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1.
Respir Med ; 179: 106312, 2021 04.
Artículo en Inglés | MEDLINE | ID: covidwho-1081264

RESUMEN

INTRODUCTION: Efforts to meet increased oxygen demands in COVID-19 patients are a priority in averting mechanical ventilation (MV), associated with high mortality approaching 76.4-97.2%. Novel methods of oxygen delivery could mitigate that risk. Oxygen hoods/helmets may improve: O2-saturation (SaO2), reduce in-hospital mechanical ventilation and mortality rates, and reduce length of hospitalization in hypoxic Covid-19 patients failing on conventional high-flow oxygen delivery systems. METHODS: DesignProspective Controlled Cohort Study. SettingSingle Center. ParticipantsAll patients admitted with a diagnosis of COVID-19 were reviewed and 136/347 patients met inclusion criteria. Study period3/6/2020 to 5/1/2020. 136 participants completed the study with known status for all outcome measures. Intervention or exposureOxygen hoods/helmets as compared to conventional high-flow oxygen delivery systems. MAIN OUTCOME(S) AND MEASURE(S): 1) Pre and post change in oxygen saturation (SaO2). 2) In-hospital Mechanical Ventilation (MV). 3) In-hospital Mortality. 4) Length of hospitalization. RESULTS: 136 patients including 58-intervention and 78-control patients were studied. Age, gender, and other demographics/prognostic indicators were comparable between cohorts. Oxygen hoods averted imminent or immediate intubation/MV in all 58 COVID-19 patients failing on conventional high-flow oxygen delivery systems with a mean improvement in SaO2 of 8.8%, p < 0.001. MV rates were observed to be higher in the control 37/78 (47.4%) as compared to the intervention cohort 23/58 (39.7%), a difference of 7.7%, a 27% risk reduction, not statistically significant, OR 95%CI 0.73 (0.37-1.5). Mortality rates were observed higher in the control 54/78 (69.2%) as compared to the intervention cohort 36/58 (62.1%), a difference of 7.1%, a 27% risk reduction, not statistically significant OR 95%CI 0.73 (0.36-1.5). CONCLUSION: Oxygen hoods demonstrate improvement in SaO2 for patients failing on conventional high-flow oxygen-delivery systems and prevented imminent mechanical ventilation. In-hospital mechanical ventilation and mortality rates were reduced with the use of oxygen hoods but not found to be statistically significant. The oxygen hood is a safe, effective oxygen-delivery system which may reduce intubation/MV and mortality rates. Their use should be considered in treating hypoxic COVID-19 patients. Further research is warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04407260.


Asunto(s)
/complicaciones , Hipoxia/terapia , Consumo de Oxígeno/fisiología , Terapia por Inhalación de Oxígeno/instrumentación , Respiración Artificial/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Falla de Equipo , Femenino , Humanos , Hipoxia/etiología , Hipoxia/mortalidad , Masculino , Persona de Mediana Edad , Pandemias , Pronóstico , Estudios Prospectivos , Tasa de Supervivencia/tendencias , Insuficiencia del Tratamiento , Estados Unidos/epidemiología
2.
Rev Esp Quimioter ; 34(1): 33-43, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: covidwho-1068346

RESUMEN

OBJECTIVE: To assess the impact of corticosteroids on inflammatory and respiratory parameters of patients with COVID-19 and acute respiratory distress syndrome (ARDS). METHODS: Longitudinal, retrospective, observational study conducted in an ICU of a second level hospital. Adult patients with COVID-19 were included. Baseline characteristics, data on SARS-CoV-2 infection, treatment received, evolution of respiratory and inflammatory parameters, and ICU and hospital stay and mortality were analyzed. RESULTS: A total of 27 patients were included, 63% men, median age: 68.4 (51.8, 72.2) years. All patients met ARDS criteria and received MV and corticosteroids. After corticosteroids treatment we observed a reduction in the O2 A-a gradient [day 0: 322 (249, 425); day 3: 169 (129.5, 239.5) p<0.001; day 5: 144 (127.5, 228.0) p<0.001; day 7: 192 (120, 261) p=0.002] and an increase in the pO2/FiO2 ratio on days 3 and 5, but not on day 7 [day 0: 129 (100, 168); day 3: 193 (140, 236) p=0.002; day 5: 183 (141, 255) p=0.004; day 7: 170 (116, 251) p=0.057]. CRP also decreased on days 3 and 5 and increased again on day 7 [day 0: 16 (8.6, 24); day 3: 3.4 (1.7, 10.2) p<0.001; day 5: 4.1 (1.4, 10.2) p<0.001; day 7: 13.5 (6.8, 17.3) p=0.063]. Persistence of moderate ARDS on day 7 was related to a greater risk of poor outcome (OR 6.417 [1.091-37.735], p=0.040). CONCLUSIONS: Corticosteroids appears to reduce the inflammation and temporarily improve the oxygenation in COVID-19 and ARDS patients. Persistence of ARDS after 7 days treatment is a predictor of poor outcome.


