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3.
BMC Pulm Med ; 21(1): 96, 2021 Mar 20.
Artículo en Inglés | MEDLINE | ID: covidwho-1143203

RESUMEN

BACKGROUND: Gender-related factors might affect vulnerability to Covid-19. The aim of this study was to describe the role of gender on clinical features and 28-day mortality in Covid-19 patients. METHODS: Observational study of Covid-19 patients hospitalized in Bergamo, Italy, during the first three weeks of the outbreak. Medical records, clinical, radiological and laboratory findings upon admission and treatment have been collected. Primary outcome was 28-day mortality since hospitalization. RESULTS: 431 consecutive adult patients were admitted. Female patients were 119 (27.6%) with a mean age of 67.0 ± 14.5 years (vs 67.8 ± 12.5 for males, p = 0.54). Previous history of myocardial infarction, vasculopathy and former smoking habits were more common for males. At the time of admission PaO2/FiO2 was similar between men and women (228 [IQR, 134-273] vs 238 mmHg [150-281], p = 0.28). Continuous Positive Airway Pressure (CPAP) assistance was needed in the first 24 h more frequently in male patients (25.7% vs 13.0%; p = 0.006). Overall 28-day mortality was 26.1% in women and 38.1% in men (p = 0.018). Gender did not result an independent predictor of death once the parameters related to disease severity at presentation were included in the multivariable analysis (p = 0.898). Accordingly, the Kaplan-Meier survival analysis in female and male patients requiring CPAP or non-invasive ventilation in the first 24 h did not find a significant difference (p = 0.687). CONCLUSION: Hospitalized women are less likely to die from Covid-19; however, once severe disease occurs, the risk of dying is similar to men. Further studies are needed to better investigate the role of gender in clinical course and outcome of Covid-19.


Asunto(s)
/epidemiología , Anciano , Anciano de 80 o más Años , /fisiopatología , Comorbilidad , Presión de las Vías Aéreas Positiva Contínua/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Hipoxia/epidemiología , Hipoxia/fisiopatología , Hipoxia/terapia , Italia/epidemiología , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Ventilación no Invasiva/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Factores Sexuales , Fumar/epidemiología
5.
BMC Infect Dis ; 21(1): 241, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1119412

RESUMEN

BACKGROUND: Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm. METHOD: This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above (N = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26. RESULTS: Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427-0.903, P 0.013) and higher oxygen saturation. CONCLUSION: Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted.


Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Síndrome de Liberación de Citoquinas , Hipoxia , Interleucina-6/antagonistas & inhibidores , Neumonía Viral , /epidemiología , /fisiopatología , Ensayos de Uso Compasivo/estadística & datos numéricos , Síndrome de Liberación de Citoquinas/etiología , Síndrome de Liberación de Citoquinas/inmunología , Síndrome de Liberación de Citoquinas/terapia , Femenino , Humanos , Hipoxia/etiología , Hipoxia/terapia , India/epidemiología , Interleucina-6/inmunología , Masculino , Persona de Mediana Edad , Neumonía Viral/sangre , Neumonía Viral/etiología , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Respiración Artificial/métodos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Resultado del Tratamiento
6.
Crit Care ; 25(1): 80, 2021 02 24.
Artículo en Inglés | MEDLINE | ID: covidwho-1102347

RESUMEN

BACKGROUND: Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge of patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe gas exchange impairment. Helmet is an effective interface to provide continuous positive airway pressure (CPAP) noninvasively. We report data about the usefulness of helmet CPAP during pandemic, either as treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI). METHODS: In this observational study we collected data regarding patients failing standard oxygen therapy (i.e., non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients' data were recorded before, at initiation of CPAP treatment and once a day, thereafter. CPAP failure was defined as a composite outcome of intubation or death. RESULTS: A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full treatment and 28% of the DNI patients (P < 0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P < 0.001); respiratory rate decreased from 28 [22-32] to 24 [20-29] breaths per minute, P < 0.001). C-reactive protein, time to oxygen mask failure, age, PaO2/FiO2 during CPAP, number of comorbidities were independently associated with CPAP failure. Helmet CPAP was maintained for 6 [3-9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wards. CONCLUSIONS: Helmet CPAP treatment is feasible for several days outside the ICU, despite persistent impairment in gas exchange. It was used, without escalating to intubation, in the majority of full treatment patients after standard oxygen therapy failed. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival. TRIAL REGISTRATION: NCT04424992.


