 and highlight the importance of assessing, defining, and reporting the course of AKI in patients admitted in intensive care unit. Methods: This is a single centre retrospective observational study. 542 patients with real time-PCR and rapid antigen test confirmed COVID 19 infection admitted in KIMS intensive care unit, Hubballi were taken for study. Patients with chronic kidney disease were excluded from the study. Clinical examination and laboratory investigations including renal function test, liver function test, complete blood count, chest x-ray, d-dimer, ferritin, LDH, CRP was done for all the patients. Duration: 1 year (2020 August -2021 July) Results: Out of 542 patients, 166 patients developed acute kidney injury accounting for 30.62%. 145 patients died (87.47) who had acute kidney injury. And 27 patients were discharged (12.6%) who recovered from acute kidney injury. Results: Among the patients who did not developed AKI(376) .300(79.81) died and 76(20.2) got discharged. The p value was 0.034 which was significant for increase in mortality among patients who developed AKI. The incidence of mortality among COVID patient admitted to KIMS ICU was 82.1%. Conclusion: The mortality was significantly higher in COVID patients developing AKI. So we can predict the outcome in COVID infected patients who develops acute kidney injury. AKI is one of manifestation in COVID patients due to tropism of corona virus to ace receptors present in kidney.

Cost of treating coronavirus disease 2019 (COVID-19) patients in hospitals and influencing factors: a systematic literature review

Background: Increasing beds for COVID-19 patients is not a simple matter for hospitals because hospitals cannot directly increase the number of existing beds due to limited facilities, infrastructure, equipment, and resources. Careful calculations are needed in terms of preparing the room and treating COVID patients, especially the estimated costs needed to treat COVID patients in the hospital. This expenditure is important so that it can be an illustration of the hospital how much expenditure is needed. This study aimed to determine the number of costs incurred for treating COVID-19 patients in hospitals and the factors that influence these costs. Methods: This study was conducted by systematic literature review using the PRISMA statement conducted May-June 2021. An article search was conducted on Pubmed, Scopus, Proquest, and Google Scholar with the inclusion criteria, namely research related to the cost of treating COVID-19 patients in hospitals and the factors that influence the amount of these costs. Results: A systematic search obtained six articles. Studies vary greatly in study design and perspective included in the cost category. Estimated costs for COVID-19 care range from $63/day to $2,990/day. Factors that affect the cost of care include age, previous medical history, degree of infection or severity of COVID-19, length of stay, place of care, and need for a ventilator. Conclusion: There is a considerable economic burden associated with the incident of COVID-19. Several factors affect the cost of COVID-19, namely the length of the treatment period and the need for intensive rooms and ventilators.

Timing of Intubation in COVID-19: When It Is Too Early and When It Is Too Late.

The timing of initiating mechanical ventilation in patients with acute respiratory distress syndrome due to COVID-19 remains controversial. At the outset of the pandemic, "very early" intubation was recommended in patients requiring oxygen flows above 6 L per minute but was followed closely thereafter by avoidance of invasive mechanical ventilation (IMV) due to a perceived (yet over-estimated) risk of mortality after intubation. While the use of noninvasive methods of oxygen delivery, such as high-flow nasal oxygen (HFNO) or noninvasive positive pressure ventilation (NIV), can avert the need for mechanical ventilation in some, accumulating evidence suggests delayed intubation is also associated with an increased mortality in a subset of COVID-19 patients. Close monitoring is necessary in COVID-19 patients on HFNO or NIV to identify signs of noninvasive failure and ensure appropriate provision of IMV.

Dysphagia in intensive care, a real problem: analysis of risk factors.

AIMS: To identify risk factors present in patients with dysphagia in a population of critically ill patients. METHODS: Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. OUTCOMES: 103 patients were recruited from 401 possible. The mean age was 59,33 ± 13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74 ± 6,17) and Charlson (2,98 ± 3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p < 0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65; 95% CI:1,31-16,47; p = 0,014) and a hospital stay (OR: 8,50; 95%CI: 2,20-32,83; p < 0,001) On discharge from the ICU, 37,9% of the population still had dysphagia; 12,6% maintained this problem at hospital discharge. CONCLUSIONS: Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.