Asunto(s)
/tratamiento farmacológico , Consumo de Oxígeno/efectos de los fármacos , /tratamiento farmacológico , Anciano , Femenino , Humanos , Unidades de Cuidados Intensivos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Consumo de Oxígeno/fisiología , Respiración Artificial , Estudios Retrospectivos , Centros de Atención Secundaria , España , Factores de Tiempo , Resultado del Tratamiento
3.
Physiol Rep ; 9(3): e14726, 2021 02.
Artículo en Inglés | MEDLINE | ID: covidwho-1058653

RESUMEN

Corona virus disease 2019 (COVID-19) causes symptoms from multiple organs after infection by severe acute respiratory syndrome corona virus 2 (SARS CoV-2). They range from early, low blood oxygen levels (hypoxemia) without breathlessness ("silent hypoxia"), delirium, rashes, and loss of smell (anosmia), to persisting chest pain, muscle weakness and -pain, fatigue, confusion, memory problems and difficulty to concentrate ("brain fog"), mood changes, and unexpected onset of hypertension or diabetes. SARS CoV-2 affects the microcirculation, causing endothelial cell swelling and damage (endotheliitis), microscopic blood clots (microthrombosis), capillary congestion, and damage to pericytes that are integral to capillary integrity and barrier function, tissue repair (angiogenesis), and scar formation. Similar to other instances of critical illness, COVID-19 is also associated with elevated cytokine levels in the systemic circulation. This review examines how capillary damage and inflammation may contribute to these acute and persisting COVID-19 symptoms by interfering with blood and tissue oxygenation and with brain function. Undetectable by current diagnostic methods, capillary flow disturbances limit oxygen diffusion exchange in lungs and tissue and may therefore cause hypoxemia and tissue hypoxia. The review analyzes the combined effects of COVID-19-related capillary damage, pre-existing microvascular changes, and upstream vascular tone on tissue oxygenation in key organs. It identifies a vicious cycle, as infection- and hypoxia-related inflammation cause capillary function to deteriorate, which in turn accelerates hypoxia-related inflammation and tissue damage. Finally, the review addresses the effects of low oxygen and high cytokine levels in brain tissue on neurotransmitter synthesis and mood. Methods to assess capillary functions in human organs and therapeutic means to protect capillary functions and stimulate capillary bed repair may prove important for the individualized management of COVID-19 patients and targeted rehabilitation strategies.


Asunto(s)
/complicaciones , Microvasos/patología , Consumo de Oxígeno , Oxígeno/metabolismo , Animales , /patología , Humanos , Inflamación , Microvasos/metabolismo , Microvasos/virología , Oxígeno/sangre , /patogenicidad
4.
Emerg Med J ; 37(9): 565-566, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-1024248

RESUMEN

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.


Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/métodos , Infecciones por Coronavirus , Ventilación no Invasiva/métodos , Pandemias , Neumonía Viral , Posición Prona , Insuficiencia Respiratoria , Anciano , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Italia/epidemiología , Masculino , Consumo de Oxígeno , Terapia por Inhalación de Oxígeno/métodos , Posicionamiento del Paciente , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia , Resultado del Tratamiento
5.
Int J Mol Sci ; 22(1)2020 Dec 31.
Artículo en Inglés | MEDLINE | ID: covidwho-1011560

