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2.
BMC Anesthesiol ; 20(1): 232, 2020 09 14.
Artículo en Inglés | MEDLINE | ID: covidwho-757603

RESUMEN

BACKGROUND: The challenges posed by the spread of COVID-19 disease through aerosols have compelled anesthesiologists to modify their airway management practices. Devices such as barrier boxes are being considered as potential adjuncts to full PPE's to limit the aerosol spread. Usage of the barrier box raises concerns of delay in time to intubate (TTI). We designed our study to determine if using a barrier box with glidescope delays TTI within acceptable parameters to make relevant clinical conclusions. METHODS: Seventy-eight patients were enrolled in this prospective non-inferiority controlled trial and were randomly allocated to either group C (without the barrier box) or the study group BB (using barrier box). The primary measured endpoint is time to intubate (TTI), which is defined as time taken from loss of twitches confirmed with a peripheral nerve stimulator to confirmation of end-tidal CO 2. 15 s was used as non-inferiority margin for the purpose of the study. We used an unpaired two-sample single-sided t-test to test our non- inferiority hypothesis (H 0: Mean TTI diff ≥15 s, H A: Mean TTI diff < 15 s). Secondary endpoints include the number of attempts at intubation, lowest oxygen saturation during induction, and the need for bag-mask ventilation. RESULTS: Mean TTI in group C was 42 s (CI 19.2 to 64.8) vs. 52.1 s (CI 26.1 to 78) in group BB. The difference in mean TTI was 10.1 s (CI -∞ to 14.9). We rejected the null hypothesis and concluded with 95% confidence that the difference of the mean TTI between the groups is less than < 15 s (95% CI -∞ to 14.9,p = 0.0461). Our induction times were comparable (67.7 vs. 65.9 s).100% of our patients were intubated on the first attempt in both groups. None of our patients needed rescue breaths. CONCLUSIONS: We conclude that in patients with normal airway exam, scheduled for elective surgeries, our barrier box did not cause any clinically significant delay in TTI when airway manipulation is performed by well-trained providers. The study was retrospectively registered at clinicaltrials.gov (NCT04411056) on May 27, 2020.


Asunto(s)
Manejo de la Vía Aérea/métodos , Anestesiología/métodos , Infecciones por Coronavirus/terapia , Intubación Intratraqueal/métodos , Neumonía Viral/terapia , Adulto , Aerosoles , Anciano , Manejo de la Vía Aérea/instrumentación , Anestesiólogos/organización & administración , Anestesiología/instrumentación , Infecciones por Coronavirus/prevención & control , Procedimientos Quirúrgicos Electivos/métodos , Femenino , Humanos , Intubación Intratraqueal/instrumentación , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/prevención & control , Estudios Prospectivos , Respiración Artificial/métodos , Factores de Tiempo
3.
PLoS One ; 16(3): e0238825, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1138567

RESUMEN

BACKGROUND: Superinfections, including invasive pulmonary aspergillosis (IPA), are well-known complications of critically ill patients with severe viral pneumonia. Aim of this study was to evaluate the incidence, risk factors and outcome of IPA in critically ill patients with severe COVID-19 pneumonia. METHODS: We prospectively screened 32 critically ill patients with severe COVID-19 pneumonia for a time period of 28 days using a standardized study protocol for oberservation of developement of COVID-19 associated invasive pulmonary aspergillosis (CAPA). We collected laboratory, microbiological, virological and clinical parameters at defined timepoints in combination with galactomannan-antigen-detection from nondirected bronchial lavage (NBL). We used logistic regression analyses to assess if COVID-19 was independently associated with IPA and compared it with matched controls. FINDINGS: CAPA was diagnosed at a median of 4 days after ICU admission in 11/32 (34%) of critically ill patients with severe COVID-19 pneumonia as compared to 8% in the control cohort. In the COVID-19 cohort, mean age, APACHE II score and ICU mortality were higher in patients with CAPA than in patients without CAPA (36% versus 9.5%; p<0.001). ICU stay (21 versus 17 days; p = 0.340) and days of mechanical ventilation (20 versus 15 days; p = 0.570) were not different between both groups. In regression analysis COVID-19 and APACHE II score were independently associated with IPA. INTERPRETATION: CAPA is highly prevalent and associated with a high mortality rate. COVID-19 is independently associated with invasive pulmonary aspergillosis. A standardized screening and diagnostic approach as presented in our study can help to identify affected patients at an early stage.


