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1.
Am J Phys Med Rehabil ; 99(10): 870-872, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-860314

RESUMEN

The coronavirus 2019 pandemic has resulted in a surge of patients with acute respiratory distress syndrome. Prone positioning may be used in such patients to optimize oxygenation. Severe infections may leave survivors with significant functional impairment necessitating rehabilitation. Those who have experienced prolonged prone positioning are at increased risk for complications not typically associated with critical illness. This case report describes the course and clinical findings of a survivor of acute respiratory distress syndrome due to coronavirus 2019 who was prone positioned while in intensive care and subsequently admitted to an inpatient rehabilitation facility. Her related complications, as well as those described in the literature, are reviewed. Critical elements of a comprehensive rehabilitation treatment plan for those who have been prone positioned, including implementation of preventive strategies, as well as early recognition and treatment of related injuries, will be described.


Asunto(s)
Infecciones por Coronavirus/fisiopatología , Cuidados Críticos/métodos , Posicionamiento del Paciente/efectos adversos , Neumonía Viral/fisiopatología , Posición Prona , Terapia Respiratoria/métodos , Adulto , Betacoronavirus , Infecciones por Coronavirus/rehabilitación , Infecciones por Coronavirus/virología , Femenino , Humanos , Pandemias , Neumonía Viral/rehabilitación , Neumonía Viral/virología
3.
Respir Care ; 65(7): 920-931, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-840991

RESUMEN

BACKGROUND: The overwhelming demand for mechanical ventilators due to COVID-19 has stimulated interest in using one ventilator for multiple patients (ie, multiplex ventilation). Despite a plethora of information on the internet, there is little supporting evidence and no human studies. The risk of multiplex ventilation is that ventilation and PEEP effects are largely uncontrollable and depend on the difference between patients' resistance and compliance. It is not clear whether volume control ventilation or pressure control ventilation is safer or more effective. We designed a simulation-based study to allow complete control over the relevant variables to determine the effects of various degrees of resistance-compliance imbalance on tidal volume (VT), end-expiratory lung volume (EELV), and imputed pH. METHODS: Two separate breathing simulators were ventilated with a ventilator using pressure control and volume control ventilation modes. Evidence-based lung models simulated a range of differences in resistance and compliance (6 pairs of simulated patients). Differences in VT, EELV, and imputed pH were recorded. RESULTS: Depending on differences in resistance and compliance, differences in VT ranged from 1% (with equal resistance and compliance) to 79%. Differences in EELV ranged from 2% to 109%, whereas differences in pH ranged from 0% to 5%. Failure due to excessive VT (ie, > 8 mL/kg) did not occur, but failure due to excessive EELV difference (ie, > 10%) was evident in 50% of patient pairs. There was no difference in failure rate between volume control and pressure control ventilation modes. CONCLUSIONS: These experiments confirmed the potential for markedly different ventilation and oxygenation for patients with uneven respiratory system impedances during multiplex ventilation. Three critical problems must be solved to minimize risk: (1) partitioning of inspiratory flow from the ventilator individually between the 2 patients, (2) measurement of VT delivered to each patient, and (3) provision for individual PEEP. We provide suggestions for solving these problems.


Asunto(s)
Resistencia de las Vías Respiratorias/fisiología , Infecciones por Coronavirus , Rendimiento Pulmonar/fisiología , Ensayo de Materiales/métodos , Pandemias , Neumonía Viral , Respiración Artificial , Betacoronavirus , Simulación por Computador , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Cuidados Críticos/métodos , Diseño de Equipo , Humanos , Modelos Biológicos , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Respiración Artificial/instrumentación , Respiración Artificial/métodos , Ventiladores Mecánicos/normas , Ventiladores Mecánicos/provisión & distribución
5.
J Med Case Rep ; 14(1): 191, 2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: covidwho-835873