RESUMEN

The effects of airway inflammation on airway smooth muscle (ASM) are mediated by pro-inflammatory cytokines such as tumor necrosis factor alpha (TNFα). In this review article, we will provide a unifying hypothesis for a homeostatic response to airway inflammation that mitigates oxidative stress and thereby provides resilience to ASM. Previous studies have shown that acute exposure to TNFα increases ASM force generation in response to muscarinic stimulation (hyper-reactivity) resulting in increased ATP consumption and increased tension cost. To meet this increased energetic demand, mitochondrial O2 consumption and oxidative phosphorylation increases but at the cost of increased reactive oxygen species (ROS) production (oxidative stress). TNFα-induced oxidative stress results in the accumulation of unfolded proteins in the endoplasmic reticulum (ER) and mitochondria of ASM. In the ER, TNFα selectively phosphorylates inositol-requiring enzyme 1 alpha (pIRE1α) triggering downstream splicing of the transcription factor X-box binding protein 1 (XBP1s); thus, activating the pIRE1α/XBP1s ER stress pathway. Protein unfolding in mitochondria also triggers an unfolded protein response (mtUPR). In our conceptual framework, we hypothesize that activation of these pathways is homeostatically directed towards mitochondrial remodeling via an increase in peroxisome proliferator-activated receptor-gamma coactivator 1 alpha (PGC1α) expression, which in turn triggers: (1) mitochondrial fragmentation (increased dynamin-related protein-1 (Drp1) and reduced mitofusin-2 (Mfn2) expression) and mitophagy (activation of the Phosphatase and tensin homolog (PTEN)-induced putative kinase 1 (PINK1)/Parkin mitophagy pathway) to improve mitochondrial quality; (2) reduced Mfn2 also results in a disruption of mitochondrial tethering to the ER and reduced mitochondrial Ca2+ influx; and (3) mitochondrial biogenesis and increased mitochondrial volume density. The homeostatic remodeling of mitochondria results in more efficient O2 consumption and oxidative phosphorylation and reduced ROS formation by individual mitochondrion, while still meeting the increased ATP demand. Thus, the energetic load of hyper-reactivity is shared across the mitochondrial pool within ASM cells.


Asunto(s)
Homeostasis , Inflamación/fisiopatología , Mitocondrias/fisiología , Músculo Liso/fisiología , Biogénesis de Organelos , Desplegamiento Proteico , Respuesta de Proteína Desplegada , Animales , Humanos , Músculo Liso/citología , Estrés Oxidativo , Consumo de Oxígeno , Factor de Necrosis Tumoral alfa/metabolismo
6.
Pediatr Cardiol ; 42(3): 554-559, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: covidwho-1006342

RESUMEN

The COVID-19 pandemic has had devastating direct consequences on the health of affected patients. It has also had a significant impact on the ability of unaffected children to be physically active. We evaluated the effect of deconditioning from social distancing and school shutdowns implemented during the COVID-19 pandemic on the cardiovascular fitness of healthy unaffected children. This is a single-center, retrospective case-control study performed in an urban tertiary referral center. A cohort of 10 healthy children that underwent cardiopulmonary exercise testing after COVID-19 hospital restrictions were lifted was compared to a matched cohort before COVID-19-related shutdowns on school and after-school activities. Comparisons of oxygen uptake (VO2) max and VO2 at anaerobic threshold between the pre- and post-COVID-19 cohorts were done. The VO2 max in the post-COVID cohort was significantly lower than in the pre-COVID cohort (39.1 vs. 44.7, p = 0.031). Only one out of ten patients had a higher VO2 max when compared to their matched pre-COVID control and was also the only patient with a documented history of participation in varsity-type athletics. The percentile of predicted VO2 was significantly lower in the post-COVID cohort (95% vs. 105%, p = 0.042). This study for the first time documented a significant measurable decline in physical fitness of healthy children as a result of the COVID-19 pandemic and its associated restrictions. Measures need to be identified that encourage and facilitate regular exercise in children in a way that are not solely dependent on school and organized after-school activities.