Asunto(s)
/complicaciones , Presión de las Vías Aéreas Positiva Contínua/métodos , Brotes de Enfermedades , Hipoxia/terapia , Neumonía Viral/terapia , Anciano , Estudios de Factibilidad , Femenino , Humanos , Hipoxia/virología , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Ventilación no Invasiva , Neumonía Viral/virología , Resultado del Tratamiento
7.
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
8.
J Emerg Nurs ; 47(2): 279-287.e1, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: covidwho-1071601

RESUMEN

INTRODUCTION: In March and April 2020 of the coronavirus disease 2019 pandemic, site clinical practice guidelines were implemented for prone positioning of patients with suspected coronavirus disease 2019 in hypoxic respiratory distress who are awake, alert, and spontaneously breathing. The purpose of this pandemic disaster practice improvement project was to measure changes in pulse oximetry associated with prone positioning of patients with coronavirus disease 2019 infection in adult acute respiratory distress or adult respiratory distress syndrome, who are awake, alert, spontaneously breathing, and nonintubated. METHODS: A retrospective chart review of patients who were coronavirus disease 2019 positive in the emergency department from March 30, 2020 to April 30, 2020 was conducted for patients with a room air pulse oximetry <90% and a preprone position pulse oximetry ≤94% who tolerated prone positioning for at least 30 minutes. The primary outcome was the change in pulse oximetry associated with prone positioning, measured on room air, with supplemental oxygen, and approximately 30 minutes after initiating prone positioning. Median and mean differences were compared with the Wilcoxon signed-rank test and paired t-test. RESULTS: Of the 440 patients with coronavirus disease 2019, 31 met inclusion criteria. Median pulse oximetry increased as 83% (interquartile range, 75%-86%) on room air, 90% (interquartile range, 89%-93%) with supplemental oxygen, and 96% (interquartile range, 94%-98%) with prone positioning (z = -4.48, P < .001). A total of 45% (n = 14) were intubated during their hospital stay, and 26% (n = 8) of the included patients died. DISCUSSION: In patients with coronavirus disease 2019 who are awake, alert, and spontaneously breathing, an initially low pulse oximetry reading improved with prone positioning. Future studies are needed to determine the association of prone positioning with subsequent endotracheal intubation and mortality.


Asunto(s)
/complicaciones , Posicionamiento del Paciente/métodos , /terapia , Femenino , Humanos , Hipoxia/complicaciones , Hipoxia/diagnóstico , Hipoxia/terapia , Intubación Intratraqueal , Masculino , Registros Médicos , Persona de Mediana Edad , New Jersey , Oximetría , Posición Prona , Estudios Retrospectivos
9.
A A Pract ; 14(14): e01360, 2020 Dec 17.
Artículo en Inglés | MEDLINE | ID: covidwho-1067373

RESUMEN

This single-center retrospective study evaluated a protocol for the intubation of patients with confirmed or suspected coronavirus disease 2019 (COVID-19). Twenty-one patients were intubated, 9 of whom were found to have COVID-19. Adherence to the airway management protocol was high. COVID-19 patients had lower peripheral capillary oxygen saturation by pulse oximetry (Spo2) nadirs during intubation (Spo2, 73% [72%-77%] vs 89% [86%-94%], P = .024), and a greater percentage experienced severe hypoxemia defined as Spo2 ≤80% (89% vs 25%, P = .008). The incidence of severe hypoxemia in COVID-19 patients should be considered in the development of guidelines that incorporate high-flow nasal cannula and noninvasive positive pressure ventilation.


Asunto(s)
/terapia , Hipoxia/terapia , Intubación Intratraqueal/métodos , Intubación e Inducción de Secuencia Rápida/métodos , Insuficiencia Respiratoria/terapia , Adulto , Anciano , Manejo de la Vía Aérea , Cánula , Femenino , Humanos , Hipoxia/prevención & control , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Laringoscopía , Masculino , Persona de Mediana Edad , Ventilación no Invasiva , Oximetría , Terapia por Inhalación de Oxígeno , Aisladores de Pacientes , Equipo de Protección Personal , Respiración con Presión Positiva , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
10.
Sci Rep ; 11(1): 2256, 2021 01 26.
Artículo en Inglés | MEDLINE | ID: covidwho-1049970

