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1.
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
2.
Cochrane Database Syst Rev ; 3: CD010172, 2021 03 04.
Artículo en Inglés | MEDLINE | ID: covidwho-1116499

RESUMEN

BACKGROUND: High-flow nasal cannulae (HFNC) deliver high flows of blended humidified air and oxygen via wide-bore nasal cannulae and may be useful in providing respiratory support for adults experiencing acute respiratory failure, or at risk of acute respiratory failure, in the intensive care unit (ICU). This is an update of an earlier version of the review. OBJECTIVES: To assess the effectiveness of HFNC compared to standard oxygen therapy, or non-invasive ventilation (NIV) or non-invasive positive pressure ventilation (NIPPV), for respiratory support in adults in the ICU. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane COVID-19 Register (17 April 2020), clinical trial registers (6 April 2020) and conducted forward and backward citation searches. SELECTION CRITERIA: We included randomized controlled studies (RCTs) with a parallel-group or cross-over design comparing HFNC use versus other types of non-invasive respiratory support (standard oxygen therapy via nasal cannulae or mask; or NIV or NIPPV which included continuous positive airway pressure and bilevel positive airway pressure) in adults admitted to the ICU. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by Cochrane. MAIN RESULTS: We included 31 studies (22 parallel-group and nine cross-over designs) with 5136 participants; this update included 20 new studies. Twenty-one studies compared HFNC with standard oxygen therapy, and 13 compared HFNC with NIV or NIPPV; three studies included both comparisons. We found 51 ongoing studies (estimated 12,807 participants), and 19 studies awaiting classification for which we could not ascertain study eligibility information. In 18 studies, treatment was initiated after extubation. In the remaining studies, participants were not previously mechanically ventilated. HFNC versus standard oxygen therapy HFNC may lead to less treatment failure as indicated by escalation to alternative types of oxygen therapy (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.45 to 0.86; 15 studies, 3044 participants; low-certainty evidence). HFNC probably makes little or no difference in mortality when compared with standard oxygen therapy (RR 0.96, 95% CI 0.82 to 1.11; 11 studies, 2673 participants; moderate-certainty evidence). HFNC probably results in little or no difference to cases of pneumonia (RR 0.72, 95% CI 0.48 to 1.09; 4 studies, 1057 participants; moderate-certainty evidence), and we were uncertain of its effect on nasal mucosa or skin trauma (RR 3.66, 95% CI 0.43 to 31.48; 2 studies, 617 participants; very low-certainty evidence). We found low-certainty evidence that HFNC may make little or no difference to the length of ICU stay according to the type of respiratory support used (MD 0.12 days, 95% CI -0.03 to 0.27; 7 studies, 1014 participants). We are uncertain whether HFNC made any difference to the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) within 24 hours of treatment (MD 10.34 mmHg, 95% CI -17.31 to 38; 5 studies, 600 participants; very low-certainty evidence). We are uncertain whether HFNC made any difference to short-term comfort (MD 0.31, 95% CI -0.60 to 1.22; 4 studies, 662 participants, very low-certainty evidence), or to long-term comfort (MD 0.59, 95% CI -2.29 to 3.47; 2 studies, 445 participants, very low-certainty evidence). HFNC versus NIV or NIPPV We found no evidence of a difference between groups in treatment failure when HFNC were used post-extubation or without prior use of mechanical ventilation (RR 0.98, 95% CI 0.78 to 1.22; 5 studies, 1758 participants; low-certainty evidence), or in-hospital mortality (RR 0.92, 95% CI 0.64 to 1.31; 5 studies, 1758 participants; low-certainty evidence). We are very uncertain about the effect of using HFNC on incidence of pneumonia (RR 0.51, 95% CI 0.17 to 1.52; 3 studies, 1750 participants; very low-certainty evidence), and HFNC may result in little or no difference to barotrauma (RR 1.15, 95% CI 0.42 to 3.14; 1 study, 830 participants; low-certainty evidence). HFNC may make little or no difference to the length of ICU stay (MD -0.72 days, 95% CI -2.85 to 1.42; 2 studies, 246 participants; low-certainty evidence). The ratio of PaO2/FiO2 may be lower up to 24 hours with HFNC use (MD -58.10 mmHg, 95% CI -71.68 to -44.51; 3 studies, 1086 participants; low-certainty evidence). We are uncertain whether HFNC improved short-term comfort when measured using comfort scores (MD 1.33, 95% CI 0.74 to 1.92; 2 studies, 258 participants) and responses to questionnaires (RR 1.30, 95% CI 1.10 to 1.53; 1 study, 168 participants); evidence for short-term comfort was very low certainty. No studies reported on nasal mucosa or skin trauma. AUTHORS' CONCLUSIONS: HFNC may lead to less treatment failure when compared to standard oxygen therapy, but probably makes little or no difference to treatment failure when compared to NIV or NIPPV. For most other review outcomes, we found no evidence of a difference in effect. However, the evidence was often of low or very low certainty. We found a large number of ongoing studies; including these in future updates could increase the certainty or may alter the direction of these effects.