Asunto(s)
/complicaciones , Aspergilosis Pulmonar Invasiva/etiología , Neumonía Viral/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Líquido del Lavado Bronquioalveolar/microbiología , Líquido del Lavado Bronquioalveolar/virología , /virología , Enfermedad Crítica , Femenino , Humanos , Unidades de Cuidados Intensivos , Aspergilosis Pulmonar Invasiva/microbiología , Aspergilosis Pulmonar Invasiva/virología , Masculino , Mananos/metabolismo , Persona de Mediana Edad , Neumonía Viral/microbiología , Neumonía Viral/virología , Estudios Prospectivos , Respiración Artificial/métodos , Sobreinfección/etiología , Sobreinfección/microbiología
4.
BMJ Case Rep ; 14(3)2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: covidwho-1138313

RESUMEN

A 31-year-old pregnant woman presented with symptomatic COVID-19, which was complicated by progressive hypoxaemia requiring intensive care and emergent delivery by caesarean section. Afterward, she was successfully supported with mechanical ventilation and prone positioning and ultimately recovered. We review literature regarding complications of COVID-19 affecting pregnancy and evidence-based treatment strategies.


Asunto(s)
/terapia , Cesárea , Posicionamiento del Paciente/métodos , Complicaciones Infecciosas del Embarazo/terapia , Respiración Artificial/métodos , Adulto , Femenino , Humanos , Embarazo , Posición Prona
5.
Medicine (Baltimore) ; 100(11): e24771, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: covidwho-1138013

RESUMEN

ABSTRACT: As an international tourist center, Hainan province includes both imported and local COVID-19 cases. This study aimed to investigate the clinical characteristics and outcomes of COVID-19 patients in Hainan, China.COVID-19 patients hospitalized in Hainan affiliated Hospital of Hainan Medical University in January to March 2020 were retrospectively assessed. Routine blood tests, blood gas analyses, and computed tomography imaging were performed within 24 hours. Virus nucleic acid was detected every other day. The patients were divided into local resident and traveler groups, and differences in clinical data as well as leukocyte, lymphocyte, and neutrophil levels were analyzed.A total of 70 patients aged 51.23 ±â€Š13.54 years were assessed, including 16 local residents and 54 travelers. Of these, 55 cases (78.6%) had fever, 47 (67.1%) had cough and sputum, and 9 (12.9%) had chest dyspnea; 60 and 10 cases were mild/common and severe/critical, respectively. Sex, basic diseases, smoking history and drinking history, Charlson Comorbidity Index, symptoms, time of onset to admission, clinical severity, white blood cell count, lymphocyte count, neutrophil count, oxygen inhalation, mechanical ventilation, glucocorticoid therapy, treatment, admission to ICU, hospital stay, and mortality were similar between the 2 groups.The warm and humid climate of Hainan does not seem to significantly affect patient features and outcomes from COVID-19. Unnecessary travel to tourist areas should be avoided.


Asunto(s)
/epidemiología , /terapia , Adulto , Anciano , China/epidemiología , Tos/epidemiología , Tos/virología , Femenino , Fiebre/epidemiología , Fiebre/virología , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno/métodos , Respiración Artificial/métodos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Viaje , Resultado del Tratamiento
6.
Crit Care Med ; 49(3): 490-502, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1135909