RESUMEN

BACKGROUND: Determining the infectiousness of patients with coronavirus disease 2019 is crucial for patient management. Medical staff usually refer to the results of reverse transcription polymerase chain reaction tests in conjunction with clinical symptoms and computed tomographic images. CASE PRESENTATION: We report a case of a 62-year-old Japanese man who twice had positive and negative test results by polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 over 48 days of hospitalization, including in intensive care. His respiratory symptoms and computed tomographic imaging findings consistent with coronavirus disease 2019 improved following initial intensive care, and the result of his polymerase chain reaction test became negative 3 days before discharge from the intensive care unit. However, 4 days after this first negative result, his polymerase chain reaction test result was positive again, and another 4 days later, he had a negative result once more. Eight days after the second polymerase chain reaction negative test result, the patient's test result again became positive. Finally, his polymerase chain reaction results were negative 43 days after his first hospitalization. CONCLUSIONS: This case emphasizes the importance of repeat polymerase chain reaction testing and diagnosis based on multiple criteria, including clinical symptoms and computed tomographic imaging findings. Clinical staff should consider that a negative result by polymerase chain reaction does not necessarily certify complete coronavirus disease 2019 recovery.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral , Evaluación de Síntomas/métodos , Toma de Decisiones Clínicas , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Cuidados Críticos/métodos , Reacciones Falso Negativas , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
6.
BMJ Open ; 10(10): e039887, 2020 10 05.
Artículo en Inglés | MEDLINE | ID: covidwho-835489

RESUMEN

OBJECTIVES: To determine the age-specific clinical presentations and incidence of adverse outcomes among patients with COVID-19 in Jiangsu, China. DESIGN AND SETTING: Retrospective, multicentre cohort study performed at 24 hospitals in Jiangsu, China. PARTICIPANTS: 625 patients with COVID-19 enrolled between 10 January and 15 March 2020. RESULTS: Of the 625 patients (median age, 46 years; 329 (52.6%) men), 37 (5.9%) were children (18 years or younger), 261 (41.8%) young adults (19-44 years), 248 (39.7%) middle-aged adults (45-64 years) and 79 (12.6%) elderly adults (65 years or older). The incidence of hypertension, coronary heart disease, chronic obstructive pulmonary disease and diabetes comorbidities increased with age (trend test, p<0.0001, p=0.0003, p<0.0001 and p<0.0001, respectively). Fever, cough and shortness of breath occurred more commonly among older patients, especially the elderly, compared with children (χ2 test, p=0.0008, 0.0146 and 0.0282, respectively). The quadrant score and pulmonary opacity score increased with age (trend test, both p<0.0001). Older patients had many significantly different laboratory parameters from younger patients. Elderly patients had the highest proportion of severe or critically-ill cases (33.0%, χ2 test p<0.0001), intensive care unit use (35.4%, χ2 test p<0.0001), respiratory failure (31.6%, χ2 test p<0.0001) and the longest hospital stay (median 21 days, Kruskal-Wallis test p<0.0001). CONCLUSIONS: Elderly (≥65 years) patients with COVID-19 had the highest risk of severe or critical illness, intensive care use, respiratory failure and the longest hospital stay, which may be due partly to their having a higher incidence of comorbidities and poor immune responses to COVID-19.


Asunto(s)
Factores de Edad , Infecciones por Coronavirus , Cuidados Críticos , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral , Evaluación de Síntomas , Adolescente , Anciano , Betacoronavirus/aislamiento & purificación , China/epidemiología , Estudios de Cohortes , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Cuidados Críticos/métodos , Cuidados Críticos/estadística & datos numéricos , Enfermedad Crítica/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos
7.
Dtsch Med Wochenschr ; 145(20): 1470-1475, 2020 Oct.
Artículo en Alemán | MEDLINE | ID: covidwho-834945

RESUMEN

Decisions about the initiation, continuation and termination of life-supporting treatments are a permanent challenge in intensive care units (ICUs). Decisions should be based on patient preferences and the medical indication. The medical indication is mainly the result of an assessment of the patient's prognosis and the applicable therapeutic options. Factors influencing the short term prognosis are mostly the severity of the acute leading disease, the number and severity of other organ failures and the response to initial treatment. Long term prognosis is dominated by the severity and number of comorbidities, age and the resulting frailty. Because in many patients all these informations are not available at the time of admission, in these cases a time-limited trial is often justified to gather all this information before a decision is made. These principles of decision making can also applied to situations in which ICU-capacities are limited (e. g. COVID-19 pandemic).