Asunto(s)
Cuidados Críticos/métodos , Intubación/métodos , Terapia por Inhalación de Oxígeno/métodos , Insuficiencia Respiratoria/terapia , Enfermedad Aguda , Adulto , Barotrauma/epidemiología , Sesgo , Mortalidad Hospitalaria , Humanos , Intubación/efectos adversos , Intubación/instrumentación , Tiempo de Internación , Máscaras , Mucosa Nasal/lesiones , Ventilación no Invasiva/métodos , Terapia por Inhalación de Oxígeno/efectos adversos , Terapia por Inhalación de Oxígeno/instrumentación , Medición de Resultados Informados por el Paciente , Neumonía/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Respiración Artificial/efectos adversos , Insuficiencia del Tratamiento
4.
Chest ; 159(3): e151-e154, 2021 03.
Artículo en Inglés | MEDLINE | ID: covidwho-1108122

RESUMEN

CASE PRESENTATION: A 64-year-old previously healthy man presented with 8 weeks of progressive dyspnea on exertion and cough. Prior to presentation, the patient was able to bicycle > 60 miles per week and work full-time in a home improvement store. He was up-to-date with age-appropriate cancer screening and immunizations, and home medications included famotidine for reflux and nonsteroidal antiinflammatories for osteoarthritis, both as-needed. He had no significant respiratory exposure, aside from previous work as an electrician. His symptoms began in mid-February 2020 amid the coronavirus disease 2019 pandemic, although he had no known exposure to the virus.


Asunto(s)
/diagnóstico , Fructosa-Bifosfato Aldolasa/sangre , Glucocorticoides/administración & dosificación , Pulmón/diagnóstico por imagen , Miositis , Intercambio Plasmático/métodos , Rituximab/administración & dosificación , Treonina-ARNt Ligasa/inmunología , Autoanticuerpos/sangre , Diagnóstico Diferencial , Progresión de la Enfermedad , Humanos , Inmunosupresores/administración & dosificación , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/fisiopatología , Masculino , Persona de Mediana Edad , Debilidad Muscular/diagnóstico , Debilidad Muscular/etiología , Miositis/sangre , Miositis/diagnóstico , Miositis/fisiopatología , Miositis/terapia , Terapia por Inhalación de Oxígeno/métodos , Pronóstico , Resultado del Tratamiento
5.
Cardiol Young ; 30(9): 1339-1342, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-1082976
6.
Crit Care ; 25(1): 58, 2021 02 11.
Artículo en Inglés | MEDLINE | ID: covidwho-1082883

RESUMEN

PURPOSE: Whether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high-flow nasal oxygen on ventilator-free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19. METHODS: We conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units (ICUs). Main exposure was the use of high-flow nasal oxygen (conservative group), while early invasive mechanical ventilation (within the first day of ICU admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. ICU length of stay and all-cause in-hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding. RESULTS: Out of 468 eligible patients, a total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high-flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days) and a reduction in ICU length of stay (mean difference: - 8.2 days; 95% CI - 12.7 to - 3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64). CONCLUSIONS: The use of high-flow nasal oxygen upon ICU admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in ICU length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.