Extracorporeal Membrane Oxygenation versus Conventional Ventilator Support in COVID-19 Patients with Acute Respiratory Distress Syndrome

Background: Acute respiratory distress syndrome (ARDS) is an undesirable outcome of severe coronavirus disease 2019 (COVID-19). Although venovenous extracorporeal membrane oxygenation (VV-ECMO) has been widely accepted as a rescue therapy for severe ARDS, its use in COVID-19-associated ARDS is still debated. Objective(s): To compare the clinical outcomes of COVID-19 patients treated with VV-ECMO or conventional ventilator support. Material(s) and Method(s): The authors conducted a retrospective study in Bangkok Heart Hospital, Thailand, between March and September 2021. Patients were divided into ECMO and non-ECMO or conventional ventilator support groups. The primary outcome was in-hospital mortality, and the secondary outcomes were complications, length of ICU stay, recovery time after extubation, and total length of hospital stay. Result(s): Of the 3,053 COVID-19 patients, 36 (1.18%) developed severe ARDS, which 12 were treated with VV-ECMO and 24 with a conventional ventilator. In-hospital mortality was non-significantly lower in the ECMO group at 58.3% versus 83.3% (p=0.126). Upper gastrointestinal bleeding was non-significantly more common in the ECMO group at 41.7% versus 25.0% (p=0.306) but there were no cases of deep vein thrombosis in the ECMO group at 0% versus 20.8% (p=0.088). There were no significant differences in any other complications. Six patients, including four in the ECMO group and two in the non-ECMO group underwent cytokine removal via HA330 hemoperfusion, but interleukin-6 did not decrease in these patients. Conclusion(s): VV-ECMO in COVID-19-associated ARDS patients did not significantly decreased mortality compared to conventional ventilator therapy. A multidisciplinary team should develop an optimal treatment plan for each COVID-19-associated ARDS patient. Copyright © 2023 JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND.

Analysis of hospitalized patients with COVID-19 from surge 3 to 5 of the COVID-19 pandemic

Objective: This study was aimed at clarifying the clinical characteristics and prognosis of patients hospitalized with COVID-19 and the treatment strategies for COVID-19 in each surge of the COVID-19 pandemic. Subjects and methods: We retrospectively examined the data of 358 patients with confirmed COVID-19 (116 in surge 3, 137 in surge 4, and 105 in surge 5) who were admitted to the Yoshijima Hospital.

Mechanical ventilation and death in pregnant patients admitted for COVID-19: a prognostic analysis from the Brazilian COVID-19 registry score.

BACKGROUND: The assessment of clinical prognosis of pregnant COVID-19 patients at hospital presentation is challenging, due to physiological adaptations during pregnancy. Our aim was to assess the performance of the ABC2-SPH score to predict in-hospital mortality and mechanical ventilation support in pregnant patients with COVID-19, to assess the frequency of adverse pregnancy outcomes, and characteristics of pregnant women who died. METHODS: This multicenter cohort included consecutive pregnant patients with COVID-19 admitted to the participating hospitals, from April/2020 to March/2022. Primary outcomes were in-hospital mortality and the composite outcome of mechanical ventilation support and in-hospital mortality. Secondary endpoints were pregnancy outcomes. The overall discrimination of the model was presented as the area under the receiver operating characteristic curve (AUROC). Overall performance was assessed using the Brier score. RESULTS: From 350 pregnant patients (median age 30 [interquartile range (25.2, 35.0)] years-old]), 11.1% had hypertensive disorders, 19.7% required mechanical ventilation support and 6.0% died. The AUROC for in-hospital mortality and for the composite outcome were 0.809 (95% IC: 0.641-0.944) and 0.704 (95% IC: 0.617-0.792), respectively, with good overall performance (Brier = 0.0384 and 0.1610, respectively). Calibration was good for the prediction of in-hospital mortality, but poor for the composite outcome. Women who died had a median age 4 years-old higher, higher frequency of hypertensive disorders (38.1% vs. 9.4%, p < 0.001) and obesity (28.6% vs. 10.6%, p = 0.025) than those who were discharged alive, and their newborns had lower birth weight (2000 vs. 2813, p = 0.001) and five-minute Apgar score (3.0 vs. 8.0, p < 0.001). CONCLUSIONS: The ABC2-SPH score had good overall performance for in-hospital mortality and the composite outcome mechanical ventilation and in-hospital mortality. Calibration was good for the prediction of in-hospital mortality, but it was poor for the composite outcome. Therefore, the score may be useful to predict in-hospital mortality in pregnant patients with COVID-19, in addition to clinical judgment. Newborns from women who died had lower birth weight and Apgar score than those who were discharged alive.

