ABSTRACT
Background: Convalescent plasma is a potential therapeutic option for critically ill patients with coronavirus disease 19 (COVID-19), yet its efficacy remains to be determined. The aim was to investigate the effects of convalescent plasma (CP) in critically ill patients with COVID-19. Methods: This was a single-center prospective observational study conducted in Rio de Janeiro, Brazil, from March 17th to May 30th, with final follow-up on June 30th. We included 113 laboratory-confirmed COVID-19 patients with respiratory failure. Primary outcomes were time to clinical improvement and survival within 28 days. Secondary outcomes included behavior of biomarkers and viral loads. Kaplan-Meier analyses and Cox proportional-hazards regression using propensity score with inverse-probability weighing were performed. Results: 41 patients received CP and 72 received standard of care (SOC). Median age was 61 years (IQR 48-68), disease duration was 10 days (IQR 6-13), and 86% were mechanically ventilated. At least 29 out of 41CP-recipients had baseline IgG titers ≥ 1:1,080. Clinical improvement within 28 days occurred in 19 (46%) CP-treated patients, as compared to 23 (32%) in the SOC group [adjusted hazard ratio (aHR) 0.91 (0.49-1.69)]. There was no significant change in 28-day mortality (CP 49% vs. SOC 56%; aHR 0.90 [0.52-1.57]). Biomarker assessment revealed reduced inflammatory activity and increased lymphocyte count after CP. Conclusions: In this study, CP was not associated with clinical improvement or increase in 28-day survival. However, our study may have been underpowered and included patients with high IgG titers and life-threatening disease. Clinical Trial Registration: The study protocol was retrospectively registered at the Brazilian Registry of Clinical Trials (ReBEC) with the identification RBR-4vm3yy (http://www.ensaiosclinicos.gov.br).
ABSTRACT
OBJECTIVE: The purpose of this case report was to describe the role of physical therapists in a neurosurgical center that was converted into a COVID-19 center for critically ill patients. METHODS (CASE DESCRIPTION): On March 16, 2020, the state government of Rio de Janeiro, Brazil, determined that a neurosurgical center with 44 ICU beds equipped with mechanical ventilators should immediately transfer all patients with neurological conditions to other institutions and prepare for patients who were critically ill with COVID-19. The staff, including physical therapists, were trained to handle patients with COVID-19, many of whom were developing acute respiratory distress syndrome (ARDS) with complex and multifactorial ventilatory support needs. Adjustments were made to the physical therapy routine and protocols. Following the stabilization of patients' respiratory condition, physical therapist interventions focused on restoring physical function. RESULTS: A total of 116 confirmed COVID-19 cases were treated from March 17 to May 17, 2020. Sixty percent were men (70) and 40% were women (46), with a median age of 59 years. Eighty-nine percent (103) underwent mechanical ventilation during hospitalization, of which 11% (11) were successfully extubated. Thirty percent (31) of patients underwent tracheostomy, and 26% of those (8) were successfully decannulated. Of the total patients, 57 patients died (mortality rate of 49%), 4 (3%) were transferred to another institution, 23 (20%) were discharged home, and 32 (28%) continued to be hospitalized. CONCLUSION: Physical therapists in the ICU can facilitate care for critical events such as intubation, patient positioning, ventilatory adjustments, extubation, and functional training. IMPACT: The coronavirus pandemic has highlighted the importance of physical therapists, specifically in the care of patients who are critically ill with COVID-19. The availability and expertise of physical therapists in the ICU are important for managing critical events such as intubation, patient positioning, ventilatory adjustments, extubation, and functional training.