RESUMEN

Patients suffering from CVOID-19 mostly experience a benign course of the disease. Approximately 14% of SARS-CoV2 infected patients are admitted to a hospital. Cohorts exhibiting severe lung failure in the form of acute respiratory distress syndrome (ARDS) have been well characterized. Patients without ARDS but in need of supplementary oxygen have received much less attention. This study describes the diagnosis, symptoms, treatment and outcomes of hospitalized patients with COVID-19 needing oxygen support during their stay on regular ward. All 133 patients admitted to the RWTH Aachen university hospital with the diagnosis of COVID-19 were included in an observational registry. Clinical data sets were extracted from the hospital information system. This analysis includes all 57 patients requiring supplemental oxygen not admitted to the ICU. 57 patients needing supplemental oxygen and being treated outside the ICU were analyzed. Patients exhibited the typical set of symptoms for COVID-19. Of note, hypoxic patients mostly did not suffer from clinically relevant dyspnea despite oxygen saturations below 92%. Patients had fever for 7 [2-11] days and needed supplemental oxygen for 8 [5-13] days resulting in an overall hospitalization time of 12 [7-20] days. In addition, patients had persisting systemic inflammation with CRP levels remaining elevated until discharge or death. This description of COVID-19 patients requiring oxygen therapy should be taken into account when planning treatment capacity. Patients on oxygen need long-term inpatient care.


Asunto(s)
/terapia , Terapia por Inhalación de Oxígeno/métodos , Oxígeno/uso terapéutico , /virología , Anciano , Anciano de 80 o más Años , Disnea/terapia , Femenino , Hospitalización , Humanos , Hipoxia/terapia , Inflamación , Pacientes Internos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , ARN Viral , Sistema de Registros
11.
BMC Pulm Med ; 21(1): 25, 2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: covidwho-1024364

RESUMEN

BACKGROUND: Intermittent Prone Positioning (IPP) for Acute Respiratory Distress Syndrome (ARDS) decreases mortality. We present a program for IPP using expedient materials for settings of significant limitations in both overwhelmed established ICUs and particularly in low- and middle-income countries (LMICs) treating ARDS due to COVID-19 caused by SARS CoV-2. METHODS: The proning program evolved based on the principles of High Reliability Organizations (HROs) and Crew Resource Management (CRM). Patients with severe ARDS [PaO2:FiO2 ratio (PFr) ≤ 150 on FiO2 ≥ 0.6 and PEEP ≥ 5 cm H2O] received IPP. Patients were placed prone 16 h each day. When PFr was ≥ 200 for > 8 h supine IPP ceased. IPP used available materials without requiring additional work from the bedside team. Changes in PFr, PaCO2, and the SaO2:FiO2 ratio (SaFr) positionally were evaluated using t-statistics and ANOVA with Bonferroni correction (p < 0.017). RESULTS: Between 14APR2020 and 09MAY2020, at the peak of deaths in New York, there were 202 IPPs in 29 patients. Patients were 58.5 ± 1.7 years of age (37, 73), 76% male and had a body mass index (BMI) of 27.8 ± 0.8 (21, 38). Pressor agents were used in 76% and 17% received dialysis. The PFr prior to IPP was 107.5 ± 5.6 and 1 h after IPP was 155.7 ± 11.2 (p < 0.001 compared to pre-prone). PFr after the patients were placed supine was 131.5 ± 9.1 (p = 0.02). Pre-prone PaCO2 was 60.0 ± 2.5 and the 1-h post-prone PaCO2 was 67.2 ± 3.1 (p = 0.02). Supine PaCO2 after IPP was 60.4 ± 3.4 (p = 0.90). The SaFr prior to IPP was 121.3 ± 4.2 and the SaFr 1 h after positioning was 131.5 ± 5.1 (p = 0.03). The post-IPP supine SaFr was 139.7 ± 5.9 (p < 0.001). With ANOVA and Bonferroni correction there were statistically significant changes in PFr (p < 0.001) and SaFr (p < 0.001) and no significant changes in PaCO2 over the four time points measured. Using regression coefficients, the SaFrs predicted by PFrs of 150 and 200 at baseline are 133.2 and 147.3, respectively. CONCLUSIONS: An IPP program for patients with COVID-19 ARDS can be instituted rapidly, safely, and effectively during an overwhelming mass casualty scenario. This approach may be equally applicable in both traditionally austere environments in LMICs and in otherwise capable centers facing situational resource limitations.