RESUMEN

OBJECTIVES: Prone position ventilation is a potentially life-saving ancillary intervention but is not widely adopted for coronavirus disease 2019 or acute respiratory distress syndrome from other causes. Implementation of lung-protective ventilation including prone positioning for coronavirus disease 2019 acute respiratory distress syndrome is limited by isolation precautions and personal protective equipment scarcity. We sought to determine the safety and associated clinical outcomes for coronavirus disease 2019 acute respiratory distress syndrome treated with prolonged prone position ventilation without daily repositioning. DESIGN: Retrospective single-center study. SETTING: Community academic medical ICU. PATIENTS: Sequential mechanically ventilated patients with coronavirus disease 2019 acute respiratory distress syndrome. INTERVENTIONS: Lung-protective ventilation and prolonged protocolized prone position ventilation without daily supine repositioning. Supine repositioning was performed only when Fio2 less than 60% with positive end-expiratory pressure less than 10 cm H2O for greater than or equal to 4 hours. MEASUREMENTS AND MAIN RESULTS: Primary safety outcome: proportion with pressure wounds by Grades (0-4). Secondary outcomes: hospital survival, length of stay, rates of facial and limb edema, hospital-acquired infections, device displacement, and measures of lung mechanics and oxygenation. Eighty-seven coronavirus disease 2019 patients were mechanically ventilated. Sixty-one were treated with prone position ventilation, whereas 26 did not meet criteria. Forty-two survived (68.9%). Median (interquartile range) time from intubation to prone position ventilation was 0.28 d (0.11-0.80 d). Total prone position ventilation duration was 4.87 d (2.08-9.97 d). Prone position ventilation was applied for 30.3% (18.2-42.2%) of the first 28 days. Pao2:Fio2 diverged significantly by day 3 between survivors 147 (108-164) and nonsurvivors 107 (85-146), mean difference -9.632 (95% CI, -48.3 to 0.0; p = 0·05). Age, driving pressure, day 1, and day 3 Pao2:Fio2 were predictive of time to death. Thirty-eight (71.7%) developed ventral pressure wounds that were associated with prone position ventilation duration and day 3 Sequential Organ Failure Assessment. Limb weakness occurred in 58 (95.1%) with brachial plexus palsies in five (8.2%). Hospital-acquired infections other than central line-associated blood stream infections were infrequent. CONCLUSIONS: Prolonged prone position ventilation was feasible and relatively safe with implications for wider adoption in treating critically ill coronavirus disease 2019 patients and acute respiratory distress syndrome of other etiologies.


Asunto(s)
/complicaciones , Evaluación de Procesos y Resultados en Atención de Salud , Posicionamiento del Paciente , Respiración Artificial/métodos , Insuficiencia Respiratoria/terapia , Centros Médicos Académicos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Posición Prona , Insuficiencia Respiratoria/etiología , Estudios Retrospectivos , Estados Unidos/epidemiología
7.
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
8.
BMJ Case Rep ; 14(3)2021 Mar 02.
Artículo en Inglés | MEDLINE | ID: covidwho-1115107

RESUMEN

The COVID-19 pandemic has dealt a devastating blow to healthcare systems globally. Approximately 3.2% of patients infected with COVID-19 require invasive ventilation during the course of the illness. Within this population, 25% of patients are affected with neurological manifestations. Among those who are affected by severe neurological manifestations, some may have acute cerebrovascular complications (5%), impaired consciousness (15%) or exhibit skeletal muscle hypokinesis (20%). The cause of the severe cognitive impairment and hypokinesis is unknown at this time. Potential causes include COVID-19 viral encephalopathy, toxic metabolic encephalopathy, post-intensive care unit syndrome and cerebrovascular pathology. We present a case of a 60 year old patient who sustained a prolonged hospitalization with COVID-19, had a cerebrovascular event and developed a persistent unexplained encephalopathy along with a hypokinetic state. He was treated successfully with modafinil and carbidopa/levodopa showing clinical improvement within 3-7 days and ultimately was able to successfully discharge home.


Asunto(s)
Encefalopatías , Carbidopa/administración & dosificación , Hipocinesia , Levodopa/administración & dosificación , Modafinilo/administración & dosificación , Rehabilitación/métodos , /aislamiento & purificación , Coagulación Sanguínea , Encefalopatías/fisiopatología , Encefalopatías/virología , /complicaciones , /terapia , Estimulantes del Sistema Nervioso Central/administración & dosificación , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/etiología , Cuidados Críticos/métodos , Combinación de Medicamentos , Humanos , Hipocinesia/diagnóstico , Hipocinesia/etiología , Hipocinesia/terapia , /etiología , /terapia , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Respiración Artificial/métodos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Desconexión del Ventilador/métodos
9.
Chest ; 159(3): e159-e162, 2021 03.
Artículo en Inglés | MEDLINE | ID: covidwho-1108124

RESUMEN

CASE PRESENTATION: A 78-year-old woman was admitted to the ED with a 10-day history of diarrhea and recent onset of dry cough, fever, and asthenia. She had a medical history of obesity (BMI 32) and arterial hypertension treated with irbesartan. In the context of a large-scale lockdown in France during the COVID-19 pandemic, she only had physical contact with her husband, who did not report any symptoms. She required mechanical ventilation because of severe hypoxemia within 1 hour after admission to the ED.