Dysphagia in intensive care, a real problem: analysis of risk factors

Aims: To identify risk factors present in patients with dysphagia in a population of critically ill patients. Methods: Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. Outcomes: 103 patients were recruited from 401 possible. The mean age was 59,33±13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74±6,17) and Charlson (2,98±3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p<0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65;95% CI:1,31-16,47;p=0,014) and a hospital stay (OR: 8,50;95%CI: 2,20-32,83;p<0,001). On discharge from the ICU, 37,9% of the population still had dysphagia;12,6% maintained this problem at hospital discharge. Conclusions: Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization. © 2022 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC)

COVID pneumonia in patients admitted to the Department of Pneumology, Second Faculty of Medicine, Charles University and University Hospital in Motol during the first and fourth pandemic waves

In the last two years, COVID pneumonia has frequently been dealt with by both outpatient and inpatient pulmonology centers. To describe the actual situation, we conducted a retrospective study including 200 patients admitted to the Department of Pneumology, Second Faculty of Medicine. Charles University and University Hospital in Motol during the first (autumn 2020) and fourth (autumn 2021) waves of the COVID-19 pandemic. Of those, 25% of patients died, significantly more in the first wave (33%) than in the fourth wave (17%). The mean age of the deceased was 76 years. as compared with 67 years in the entire sample. The risk factor for admissions was. besides older age, a higher number of comorbidities, with 38% of patients being obese. A negative prognostic factor was high C-reactive protein. There were fewer deaths among patients treated with remdesivir (18% vs. 30%) and those with a body mass index over 31 (17% vs. 30%). Two thirds of patients died of COVID-19;one third died with the disease. Vaccination was beneficial for patients in the fourth wave. with significantly fewer of them dying. staying in intensive care units and requiring mechanical ventilation or extracorporeal membrane oxygenation. COVID pneumonia is a severe, life-threatening disease whose course was positively influenced by vaccination. treatment and herd immunity through previous infection.

La disfagia en cuidados intensivos, un problema real: análisis de factores de riesgo

Resumen Objetivos Determinar los factores de riesgo presentes en los pacientes con disfagia en relación con una población de pacientes críticos. Método Serie de casos de una cohorte de pacientes reclutados en la unidad de cuidados intensivos (UCI) hasta el alta hospitalaria. Se reclutaron a aquellos pacientes que dieron su consentimiento y cumplían los criterios de inclusión. El método de exploración clínica Volumen-Viscosidad fue utilizado para la detección de la disfagia. Se realizó un análisis estadístico uni- y bivariante, a través del odds ratio (OR) para detectar los factores de riesgo en la disfagia. Resultados 103 pacientes fueron reclutados de 401 posibles. La media de edad fue de 59,33±13,23;los hombres representaban el 76,7%. La gravedad media fue: APACHE II (12,74±6,17) y Charlson (2,98±3,31). Un 45,6% de los pacientes desarrollaron disfagia, obteniendo valores significativos de OR (p<0,050) para el desarrollo de disfagia: la mayor edad, los antecedentes neurológicos, COVID19, la alta estancia en UCI y hospitalización y la presencia de traqueotomía. Los pacientes COVID19 representaban el 46,6%, por lo que se realizó un análisis de este subgrupo observando resultados similares, con un riesgo de Charlson (OR:4,65;IC95%: 1,31-16,47;p=0,014) y una estancia hospitalaria (OR: 8,50;IC95%: 2,20-32,83;p<0,001). Al alta de UCI, el 37,9% de la población presentaba todavía disfagia, y mantenía este problema al alta hospitalaria el 12,6%. Conclusiones Casi la mitad de nuestros pacientes presentaron disfagia. Fueron factores de riesgo la gravedad clínica y la presencia de traqueotomía. Se observó en estos pacientes una mayor estancia tanto en UCI como en hospitalización. Aims To identify risk factors present in patients with dysphagia in a population of critically ill patients. Methods Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. Outcomes 103 patients were recruited from 401 possible. The mean age was 59,33±13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74±6,17) and Charlson (2,98±3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p<0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65;95% CI:1,31-16,47;p=0,014) and a hospital stay (OR: 8,50;95%CI: 2,20-32,83;p<0,001). On discharge from the ICU, 37,9% of the population still had dysphagia;12,6% maintained this problem at hospital discharge. Conclusions Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.