Asunto(s)
/complicaciones , Hipoxia/etiología , Hipoxia/terapia , Posicionamiento del Paciente/métodos , Posicionamiento del Paciente/normas , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Adulto , Anciano , Protocolos Clínicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Posición Prona , Estudios Prospectivos , Índice de Severidad de la Enfermedad
12.
BMJ Case Rep ; 14(1)2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1015618

RESUMEN

As of 28 October 2020, there are over 44 000 000 confirmed COVID-19 infections and over 1 000 000 deaths worldwide, including 945 367 infections and 45 765 deaths in the UK. Acute respiratory distress syndrome occurs in 50% of patients with secondary haemophagocytic lymphohistiocytosis, a hyperinflammatory syndrome characterised by a surge of cytokines, including interleukin 6 (IL-6). Here we describe the case of the first patient with severe COVID-19 pneumonia successfully treated with tocilizumab, a humanised monoclonal antibody against the IL-6 receptor, in the UK. Early treatment (after 7-10 days from the onset of symptoms) with tocilizumab could (1) reduce the risk of requiring non-invasive or invasive ventilation; (2) offer a chance of survival to people who are not fit for escalation or have refused to be ventilated; and (3) potentially increase the chance of survival in some patients who are already ventilated but fail to improve with supportive treatment.


Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Hipoxia/terapia , Anciano , /fisiopatología , Diabetes Mellitus Tipo 2/complicaciones , Humanos , Hipertensión/complicaciones , Hipoxia/fisiopatología , Masculino , Terapia por Inhalación de Oxígeno , Receptores de Interleucina-6/antagonistas & inhibidores , Índice de Severidad de la Enfermedad
13.
A A Pract ; 14(9): e01287, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-992616

RESUMEN

Methemoglobinemia is a rare disorder of the blood in which there is an increase in methemoglobin, which occurs when hemoglobin is present in the oxidized form. Methemoglobin impairs hemoglobin's ability to transport oxygen, produces functional anemia, and leads to tissue hypoxia. We report the successful management of a case of refractory hypoxia due to acutely acquired methemoglobinemia in a patient undergoing treatment for coronavirus disease 2019 (COVID-19) pneumonia. The cause of methemoglobinemia in this patient remains unknown. Hypoxia and methemoglobinemia did not respond to methylene blue and required administration of packed red blood cell transfusions.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Hipoxia/etiología , Metahemoglobinemia/complicaciones , Neumonía Viral/complicaciones , Insuficiencia Respiratoria/etiología , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/terapia , Anciano , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antioxidantes/uso terapéutico , Ácido Ascórbico/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Corynebacterium , Infecciones por Corynebacterium/complicaciones , Infecciones por Corynebacterium/terapia , Síndrome de Liberación de Citoquinas/complicaciones , Inhibidores Enzimáticos/uso terapéutico , Transfusión de Eritrocitos , Hematínicos/uso terapéutico , Humanos , Hidroxocobalamina/uso terapéutico , Hidroxicloroquina/uso terapéutico , Hipoxia/terapia , Masculino , Metahemoglobinemia/terapia , Azul de Metileno/uso terapéutico , Pandemias , Neumonía Bacteriana/complicaciones , Neumonía Bacteriana/terapia , Neumonía Viral/tratamiento farmacológico , Terapia de Reemplazo Renal , Insuficiencia Respiratoria/terapia , Choque Séptico/complicaciones
14.
BMC Pulm Med ; 20(1): 324, 2020 Dec 24.
Artículo en Inglés | MEDLINE | ID: covidwho-992471