Asunto(s)
/métodos , Pulmón/diagnóstico por imagen , Respiración Artificial/métodos , Insuficiencia Respiratoria , Tomografía Computarizada por Rayos X/métodos , Anciano , /epidemiología , /terapia , Comorbilidad , Diagnóstico Diferencial , Diarrea/diagnóstico , Diarrea/etiología , Femenino , Humanos , Obesidad/diagnóstico , Obesidad/epidemiología , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Resultado del Tratamiento
10.
Am J Nurs ; 121(3): 28-38, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1099630

RESUMEN

ABSTRACT: To assist nurses caring for hospitalized adults with coronavirus disease 2019 (COVID-19), the authors synthesize evidence-based information on the disease, providing background on the epidemiology and history of severe acute respiratory syndrome coronavirus 2, the causative virus. They also discuss the risks for severe effects of the illness, the multiple signs and symptoms hospitalized adults with COVID-19 may manifest, and the precautions hospitals should take to keep health care providers and patients safe during the course of this pandemic.


Asunto(s)
/enfermería , Control de Infecciones/métodos , Adulto , /fisiopatología , Femenino , Humanos , Masculino , Pandemias , Respiración Artificial/métodos , Factores de Riesgo , Índice de Severidad de la Enfermedad
12.
Curr Opin Pulm Med ; 27(3): 169-175, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1091192

RESUMEN

PURPOSE OF REVIEW: Coronavirus disease 2019 (COVID-19) is an acute multisystem disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Investigations are ongoing in the search for effective therapeutics, with clinical approaches evolving based upon such evidence. RECENT FINDINGS: The antiviral agent, remdesivir, and the immunomodulator, dexamethasone, are the first therapeutics for which there is evidence of efficacy from randomized trials. Subgroup analyses suggest remdesivir is beneficial in hospitalized patients whose severity of illness falls at the lower end of the spectrum, while dexamethasone is more beneficial in hospitalized patients whose severity of illness falls at the higher end of the spectrum. We recommend that inpatients who require supplemental oxygen but are not mechanically ventilated receive both remdesivir and dexamethasone, and inpatients who require mechanical ventilation receive dexamethasone monotherapy. Additional evidence regarding anti-SARS-CoV-2 antibodies, convalescent plasma, and a variety of antiinterleukin therapies is forthcoming. SUMMARY: The body of evidence related to COVID-19 therapeutics continues to evolve and, as a result, management is likely to change with time. As new evidence is generated and published, the optimal approach to managing patients with COVID-19 should be reconsidered.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Dexametasona/farmacología , Respiración Artificial/métodos , Adenosina Monofosfato/farmacología , Alanina/farmacología , Antivirales/farmacología , Humanos , Inmunización Pasiva/métodos , Factores Inmunológicos/farmacología , Selección de Paciente , /efectos de los fármacos
13.
Cardiol Young ; 30(9): 1346-1349, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-1083646

RESUMEN

We present our recent experience with a 6-month-old infant with a personal history of short bowel syndrome that presented with fever, cyanosis, and cardiogenic shock secondary to severe pulmonary hypertension and right ventricular failure without pulmonary thromboembolism. He did not present signs of toxin-mediated disease or Kawasaki disease. He was finally diagnosed with SARS-CoV-2 infection. If this presentation is confirmed in future research, the severe cardiovascular impairment in children with COVID-19 could be also attributable to the primary pulmonary infection, not only to a multisystem inflammatory syndrome but also in children without heart disease.


Asunto(s)
Angiografía por Tomografía Computarizada , Infecciones por Coronavirus , Insuficiencia Cardíaca , Hipertensión Pulmonar , Pandemias , Neumonía Viral , Choque Cardiogénico , Síndrome de Respuesta Inflamatoria Sistémica , Betacoronavirus/aislamiento & purificación , Angiografía por Tomografía Computarizada/métodos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Cuidados Críticos/métodos , Ecocardiografía/métodos , Electrocardiografía/métodos , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/etiología , Lactante , Masculino , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Radiografía Torácica , Respiración Artificial/métodos , Índice de Severidad de la Enfermedad , Choque Cardiogénico/diagnóstico , Choque Cardiogénico/etiología , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/fisiopatología , Resultado del Tratamiento
14.
PLoS One ; 16(2): e0246318, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1079358