Asunto(s)
/epidemiología , Ejercicio Físico/fisiología , Estado de Salud , Consumo de Oxígeno/fisiología , Pandemias , Aptitud Física/fisiología , Instituciones Académicas , Adolescente , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Masculino , New York/epidemiología , Estudios Retrospectivos
7.
Eur Rev Med Pharmacol Sci ; 24(24): 13049-13055, 2020 12.
Artículo en Inglés | MEDLINE | ID: covidwho-1000850

RESUMEN

OBJECTIVE: This review was conducted to systematically analyze the effects of aerobic exercise on immunological biomarkers to provide safe aerobic exercise recommendations and specifications for patients with COVID-19. MATERIALS AND METHODS: A systematic search was conducted through MEDLINE (PubMed), Science Direct, Web of Science, Scopus, Cochrane Library, and SciELO databases. The search included the following keywords "immune system", "immune cell", or "immune function"; "aerobic training", "aerobic exercise", or "physical activity"; "human" or "adult"; and "cytokine", "killer cell", "T cell", "interleukin", "lymphocyte", "leukocyte" or "adhesion molecule". RESULTS: Eleven studies met the inclusion and exclusion criteria of this search. The most used exercise prescriptions included walking, cycling, or running. The duration of exercise ranged from 18 to 60 min with an intensity of 55% to 80% of VO2max or 60%-80% of maximum heart rate. The frequency range was 1 to 3 times/week. The mainly increased immunological biomarkers included leukocytes, lymphocytes, neutrophils, monocytes, eosinophils, IL-6, CD16-56, CD16, CD4, CD3, CD8, and CD19. CONCLUSIONS: This review demonstrated that patients with COVID-19 should follow a regular program of aerobic exercise for 20-60 min. This program should be in the form of cycling or walking with an intensity of 55%-80% VO2max or 60%-80% of maximum heart rate. This program should be repeated 2-3 sessions/week. These previous parameters could safely enhance immune functions without producing any exhaustion.


Asunto(s)
/rehabilitación , Terapia por Ejercicio/métodos , Ejercicio Físico/fisiología , Ciclismo , Citocinas/inmunología , Humanos , Inmunoglobulinas/inmunología , Recuento de Leucocitos , Recuento de Linfocitos , Neutrófilos , Consumo de Oxígeno , Carrera , Caminata
8.
Int J Infect Dis ; 103: 452-456, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: covidwho-968530

RESUMEN

OBJECTIVE: To investigate the use of oxygen metabolism markers as predictors of mortality in patients with severe coronavirus disease 2019 (COVID-19). METHODS: A retrospective analysis was undertaken to compare the medical records of patients with severe COVID-19 (53 deceased patients and 50 survivors). The survivors were selected from 222 records using a random number generator. In addition, 28 individuals who considered themselves to be healthy and who had no history of serious illness were included in the study for comparison. Oxygen saturation in arterial blood, oxygen saturation in central venous blood (ScvO2), arterial partial pressure of oxygen (PaO2), respiratory index (PaO2/fraction of inspired oxygen), oxygen delivery, oxygen consumption (VO2) and oxygen extraction (O2ER) were compared in all participants. The optimal cut-off point for each oxygen metabolism marker in the prediction of mortality was determined based on the maximum value of the Youden Index in receiver operating characteristic curve analysis. RESULTS: Significant differences in all studied oxygen metabolism markers were found between survivors compared with deceased patients (p < 0.001). ScvO2, VO2 and O2ER [area under curve (AUC) 1.0] were the strongest predictors of mortality, and PaO2 was the weakest predictor of mortality (AUC 0.81). ScvO2 <29%, VO2 >124.6 ml/min and O2ER >30.2% were identified as predictors of mortality in patients with COVID-19. CONCLUSION: ScvO2, VO2 and O2ER are good predictors of mortality in critically ill patients with COVID-19.


Asunto(s)
/mortalidad , Oxígeno/metabolismo , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Consumo de Oxígeno , Estudios Retrospectivos
9.
Int J Environ Res Public Health ; 17(21)2020 Nov 03.
Artículo en Inglés | MEDLINE | ID: covidwho-921198