Asunto(s)
Toma de Decisiones Clínicas , Cuidados Críticos , Betacoronavirus , Infecciones por Coronavirus , Humanos , Unidades de Cuidados Intensivos , Pandemias , Neumonía Viral , Pronóstico
9.
Recenti Prog Med ; 111(4): 212-222, 2020 Apr.
Artículo en Italiano | MEDLINE | ID: covidwho-829977

RESUMEN

On 6 March 2020, the Italian Society of Anaesthesia Analgesia Resuscitation and Intensive care (SIAARTI) published the document "Clinical Ethics Recommendations for Admission to and Suspension of Intensive Care in Exceptional Conditions of Imbalance between Needs and Available Resources". The document, which aims to propose treatment decision-making criteria in the face of exceptional imbalances between health needs and available resources, has produced strong reactions, within the medical-scientific community, in the academic world, and in the media. In the current context of international public health emergency caused by the CoViD-19 epidemic, this work aims to explain the ethical, deontological and legal bases of the SIAARTI Document and to propose methodologic and argumentative integrations that are useful for understanding and placing in context the decision-making criteria proposed. The working group that contributed to the drafting of this paper agrees that it is appropriate that healthcare personnel, who is particularly committed to taking care of those who are currently in need of intensive or sub-intensive care, should benefit from clear operational indications that are useful to orient care and, at the same time, that the population should know in advance which criteria will guide the tragic choices that may fall on each one of us. This contribution therefore firstly reflects on the appropriateness of the SIAARTI standpoint and the objectives of the SIAARTI Document. It then turns to demonstrate how the recommendations it proposes can be framed within a shared interdisciplinary, ethical, deontological and legal perspective.


Asunto(s)
Infecciones por Coronavirus , Cuidados Críticos , Pandemias , Neumonía Viral , Asignación de Recursos/ética , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Cuidados Críticos/ética , Cuidados Críticos/legislación & jurisprudencia , Recursos en Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Unidades de Cuidados Intensivos , Comunicación Interdisciplinaria , Italia , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Guías de Práctica Clínica como Asunto , Asignación de Recursos/legislación & jurisprudencia
10.
Rev Med Suisse ; 16(N° 691-2): 863-868, 2020 Apr 29.
Artículo en Francés | MEDLINE | ID: covidwho-827285

RESUMEN

The SARS-coronavirus 2 disease initially reported in December 2019 in China (COVID-19) represents a major challenge for intensive care medicine, due to the high number of ICU admission and the prolonged stay for many patients. Up to 5 % of COVID-19 infected patients develop severe acute hypoxemic respiratory failure requiring invasive mechanical ventilation as supportive treatment. Apart from early antiviral and anti-inflammatory treatment, the management of COVID-19 patients is mainly applying protective mechanical ventilation, to support the injured lungs. However recently acquired data and clinical experience suggest that COVID-19-related ARDS presents some specificities that will be summarized in the present article.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Cuidados Críticos , Pandemias , Neumonía Viral , China , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Respiración Artificial
11.
J Med Case Rep ; 14(1): 186, 2020 Oct 06.
Artículo en Inglés | MEDLINE | ID: covidwho-818136