RESUMEN

BACKGROUND: Insight into COVID-19 intensive care unit (ICU) patient characteristics, rates and risks of invasive mechanical ventilation (IMV) and associated outcomes as well as any regional discrepancies is critical in this pandemic for individual case management and overall resource planning. METHODS AND FINDINGS: Electronic searches were performed for reports through May 1 2020 and reports on COVID-19 ICU admissions and outcomes were included using predefined search terms. Relevant data was subsequently extracted and pooled using fixed or random effects meta-analysis depending on heterogeneity. Study quality was assessed by the NIH tool and heterogeneity was assessed by I2 and Q tests. Baseline patient characteristics, ICU and IMV outcomes were pooled and meta-analyzed. Pooled odds ratios (pOR) were calculated for clinical features against ICU, IMV mortality. Subgroup analysis was carried out based on patient regions. A total of twenty-eight studies comprising 12,437 COVID-19 ICU admissions from seven countries were meta-analyzed. Pooled ICU admission rate was 21% [95% CI 0.12-0.34] and 69% of cases needed IMV [95% CI 0.61-0.75]. ICU and IMV mortality were 28.3% [95% CI 0.25-0.32], 43% [95% CI 0.29-0.58] and ICU, IMV duration was 7.78 [95% CI 6.99-8.63] and 10.12 [95% CI 7.08-13.16] days respectively. Besides confirming the significance of comorbidities and clinical findings of COVID-19 previously reported, we found the major correlates with ICU mortality were IMV [pOR 16.46, 95% CI 4.37-61.96], acute kidney injury (AKI) [pOR 12.47, 95% CI 1.52-102.7], and acute respiratory distress syndrome (ARDS) [pOR 6.52, 95% CI 2.66-16.01]. Subgroup analyses confirm significant regional discrepancies in outcomes. CONCLUSIONS: This is a comprehensive systematic review and meta-analysis of COVID-19 ICU and IMV cases and associated outcomes. The significant association of AKI, ARDS and IMV with mortality has implications for ICU resource planning for AKI and ARDS as well as suggesting the need for further research into optimal ventilation strategies for COVID-19 patients in the ICU setting. Regional differences in outcome implies a need to develop region specific protocols for ventilatory support as well as overall treatment.


Asunto(s)
/terapia , Respiración Artificial , /epidemiología , Cuidados Críticos/métodos , Humanos , Unidades de Cuidados Intensivos , Respiración Artificial/métodos , Medición de Riesgo , Resultado del Tratamiento
15.
Clin Obes ; 11(2): e12442, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: covidwho-1069385

RESUMEN

Excess weight is associated with severe outcomes of coronavirus disease 2019 (COVID-19). We aimed to estimate the total secondary care costs by body mass index (BMI, kg/m2 ) category when hospitalized due to COVID-19 in Europe during the first wave of the pandemic from January to June 2020. Building a health-care cost model, this study aimed to estimate the total costs of COVID-19. Information on risk of hospitalization, admission to intensive care unit (ICU) and risk of ventilation were based on published data. Average cost per patient and in total were calculated based on risks of admission to ICU, risk of invasive mechanical ventilation and length of hospital stay when hospitalized and published costs associated with hospitalization. The total direct costs of secondary care during the first wave of COVID-19 in Europe were estimated at EUR 13.9 billon, whereof 76% accounted for treating people with overweight and obesity. The average cost per hospital admission increased with BMI, from EUR 15831 for BMI <25 kg/m2 to EUR 30982 for BMI ≥40 kg/m2 . This study reveals that excess weight contributes disproportionally to the costs of COVID-19. This might reflect that overweight and obesity caused the COVID-19 pandemic to result in more severe outcomes for citizens and higher secondary care costs throughout Europe.


Asunto(s)
Costo de Enfermedad , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización , Obesidad , Índice de Masa Corporal , /epidemiología , Comorbilidad , Europa (Continente)/epidemiología , Femenino , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Obesidad/economía , Obesidad/epidemiología , Respiración Artificial/métodos , Respiración Artificial/estadística & datos numéricos , Medición de Riesgo , Factores de Riesgo
16.
Emerg Infect Dis ; 27(4): 1077-1086, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1067634

RESUMEN

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease-associated pulmonary aspergillosis (CAPA) worldwide during March-August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.