RESUMEN

BACKGROUND: It had been shown that High-flow nasal cannula (HFNC) is an effective initial support strategy for patients with acute respiratory failure. However, the efficacy of HFNC for patients with COVID-19 has not been established. This study was performed to assess the efficacy of HFNC for patients with COVID-19 and describe early predictors of HFNC treatment success in order to develop a prediction tool that accurately identifies the need for upgrade respiratory support therapy. METHODS: We retrospectively reviewed the medical records of patients with COVID-19 treated by HFNC in respiratory wards of 2 hospitals in Wuhan between 1 January and 1 March 2020. Overall clinical outcomes, the success rate of HFNC strategy and related respiratory variables were evaluated. RESULTS: A total of 105 patients were analyzed. Of these, 65 patients (61.9%) showed improved oxygenation and were successfully withdrawn from HFNC. The PaO2/FiO2 ratio, SpO2/FiO2 ratio and ROX index (SpO2/FiO2*RR) at 6h, 12h and 24h of HFNC initiation were closely related to the prognosis. The ROX index after 6h of HFNC initiation (AUROC, 0.798) had good predictive capacity for outcomes of HFNC. In the multivariate logistic regression analysis, young age, gender of female, and lower SOFA score all have predictive value, while a ROX index greater than 5.55 at 6 h after initiation was significantly associated with HFNC success (OR, 17.821; 95% CI, 3.741-84.903 p<0.001). CONCLUSIONS: Our study indicated that HFNC was an effective way of respiratory support in the treatment of COVID-19 patients. The ROX index after 6h after initiating HFNC had good predictive capacity for HFNC outcomes.


Asunto(s)
/terapia , Hipoxia/terapia , Terapia por Inhalación de Oxígeno/métodos , Oxígeno/administración & dosificación , Oxígeno/sangre , Anciano , /fisiopatología , Cánula , Femenino , Humanos , Hipoxia/fisiopatología , Hipoxia/virología , Masculino , Persona de Mediana Edad , Presión Parcial , Frecuencia Respiratoria , Estudios Retrospectivos , Resultado del Tratamiento
15.
Eur Rev Med Pharmacol Sci ; 24(23): 12527-12535, 2020 12.
Artículo en Inglés | MEDLINE | ID: covidwho-995013

RESUMEN

Since December 2019, an outbreak of a new coronavirus, COVID-19, infection has been taking place. At present, COVID-19 has spread to most countries worldwide. The latest evidence suggests that cytokine storm syndrome (CSS) is an important cause of the transition from mild to critical pneumonia and critically ill patients' death. The sudden exacerbation of COVID-19 may be related to a cytokine storm. Therefore, early identification and active treatment of CSS may play very important roles in improving the patients' prognosis, and these tasks are given attention in the current treatment of new Coronavirus pneumonia. However, there is still no specific medicine for this purpose. This article reviews cytokine storms and conducts an exploratory review of pharmacotherapy for cytokine storms to provide a reference for clinical treatment.


Asunto(s)
/inmunología , Síndrome de Liberación de Citoquinas/inmunología , Miocarditis/inmunología , /metabolismo , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antioxidantes/uso terapéutico , Apoptosis , Factor Natriurético Atrial/uso terapéutico , Azetidinas/uso terapéutico , Compuestos de Bencilo/uso terapéutico , Síndrome de Liberación de Citoquinas/tratamiento farmacológico , Inhibidores Enzimáticos/uso terapéutico , Glucocorticoides/uso terapéutico , Glicoproteínas/uso terapéutico , Humanos , Hipoxia/metabolismo , Hipoxia/terapia , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Isquemia Miocárdica/metabolismo , Miocarditis/metabolismo , Miocarditis/terapia , Miocitos Cardíacos/metabolismo , Estrés Oxidativo , Terapia por Inhalación de Oxígeno , Respiración Artificial , Moduladores de los Receptores de fosfatos y esfingosina 1/uso terapéutico , Inhibidores de Tripsina/uso terapéutico , Inhibidores del factor de Necrosis Tumorales/uso terapéutico , alfa-Metiltirosina/uso terapéutico
17.
Med Hypotheses ; 146: 110421, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: covidwho-974427