RESUMEN

INTRODUCTION: A novel coronavirus named severe acute respiratory syndrome coronavirus 2, was first reported in Wuhan, China, in December 2019. The virus, known as COVID-19, is recognized as a potentially life-threatening disease by causing severe respiratory disease. Since this virus has not previously been detected in humans, there is a paucity of information regarding its effects on humans. In addition, only limited or no information exists about its impact during pregnancy. CASE PRESENTATION: In the present case study, we report the death of a neonate born to a 32-year-old mother with coronavirus disease 2019 in Ilam, Iran, with Kurdish ethnicity. We report the infection and death of a neonate in Iran with a chest X-ray (CXR) marked abnormality 2 hours after birth demonstrating coronavirus disease 2019 disease. The neonate was born by elective cesarean section, the fetal health was assessed using fetal heart rate and a non-stress test before the birth, and there was no evidence of fetal distress. All the above-mentioned facts and radiographic abnormalities suggested that coronavirus disease 2019 is involved. CONCLUSIONS: In this case study, we report the death of a neonate born to a mother with coronavirus disease 2019, 11 hours after birth. There is a paucity of data on the vertical transmission and the adverse maternal-fetal consequences of this disease, so vertical transmission from mother to child remains to be confirmed.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Cuidados Críticos/métodos , Enfermedades del Recién Nacido , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Adulto , Cesárea/métodos , Deterioro Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/transmisión , Resultado Fatal , Femenino , Humanos , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Enfermedades del Recién Nacido/fisiopatología , Enfermedades del Recién Nacido/terapia , Transmisión Vertical de Enfermedad Infecciosa , Irán , Tamizaje Neonatal/métodos , Muerte Perinatal , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Neumonía Viral/transmisión , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/fisiopatología , Complicaciones Infecciosas del Embarazo/terapia , Respiración Artificial/métodos
12.
Rev. Ocup. Hum. (En línea) ; 20(1)2020.
Artículo en Español | LILACS (Américas) | ID: covidwho-808314

RESUMEN

El amplio espectro clínico de la enfermedad COVID-19 tiene importantes implicaciones funcionales para el cuidado hospitalario agudo y subagudo en unidades de cuidado inten-sivo. Ante la emergencia sanitaria desencadenada por esta enfermedad, el Colegio Colom-biano de Terapia Ocupacional convocó a un grupo de profesionales expertas en el área para proveer lineamientos para terapeutas ocupacionales que participan en la rehabilitación tem-prana de pacientes con COVID-19 en Colombia. Se realizó una revisión de literatura sobre la clasificación y las manifestaciones clínicas de la enfermedad, la efectividad de la reha-bilitación temprana adulta, pediátrica y neonatal, y el rol y la experiencia de profesionales en Terapia Ocupacional en el uso de guías de salud existentes. Un consenso de expertas determinó la aplicabilidad de los lineamientos al contexto colombiano. Terapia Ocupacio-nal, como parte del equipo de rehabilitación temprana, juega un papel fundamental en la restauración y el mantenimiento de la independencia funcional; la adaptación del ambiente y el acondicionamiento holístico gradual de las funciones respiratorias, cardiovasculares, sensoriomotoras y cognitivas durante las actividades básicas cotidianas, y la prevención del deterioro físico, mental, espiritual y social de la persona hospitalizada y su familia. Estos lineamientos constituyen un recurso técnico y educativo relevante para la Terapia Ocupa-cional hospitalaria.(AU)


The broad clinical spectrum of COVID-19 disease has critical functional implications for acute and subacute hospital care in intensive care units. Faced with the health emergency triggered by this disease, the Colombian College of Occupational Therapy convened a group of professional experts in the area to provide guidelines for occupational therapists involved in the early rehabilitation of patients with COVID-19 in Colombia. A literature review was conducted on the classification and clinical manifestations of the disease, the effectiveness of early adult, pediatric and neonatal rehabilitation, and the occupational therapist's role and experience in the use of existing health guidelines. A consensus of experts determined the applicability of the guidelines to the Colombian context. Occu-pational Therapy, as part of the early rehabilitation team, plays a fundamental role in res-toring and maintaining functional independence, the adaptation of the environment and the gradual holistic conditioning of respiratory, cardiovascular, sensorimotor and cognitive functions during basic daily activities, and the prevention of physical, mental, spiritual and social deterioration of the hospitalized person and their family. These guidelines cons-titute a relevant technical and educational resource for hospital Occupational Therapy.(AU)