Asunto(s)
Aspergillus fumigatus/aislamiento & purificación , Unidades de Cuidados Intensivos/estadística & datos numéricos , Aspergilosis Pulmonar , Voriconazol/uso terapéutico , Anciano , Antifúngicos/uso terapéutico , /inmunología , /terapia , Femenino , Humanos , Factores Inmunológicos/administración & dosificación , Factores Inmunológicos/efectos adversos , Incidencia , Cooperación Internacional , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Aspergilosis Pulmonar/diagnóstico , Aspergilosis Pulmonar/tratamiento farmacológico , Aspergilosis Pulmonar/mortalidad , Sistema de Registros , Respiración Artificial/métodos , Factores de Riesgo , /aislamiento & purificación
17.
Trials ; 22(1): 92, 2021 Jan 26.
Artículo en Inglés | MEDLINE | ID: covidwho-1067263

RESUMEN

OBJECTIVES: To evaluate the efficacy of early treatment with prednisone to decrease the progression of COVID-19 pneumonia. TRIAL DESIGN: This is a pragmatic, non-blinded, randomized, two arms, parallel trial. PARTICIPANTS: Patients between 18 and 90 years, with COVID-19 pneumonia, confirmed by RT PCR. The setting for the trial is the Hospital Santiago Oriente which is a secondary level hospital with an emergency room, intensive care, and all basic specialties of medicine. INCLUSION CRITERIA: 18 years or more COVID-19 confirmed by RT-PCR Oxygen requirements up to 35% by venturi mask or 5 liters per minute by nasal cannula (approximately FiO2 40%) Consent form signed Exclusion Criteria: Previous steroid use for more than 48 hours. Pregnancy Chronic respiratory failure Requirements of mechanical ventilation (invasive or no invasive) Chronic liver damage Child Pugh B or C Chronic kidney disease stage IV or V. Immunosuppressed Participation in another trial. INTERVENTION AND COMPARATOR: Experimental arm Prednisone 40 mg days 1 to 4. Then Prednisone 20 mg days 5 to 8. Usual care defined by the attending physician. Control arm No intervention. Usual care defined by the attending physician. MAIN OUTCOMES: Primary outcome Composite Primary End-point: Admission to ICU, Need for Invasive Mechanical Ventilation or All-cause Death by Day 28 Secondary outcomes (followed until day 28). Time to respiratory deterioration Incidence of patients requiring mechanical ventilation: Number of days on mechanical ventilation Special emphasis will be placed on observing the following serious adverse events Deterioration of the glycemic profile that requires the use of insulin Delirium Incidence of hospital infections (pneumonia, urinary tract infection, device associated infections) Cumulative incidence of grade 3 and 4 adverse events (AE). Interruption or temporary suspension of treatment for any reason RANDOMISATION: Randomisation in permuted block. Computer generated random numbers in an allocation rate of 1:1. Stata 14.0 was used. Allocated by the principal investigator (direct communication). BLINDING (MASKING): Patients not blinded. Caregivers not blinded. Participants not blinded. Statistician will not know the allocation. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 92 patients in each arm. 184 total number of patients. TRIAL STATUS: Protocol version 2.0., approved October 2, 2020. Trial ongoing. Recruitment start: June 23, 2020. Anticipate finish recruiting: November 30, 2020. The protocol has been submitted before the last patient and last visit. The delay in sending to publication is responsibility of the authors. TRIAL REGISTRATION: Early Use of Corticosteroids in Non-critical Patients With COVID-19 Pneumonia (PREDCOVID). Registration number NCT04451174 . Date of trial registration: June 26, 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
/terapia , Cuidados Críticos , ARN Viral/análisis , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Respiración Artificial/métodos , /genética , /epidemiología , Hospitalización/tendencias , Humanos , Resultado del Tratamiento
18.
J Laryngol Otol ; 135(1): 86-87, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: covidwho-1065742

RESUMEN

BACKGROUND: Since the start of the coronavirus disease 2019 pandemic, transnasal humidified rapid-insufflation ventilatory exchange ('THRIVE') has been classified as a high-risk aerosol-generating procedure and is strongly discouraged, despite a lack of conclusive evidence on its safety. METHODS: This study aimed to investigate the safety of transnasal humidified rapid-insufflation ventilatory exchange usage and its impact on staff members. A prospective study was conducted on all transnasal humidified rapid-insufflation ventilatory exchange cases performed in our unit between March and July 2020. RESULTS: During the study period, 18 patients with a variety of airway pathologies were successfully managed with transnasal humidified rapid-insufflation ventilatory exchange. For each case, 7-10 staff members were present. Appropriate personal protective equipment protocols were strictly implemented and adhered to. None of the staff involved reported symptoms or tested positive for coronavirus disease 2019, up to at least a month following their exposure to transnasal humidified rapid-insufflation ventilatory exchange. CONCLUSION: With strictly correct personal protective equipment use, transnasal humidified rapid-insufflation ventilatory exchange can be safely employed for carefully selected patients in the current pandemic, without jeopardising the health and safety of the ENT and anaesthetic workforce.