Asunto(s)
/complicaciones , Ventilación no Invasiva , Terapia por Inhalación de Oxígeno/métodos , /terapia , Anciano , Cánula , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento
7.
PLoS One ; 16(2): e0246123, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1082172

RESUMEN

BACKGROUND: Nasal High Flow (NHF) therapy delivers flows of heated humidified gases up to 60 LPM (litres per minute) via a nasal cannula. Particles of oral/nasal fluid released by patients undergoing NHF therapy may pose a cross-infection risk, which is a potential concern for treating COVID-19 patients. METHODS: Liquid particles within the exhaled breath of healthy participants were measured with two protocols: (1) high speed camera imaging and counting exhaled particles under high magnification (6 participants) and (2) measuring the deposition of a chemical marker (riboflavin-5-monophosphate) at a distance of 100 and 500 mm on filter papers through which air was drawn (10 participants). The filter papers were assayed with HPLC. Breathing conditions tested included quiet (resting) breathing and vigorous breathing (which here means nasal snorting, voluntary coughing and voluntary sneezing). Unsupported (natural) breathing and NHF at 30 and 60 LPM were compared. RESULTS: Imaging: During quiet breathing, no particles were recorded with unsupported breathing or 30 LPM NHF (detection limit for single particles 33 µm). Particles were detected from 2 of 6 participants at 60 LPM quiet breathing at approximately 10% of the rate caused by unsupported vigorous breathing. Unsupported vigorous breathing released the greatest numbers of particles. Vigorous breathing with NHF at 60 LPM, released half the number of particles compared to vigorous breathing without NHF.Chemical marker tests: No oral/nasal fluid was detected in quiet breathing without NHF (detection limit 0.28 µL/m3). In quiet breathing with NHF at 60 LPM, small quantities were detected in 4 out of 29 quiet breathing tests, not exceeding 17 µL/m3. Vigorous breathing released 200-1000 times more fluid than the quiet breathing with NHF. The quantities detected in vigorous breathing were similar whether using NHF or not. CONCLUSION: During quiet breathing, 60 LPM NHF therapy may cause oral/nasal fluid to be released as particles, at levels of tens of µL per cubic metre of air. Vigorous breathing (snort, cough or sneeze) releases 200 to 1000 times more oral/nasal fluid than quiet breathing (p < 0.001 with both imaging and chemical marker methods). During vigorous breathing, 60 LPM NHF therapy caused no statistically significant difference in the quantity of oral/nasal fluid released compared to unsupported breathing. NHF use does not increase the risk of dispersing infectious aerosols above the risk of unsupported vigorous breathing. Standard infection prevention and control measures should apply when dealing with a patient who has an acute respiratory infection, independent of which, if any, respiratory support is being used. CLINICAL TRIAL REGISTRATION: ACTRN12614000924651.


Asunto(s)
Espiración , Terapia por Inhalación de Oxígeno/efectos adversos , Terapia por Inhalación de Oxígeno/métodos , Adulto , Pruebas Respiratorias/métodos , Cánula , Femenino , Humanos , Masculino , Microscopía por Video , Nariz/química , Respiración , Frecuencia Respiratoria
8.
Monaldi Arch Chest Dis ; 91(1)2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: covidwho-1050664

RESUMEN

Dear Editor, The Corona virus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in the Wuhan province of china in December 2019. COVID-19 spread to the world in a short time and was declared as public health emergency of international concern by World Health Organization...


Asunto(s)
Diabetes Mellitus Tipo 2 , Hemoglobina A Glucada/análisis , Pulmón , Terapia por Inhalación de Oxígeno/métodos , Anciano , /diagnóstico , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Resultado Fatal , Fibrosis/diagnóstico , Fibrosis/etiología , Fibrosis/terapia , Servicios de Atención de Salud a Domicilio , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
9.
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
10.
PLoS One ; 16(1): e0245690, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1043425