O amplo espectro clínico da doença COVID-19 tem implicações funcionais relevantes para os cuidados hospitalares agudos e subagudos em unidades de terapia intensiva. Diante da emergência sanitária desencadeada por esta doença, o Colégio Colombiano de Tera-pia Ocupacional reuniu um grupo de profissionais, especializados na área, para fornecer orientações aos terapeutas ocupacionais, envolvidos na reabilitação precoce de pacientes com COVID-19, na Colômbia. Foi realizada uma revisão da literatura sobre a classificação e as manifestações clínicas da doença, a eficácia da reabilitação adulta precoce, pediá-trica e neonatal, bem como o papel e experiência do terapeuta ocupacional no uso das diretrizes de saúde existentes. Um consenso de especialistas determinou a aplicabilidade das diretrizes ao contexto colombiano. A Terapia Ocupacional, como parte da equipe de reabilitação precoce, desempenha um papel fundamental na restauração e manutenção da independência funcional; a adaptação do meio ambiente e o condicionamento holístico gradual das funções respiratórias, cardiovasculares, sensório-motoras e cognitivas, durante as atividades diárias básicas; e a prevenção da deterioração física, mental, espiritual e so-cial da pessoa hospitalizada e sua família. Essas orientações constituem um recurso técnico e educacional relevante para a Terapia Ocupacional hospitalar.(AU)


Asunto(s)
Humanos , Infecciones por Coronavirus/rehabilitación , Cuidados Críticos , Servicios de Rehabilitación , Servicio de Terapia Ocupacional en Hospital , Colombia
13.
BMJ Open ; 10(9): e040175, 2020 09 29.
Artículo en Inglés | MEDLINE | ID: covidwho-809016

RESUMEN

INTRODUCTION: The course of the disease in SARS-CoV-2 infection in mechanically ventilated patients is unknown. To unravel the clinical heterogeneity of the SARS-CoV-2 infection in these patients, we designed the prospective observational Maastricht Intensive Care COVID cohort (MaastrICCht). We incorporated serial measurements that harbour aetiological, diagnostic and predictive information. The study aims to investigate the heterogeneity of the natural course of critically ill patients with a SARS-CoV-2 infection. METHODS AND ANALYSIS: Mechanically ventilated patients admitted to the intensive care with a SARS-CoV-2 infection will be included. We will collect clinical variables, vital parameters, laboratory variables, mechanical ventilator settings, chest electrical impedance tomography, ECGs, echocardiography as well as other imaging modalities to assess heterogeneity of the course of a SARS-CoV-2 infection in critically ill patients. The MaastrICCht is also designed to foster various other studies and registries and intends to create an open-source database for investigators. Therefore, a major part of the data collection is aligned with an existing national intensive care data registry and two international COVID-19 data collection initiatives. Additionally, we create a flexible design, so that additional measures can be added during the ongoing study based on new knowledge obtained from the rapidly growing body of evidence. The spread of the COVID-19 pandemic requires the swift implementation of observational research to unravel heterogeneity of the natural course of the disease of SARS-CoV-2 infection in mechanically ventilated patients. Our study design is expected to enhance aetiological, diagnostic and prognostic understanding of the disease. This paper describes the design of the MaastrICCht. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the medical ethics committee (Medisch Ethische Toetsingscommissie 2020-1565/3 00 523) of the Maastricht University Medical Centre+ (Maastricht UMC+), which will be performed based on the Declaration of Helsinki. During the pandemic, the board of directors of Maastricht UMC+ adopted a policy to inform patients and ask their consent to use the collected data and to store serum samples for COVID-19 research purposes. All study documentation will be stored securely for fifteen years after recruitment of the last patient. The results will be published in peer-reviewed academic journals, with a preference for open access journals, while particularly considering deposition of the manuscripts on a preprint server early. TRIAL REGISTRATION NUMBER: The Netherlands Trial Register (NL8613).