RESUMEN

Wearing face masks is recommended for the prevention of contracting or exposing others to cardiorespiratory infections, such as COVID-19. Controversy exists on whether wearing face masks during vigorous exercise affects performance. We used a randomized, counterbalanced cross-over design to evaluate the effects of wearing a surgical mask, a cloth mask, or no mask in 14 participants (7 men and 7 women; 28.2 ± 8.7 y) during a cycle ergometry test to exhaustion. Arterial oxygen saturation (pulse oximetry) and tissue oxygenation index (indicator of hemoglobin saturation/desaturation) at vastus lateralis (near-infrared spectroscopy) were assessed throughout the exercise tests. Wearing face masks had no effect on performance (time to exhaustion (mean ± SD): no mask 622 ± 141 s, surgical mask 657 ± 158 s, cloth mask 637 ± 153 s (p = 0.20); peak power: no mask 234 ± 56 W, surgical mask 241 ± 57 W, cloth mask 241 ± 51 W (p = 0.49)). When expressed relative to peak exercise performance, no differences were evident between wearing or not wearing a mask for arterial oxygen saturation, tissue oxygenation index, rating of perceived exertion, or heart rate at any time during the exercise tests. Wearing a face mask during vigorous exercise had no discernable detrimental effect on blood or muscle oxygenation, and exercise performance in young, healthy participants (ClinicalTrials.gov, NCT04557605).


Asunto(s)
Infecciones por Coronavirus/prevención & control , Ejercicio Físico , Máscaras/clasificación , Pandemias/prevención & control , Neumonía Viral/prevención & control , Adulto , Betacoronavirus , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Oximetría , Consumo de Oxígeno , Adulto Joven
10.
Clin Nutr ESPEN ; 41: 443-446, 2021 02.
Artículo en Inglés | MEDLINE | ID: covidwho-917265

RESUMEN

BACKGROUND & AIMS: During the coronavirus disease 2019 (COVID-19) pandemic the use of Indirect calorimetry (IC) during nutritional rehabilitation program requires special precautions due to possible contagions for patients and health professionals. We evaluated in a sample of healthy subjects the agreement between oxygen consumption (VO2 mL/min), carbon dioxide production (VCO2 mL/min), respiratory quotient (RQ) and resting energy expenditure (REE kcal/24 h/day) measured by IC with and without a filtering facepiece mask. MATERIALS: 10 subjects with a mean (SD) age of 43 (10) years and a body mass index of 25.2 (5.8) kg/m2 underwent indirect calorimetry both with and without a class 2 filtering facepiece mask (FFP2), in random order. The limits of agreement (LOA) and the concordance correlation coefficient (CCC) were used to evaluate the interchangeability of the measurement conditions. RESULTS: The LOA between REE measured with and without FFP2 (-111 to 189 kcal/day) were comparable to those for repeated IC tests without wearing masks and CCC (0.95) showed substantial agreement. CONCLUSIONS: We observed high agreement between REE measured by IC with and without FFP2 mask. These procedures are interchangeable in clinical practice.


Asunto(s)
Metabolismo Basal , Calorimetría Indirecta/métodos , Dióxido de Carbono/metabolismo , Máscaras , Consumo de Oxígeno , Pandemias , Adulto , Índice de Masa Corporal , Femenino , Humanos , Masculino , Máscaras/efectos adversos , Persona de Mediana Edad , Equipo de Protección Personal , Proyectos Piloto , Respiración , Descanso
11.
CJEM ; 22(5): 587-590, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-834795

RESUMEN

A 37-year-old female presents with cough, fever, dyspnea, and myalgias for five days after recent contact with a family member with confirmed 2019 coronavirus disease (COVID-19). Her vital signs include T 38.3° C, HR 108, BP 118/70 mm Hg, RR 26 breaths per minute, and oxygen saturation 67% on room air. She is not in respiratory distress currently and is protecting her airway. Her chest X-ray reveals bilateral airspace opacities. You plan to immediately intervene and address her hypoxia.


Asunto(s)
Infecciones por Coronavirus/terapia , Ventilación no Invasiva/métodos , Terapia por Inhalación de Oxígeno/métodos , Oxígeno/sangre , Neumonía Viral/terapia , Síndrome Respiratorio Agudo Grave/terapia , Adulto , Manejo de la Vía Aérea/métodos , Canadá , Infecciones por Coronavirus/diagnóstico , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Consumo de Oxígeno/fisiología , Pandemias , Neumonía Viral/diagnóstico , Medición de Riesgo , Rol , Síndrome Respiratorio Agudo Grave/diagnóstico , Resultado del Tratamiento , Signos Vitales
12.
Euro Surveill ; 25(36)2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-760822