RESUMEN

BACKGROUND: The number of hospitalized young coronavirus disease 2019 (COVID-19) patients has increased significantly. However, specific data about COVID-19 patients under 65 years old who are admitted to the hospital are scarce. METHODS: The COVID-19 patients under 65 years old who were admitted to the hospital in Sichuan Province, Renmin Hospital of Wuhan University, and Wuhan Red Cross Hospital were included in this study. Demographic information, laboratory data and clinical treatment courses were extracted from electronic medical records. Risk factors associated with oxygen therapy were explored. RESULTS: Eight hundred thirty-three COVID-19 patients under 65 years old were included. Of the included patients, 29.4% had one or more comorbidities. Oxygen therapy was required in 63.1% of these patients, and the mortality was 2.9% among the oxygen therapy patients. Fever (odds ratio [OR] 2.072, 95% confidence interval [CI] 1.312-3.271, p = 0.002), dyspnea (OR 2.522, 95% CI 1.213-5.243, p = 0.013), chest distress (OR 2.278, 95% CI 1.160-4.473, p = 0.017), elevated respiratory rate (OR 1.114, 95% CI 1.010-1.228, p = 0.031), and decreased albumin (OR 0.932, 95% CI 0.880-0.987, p = 0.016) and globulin levels (OR 0.929, 95% 0.881-0.980, p = 0.007) were independent factors related to oxygen therapy. CONCLUSIONS: Oxygen therapy is highly required in COVID-19 patients under 65 years old who are admitted to the hospital, but the success rate is high. Respiratory failure-related symptoms, elevated respiratory rate, low albumin and globulin levels, and fever at admission are independent risk factors related to the requirement of oxygen.


Asunto(s)
/terapia , Terapia por Inhalación de Oxígeno/métodos , Adulto , Factores de Edad , /epidemiología , China/epidemiología , Disnea/complicaciones , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno/efectos adversos , Factores de Riesgo , Resultado del Tratamiento
11.
Monaldi Arch Chest Dis ; 90(4)2020 Dec 23.
Artículo en Inglés | MEDLINE | ID: covidwho-1042105

RESUMEN

We report the case of a man affected by cystic fibrosis who developed a severe SARS-CoV-2 related pneumonia in March 2020. In addition to lopinavir/ritonavir and hydroxychloroquine, he was treated with two doses of tocilizumab, displaying a significant clinical improvement. This is the first case described in the literature of an adult patient affected by cystic fibrosis who received tocilizumab for COVID-19, with documented total recovery, also assessed by a spirometry.


Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Fibrosis Quística , Hidroxicloroquina/administración & dosificación , Lopinavir/administración & dosificación , Neumonía Viral , Infecciones del Sistema Respiratorio/microbiología , Ritonavir/administración & dosificación , /aislamiento & purificación , Adulto , Antivirales/administración & dosificación , /diagnóstico , /fisiopatología , Fibrosis Quística/complicaciones , Fibrosis Quística/inmunología , Fibrosis Quística/fisiopatología , Combinación de Medicamentos , Humanos , Pulmón/diagnóstico por imagen , Pulmón/fisiopatología , Masculino , Terapia por Inhalación de Oxígeno/métodos , Neumonía Viral/diagnóstico , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/etiología , Receptores de Interleucina-6/antagonistas & inhibidores , Pruebas de Función Respiratoria/métodos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/etiología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
12.
Emerg Med J ; 37(9): 565-566, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-1024248

RESUMEN

We report the experience of prone ventilation in selected patients treated with helmet non-invasive ventilation (NIV) continuous positive airway pressure (CPAP) for acute respiratory failure in COVID-19 pneumonia. Preliminary results showed an improvement in the PaO2 value and PaO2/FiO2 ratio after 1 hour of prone ventilation. No variation of the lung ultrasound pattern before and after prone ventilation has been detected. At the time of writing, we attempted proning with helmet NIV CPAP in 10 patients. In 4 out of 10 patients, the attempt failed due to lack of compliance of the patient, scarce pain control even with ongoing treatment and refusal by the patient to prone positioning.


Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/métodos , Infecciones por Coronavirus , Ventilación no Invasiva/métodos , Pandemias , Neumonía Viral , Posición Prona , Insuficiencia Respiratoria , Anciano , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Italia/epidemiología , Masculino , Consumo de Oxígeno , Terapia por Inhalación de Oxígeno/métodos , Posicionamiento del Paciente , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia , Resultado del Tratamiento
13.
Scand J Trauma Resusc Emerg Med ; 29(1): 16, 2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: covidwho-1024370

RESUMEN

OBJECTIVE: Despite critical hypoxemia, Covid-19 patients may present without proportional signs of respiratory distress. We report three patients with critical respiratory failure due to Covid-19, in which all presented with severe hypoxemia refractory to supplemental oxygen therapy. We discuss possible strategies for ventilatory support in the emergency pre-hospital setting, and point out some pitfalls regarding the management of these patients. Guidelines for pre-hospital care of critically ill Covid-19 patients cannot be established based on the current evidence base, and we have to apply our understanding of respiratory physiology and mechanics in order to optimize respiratory support. METHODS: Three cases with similar clinical presentation were identified within the Norwegian national helicopter emergency medical service (HEMS) system. The HEMS units are manned by a consultant anaesthesiologist. Patient's next of kin and the Regional committee for medical and health research ethics approved the publication of this report. CONCLUSION: Patients with Covid-19 and severe hypoxemia may pose a considerable challenge for the pre-hospital emergency medical services. Intubation may be associated with a high risk of complications in these patients and should be carried out with diligence when considered necessary. The following interventions are worth considering in Covid-19 patients with refractory hypoxemia before proceeding to intubation. First, administering oxygen via a tight fitting BVM with an oxygen flow rate that exceeds the patient's ventilatory minute volume. Second, applying continuous positive airway pressure, while simultaneously maintaining a high FiO2. Finally, assuming the patient is cooperative, repositioning to prone position.


Asunto(s)
/terapia , Cuidados Críticos/métodos , Enfermedad Crítica/terapia , Terapia por Inhalación de Oxígeno/métodos , Insuficiencia Respiratoria/terapia , /complicaciones , Presión de las Vías Aéreas Positiva Contínua , Femenino , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Noruega , Insuficiencia Respiratoria/etiología
14.
Med Gas Res ; 10(4): 193-200, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-1004844

RESUMEN

Recent development regarding mixture of H2 (concentration of ~66%) with O2 (concentration of ~34%) for medical purpose, such as treatment of coronavirus disease-19 (COVID-19) patients, is introduced. Furthermore, the design principles of a hydrogen inhaler which generates mixture of hydrogen (~66%) with oxygen (~34%) for medical purpose are proposed. With the installation of the liquid blocking module and flame arresters, the air pathway of the hydrogen inhaler is divided by multiple isolation zones to prevent any unexpected explosion propagating from one zone to the other. An integrated filtering/cycling module is utilized to purify the impurity, and cool down the temperature of the electrolytic module to reduce the risk of the explosion. Moreover, a nebulizer is provided to selectively atomize the water into vapor which is then mixed with the filtered hydrogen-oxygen mix gas, such that the static electricity of a substance hardly occurs to reduce the risk of the explosion. Furthermore, hydrogen concentration detector is installed to reduce the risk of hydrogen leakage. Result shows that the hydrogen inhaler implementing the aforesaid design rules could effectively inhibit the explosion, even ignition at the outset of the hydrogen inhaler which outputs hydrogen-oxygen gas (approximately 66% hydrogen: 34% oxygen).


Asunto(s)
/terapia , Hidrógeno/administración & dosificación , Nebulizadores y Vaporizadores , Terapia por Inhalación de Oxígeno/métodos , Oxígeno/administración & dosificación , Explosiones/prevención & control , Humanos , Nebulizadores y Vaporizadores/normas , Terapia por Inhalación de Oxígeno/normas , Electricidad Estática/efectos adversos , Volatilización
15.
Glob Health Sci Pract ; 8(4): 858-862, 2020 12 23.
Artículo en Inglés | MEDLINE | ID: covidwho-1000594

RESUMEN

Oxygen therapy is an essential medicine and core component of effective hospital systems. However, many hospitals in low- and middle-income countries lack reliable oxygen access-a deficiency highlighted and exacerbated by the coronavirus disease (COVID-19) pandemic. Oxygen access can be challenged by equipment that is low quality and poorly maintained, lack of clinical and technical training and protocols, and deficiencies in local infrastructure and policy environment. We share learnings from 2 decades of oxygen systems work with hospitals in Africa and the Asia-Pacific regions, highlighting practical actions that hospitals can take to immediately expand oxygen access. These include strategies to: (1) improve pulse oximetry and oxygen use, (2) support biomedical engineers to optimize existing oxygen supplies, and (3) expand on existing oxygen systems with robust equipment and smart design. We make all our resources freely available for use and local adaptation.