Asunto(s)
Infecciones por Coronavirus , Cuidados Críticos/métodos , Enfermedad Crítica , Imagen Multimodal/métodos , Pandemias , Neumonía Viral , Respiración Artificial , Betacoronavirus/aislamiento & purificación , Estudios de Cohortes , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Enfermedad Crítica/epidemiología , Enfermedad Crítica/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Pronóstico , Sistema de Registros/estadística & datos numéricos , Respiración Artificial/métodos , Respiración Artificial/estadística & datos numéricos , Índice de Severidad de la Enfermedad
16.
Br J Hosp Med (Lond) ; 81(9): 1-9, 2020 Sep 02.
Artículo en Inglés | MEDLINE | ID: covidwho-807015

RESUMEN

Guidance regarding appropriate use of personal protective equipment in hospitals is in constant flux as research into SARS-COV-2 transmission continues to develop our understanding of the virus. The risk associated with procedures classed as 'aerosol generating' is under constant debate. Current guidance is largely based on pragmatic and cautious logic, as there is little scientific evidence of aerosolization and transmission of respiratory viruses associated with procedures. The physical properties of aerosol particles which may contain viable virus have implications for the safe use of personal protective equipment and infection control protocols. As elective work in the NHS is reinstated, it is important that the implications of the possibility of airborne transmission of the virus in hospitals are more widely understood. This will facilitate appropriate use of personal protective equipment and help direct further research into the true risks of aerosolization during these procedures to allow safe streamlining of services for staff and patients.


Asunto(s)
Microbiología del Aire , Infecciones por Coronavirus , Cuidados Críticos , Adhesión a Directriz/normas , Control de Infecciones , Pandemias , Equipo de Protección Personal , Neumonía Viral , Gestión de Riesgos/organización & administración , Aerosoles , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Cuidados Críticos/métodos , Cuidados Críticos/tendencias , Transmisión de Enfermedad Infecciosa/prevención & control , Humanos , Control de Infecciones/instrumentación , Control de Infecciones/métodos , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Reino Unido/epidemiología
17.
J Assoc Physicians India ; 68(10): 56-58, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-801766

RESUMEN

Covid-19 pandemic in India has rapidly grown though we have a low case fatality rate, high recovery rate and large population is asymptomatic or presymptomatic. Public health measures to close the tap across the country need hypervigilance and follow simple dictum of aggressive testing, tracing and isolation. The covid cases need an early diagnosis with treat and care model. Most can be managed with home isolation under telemedicine supervision with oxygen saturation screening by a simple six minute walk test. Hospitalised cases have emerging evidence in different therapies from antivirals, steroids, immunologic to heparins but high flow oxygen, prone position and supportive care remains the cornerstone in critical care with nursing and nutrition. Vaccine research is ongoing but currently only social vaccine can mitigate the pandemic. Covid appropriate behaviour of Masking, sanitisation and physical distancing with immune modulating behaviour like adequate sleep, digital detox for two hour and clean well ventilated environment is the key with breathing exercises including yoga and positive mental health and avoidance of crowds the only vaccine to live with covid -19 today.