RESUMEN

In March 2020, we observed an outbreak of COVID-19 among a relatively homogenous group of 199 young (median age 21 years; 87% men) Swiss recruits. By comparing physical endurance before and in median 45 days after the outbreak, we found a significant decrease in predicted maximal aerobic capacity in COVID-19 convalescent but not in asymptomatically infected and SARS-CoV-2 naive recruits. This finding might be indicative of lung injury after apparently mild COVID-19 in young adults.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Coronavirus/aislamiento & purificación , Ejercicio Físico/fisiología , Lesión Pulmonar/etiología , Consumo de Oxígeno , Resistencia Física/fisiología , Neumonía Viral/diagnóstico , Ventilación Pulmonar/fisiología , Adulto , Infecciones Asintomáticas , Betacoronavirus , Convalecencia , Coronavirus/genética , Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades , Femenino , Humanos , Masculino , Personal Militar , Pandemias , Resistencia Física/inmunología , Aptitud Física , Neumonía Viral/epidemiología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de Riesgo , Suiza/epidemiología , Adulto Joven
13.
BMC Infect Dis ; 20(1): 637, 2020 Aug 27.
Artículo en Inglés | MEDLINE | ID: covidwho-733046

RESUMEN

BACKGROUND: An ongoing outbreak of coronavirus disease 2019 (COVID-19) is spreading globally. Recently, several articles have mentioned that the early acute respiratory distress syndrome (ARDS) caused by COVID-19 significantly differ from those of ARDS due to other causes. Actually, we newly observed that some mechanically ventilated COVID-19 patients recovering from severe ARDS (more than 14 days after invasive ventilation) often experienced evidently gradual increases in CO2 retention and minute ventilation. However, the underlying mechanics remain unclear. CASE PRESENTATION: To explain these pathophysiological features and discuss the ventilatory strategy during the late phase of severe ARDS in COVID-19 patients, we first used a metabolic module on a General Electric R860 ventilator (Engstrom Carestation; GE Healthcare, USA) to monitor parameters related to gas metabolism, lung mechanics and physiological dead space in two COVID-19 patients. We found that remarkably decreased ventilatory efficiency (e.g., the ratio of dead space to tidal volume 70-80%, arterial to end-tidal CO2 difference 18-23 mmHg and ventilatory ratio 3-4) and hypermetabolism (oxygen consumption 300-400 ml/min, CO2 elimination 200-300 ml/min) may explain why these patients experienced more severe respiratory distress and CO2 retention in the late phase of ARDS caused by COVID-19. CONCLUSION: During the recovery period of ARDS among mechanically-ventilated COVID-19 patients, attention should be paid to the monitoring of physiological dead space and metabolism. Tidal volume (8-9 ml/kg) could be increased appropriately under the limited plateau pressure; however, barotrauma should still be kept in mind.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Respiración Artificial , /terapia , Anciano , Infecciones por Coronavirus/complicaciones , Femenino , Humanos , Monitoreo Fisiológico , Consumo de Oxígeno , Pandemias , Neumonía Viral/complicaciones , Volumen de Ventilación Pulmonar , Ventiladores Mecánicos
14.
Respir Res ; 21(1): 198, 2020 Jul 28.
Artículo en Inglés | MEDLINE | ID: covidwho-680693

RESUMEN

The novel coronavirus disease 2019 (COVID-19) pandemic is a global crisis, challenging healthcare systems worldwide. Many patients present with a remarkable disconnect in rest between profound hypoxemia yet without proportional signs of respiratory distress (i.e. happy hypoxemia) and rapid deterioration can occur. This particular clinical presentation in COVID-19 patients contrasts with the experience of physicians usually treating critically ill patients in respiratory failure and ensuring timely referral to the intensive care unit can, therefore, be challenging. A thorough understanding of the pathophysiological determinants of respiratory drive and hypoxemia may promote a more complete comprehension of a patient's clinical presentation and management. Preserved oxygen saturation despite low partial pressure of oxygen in arterial blood samples occur, due to leftward shift of the oxyhemoglobin dissociation curve induced by hypoxemia-driven hyperventilation as well as possible direct viral interactions with hemoglobin. Ventilation-perfusion mismatch, ranging from shunts to alveolar dead space ventilation, is the central hallmark and offers various therapeutic targets.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Hipoxia/etiología , Pulmón/fisiopatología , Consumo de Oxígeno/fisiología , Pandemias , Neumonía Viral/complicaciones , Insuficiencia Respiratoria/complicaciones , Infecciones por Coronavirus/epidemiología , Enfermedad Crítica , Humanos , Hipoxia/metabolismo , Hipoxia/fisiopatología , Neumonía Viral/epidemiología , Insuficiencia Respiratoria/metabolismo , Insuficiencia Respiratoria/fisiopatología
15.
Respir Res ; 21(1): 194, 2020 Jul 22.
Artículo en Inglés | MEDLINE | ID: covidwho-670959