Asunto(s)
/epidemiología , Países en Desarrollo , Terapia por Inhalación de Oxígeno/métodos , Terapia por Inhalación de Oxígeno/estadística & datos numéricos , Oxígeno/provisión & distribución , /terapia , Accesibilidad a los Servicios de Salud , Administración Hospitalaria/estadística & datos numéricos , Humanos , Oximetría , Pandemias
16.
Monaldi Arch Chest Dis ; 90(4)2020 Dec 23.
Artículo en Inglés | MEDLINE | ID: covidwho-1000398

RESUMEN

COVID-19 pneumonia has a significant case fatality rate and no effective antiviral drugs are available even after 9 months of the pandemic. The spectrum of COVID-19 disease ranges from asymptomatic cases to severe ARDS with myriad manifestations. Here we report a case of a male patient with severe COVID-19 ARDS who improved after receiving standard therapy but again 'deteriorated' after being stepped down to ward. He complained of worsening shortness of breath and hypoxemia which was found to be mainly positional. After ruling out other causes, he was labeled as a case of platypnea-orthodeoxia syndrome due to underlying lung involvement.  It is important to be aware of this condition in the context of COVID-19 which can be easily diagnosed bedside with pulse oximetry.


Asunto(s)
Disnea , Hipoxia , Pulmón , Posicionamiento del Paciente/métodos , Neumonía Viral , Anciano , /fisiopatología , Deterioro Clínico , Diagnóstico Diferencial , Disnea/diagnóstico , Disnea/etiología , Humanos , Hipoxia/diagnóstico , Hipoxia/etiología , Pulmón/diagnóstico por imagen , Pulmón/fisiopatología , Masculino , Oximetría/métodos , Terapia por Inhalación de Oxígeno/métodos , Manejo de Atención al Paciente , Neumonía Viral/diagnóstico , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Pruebas de Función Respiratoria/métodos , Síndrome , Tomografía Computarizada por Rayos X/métodos
17.
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
18.
J Infect Chemother ; 27(2): 336-341, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: covidwho-978337

RESUMEN

INTRODUCTION: In patients with severe coronavirus disease 2019 (COVID-19), respiratory failure is a major complication and its symptoms occur around one week after onset. The CURB-65, A-DROP and expanded CURB-65 tools are known to predict the risk of mortality in patients with community-acquired pneumonia. In this retrospective single-center retrospective study, we aimed to assess the correlations of the A-DROP, CURB-65, and expanded CURB-65 scores on admission with an increase in oxygen requirement in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. METHODS: We retrospectively analyzed 207 patients who were hospitalized with SARS-CoV-2 pneumonia at the Self-Defense Forces Central Hospital in Tokyo, Japan. Performance of A-DROP, CURB-65, and the expanded CURB-65 scores were validated. In addition, we assessed whether there were any associations between an increase in oxygen requirement and known risk factors for critical illness in COVID-19, including elevation of liver enzymes and C-reactive protein (CRP), lymphocytopenia, high D-dimer levels and the chest computed tomography (CT) score. RESULTS: The areas under the curve for the ability of CURB-65, A-DROP, and the expanded CURB-65 scores to predict an increase in oxygen requirement were 0.6961, 0.6980 and 0.8327, respectively, and the differences between the three groups were statistically significant (p < 0.001). Comorbid cardiovascular disease, lymphocytopenia, elevated CRP, liver enzyme and D-dimer levels, and higher chest CT score were significantly associated with an increase in oxygen requirement CONCLUSIONS: The expanded CURB-65 score can be a better predictor of an increase in oxygen requirement in patients with SARS-CoV-2 pneumonia.


Asunto(s)
/terapia , Terapia por Inhalación de Oxígeno/métodos , Índice de Severidad de la Enfermedad , Adulto , Anciano , Proteína C-Reactiva/análisis , /mortalidad , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Linfopenia/epidemiología , Masculino , Persona de Mediana Edad , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Pronóstico , Insuficiencia Respiratoria/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Tokio , Tomografía Computarizada por Rayos X
19.
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
20.
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
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