RESUMEN

BACKGROUND: Infection with SARS-CoV-2 is responsible for the COVID-19 crisis affecting the whole world. This virus can provoke acute respiratory distress syndrome (ARDS) leading to overcrowed the intensive care unit (ICU). Over the last months, worldwide experience demonstrated that the ARDS in COVID-19 patients are in many ways "atypical". The mortality rate in ventilated patients is high despite the application of the gold standard treatment (protective ventilation, curare, prone position, inhaled NO). Several studies suggested that the SARS-CoV-2 could interact negatively on red blood cell homeostasis. Furthermore, SarsCov2 creates Reactive Oxygen Species (ROS), which are toxic and generate endothelial dysfunction. Hypothesis/objective(s) We hypothesis that HEMO2Life® administrated intravenously is safe and could help symptomatically the patient condition. It would increase arterial oxygen content despite lung failure and allow better tissue oxygenation control. The use of HEMO2Life® is also interesting due to its anti-oxidative effect preventing cytokine storm induced by the SARS-CoV-2. Evaluation of the hypothesis: Hemarina is based on the properties of the hemoglobin of the Arenicola marina sea-worm (HEMO2Life®). This extracellular hemoglobin has an oxygen capacity 40 times greater than the hemoglobin of vertebrates. Furthermore, the size of this molecule is 250 times smaller than a human red blood cell, allowing it to diffuse in all areas of the microcirculation, without diffusing outside the vascular sector. It possesses an antioxidative property du a Superoxide Dismutase Activity. This technology has been the subject of numerous publications and HEMO2Life® was found to be well-tolerated and did not induce toxicity. It was administered intravenously to hamsters and rats, and showed no acute effect on heart rate and blood pressure and did not cause microvascular vasoconstriction. In preclinical in vivo models (mice, rats, and dogs), HEMO2Life® has enabled better tissue oxygenation, especially in the brain. This molecule has already been used in humans in organ preservation solutions and the patients showed no abnormal clinical signs. CONSEQUENCES OF THE HYPOTHESIS: The expected benefits of HEMO2Life® for COVID-19 patients are improved survival, avoidance of tracheal intubation, shorter oxygen supplementation, and the possibility of treating a larger number of patients as molecular respirator without to use an invasive machine.


Asunto(s)
/complicaciones , Hemoglobinas/uso terapéutico , Hipoxia/etiología , Hipoxia/terapia , Modelos Biológicos , Oxígeno/administración & dosificación , Animales , Cricetinae , Perros , Hemoglobinas/administración & dosificación , Hemoglobinas/metabolismo , Humanos , Hipoxia/fisiopatología , Inyecciones Intravenosas , Ratones , Estrés Oxidativo/efectos de los fármacos , Oxígeno/metabolismo , Pandemias , Ratas , Investigación en Medicina Traslacional
18.
S Afr Med J ; 110(12): 1168-1171, 2020 10 08.
Artículo en Inglés | MEDLINE | ID: covidwho-948164

RESUMEN

The COVID-19 pandemic has placed significant strain on the oxygen delivery infrastructure of health facilities in resource-constrained health systems. In this case report, we describe a patient with severe COVID-19 pneumonia who was managed with high-flow nasal oxygen for 40 days, with an eventual successful outcome. We discuss the oxygen delivery infrastructure needed to offer this intervention, as well as the psychosocial impact on those undergoing treatment.


Asunto(s)
Anticoagulantes/uso terapéutico , Glucocorticoides/uso terapéutico , Hipoxia/terapia , Terapia por Inhalación de Oxígeno/métodos , Oxígeno/provisión & distribución , Posicionamiento del Paciente/métodos , Sistemas de Apoyo Psicosocial , Antibacterianos/uso terapéutico , Ansiedad/psicología , Ansiedad/terapia , Análisis de los Gases de la Sangre , /fisiopatología , Cánula , Citalopram/uso terapéutico , Consejo , Dexametasona/uso terapéutico , Progresión de la Enfermedad , Enoxaparina/uso terapéutico , Inhibidores del Factor Xa/sangre , Femenino , Neumonía Asociada a la Atención Médica/complicaciones , Neumonía Asociada a la Atención Médica/diagnóstico , Neumonía Asociada a la Atención Médica/tratamiento farmacológico , Hematoma/inducido químicamente , Humanos , Hipoxia/sangre , Hipoxia/fisiopatología , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno/psicología , Grupo de Atención al Paciente , Posicionamiento del Paciente/psicología , Combinación Piperacilina y Tazobactam/uso terapéutico , Posición Prona , Psiquiatría , Resiliencia Psicológica , Inhibidores de la Captación de Serotonina/uso terapéutico , Índice de Severidad de la Enfermedad , Servicio de Asistencia Social en Hospital , Muslo , Resultado del Tratamiento
19.
BMJ Open ; 10(11): e041520, 2020 11 11.
Artículo en Inglés | MEDLINE | ID: covidwho-920921