Asunto(s)
/terapia , Insuflación , Respiración Artificial , Humanos , Humidificadores , Insuflación/métodos , Nariz , Estudios Prospectivos , Respiración Artificial/métodos , Factores de Tiempo
19.
Obstet Gynecol ; 136(5): 1016-1020, 2020 11.
Artículo en Inglés | MEDLINE | ID: covidwho-1059680

RESUMEN

BACKGROUND: The risk of vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unknown. Positive reverse-transcription polymerase chain reaction (RT-PCR) test results for SARS-CoV-2 infection in neonates and placental tissue have been reported, and immunoglobulin M antibodies have been detected in neonates born to mothers with infection. CASES: The first case is a woman at 22 3/7 weeks of gestation with coronavirus disease 2019 (COVID-19) who was admitted to the intensive care unit. In the second case, the patient remained at home with mild symptoms, starting at 20 weeks of gestation. In both cases, fetal skin edema was observed on ultrasound examination while maternal SARS-COV-2 RT-PCR test results were positive and resolved when maternal SARS-COV-2 RT-PCR test results became negative. The RT-PCR test result for SARS-CoV-2 in amniotic fluid was negative in both cases. The two pregnancies are ongoing and uneventful. CONCLUSION: Transient fetal skin edema noted in these two patients with COVID-19 in the second trimester may represent results of fetal infection or altered fetal physiology due to maternal disease or may be unrelated to the maternal illness.


Asunto(s)
Infecciones por Coronavirus , Monitoreo Fetal/métodos , Hidropesía Fetal/diagnóstico , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Piel/diagnóstico por imagen , Adulto , Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Femenino , Edad Gestacional , Humanos , Inmunoglobulina M/sangre , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Persona de Mediana Edad , Placenta/virología , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/fisiopatología , Complicaciones Infecciosas del Embarazo/terapia , Complicaciones Infecciosas del Embarazo/virología , Respiración Artificial/métodos , Resultado del Tratamiento , Ultrasonografía Prenatal/métodos
20.
Physiol Rep ; 9(3): e14715, 2021 02.
Artículo en Inglés | MEDLINE | ID: covidwho-1059985

RESUMEN

INTRODUCTION: Current knowledge on the use of extracorporeal membrane oxygenation (ECMO) in COVID-19 remains limited to small series and registry data. In the present retrospective monocentric study, we report on our experience, our basic principles, and our results in establishing and managing ECMO in critically ill COVID-19 patients. METHODS: A cohort study was conducted in patients with severe acute respiratory distress syndrome (ARDS) related to COVID-19 pneumonia admitted to the ICU of the Geneva University Hospitals and supported by VV-ECMO from March 14 to May 31. The VV-ECMO implementation criteria were defined according to an institutional algorithm validated by the local crisis unit and the Swiss Society of Intensive Care Medicine. RESULTS: Out of 137 ARDS patients admitted to our ICU, 10 patients (age 57 ± 4 years, BMI 31.5 ± 5 kg/m2 , and SAPS II score 56 ± 3) were put on VV-ECMO. The mean duration of mechanical ventilation before ECMO and mean time under ECMO were 7 ± 3 days and 19 ± 11 days, respectively. The ICU and hospital length of stay were 26 ± 11 and 35 ± 10 days, respectively. The survival rate for patients on ECMO was 40%. The comparative analysis between survivors and non-survivors highlighted that survivors had a significantly shorter mechanical ventilation duration before ECMO (4 ± 2 days vs. 9 ± 2 days, p = 0.01). All the patients who had more than 150 h of mechanical ventilation before the application of ECMO ultimately died. CONCLUSION: The present results suggest that VV-ECMO can be safely utilized in appropriately selected COVID-19 patients with refractory hypoxemia. The main information for clinicians is that late VV-ECMO therapy (i.e., beyond the seventh day of mechanical ventilation) seems futile.


Asunto(s)
/terapia , Oxigenación por Membrana Extracorpórea/métodos , /patología , Oxigenación por Membrana Extracorpórea/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Respiración Artificial/métodos , Análisis de Supervivencia , Factores de Tiempo
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