Asunto(s)
Infecciones por Coronavirus , Pandemias , Neumonía Viral , Betacoronavirus , Cuidados Críticos , Humanos , India/epidemiología , Salud Pública
19.
Eur J Phys Rehabil Med ; 56(4): 515-524, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: covidwho-796869

RESUMEN

COVID-19 pandemic is rapidly spreading all over the world, creating the risk for a healthcare collapse. While acute care and intensive care units are the main pillars of the early response to the disease, rehabilitative medicine should play an important part in allowing COVID-19 survivors to reduce disability and optimize the function of acute hospital setting. The aim of this study was to share the experience and the international perspective of different rehabilitation centers, treating COVID-19 survivors. A group of Physical Medicine and Rehabilitation specialists from eleven different countries in Europe and North America have shared their clinical experience in dealing with COVID-19 survivors and how they have managed the re-organization of rehabilitation services. In our experience the most important sequelae of severe and critical forms of COVID-19 are: 1) respiratory; 2) cognitive, central and peripheral nervous system; 3) deconditioning; 4) critical illness related myopathy and neuropathy; 5) dysphagia; 6) joint stiffness and pain; 7) psychiatric. We analyze all these consequences and propose some practical treatment options, based on current evidence and clinical experience, as well as several suggestions for management of rehabilitation services and patients with suspected or confirmed infection by SARS-CoV-2. COVID-19 survivors have some specific rehabilitation needs. Experience from other centers may help colleagues in organizing their services and providing better care to their patients.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/rehabilitación , Cuidados Críticos/métodos , Pandemias , Medicina Física y Rehabilitación/organización & administración , Neumonía Viral/rehabilitación , Especialización , Infecciones por Coronavirus/epidemiología , Europa (Continente)/epidemiología , Humanos , Neumonía Viral/epidemiología
20.
BMJ Open ; 10(9): e040729, 2020 09 25.
Artículo en Inglés | MEDLINE | ID: covidwho-796628

RESUMEN

OBJECTIVES: Several physiological abnormalities that develop during COVID-19 are associated with increased mortality. In the present study, we aimed to develop a clinical risk score to predict the in-hospital mortality in COVID-19 patients, based on a set of variables available soon after the hospitalisation triage. SETTING: Retrospective cohort study of 516 patients consecutively admitted for COVID-19 to two Italian tertiary hospitals located in Northern and Central Italy were collected from 22 February 2020 (date of first admission) to 10 April 2020. PARTICIPANTS: Consecutive patients≥18 years admitted for COVID-19. MAIN OUTCOME MEASURES: Simple clinical and laboratory findings readily available after triage were compared by patients' survival status ('dead' vs 'alive'), with the objective of identifying baseline variables associated with mortality. These were used to build a COVID-19 in-hospital mortality risk score (COVID-19MRS). RESULTS: Mean age was 67±13 years (mean±SD), and 66.9% were male. Using Cox regression analysis, tertiles of increasing age (≥75, upper vs <62 years, lower: HR 7.92; p<0.001) and number of chronic diseases (≥4 vs 0-1: HR 2.09; p=0.007), respiratory rate (HR 1.04 per unit increase; p=0.001), PaO2/FiO2 (HR 0.995 per unit increase; p<0.001), serum creatinine (HR 1.34 per unit increase; p<0.001) and platelet count (HR 0.995 per unit increase; p=0.001) were predictors of mortality. All six predictors were used to build the COVID-19MRS (Area Under the Curve 0.90, 95% CI 0.87 to 0.93), which proved to be highly accurate in stratifying patients at low, intermediate and high risk of in-hospital death (p<0.001). CONCLUSIONS: The COVID-19MRS is a rapid, operator-independent and inexpensive clinical tool that objectively predicts mortality in patients with COVID-19. The score could be helpful from triage to guide earlier assignment of COVID-19 patients to the most appropriate level of care.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Cuidados Críticos , Vías Clínicas , Pandemias , Neumonía Viral , Medición de Riesgo/métodos , Triaje , Anciano , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Cuidados Críticos/métodos , Cuidados Críticos/estadística & datos numéricos , Vías Clínicas/organización & administración , Vías Clínicas/normas , Femenino , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Neumonía Viral/sangre , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Pronóstico , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Triaje/métodos , Triaje/estadística & datos numéricos
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