RESUMEN

INTRODUCTION: Prone positioning (PP) is an effective first-line intervention to treat patients with moderate to severe acute respiratory distress syndrome (ARDS) receiving invasive mechanical ventilation, as it improves gas exchanges and reduces mortality. The use of PP in awake spontaneous breathing patients with ARDS secondary to COVID-19 was reported to improve oxygenation in few retrospective trials with small sample size. High-level evidence of awake PP for hypoxaemic patients with COVID-19 patients is still lacking. METHODS AND ANALYSIS: The protocol of this meta-trial is a prospective collaborative individual participant data meta-analysis of randomised controlled open label superiority trials. This design is particularly adapted to a rapid scientific response in the pandemic setting. It will take place in multiple sites, among others in USA, Canada, Ireland, France and Spain. Patients will be followed up for 28 days. Patients will be randomised to receive whether awake PP and nasal high flow therapy or standard medical treatment and nasal high flow therapy. Primary outcome is defined as the occurrence rate of tracheal intubation or death up to day 28. An interim analysis plan has been set up on aggregated data from the participating research groups. ETHICS AND DISSEMINATION: Ethics approvals were obtained in all participating countries. Results of the meta-trial will be submitted for publication in a peer-reviewed journal. Each randomised controlled trial was registered individually, as follows: NCT04325906, NCT04347941, NCT04358939, NCT04395144 and NCT04391140.


Asunto(s)
Infecciones por Coronavirus/terapia , Hipoxia/terapia , Terapia por Inhalación de Oxígeno/métodos , Posicionamiento del Paciente/métodos , Neumonía Viral/terapia , Posición Prona , Betacoronavirus , Cánula , Estudios de Equivalencia como Asunto , Humanos , Metaanálisis como Asunto , Pandemias , Ensayos Clínicos Controlados Aleatorios como Asunto , Vigilia
20.
Cardiol Rev ; 29(1): 39-42, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-900593

RESUMEN

Patients older than 65 years hospitalized with COVID-19 have higher rates of intensive care unit admission and death when compared with younger patients. Cardiovascular conditions associated with COVID-19 include myocardial injury, acute myocarditis, cardiac arrhythmias, cardiomyopathies, cardiogenic shock, thromboembolic disease, and cardiac arrest. Few studies have described the clinical course of those at the upper extreme of age. We characterize the clinical course and outcomes of 73 patients with 80 years of age or older hospitalized at an academic center between March 15 and May 13, 2020. These patients had multiple comorbidities and often presented with atypical clinical findings such as altered sensorium, generalized weakness and falls. Cardiovascular manifestations observed at the time of presentation included new arrhythmia in 7/73 (10%), stroke/intracranial hemorrhage in 5/73 (7%), and elevated troponin in 27/58 (47%). During hospitalization, 38% of all patients required intensive care, 13% developed a need for renal replacement therapy, and 32% required vasopressor support. All-cause mortality was 47% and was highest in patients who were ever in intensive care (71%), required mechanical ventilation (83%), or vasopressors (91%), or developed a need for renal replacement therapy (100%). Patients older than 80 years old with COVID-19 have multiple unique risk factors which can be associated with increased cardiovascular involvement and death.


Asunto(s)
Lesión Renal Aguda/terapia , Mortalidad Hospitalaria , Terapia de Reemplazo Renal/estadística & datos numéricos , Respiración Artificial/estadística & datos numéricos , Vasoconstrictores/uso terapéutico , Centros Médicos Académicos , Accidentes por Caídas , Lesión Renal Aguda/etiología , Anciano de 80 o más Años , Arritmias Cardíacas/etiología , Arritmias Cardíacas/fisiopatología , Aspartato Aminotransferasas/metabolismo , Proteína C-Reactiva/metabolismo , /metabolismo , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/metabolismo , Enfermedades Cardiovasculares/fisiopatología , Causas de Muerte , Trastornos de la Conciencia/fisiopatología , Disnea/fisiopatología , Femenino , Ferritinas/metabolismo , Fiebre/fisiopatología , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Hospitalización , Humanos , Hipoxia/fisiopatología , Hipoxia/terapia , Vida Independiente , Unidades de Cuidados Intensivos/estadística & datos numéricos , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/fisiopatología , Recuento de Leucocitos , Hepatopatías/etiología , Hepatopatías/metabolismo , Recuento de Linfocitos , Masculino , Debilidad Muscular/fisiopatología , Péptido Natriurético Encefálico/metabolismo , Casas de Salud , Terapia por Inhalación de Oxígeno , Polipéptido alfa Relacionado con Calcitonina/metabolismo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Troponina I/metabolismo
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