RESUMEN

RATIONALE: Oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) has been described as potential predictor of poor outcome for COVID-19, without considering its time-varying behavior though. METHODS: Prognostic value of SpO2/FiO2 was evaluated by jointly modeling the longitudinal responses of SpO2/FiO2 and time-to-event data retrieved from 280 severe and critically ill (intensive care) patients with COVID-19. RESULTS: A sharply decrease of SpO2/FiO2 from the first to second measurement for non-survivors was observed, and a strong association between square root SpO2/FiO2 and mortality risk was demonstrated, with a unit decrease in the marker corresponding to 1.82-fold increase in mortality risk (95% CI: 1.56-2.13). CONCLUSIONS: The current study suggested that SpO2/FiO2 could serve as a non-invasive prognostic marker to facilitate early adjustment for treatment, thus improving overall survival.


Asunto(s)
Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/mortalidad , Cuidados Críticos/métodos , Enfermedad Crítica/mortalidad , Mortalidad Hospitalaria/tendencias , Consumo de Oxígeno/fisiología , Neumonía Viral/sangre , Neumonía Viral/mortalidad , Biomarcadores/sangre , China , Estudios de Cohortes , Infecciones por Coronavirus/diagnóstico , Enfermedad Crítica/terapia , Femenino , Humanos , Unidades de Cuidados Intensivos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Oximetría/métodos , Oxígeno/sangre , Pandemias , Neumonía Viral/diagnóstico , Valor Predictivo de las Pruebas , Pronóstico
18.
BMJ Open Respir Res ; 7(1)2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-634563

RESUMEN

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.


Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/métodos , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Unidades de Cuidados Respiratorios , Insuficiencia Respiratoria , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Vías Clínicas/tendencias , Femenino , Humanos , Masculino , Registros Médicos/estadística & datos numéricos , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Consumo de Oxígeno , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Unidades de Cuidados Respiratorios/métodos , Unidades de Cuidados Respiratorios/organización & administración , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/mortalidad , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia , Análisis de Supervivencia , Reino Unido/epidemiología
19.
BMJ Open Respir Res ; 7(1)2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-634533

RESUMEN

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.


Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/métodos , Infecciones por Coronavirus , Fragilidad , Evaluación Geriátrica/métodos , Pandemias , Neumonía Viral , Unidades de Cuidados Respiratorios , Insuficiencia Respiratoria , Anciano de 80 o más Años , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Femenino , Fragilidad/diagnóstico , Fragilidad/fisiopatología , Fragilidad/terapia , Humanos , Pulmón/diagnóstico por imagen , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Oximetría/métodos , Oximetría/estadística & datos numéricos , Consumo de Oxígeno , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Unidades de Cuidados Respiratorios/métodos , Unidades de Cuidados Respiratorios/organización & administración , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/mortalidad , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia , Análisis de Supervivencia , Tomografía Computarizada por Rayos X/métodos , Reino Unido/epidemiología
20.
J Intensive Care Med ; 35(8): 818-824, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: covidwho-634271

RESUMEN

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.


Asunto(s)
Ansiedad , Infecciones por Coronavirus , Obesidad , Pandemias , Posicionamiento del Paciente/métodos , Neumonía Viral , Posición Prona/fisiología , Insuficiencia Respiratoria , Adulto , Ansiedad/fisiopatología , Ansiedad/prevención & control , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/metabolismo , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Humanos , Hipoxia/etiología , Hipoxia/terapia , Masculino , Obesidad/epidemiología , Obesidad/fisiopatología , Consumo de Oxígeno , Terapia por Inhalación de Oxígeno/métodos , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/epidemiología , Neumonía Viral/etiología , Neumonía Viral/metabolismo , Neumonía Viral/fisiopatología , Neumonía Viral/psicología , Neumonía Viral/terapia , Respiración Artificial/métodos , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/psicología , Insuficiencia Respiratoria/terapia , Resultado del Tratamiento
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